Alpha Kappa Alpha Sorority, Theta Theta Omega Chapter "AKA Day at the Capitol" schedule and supplementary resources

Alpha Kappa Alpha Sorority, Inc. Theta Theta Omega Chapter Please join usAKA Day at the Capitol Carson City, NevadaTuesday, March 18, 2003 8:00 a.m.Schedule of EventsPlanning MeetingFar Western Regional Director Diana G. Shipley Theta Theta Omega Chapter and Far Western Region Visiting Sorors Monday, March 17, 2003 - 5:00 p.m. - 7:00 p.m.Golden Phoenix Hotel/Casino — Reno, Nevada Dinner on your ownTravel to Carson City, Nevada Tuesday, March 17, 2003 - 6:30 a.m.Legislative Testimony and Meeting with Nevada Legislators Tuesday, March 18, 2003 - 8:00 a.m. - 11:30 a.m.Nevada State Assembly — Legislative Committee on HealthCarson City, NevadaLuncheon with Nevada Legislators 12:00 noon - 2:00 p.m.Location: Governor’s Mansion (Confirmation Pending)Return to Reno - 2:30 p.m.Accommodations: Deadline for group rate is March 1, 2003 - Contact Hotel for Reservations Golden Phoenix Hotel Casino - $39.95 + 13% room tax, per night/Double Occupancy 255 N. Sierra Street Reno, NV 89501Reservations: 1-800-648-1828 x 7485 (Code: Alpha Kappa Alpha Group)Registration Fee: $50.00 (Includes Materials, Luncheon and Transportation from Reno to Carson City)Mail Registration and Fees to: Soror Verlia Hoggard, Nevada Connection Chairman Alpha Kappa Alpha Sorority, Inc. - Theta Theta Omega ChapterP. O. Box 270520 Las Vegas, NV 89127_____________ The Spirit: Let's Share It and Connect
Alpha Kappa Alpha Sorority, Inc.
Theta Theta Omega Chapter
AKA Day at the Capitol
Carson City, Nevada
March 17-18,2003
REGISTRATION
CHAPTER_____________________ _ LOCATION________________________
NAME______________________
HOME ADDRESS____________________
CITY__________________ _____________ STATE________________ ZIP______________
PHONE____________________ ________ E-MAIL________________________
SPECIAL NEEDS_____________________
REGISTRATION FEE: $50.00 (Includes Materials, Luncheon, and Transportation
from Reno to Carson City) - Deadline: March 1, 2003
Mail Registration and Fees to:
Soror Verlia Davis Hoggard
Nevada Connection Chairman *
Alpha Kappa Alpha Sorority, Inc.
Theta Theta Omega Chapter
P. O. Box 270520
Las Vegas, NV 89127
Hotel Accommodations-. Deadline for group rate is March 1, 2003
Golden Phoenix Hotel Casino - $39.95 + 13% room tax, per night/Double Occupancy
255 N. Sierra Street Reno, NV 89501
Reservations: 1-800-648-1828 x 7485 (Code: Alpha Kappa Alpha Group)
Contact Golden Phoenix directly for hotel reservations
Soror Diana G. Shipley, Far Western Regional Director
Soror Ferial Bishop, International Connection Committee Chairman
Soror Billie Rayford, Basileus
Far Western Region International Connection Committee Representative
The Spirit: Let’s Share It and Connect
Alpha Kappa Alpha Sorority, Inc. Theta Theta Omega Chapter AKA Day at the Capitol Carson City, Nevada March 18,2003Diana G. Shipley, Far Western Regional Director Billie K. Rayford, BasileusVerlia Davis Hoggard, Nevada Connection Chair
« NEVADA FACTS» THE NEVADA LEGISLATUREAKA DAY AT THE CAPITOL . CARSON CITY, NEVADA March 18,2003
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Nevada Facts
An Act of Congress, signed by President Janies Buchanan, which became effective on March 2, 1861,
created the Territory of Nevada. President Abraham Lincoln appointed James W. Nye of New York as
Nevada's first Territorial Governor.
On October 31, 1864, President Lincoln proclaimed Nevada's admission
to the Union as the 36th state. California and Oregon were the only western
states admitted earlier. Nevada's early statehood was the result of a number
of factors pertaining to the politics of the Civil War and President Lincoln's
reelection campaign. During the next 75 years, many mining towns
flourished, if only briefly, all over the state. Since 1931, tourism,
particularly entertainment and legalized gaming, have become increasingly
important to Nevada's economy. Mining also has rebounded in recent years,
and Nevada now produces more’ gold than any other state. Federal
legislation enacted in 1986 created the Great Basin National Park, the first
national park in the state, which includes the area around Wheeler Peak and
Lehman Caves in eastern Nevada. A small part of Death Valley National
Park is located along Nevada's western boundary with California.
Nevada Nicknames:
Sagebrush State, Silver State, Battle-Bom State
The origin of the state's name is Spanish, meaning "snow-capped."
Vital Facts:
Population 1,998,257
Rank: 35th largest state (2000 Census)
Capital: Carson City, population - 52,457 (2000 Census)
Most populous city: Las Vegas - 478,434 (2000 Census)
Most populous county: Clark County - 1,375,765 (2000 Census)
Area: 110,540 square miles RANK: 7th largest
(87 percent of Nevada's land area is federally controlled.)
Highest elevation: Boundary Peak in Esmeralda County - 13,140 feet
Lowest elevation: On the Colorado River in Clark County - 470 feet
State Artifact -
The Tule Duck was created by early Nevadans almost 2,000 years ago.
Discovered by archeologists in 1924 during an excavation at Lovelock Cave,
the 11 decoys are each formed of a bundle of bullrush (tule) stems, bound
httpT/www.leg.state.nvyus/General/FACTS.cfm 3/16/2003
together aSj^haped ^qE^nblTa can^^ad^uck.[st$frtjfcx>sW-rShonisaunisWRil ^as^ouna in Berlin, east of Gabbs. Nevada is the only state to possess a complete skeleton (approximately 55 jlee^lon^nf tliisE^mct marine^pptil^^gjateRninmp^d j^S’oH manywiamwl ins^nsM^^^^^nember%jtl the thrush family and its song is a clear, short warble like the caroling of a Fobin. The! REll^azurFblue wrt^3^hr^bell}^^mile thejem^e brown with a bluish rump, tailj^md wmg^Bl^^eMSimal -tharq^Xc^^fc^int^nFSsn^Mpas^a^d^pr^Mf horns. The bighorn is well-suited for Nevada's mountainous desert country because it can survive ^rAlSMper^dj^TOiout water. The large rams stand abouffijKlfeetdall and Fan^eig^s^i^hi^ ifcXpound^HState Fish -^^gL^ont^^Qitthroat [froi^MSalmoM/larKi henshawi), a native trout found in 14 of the state's 17 counties, is adapted to habitats rangingfeom high mountain creeks ^^IpunMa^F^^annlliifte^ment lowland streams and InBum^lMesB^efej^o’ther'ixoutEaruiye^^^t^KenmeMThe Desert Tortoise (Gopherus agassizii), the latest reptile in the Southwestern United States, lil^pgthejMeme Southern parts of Nevada. I^hard, dor^shaped^s^l^ang^^Bm Jan to black in color. This reptile spends much lif^Sunqgrg^und burrowjFk^^^apeJhe harengunimcS heal andl&vmt^lmla^rhel3^Srtyoru)ise..can li^^^^npre^han^i^j^^j old.i&tMe FJowfWhttp://www.leg.state.nv.us/General/FACTS.cfmB7W001
Sagebrush (Artemisia tridentata) grows abundantly in the deserts of the Western United States. A member of the wormwood family, sagebrush is a branching bush (1 to 12 feet high) and grows in regions where other kinds of vegetation cannot subsist. Known for its pleasant aroma, its gray-green twigs, and pale yellow flowers, sagebrush is an important winter food for sheep and cattle.State Trees-The Single-Leaf Pinon (Pinus monophylla) is an aromatic pine tree with short, stiff needles and gnarled branches. The tree grows in coarse, rocky soils and rock crevices. Though its normal height is about 15 feet, the singleleaf pinon can grow as high as 50 feet under ideal conditions.The Bristlecone Pine (Pinus aristata) shares the state tree designation. The bristlecone pine is the oldest living thing on Earth, with some specimens in Nevada more than 4,000 years of age. The tree can be found at high elevations. Normal height for older trees is about 15 to 30 feet, although some have attained a height of 60 feet. Diameter growth continues throughout the long life of the tree, resulting in massive trunks with a few contorted limbs.State Grass -Indian Ricegrass (Oryzopsis hymenoides), once a staple food source for Nevada Indians, now provides valuable feed for wildlife and range livestock. This tough native grass, which is found throughout the state, is known for its ability to reseed and establish itself on sites damaged by fire or over grazing.State Rock -Sandstone, in its more traditionally recognized form or as quartzite, is found throughout the state. In areas such as the Valley of Fire State Park and Red Rock Canyon Recreational Lands, both near Las Vegas, it provides some of Nevada's most spectacular scenery. The State Capitol, and the former United States Mint, are built of sandstone.State Precious Gemstone -Among the many gemstones found in Nevada, the Virgin Valley Black Fire Opal is one of the most beautiful. The Virgin Valley in northern Nevada is the only place in North America where the Black Fire Opal is found in any significant quantity.http ://www.leg. state.nv.us/General/F ACTS .cfm3/16/2003
v jl cX\>voxState Semi-precious Gemstone -Nevada Turquoise, sometimes called the "Jewel of the Desert," is found in many parts of the state.State Soil -The Orovada Series Soil was designated as Nevada's official state soil in 2001. This soil is classified as coarse-loamy, mixed, superactive, mesic Durinodic Xeric Haplocambids, and is found in Northern and Central Nevada. Orovada soil grows most crops common to Nevada and is considered prime farmland because it contains volcanic ash that reduces the amount of water needed for irrigation.State Song -In 1933, the Legislature adopted "Home Means Nevada" as the official state song.Mrs. Bertha Raffetto of Reno wrote the song to honor the state. The refrain of the song goes as follows:"Home" means Nevada, "Home" means the hills, "Home" means the sage and the pines. Out by the Truckee's silvery rills. Out where the sun always shines. There is a land that 1 love the best, Fairer than all I can see. Right in the heart of the golden west "Home" means Nevada to me.(Special thanks to Mrs Alami's and Paragini's 3rd Grade classes at Greenbrae Elementary for recording the state song).State Tartan -The tartan designed by Richard Zygmunt Pawlowski is designated as the official state tartan. The colors and design of the tartan represent the many features that make Nevada a unique and bountiful state. Blue represents one of the state colors of Nevada, the pristine waters of Lake Tahoe and the mountain bluebird. Silver represents the other state color,and the official state mineral. Red represents the Virgin Valley black fire opal, and the red rock formations of southern Nevada. Yellow represents sagebrush and symbolizes the great basin region of central Nevada. White represents the name of this state meaning snow-covered, which is the translation of the Spanish word “nevada”. The crossing of the yellow and red stripes represents the different colors of Nevada sandstone. The white intersection on die silver field stands for the snow-capped peaks of granite mountains, which make up the Sierra Nevada mountain range. The four blue lines represent the four main rivers of Nevada which are the Colorado River, Truckee River, Humboldt River andhtty/www. leg, state .nv.us/General/F ACTS. cfm3/16/2003
incvaaa. rauibrage j ui jWalker River. The intersecting blue lines in the silver field represent the Colorado River as it meets Hoover Dam and creates Lake Mead. The small solid “boxes” of silver and blue number 8 by 8, or 64, to signify the year (1864) that Nevada was admitted into statehood. The 13 solid-colored intersections of the small stripes represent Boundary Peak, the highest point in Nevada, which stands at an elevation of 13,143 feet. Finally, the 16 solid silver intersections and the solid white intersection in the center of the tartan represent the 16 counties and the one consolidated city-county government of Nevada.State Metal -Silver (Ag)State Colors -Silver and BlueSession .Info I .Interim.Info | LawLibrary. | General Info |. Counsel Bureau i Research Library | Assembly | Senate Scheduled Meetings | Ljye Meetings | Publications | Proposals | Career Opppitunities J Gift Shop©20(13http ://www. leg. state .nv.us/General/F ACTS. cfm3/16/2003
General Information; Brief OverviewPage 1 of2I Home | ScheduledI Site Map | Contact Us |Facts about the Nevada LegislatureSessionsRegular sessions of the Legislature begin the first Monday in February of odd-numbered years. Nevada is one of only six states that have true biennial sessions.From 1961 through 1997, the length of legislative sessions in Nevada depended upon the time required to Process proposed legislation, review the spending proposals of state agencies, and adopt a biennial state budget. At the 1998 General Election, Nevada voters approved a constitutional amendment limiting future regular biennial sessions to 120 days. The amendment also requires the governor to submit the executive budget to the Legislature two weeks before the start of session. Both the 1999 and 2001 regular sessions ran for the full 120 days.The Governor may also call the Legislature into a special session. A 1-day special session in 2001 was only the 17th special session m the past 138 years. JThe Legislature Between SessionsThe Legislature has an ongoing staff agency known as the Legislative Counsel Bureau. This agency encompasses the Fiscal, Legal, and Research Divisions, which provide support for the Legislature. It also mcludes the Audit Division whose job consists of auditing the accounts of state agencies, and an Administrative Division, which provides accounting, security and various "housekeeping" functions.The Legislative Counsel Bureau is supervised by the Legislative Commission, a body of 12 legislators six JOnJ ht .yse’ The commission also takes actions on behalf of the legislative branch of government when the full Legislature is not in session. This body meets every few months between sessions to provide guidance to staff of the Legislative Counsel Bureau and to deal with other interim matters.e Interim Finance Committee, composed of the members of the Senate Committee on Finance and the Assembly Committee on Ways and Means from the preceding session, makes fiscal decisions for the Legislature during the period between regular sessions. The Interim Finance Committee endeavors to maintain an adequate fund balance to meet unforeseen financial emergencies.Every member of the Legislature is involved in interim subcommittee work between sessions. In addition several statutory committees meet regularly, including the Committees on Education, Health Care High- ’ Level Radioactive Waste, and Public Lands. During each regular session, the Legislature passes several bills and resolutions directmg the Legislative Commission to study particular subjects and report when the Legislature reconvenes The commission accomplishes its task by creating subcommittees drawn from the entire membership of the Legislature and assigning staff resources to the subcommittees. The interim theLegklature d heanngS’ direCt research and deliberate on proposed legislation for the next session ofQualifications of Legislators
i agp z, uiTo be elected to either house of the Legislature, a person must be at least 21 years of age at the time of the election, a resident of the state for 1 year and a qualified elector in the district to be represented.Terms of OfficeAll members of the Assembly are elected for 2-year terms at the general election held in even-numbered years. Members of the Senate are elected for 4-year terms, with half being elected in one general election and the other half in the next. Effective for the 2010 General Election, a current or former Assembly or Senate member may not seek election to a house in which he or she has served for 12 years or more.CompensationLegislators receive a salary of $130 per day for the first 60 days of each regular session and the first 20 days of each special session. In addition, a per diem allowance of $80 per day is authorized for each day of the session by statute. Legislators receive additional allowances for stationery, postage, travel, and telephone use.Session Info | Interim Info | Law Library i General Info | Counsel Bureau | Research Library | Assembly | Senate Scheduled Meetings j Live Meetings | Publications | Proposals | Career Opportunities | Gift Shophttp://www.leg.state.nv.us/General/General Short.cfm3/16/2003
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Assembly Ways and Means
Agendas and Minutes
Regular meetings in Room 3137 at 7:30 a.m. Mondays, Tuesdays, Wednesdays, Thursdays and
Fridays.
• Morse Arberry -Chair
• Chris Giunchigliani -Vice Chair
• Vonne Chowninq
• David Goldwater
• Sheila Leslie
• Kathy McClain
• David Parks
• Richard Perkins
• Walter Andonov
• Bob Beers
• Dawn Gibbons
• Lynn Hettrick
• Josh Griffimi
• John Marvel
Staff Assignments
“ ’ -------------------- -—------ ----------------------- _____— ---- .
Fiscal Analyst Mark Stevens 684-6821 Sedway Bldg
Principal Deputy Fiscal
Analyst Steve Abba 684-6821 Sedway Bldg
Committee Manager Reba Coombs 684-8587 Room 3133
Lead Secretary Connie Davis 684-8588 Room 3133D
Secretary Anne Bowen 984-8557 Room 3134B
Secretary Kate Caldwell 684-8591 Room 3134B
Secretary Susan Cherpeski 684-8590 Room 3133D
Secretary Lila Clark 684-8561 Room 3134B
Secretary Linda Smith 684-8580 Room 3134B
Secretary Carol Thomsen 684-8513 Room 3134B
I IQ'
Session Info \ Interim Info j Law Library \ General Info | Counsel Bureau | Research Library | Assembly * \| » I I I . , 11 . . , . Sen ate A?
Scheduled_Meetmgs j Live Meetings [Publications | Proposals | Career Opportunities [ gift Shop
w .
http://www.leg.state.nv.us/72nd/committees/a committees/WM.cfm 3/16/2003
2-1.00131 viui^ i oimwiiw V.M1VHVH1 injc,0 (reviscu version, iz/jv; rage i oi z
ASSEMBLY STANDING COMMITTEES
SEVENTY SECOND SESSION, 2003
PERMANENT SCHEDULE OF MEETINGS
(For each committee, the Chairman is named first; the Vice Chairman second; followed by majority party members in alphabetical order and then
________________________ minority party members in alphabetical order.)
COMMITTEE ROOM
NO.
MEMBERSHIP DAY AND TIME
Monday Tuesday Wednesday Thursday Friday
COMMERCE AND LABOR 4100 David Goldwater, Barbara
Buckley, Morse Arberry, Chris
Giunchigliani, Sheila Leslie,
John Oceguera, David Parks,
Richard Perkins, Bob Beers,
David Brown, Dawn Gibbons,
Josh Griffin, Lynn Hettrick,
Ron Knecht
2:00
p.m.
2:00 p.m. 2:00 p.m.
CONSTITUTIONAL
AMENDMENTS
3161 Harry Mortenson, Bob
McCleary, William Horne, Don
Gustavson, Rod Sherer
Upon
Adjournment
EDUCATION 3143 Wendell Williams, William
Horne, Kelvin Atkinson, Vonne
Chowning, Ellen Koivisto,
Mark Manendo, Bob
McCleary, Walter Andonov,
Sharroh Angle, Jason
Geddes, Joe Hardy, Garn
Mabey
3:45
p.m.
3:45 p.m.
ELECTIONS,
PROCEDURES, AND
ETHICS
3138 Chris Giunchigliani, Marcus
Conklin, Bernie Anderson,
Kathy McClain, Bob McCleary,
Peggy Pierce, Bob Beers,
Chad Christensen, Tom
Grady, Valerie Weber
3:45 p.m. 3:45 p.m.
GOVERNMENT AFFAIRS 3143 Mark Manendo, Wendell
Williams, Kelvin Atkinson,
Tom Collins, Ellen Koivisto,
Bob McCleary, Peggy Pierce,
Chad Christensen, Pete
Goicoechea, Tom Grady, Joe
Hardy, Ron Knecht, Valerie
Weber
9:00
a.m.
8:00 a.m. 8:00 a.m. 8:00 a.m. 8:00 a.m.
HEALTH AND HUMAN
SERVICES
3138 Ellen Koivisto, Kathy McClain,
William Horne, Sheila Leslie,
Peggy Pierce, Wendell
Williams, Sharron Angle, Joe
Hardy, Garn Mabey, Valerie
Weber
1:30
p.m.
1:30 p.m.
JUDICIARY 3138 Bernie Anderson, John
Oceguera, Barbara Buckley,
Jerry Claborn, Marcus
Conklin, William Horne, Harry
Mortenson, Genie
Ohrenschall, Sharron Angle,
David Brown, John Carpenter,
Jason Geddes, Don
Gustavson, Garn Mabey, Rod
Sherer
7:30
a.m.
7:30 a.m. 7:30 a.m. 7:30 a.m. 7:30 a.m.
NATURAL RESOURCES,
AGRICULTURE, AND
MINING
3161 Tom Collins, Jerry Claborn,
Kelvin Atkinson, Marcus
Conklin, Bob McCleary, Harry
Mortenson, Genie
Ohrenschall, John Carpenter,
Chad Christensen, Jason
Geddes, Pete Goicoechea,
John Marvel,
1:30
p.m.
1:30 p.m.
TAXATI ON
TRANSPORTATION
3142 David Parks, David Goldwater,
Bernie Anderson, Morse
Arberry, Kathy McClain, Harry
Mortenson, Peggy Pierce,
Dawn Gibbons, Tom Grady,
Josh Griffin, Lynn Hettrick,
John Marvel
1:30 p.m. 1:30 p.m.
3143 Vonne Chowning, Genie 1:30 p.m. 1:30 p.m.
http://www.leg.state.nv.us/72nd/committees/AScheduleOfMeetin2s.htm 3/16/2003
jAoomviDu i 01 AiNuiiNkj v^vjivuvii 11end (revised version, iz/ju; rage zor z
Ohrenschall, Kelvin Atkinson,
Jerry Claborn, Tom Collins,
Mark Manendo, John
Oceguera, John Carpenter,
Don Gustavson, Pete
Goicoechea, Ron Knecht, Rod
___________________________________ Sherer__________________________________________________________________________
WAYS AND MEANS 3137 Morse Arberry, Chris 7:30 7:30 a.m. 7:30 a.m. 7:30 a.m. 7:30 a.m.
Giunchigliani, Vonne a.m.
Chowning, David Goldwater,
Sheila Leslie, Kathy McCiain,
David Parks, Richard Perkins,
Walter Andonov, Bob Beers,
Dawn Gibbons, Lynn Hettrick,
Josh Griffin, John Marvel
SPEAKER - Richard D. Perkins MINORITY FLOOR LEADER - Lynn Hettrick
SPEAKER PRO TEMPORE - Wendell Williams ASSISTANT MINORITY FLOOR LEADER - Josh Griffin
MAJORITY FLOOR LEADER - Barbara Buckley MINORITY WHIP - Sharron Angle
ASSISTANT MAJORITY FLOOR LEADER - John Oceguera MINORITY WHIP - David Brown
MAJORITY WHIP - Bernie Anderson
ASSISTANT MAJORITY WHIP - Sheila Leslie
ASSISTANT MAJORITY WHIP - Mark Manendo
ASSISTANT MAJORITY WHIP FOR PROCEDURE - Genie
Ohrenschall.
PHONE NUMBERS OF ASSEMBLYMEN**
"All phone numbers - area code 775, prefix 684 - toll free number for Legislature 1-800-978-2878 or 1-800-995-9080
ANDERSON,
BERNIE.........
8563
BROWN,
DAVID.................
8823
COLLINS,
TOM...................
8509
GOLDWATER,
DAVID....... 8541
HORNE,
WILLIAM..............
8847
MARVEL,
JOHN.................
8851
PARKS,
DAVID.........
8821
ANDONOV,
WALTER.........
8839
BUCKLEY,
BARBARA.......
8537
CONKLIN,
MARCUS...........
8505
GRADY,
TOM....................
8507
KNECHT,
RON....................
8825
MCCLAIN,
KATHY.............
8835
PERKINS,
RICHARD ....
8503
ANGLE,
SHARRON...........
8848
CARPENTER,
JOHN...........
8831
GEDDES,
JASON...............
8559
GRIFFIN,
JOSH..................
8837
KOIVISTO,
ELLEN ..............
8597
MCCLEARY,
BOB..............
8553
PIERCE,
PEGGY.......
8599
ARBERRY,
MORSE...........
8587
CHOWNING,
VONNE.........
8583
GIBBONS,
DAWN..............
8855
GUSTAVSON,
DON........... 8841
LESLIE,
SHEILA.................
8845
MORTENSON,
HARRY......
8803
SHERER,
ROD............
8805
ATKINSON,
KELVIN............
8577
CHRISTENSEN,
CHAD....... 8853
GIUNCHIGLIANI,
CHRIS...... 8549
HARDY,
JOE ......................
8857
MABEY,
GARN.................
8827
OCEGUERA,
JOHN............
8595
WEBER,
VALERIE.....
8833
BEERS,
BOB.......................
8829
CLABORN,
JERRY............
8569
GOICOECHEA,
PETE...........
8573
HETTRICK,
LYNN...............
8843
MANENDO,
MARK.............
8801
OHRENSCHALL,
GENIE...... 8819
WILLIAMS,
WENDELL ...
8545
Revised March 3, 2003
htto://www.les. state. nv.us/72nd/comrmttees/ A SchedideOfMeetinps.htm 3/16/2.003
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2003 SENATE STANDING COMMITTEES - SEVENTY-SECOND SESSION
PERMANENT SCHEDULE OF MEETINGS
(The Chairman is named first on each committee; the Vice Chairman is named second on each committee,)
_______ ________ __________________ Revised - December 12,2002
COMMITTEE ROOM
NO.
MEMBERSHIP DAY AND TIME
Monday Tuesday Wednesday Thursday Friday
COMMERCE &
LABOR
2135 Townsend, Hardy,
O’Connell, Shaffer,
Neal, Schneider,
Carlton
8:00
a.m.
8:00
a.m.
8:00 a.m. 8:00 a.m. 8:00
a.m.
FINANCE 2134 Raggio, Rawson,
Rhoads, Cegavske,
Tiffany, Coffin,
Mathews
8:00 a.m. 8:00
a.m.
8:00 a.m. 8:00 a.m. 8:00
a.m.
GOVERNMENT
AFFAIRS
2149 O’Connell, Tiffany,
Raggio, Townsend,
Hardy, Titus, Care
2:00 p.m. 2:00 p.m. 2:00
p.m.
HUMAN RESOURCES
& FACILITIES
2135 Rawson, Cegavske,
Washington, Nolan,
Neal, Mathews, Wiener
1:30 p.m. 1:30 p.m. 1:30
p.m.
JUDICIARY 2149 Amodei, Washington,
McGinness, Nolan,
Titus, Wiener, Care
8:00
a.m.
8:00
a.m.
8:00 a.m. 8:00 a.m. 8:00
a.m.
LEGISLATIVE
AFFAIRS &
OPERATIONS
2144 Washington, Cegavske,
Raggio, Rawson, Titus,
Mathews, Wiener
3:30 p.m.
NATURAL
RESOURCES
2144 Rhoads, McGinness,
Shaffer, Amodei,
Coffin, Schneider,
Carlton
1:30
p.m.
. 1:30 p.m. 1:30
p.m.
TAXATION 2135 McGinness, Rhoads,
Townsend, O’Connell,
Tiffany, Neal, Coffin
2:00 p.m. 2:00 p.m.
TRANSPORTATION 2149 Shaffer, Nolan,
Amodei, Hardy,
Schneider, Care,
Carlton
1:30 p.m. 1:30 p.m
* • • * 4**^
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Assembly Page 1 of 2
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Assembly Leadership and Members
Speaker
Richard Perkins
Speaker Pro Tempore
Wendell Williams
Majority Leadership Minority Leadership
Majority Floor Leader
Barbara Buckley
Majority Whip
Bernie Anderson
Asst Majority Floor
Leader
John Oceguera
Asst Majority Whips
Sheila Leslie
Mark Manendo
Minority Floor Leader Minority Whips
Lynn Hettrick Sharron Angle
David Brown
Asst Minority Floor Leader
Josh Griffin
Asst Majority Floor
Leader for Procedure
Genie Ohrenschalfe
District Name District Name District Name
i Collins 2 Mabey 3 Pierce
► 4 Beers ► 5 Weber 6 Williams
!► 7 Arberry 8 Buckley 9 Giunchigliani
10 Goldwater ► 11 McCleary 12 Ohrenschall
13 Christensen 14 Koivisto l> 15 McClain
16 Oceguera 17 Atkinson ► 18 Manendo
19 Clabom ► 20 Hardy ► 21 Andonov
o 22 Brown ► 23 Perkins 24 Geddes
► 25 Gibbons 26 Angle 27 Leslie
► 28 Chowning ► 29 Griffin 30 Gustavson
!► 31 Anderson 32 Marvel ► 33 Carpenter
► 34 Horne 35 Goicoechea 36 Sherer
37 Conklin 38 Grady 39 Hettrick
o/ir /nnno
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President
Lieutenant Governor Hunt
Lorraine Hunt
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President Pro Tempore
Minority Leadership
Majority Leader
William Raggio
Asst Majority Leader
Raymond Rawson
Majority Whip T .
Maurice Minority Leader Minority Whip
Washington DiMlitBS YaktteWiener
Asst Majority Whip Asst Minority Leader
Mark Amodei Bernice Mathews
Name District Name District
ll> Amodei Capital ► Cegavske Clark 8
McGinness Central
Nevada Nolan Clark 9
Shaffer Clark 1 ► Coffin Clark 10
Carlton Clark 2 ► Schneider Clark 11
Wiener Clark 3 Hardy Clark 12
► Neal Clark 4 ► Rhoads Northern
Nevada
Tiffany Clark 5 ► Mathews Washoe 1
► O'Connell Clark 5 ► Washington Washoe 2
Rawson Clark 6 ► Raggip Washoe 3
Care Clark? Townsend Washoe 4
Titus Clark? —
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©2003
httn./Avun., 1O„ +____ /c____ ________ J
e PROPOSED LEGISLATIONA.B.236—Prescription DrugsA.B.283—Subsidies for a Healthy NevadaA.B. 307—Commission on Prescription DrugsS.B. 249—Commission on Minority AffairsS.B. 289—Single Payer Health Care System and Expansion of Medicad program0 LEGISLATION SIGNED BY GOVERNORS.B. 32—Fund for a Healthy NevadaAKA DAY AT THE CAPITOL CARSON CITY, NEVADA March 18,2003
A.B. 236Assembly Bill No. 236-Assemblymen Buckley, Perkins Goldwater, Koivisto, Gibbons, Angle, Arberry Atkinson Beers, Carpenter, Chowning, Claborn’ Collins, Geddes, Giunchigliani, Goicoechea, Grady’ Griffin, Gustavson, Hettrick, Knecht, Mabey’ Manendo, Marvel, McClain, McCleary’ Mortenson, Pierce and WeberMarch 4,2003Referred to Committee on Commerce and LaborSUMMARY -Directs Office for Consumer Health Assistance to assist consumers in gaining information regarding certain prescription drug programs. (BDR 18-203)FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes.EXPLANATION - Matter in bolded italics is new; matter between brackets lemitted-ntateHal} is material to be omitted.AN ACT relating to the Office for Consumer Health Assistancerequiring the Office to assist consumers in gaining formation regarding certain prescription drug programs- authorizing the Office to accept gifts, grants and donations to support this service; and providing other matters properly relating thereto.THEW^Ptr'a^J^ccS^TE OF NEVADA> REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:a m Section 1- Chapter 223 of NRS is hereby amended by adding2 thereto a new section to read as follows: s3 Prescription drug program ” means a program:5 druoc °r conducted by a manufacturer of prescriptionj at ugs at no charge; or j r r1 fh^f°ffered by thC State °f Nevada a political subdivisionIIBIHIM* A B 2 3 6 *
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Sec. 2. NRS 223.500 is hereby amended to read as follows:
223.500 As used in NRS 223.500 to 223.580, inclusive, and
section 1 of this act, unless the context otherwise requires, the
words and terms defined in NRS 223.510, 223.520 and 223.530 and
section 1 of this act have the meanings ascribed to them in those
sections.
Sec. 3. NRS 223.510 is hereby amended to read as follows:
223.510 “Consumer” means a natural person who has or is in
need of coverage under a health care plan jv} or who is in need of
information or other assistance regarding a prescription drug
program.
Sec. 4. NRS 223.550 is hereby amended to read as follows:
223.550 1. The Office for Consumer Health Assistance is
hereby established in the Office of the Governor. The Governor
shall appoint the Director. The Director must:
(a) Be:
(1) A physician, as that term is defined in NRS 0.040;
(2) A registered nurse, as that term is defined in
NRS 632.019;
(3) An advanced practitioner of nursing, as that term is
defined in NRS 453.023; or
(4) A physician assistant, as that term is defined in
NRS 630.015; and
(b) Have expertise and experience in the field of advocacy.
2. The cost of carrying out the provisions of NRS 223.500 to
223.580, inclusive, must be paid as follows:
(a) That portion of the cost related to providing assistance to
consumers and injured employees concerning workers’
compensation must be paid from the assessments levied pursuant to
NRS 232.680.
(b) That portion of the cost related to the operation of the
Bureau for Hospital Patients created pursuant to NRS 223.575 must
be paid from the assessments levied pursuant to that section.
(c) That portion of the cost related to providing assistance to
consumers in need of information or other facilitation regarding a
prescription drug program may, to the extent money is available
from this source, be paid from the proceeds of any gifts, grants or
donations that are received by the Director for this purpose.
(d) The remaining cost must be provided by direct legislative
appropriation from the State General Fund and be paid out on claims
as other claims against the State are paid.
Sec. 5. NRS 223.560 is hereby amended to read as follows:
223.560 The Director shall:
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1. Respond to written and telephonic inquiries received from
consumers and injured employees regarding concerns and problems
related to health care and workers’ compensation;
2. Assist consumers and injured employees in understanding
their rights and responsibilities under health care plans and policies
of industrial insurance;
3. Identify and investigate complaints of consumers and
injured employees regarding their health care plans and policies of
industrial insurance and assist those consumers and injured
employees to resolve their complaints, including, without limitation:
(a) Referring consumers and injured employees to the
appropriate agency, department or other entity that is responsible for
addressing the specific complaint of the consumer or injured
employee; and
(b) Providing counseling and assistance to consumers and
injured employees concerning health care plans and policies of
industrial insurance;
4. Provide information to consumers and injured employees
concerning health care plans and policies of industrial insurance in
this state;
5. Establish and maintain a system to collect and maintain
information pertaining to the written and telephonic inquiries
received by the Office;
6. Take such actions as are necessary to ensure public
awareness of the existence and purpose of the services provided by
the director pursuant to this section; [and]
7. In appropriate cases and pursuant to the direction of the
Governor, refer a complaint or the results of an investigation to the
Attorney General for further action [4 ; and
8. Provide information to and applications for prescription
drug programs for consumers without insurance coverage for
prescription drugs or pharmaceutical services.
Sec. 6. NRS 223.570 is hereby amended to read as follows:
223.570 1. The Director may:
(a) Within the limits of available money, employ:
(1) Such persons in the unclassified service of the State as he
determines to be necessary to carry out the provisions of this section
and NRS 223.560 and 223.580, including, without limitation, a
provider of health care, as that term is defined in NRS 449.581.
(2) Such additional personnel as may be required to carry out
the provisions of this section and NRS 223.560 and 223.580, who
must be in the classified service of the state.
A person employed pursuant to the authority set forth in this
subsection must be qualified by training and experience to perform
the duties for which the Director employs him.
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(b) To the extent not otherwise prohibited by law, obtain such
information from consumers, injured employees, health care plans ,
prescription drug programs and policies of industrial insurance as
he determines to be necessary to carry out the provisions of this
section and NRS 223.560 and 223.580.
(c) Adopt such regulations, as he determines to be necessary to
carry out the provisions of this section and NRS 223.560 and
223.580.
(d) Apply for any available grants, accept any gifts, grants or
donations and use any such gifts, grants or donations to aid the
Office in carrying out its duties pursuant to subsection 8 of
NRS 223.560.
2. The Director and his employees shall not have any conflict
of interest relating to the performance of their duties pursuant to this
section and NRS 223.560 and 223.580. For the purposes of this
subsection, a conflict of interest shall be deemed to exist if the
Director or employee, or any person affiliated with the Director or
employee:
(a) Has direct involvement in the licensing, certification or
accreditation of a health care facility, insurer or provider of health
care;
(b) Has a direct ownership interest or investment interest in a
health care facility, insurer or provider of health care;
(c) Is employed by, or participating in, the management of a
health care facility, insurer or provider of health care; or
(d) Receives or has the right to receive, directly or indirectly,
remuneration pursuant to any arrangement for compensation with a
health care facility, insurer or provider of health care.
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A.B. 283Assembly Bill No. 283-Assemblymen McClain, Koivisto, Parks, Chowning, Claborn, Anderson, Andonov, Angle, Arberry, Atkinson, Brown, Buckley, Carpenter, Christensen, Collins, Conklin, Geddes, Gibbons, Giunchigliani, Goicoechea, Goldwater, Grady, Griffin, Hardy, Hettrick, Horne, Knecht, Leslie, Manendo, Marvel, McCleary, Mortenson, Oceguera, Ohrenschall, Perkins, Pierce, Sherer, Weber and WilliamsMarch 11,2003Referred to Concurrent Committees on Health and Human Services and Ways and MeansSUMMARY—Provides subsidies from Fund for a Healthy Nevada for coverage of limited-scope dental and vision benefits to certain senior citizens. (BDR 40-152)FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes.EXPLANATION - Matter in bolded italics is new; matter between brackets {omitted matorialj is material to be omitted.AN ACT relating to public health; providing subsidies from the Fund for a Healthy Nevada for the coverage of limitedscope dental and vision benefits within the program of subsidies for the provision of prescription drugs and pharmaceutical services to senior citizens; and providing other matters properly relating thereto.THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:1 Section 1. NRS 439.630 is hereby amended to read as follows: 439.630 1. The Task Force for the Fund for a Healthy3 Nevada shall:4 (a) Conduct public hearings to accept public testimony from a5 wide variety of sources and perspectives regarding existing or6 proposed programs that:iiiiiHiun* A B 2 8 3 *
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(1) Promote public health;
(2) Improve health services for children, senior citizens and
persons with disabilities;
(3) Reduce or prevent the use of tobacco;
(4) Reduce or prevent the abuse of and addiction to alcohol
and drugs; and
(5) Offer other general or specific information on health care
in this state.
(b) Establish a process to evaluate the health and health needs of
the residents of this state and a system to rank the health problems
of the residents of this state, including, without limitation, the
specific health problems that are endemic to urban and rural
communities.
(c) Reserve not more than 30 percent of all revenues deposited
in the Fund for a Healthy Nevada each year for direct expenditure
by the Department to pay for prescription drugs , [and]
pharmaceutical services and limited-scope dental and vision
benefits for senior citizens pursuant to NRS 439.635 to 439.690,
inclusive. From the money reserved to the Department pursuant to
this paragraph, the Department shall subsidize all of the cost of
policies of health insurance that provide coverage to senior citizens
for prescription drugs , {and] pharmaceutical services and limitedscope
dental and vision benefits pursuant to NRS 439.635 to
439.690, inclusive. The Department shall consider recommendations
from the Task Force for the Fund for a Healthy Nevada in carrying
out the provisions of NRS 439.635 to 439.690, inclusive. The
Department shall submit a quarterly report to the Governor, the Task
Force for the Fund for a Healthy Nevada and the Interim Finance
Committee regarding the general maimer in which expenditures
have been made pursuant to this paragraph and the status of the
program.
(d) Reserve not more than 30 percent of all revenues deposited
in the Fund for a Healthy Nevada each year for allocation by the
Aging Services Division of the Department in the form of grants for
existing or new programs that assist senior citizens with independent
living, including, without limitation, programs that provide:
(1) Respite care or relief of family caretakers;
(2) Transportation to new or existing services to assist senior
citizens in living independently; and
(3) Care in the home which allows senior citizens to remain
at home instead of in institutional care.
The Aging Services Division of the Department shall consider
recommendations from the Task Force for the Fund for a Healthy
Nevada concerning the independent living needs of senior citizens.
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(e) Allocate for expenditure not more than 20 percent of all
revenues deposited in the Fund for a Healthy Nevada each year for
programs that prevent, reduce or treat the use of tobacco and the
consequences of the use of tobacco.
(f) Allocate for expenditure not more than 20 percent of all
revenues deposited in the Fund for a Healthy Nevada each year for
programs that improve health services for children and the health
and well-being of persons with disabilities.
(g) Maximize expenditures through local, federal and private
matching contributions.
(h) Ensure that any money expended from the Fund for a
Healthy Nevada will not be used to supplant existing methods of
funding that are available to public agencies.
(i) Develop policies and procedures for the administration and
distribution of grants and other expenditures to state agencies,
political subdivisions of this state, nonprofit organizations,
universities and community colleges. A condition of any such grant
must be that not more than 8 percent of the grant may be used for
administrative expenses or other indirect costs. The procedures must
require at least one competitive round of requests for proposals per
fiscal year.
(j) To make the allocations required by paragraphs (e) and (f):
(1) Prioritize and quantify the needs for these programs;
(2) Develop, solicit and accept grant applications for
allocations;
(3) Conduct annual evaluations of programs to which
allocations have been awarded; and
(4) Submit annual reports concerning the programs to the
Governor and the Interim Finance Committee.
(k) Transmit a report of all findings, recommendations and
expenditures to the Governor and each regular session of the
Legislature.
2. The Task Force may take such other actions as are necessary
to carry out its duties.
3. The Department shall take all actions necessary to ensure
that all allocations for expenditures made by the Task Force are
carried out as directed by the Task Force.
4. To make the allocations required by paragraph (d) of
subsection 1, the Aging Services Division of the Department shall:
(a) Prioritize and quantify the needs of senior citizens for these
programs;
(b) Develop, solicit and accept grant applications for allocations;
(c) As appropriate, expand or augment existing state programs
for senior citizens upon approval of the Interim Finance Committee;
(d) Award grants or other allocations; ■ ininiiiiiiiiii * A B 2 8 3 *
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(e) Conduct annual evaluations of programs to which grants or
other allocations have been awarded; and
(f) Submit annual reports concerning the grant program to the
Governor and the Interim Finance Committee.
5. The Aging Services Division of the Department shall submit
each proposed grant which would be used to expand or augment an
existing state program to the Interim Finance Committee for
approval before the grant is awarded. The request for approval must
include a description of the proposed use of the money and the
person or entity that would be authorized to expend the money. The
Aging Services Division of the Department shall not expend or
transfer any money allocated to the Aging Services Division
pursuant to this section to subsidize any portion of the cost of
policies of health insurance that provide coverage to senior citizens
for prescription drugs and pharmaceutical services pursuant to NRS
439.635 to 439.690, inclusive.
6. The Department, on behalf of the Task Force, shall submit
each allocation proposed pursuant to paragraph (e) or (f) of
subsection 1 which would be used to expand or augment an existing
state program to the Interim Finance Committee for approval before
the grant is awarded. The request for approval must include a
description of the proposed use of the money and the person or
entity that would be authorized to expend the money.
Sec. 2. NRS 439.665 is hereby amended to read as follows:
439.665 1. The Department shall enter into contracts with
private insurers who transact health insurance in this state to arrange
for the availability, at a reasonable cost, of policies of health
insurance that provide coverage to senior citizens for prescription
drugs , {and} pharmaceutical services {4 limited-scope dental
and vision benefits.
2. Within the limits of the money available for this purpose in
the Fund for a Healthy Nevada, a senior citizen who is not eligible
for Medicaid and who purchases a policy of health insurance that is
made available pursuant to subsection 1 is entitled to an annual
grant from the {Trust] Fund to subsidize the cost of that insurance,
including premiums and deductibles, if he has been domiciled in this
state for at least 1 year immediately preceding the date of his
application and his household income is not over $21,500.
3. The subsidy granted pursuant to this section must not exceed
the annual cost of insurance that [provides-coverage for prescription
drHgs-and-phafffiaeetttieaJ-oeFviees;] is made available pursuant to
subsection 1, including premiums and deductibles.
4. A policy of health insurance that is made available pursuant
to subsection 1 must provide for:
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(a) A copayment of not more than $10 per prescription drug or
pharmaceutical service that is generic as set forth in the formulary of
the insurer; and
(b) A copayment of not more than $25 per prescription drug or
pharmaceutical service that is preferred as set forth in the formulary
of the insurer.
5. The Department may waive the eligibility requirement set
forth in subsection 2 regarding household income upon written
request of the applicant if the circumstances of the applicant’s
household have changed as a result of:
(a) Illness;
(b) Disability; or
(c) Extreme financial hardship based on a significant reduction
of income, when considering the applicant’s current financial
circumstances.
An applicant who requests such a waiver shall include with that
request all medical and financial documents that support his request.
6. If the Federal Government provides any coverage for dental
or vision benefits or coverage of prescription drugs and
pharmaceutical services for senior citizens who are eligible for a
subsidy pursuant to subsections 1 to 5, inclusive, the Department
may, upon approval of the Legislature, or the Interim Finance
Committee if the Legislature is not in session, change any program
established pursuant to NRS 439.635 to 439.690, inclusive, and
otherwise provide assistance with prescription drugs , [and]
pharmaceutical services and limited-scope dental and vision
benefits for senior citizens within the limits of the money available
for this purpose in the Fund for a Healthy Nevada.
7. The provisions of subsections 1 to 5, inclusive, do not apply
{if| to the extent that the Department provides assistance [with
preseription-drugs-aftd-pharmaeeutical-^eFvieesJ for senior citizens
pursuant to subsection 6.
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A.B. 307
Assembly Bill No. 307-Assemblymen Leslie, Giunchigliani,
Conklin, McClain, Koivisto, Anderson, Atkinson,
Crowning, Collins, Horne, Mortenson and Parks
March 13,2003
Joint Sponsor: Senator Wiener
Referred to Concurrent Committees on Elections,
Procedures, and Ethics and Ways and Means
SUMMARY—Creates Silver State Commission on Prescription
Drugs. (BDR 17-165)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
EXPLANATION - Matter in bolded italics is new; matter between brackets is material to be omitted.
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AN ACT relating to health care; creating the Silver State
Commission on Prescription Drugs; prescribing the
membership and duties of the Commission; providing for
the payment of compensation, per diem allowances and
travel expenses for certain members of the Commission;
and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 218 of NRS is hereby amended by adding
thereto the provisions set forth as sections 2 to 8, inclusive, of this
act.
Sec. 2. As used in sections 2 to 8, inclusive, of this act,
“Commission” means the Silver State Commission on Prescription
Drugs created pursuant to section 3 of this act.
Sec. 3. 1. The Silver State Commission on Prescription
Drugs is hereby created. The membership of the Commission
consists of:
(a) The following voting members:
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(1) The Chairman of the Senate Standing Committee on
Human Resources and Facilities during the immediately
preceding session of the Legislature, or a member of that
Committee during the immediately preceding session of the
Legislature appointed by the Chairman.
(2) The Chairman of the Assembly Standing Committee on
Health and Human Services during the immediately preceding
session of the Legislature, or a member of that Committee during
the immediately preceding session of the Legislature appointed by
the Chairman.
(3) Three members appointed by the Governor as follows:
(I) A representative of the Nevada Hospital Association;
(II) A representative of the Nevada State Medical
Association; and
(III) A member of the general public.
(4) Three members appointed by the Speaker of the
A ssembly as follows:
(I) A representative of the Nevada State Office of the
American Association of Retired Persons;
(II) A representative of the Nevada Health Care Reform
Project; and
(III) A representative of the Hotel Employees and
Restaurant Employees International Union Welfare Fund.
(5) Three members appointed by the Majority Leader of the
Senate as follows:
(I) A representative of the Nevada Association of Health
Plans;
(II) A representative of the Retail Association of
Nevada; and
(HI) A representative of the Pharmaceutical Research
and Manufacturers of America.
(b) The following nonvoting members:
(1) the Director, or his designee, of the Department of
Human Resources;
(2) The Chief, or his designee, of the Purchasing Division
of the Department of Administration;
(3) The Executive Officer of the Public Employees’
Benefits Program or a representative appointed by the Board of
the Public Employees’ Benefits Program;
(4) The Director, or his designee, of the Department of
Corrections; and
(5) The Secretary, or his designee, of the State Board of
Pharmacy.
2. The Speaker of the Assembly shall select the initial
Chairman of the Commission. After the initial selection,
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ch airmanship of the Commission shall alternate each biennium
between the houses of the Legislature, with the Speaker of the
Assembly and the Majority Leader of the Senate alternating
the selection of the Chairman. If a vacancy occurs in the
chairmanship, the vacancy must be filled in the same manner as
the original selection for the remainder of the unexpired term.
3. Each voting member of the Commission who is not a
Legislator serves a term of 2 years commencing on July 1 of each
odd-numbered year.
4. A member of the Commission who is not a candidate for
reelection or who is defeated for reelection continues to serve until
the convening of the next regular session of the Legislature.
5. A vacancy on the Commission must be filled in the same
manner as the original appointment.
Sec. 4. 1. The members of the Commission shall meet
throughout the year at the times and places specified by a call of
the Chairman or a majority of the members of the Commission.
The Director of the Legislative Counsel Bureau or his designee
shall serve as the nonvoting Recording Secretary of the
Commission. Six members of the Commission constitute a
quorum, and a quorum may exercise all the power and authority
conferred on the Commission.
2. The Commission shall prescribe regulations for its own
management and government
3. Except during a regular or special session of the
Legislature, for each day or portion of a day during which a
member of the Commission who is a Legislator attends a meeting
of the Commission or is otherwise engaged in the work of the
Commission, he is entitled to receive the:
(a) Compensation provided for a majority of the members of
the Legislature during the first 60 days of the preceding regular
session;
(b) Per diem allowance provided for state officers and
employees generally; and
(c) Travel expenses provided pursuant to NRS 218.2207.
4. Each voting member of the Commission who is not a
Legislator serves without salary, except that he is entitled to
receive the per diem allowance and travel expenses provided for
state officers and employees generally for each day or portion of a
day during which he attends a meeting of the Commission or is
otherwise engaged in the work of the Commission.
5. The compensation, per diem allowances and travel
expenses of the voting members of the Commission must be paid
from the Legislative Fund.
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1 Sec. 5. 1. The Commission shall analyze, compile, review,
2 recommend and report on issues related to:
3 (a) Pharmaceutical programs that are designed to reduce the
4 price of prescription drugs for:
5 (1) Persons of low income in this state;
6 (2) Enrollees in this state's health benefits plan; and
7 (3) Participants in programs administered by this state that
8 make available or provide prescription drugs;
9 (b) Prescription drug buying clubs that are used in other states
10 and the potential for such clubs to assist the residents of this state
11 in reducing their expenses for prescription drugs;
12 (c) Methods to access manufacturer rebates for prescription
13 drugs to assist the residents of this state in reducing their expenses
14 for prescription drugs;
15 (d) Interagency bulk purchasing and interstate buying of
16 prescription drugs to reduce the prices of prescription drugs for
17 this state's programs and health benefits plan;
18 (e) Methods to negotiate for lower prices on prescription drugs
19 and a plan to carry out the methods; and
20 (f) Methods to control the prices of prescription drugs for this
21 state's programs that provide pharmaceutical assistance to
22 persons of low income in this state and for enrollees in this state's
23 health benefits plan.
24 2. The Commission may conduct investigations and hold
25 hearings in connection with its duties pursuant to this section.
26 Sec. 6. On or before July 1 of each even-numbered year, the
27 Commission shall submit a report of its activities and any
28 recommendations for legislation to the:
29 I. Governor;
30 2. Director of the Legislative Counsel Bureau for
31 transmission to the Legislative Commission;
32 3. Research Division of the Legislative Counsel Bureau for
33 transmission to the Legislative Committee on Health Care;
34 4. Fiscal Analysis Division of the Legislative Counsel Bureau
35 for transmission to the Interim Finance Committee; and
36 5. The Director of the Department of Human Resources.
37 Sec. 7. 7. If the Commission conducts investigations or
38 holds hearings pursuan t to section 5 of this act:
39 (a) The Secretary of the Commission or, in his absence, a
40 member designated by the Chairman of the Commission may
41 administer oaths.
42 (b) The Secretary or Chairman of the Commission may cause
43 the deposition of witnesses, residing either within or outside of this
44 state, to be taken in the manner prescribed by rule of court for
45 taking depositions in civil actions in the district courts.
1 (c) The Chairman of the Commission may issue subpoenas to
2 compel the attendance o f witnesses and the production of books
3 and papers.
4 2. If a witness refuses to attend or testify or produce books or
5 papers as required by the subpoena, the Chairman of the
6 Commission may report to the district court by a petition which
7 sets forth that:
8 (a) Due notice has been given of the time and place of
9 attendance of the witness or the production of the books or papers;
10 (b) The witness has been subpoenaed by the Commission
11 pursuant to this section; and
12 (c) The witness has failed or refused to attend or produce the
13 books or papers required by the subpoena before the Commission
14 that is named in the subpoena, or has refused to answer questions
15 propounded to him.
16 The petition may request an order of the court compelling the
17 witness to attend and testify or produce the books and papers
18 before the Commission.
19 3. Upon such a petition, the court shall enter an order
20 directing the witness to appear before the court at a time and place
21 to be fixed by the court in its order, the time to be not more than
22 10 days after the date of the order, and to show cause why he has
23 not attended or testified or produced the books or papers before
24 the Commission. A certified copy of the order must be served upon
25 the witness.
26 4. If it appears to the court that the subpoena was regularly
27 issued by the Commission, the court shall enter an order that the
28 witness appear before the Commission at the time and place fixed
29 in the order and testify or produce the required books or papers.
30 Failure to obey the order constitutes contempt of court.
31 Sec. 8. Each witness who appears before the Commission by
32 its order, except a state officer or employee, is entitled to receive
33 for his attendance the fees and mileage provided for witnesses in
34 civil cases in the courts of record of this state. The fees and
35 mileage must be audited and paid upon the presentation ofproper
36 claims sworn to by the witness and approved by the Secretary and
37 Chairman of the Com mission.
38 Sec. 9. As soon as practicable before July 1, 2003, the
39 Governor, the Speaker of the Assembly and the Majority Leader of
40 the Senate shall make appointments to the Silver State Commission
41 on Prescription Drugs pursuant to section 3 of this act.
42 Sec. 10. This act becomes effective upon passage and
43 approval.
S.B. 249
Senate Bill No. 249-Senators Raggio, Townsend, Rawson,
Washington, Shaffer, Amodei, Care, Carlton,
Cegavske, Coffin, Hardy, Mathews, McGinness,
Neal, Nolan, Rhoads, Schneider, Tiffany, Titus and
Wiener
March 7,2003
Referred to Committee on Government Affairs
SUMMARY—Creates Nevada Commission on Minority Affairs.
(BDR 18-766)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: No.
EXPLANATION - Matter in bolded italics is new; matter between brackets {amitted-fnateml| is material to be omitted.
AN ACT relating to the Executive Department of State
Government; creating the Nevada Commission on
Minority Affairs; providing the duties of the Commission;
requiring the Director of the Department of
Administration to provide certain staff assistance to the
Commission under certain circumstances; and providing
other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1 Section 1. Title 18 of NRS is hereby amended by adding
2 thereto a new chapter to consist of the provisions set forth as
3 sections 2 to 10, inclusive, of this act.
4 Sec. 2. As used in this chapter, unless the context otherwise
5 requires, “Commission” means the Nevada Commission on
6 Minority Affairs created by section 3 of this act.
7 Sec. 3. 1. The Nevada Commission on Minority Affairs,
8 consisting of 11 members appointed by the Governor, is hereby
9 created.
10 2. The members appointed to the Commission must represent
11 a variety of m inority groups.
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3. The Governor shall designate:
(a) One member of the Commission to serve as Chairman;
(b) One member of the Commission to serve as Vice
Chairman; and
(c) Such other officers from the membership of the
Commission as the Governor may determine to be necessary.
4. The term of office of each Chairman, Vice Chairman and
any other officer of the Commission is 1 year.
5. Not more than four members of the Commission may be
from the same minority group.
Sec. 4. Except for the initial members, the term of office of
each member of the Commission is 3 years and commences on
July 1 of the year of appointment. The members shall continue in
office until their successors are appointed. Members are eligible
for reappointment, except that no member may serve for any part
of more than two consecutive terms. Vacancies must be filled by
appointment for the unexpired terms by the Governor.
Sec. 5. Members of the Commission receive no compensation
for their services, but are entitled to be reimbursed for all travel
and other expenses actually and necessarily incurred by them in
the performance of their duties, within the limits of money
available to the Commission.
Sec. 6. 1. The Commission shall meet at the call of the
Chairman as frequently as required to perform its duties, but no
less than quarterly.
2. A majority of the members of the Commission constitutes a
quorum for the transaction of business, and a majority of those
present at any meeting is sufficient for any official action taken by
the Commission.
3. The Commission shall, on or before January 31 of each
year, submit a report to the Governor summarizing the activities,
needs and recommendations of the Commission.
Sec. 7. The Commission shall, within the limits of available
money:
1. Study matters affecting the social and economic welfare
and well-being of minorities residing in the State of Nevada;
2. Collect and disseminate information on activities,
programs and essential services available to minorities in the State
of Nevada;
3. Work in coordination with the Governor to establish
criteria and goals for the achievement of increased economic
opportunities in this state for minorities;
4. In cooperation with the Nevada Equal Rights Commission,
act as a liaison to inform persons regarding:
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(a) The laws of this state that prohibit discriminatory
practices; and
(b) The procedures pursuant to which aggrieved persons may
file complaints or otherwise take action to remedy such
discriminatory practices;
5. To the extent practicable, strive to create networks within
the business community between businesses that are owned by
minorities and businesses that are not owned by minorities;
6. Advise the Governor on matters relating to minorities and
of concern to minorities; and
7. Recommend proposed legislation to the Governor.
Sec. 8. The Chairman of the Commission may, with the
approval of the Commission, appoint committees from its members
to assist in carrying out any of the functions or duties of the
Commission.
Sec. 9. 1. The Director of the Department of
Administration shall provide staff assistance to the Commission as
the Governor deems appropriate.
2. The Commission may engage the services of volunteer
workers and consultants without compensation as is necessary
from time to time.
Sec. 10. The Commission may apply for and receive gifts,
grants, contributions or other money from governmental and
private agencies, affiliated associations and other persons for the
purposes of carrying out the provisions of this chapter and for
defraying expenses incurred by the Commission in the discharge
o f its duties.
Sec. 11. As soon as practicable after July 1, 2003, the
Governor shall appoint to the Nevada Commission on Minority
Affairs:
1. Four members to terms that expire on June 30, 2004.
2. Four members to terms that expire on June 30, 2005.
3. Three members to terms that expire on June 30, 2006.
Sec. 12. This act becomes effective on July 1, 2003.
■■■ * S B 2 4 9 *
S.B. 289
Senate Bill No. 289-SenatorNeal
March 14,2003
Referred to Committee on Human Resources and Facilities
SUMMARY—Establishes State Health Authority to plan for single
payer health care system and for expansion of
Medicaid program. (BDR 40-720)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
EXPLANATION - Matter in bolded italics is new; matter between brackets is material to be omitted.
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AN ACT relating to health care; establishing in skeleton form the
State Health Authority to plan for a single payer health
care system in the State of Nevada and for the expansion
of the Medicaid program; and providing other matters
properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 439 of NRS is hereby amended by adding
thereto the provisions set forth as sections 2 to 5, inclusive, of this
act.
Sec. 2. As used in sections 2 to 5, inclusive, of this act, unless
the context otherwise requires, “Authority” means the State
Health Authority established pursuant to section 3 of this act.
Sec. 3. 1. The State Health Authority is hereby established
within the Department of Human Resources.
2. The Authority consists of:
(a) Nine members deemed appropriate by and appointed by the
Governor;
(b) Two members who are representative of the health care
industry appointed by the Governor;
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(c) The Director of the Department of Human Resources or
his designee;
(d) The Director of the Department of Business and Industry
or his designee; and
(e) The Commissioner of Insurance or his designee.
Sec. 4. 1. The Authority’is responsible for planning for the
provision of health care services to all residents of this state. The
Authority shall:
(a) Determine the future needs of this state for providers of
health care, medical facilities, medical equipment and other health
care services;
(b) Develop a plan for providing health insurance to residents
of this state whose incomes are under 300 percen t of the federally
designated level signifying poverty and who but for their income
are otherwise eligible for benefits pursuant to Medicaid;
(c) Develop a plan for Medicaid to provide all optional services
that it is authorized to provide pursuant to federal law; and
(d) Develop a plan for the State of Nevada to purchase all
health care services for residents of this state, including, without
limitation, a method for funding the plan, based on a study of the
feasibility of:
(1) Reimbursing each provider of health care within 30
days after the provision of a service by the provider at a rate
determined by the Authority’;
(2) Collecting a monthly employer health insurance
assessment from each employee who earns a wage or salary in this
state; and
(3) Funding the plan through the collection of an employer
health insurance assessment, money provided by the Federal
Government for Medicaid, appropriations from the State General
Fund and fees paid by insurance carriers.
2. The Authority shall obtain input from the public in
developing the required plans pursuant to this section.
3. The Authority shall submit the plans it develops pursuant
to subsection 1 to the Director of the Department of Human
Resources on or before October 1, 2004.
4. The Authority shall submit the plans it develops pursuant
to subsection 1 and any suggestions for necessary’ legislation to
carry out the plans to the Legislature on or before January 1,
2005.
Sec. 5. Any agency, bureau, board, commission, department
or division of the State of Nevada that funds the provision of
health care services to residents of this state may, to the extent
authorized pursuant to federal law, transfer money’ to the
Authority to carry out the provisions of sections 2 to 5, inclusive,
IIIIIIIIIIIIH * S B 2 8 9 *
-3 -1 of this act, and to cany out a plan developed by the Authority2 pursuant to section 4 o f this act3 Sec. 6. This act becomes effective on January 1, 2004.lllllllll■lllllllll* S B 2 8 9 *
6 HEALTH FACTS—AFRICAN-AMERICANS CANCER HYPERTENSION—HIGH BLOOD PRESSURE CARDIOVASCULAR DISEASE HIV/AIDS KIDNEY DISEASE WOMEN’S HEALTHAKA DAY AT THE CAPITOL CARSON CITY, NEVADA March 18,2003
5,800
3,100 2,900
3,700 25,300 83,700 5,600
16,800 5,200 45,800 16,100
14,800 68,900 7,700 41,100
30,000 58,700
57,400
5,900
14,500 31,300
12,300 2,700 21,100
119,900
38,200
29,100
16,900 14,200 19,500 22,100
14,400
79,700
21,900
92,200
1,600
1,284,900
4,700 N/A
Estimated number of new cancer cases for 2002, excluding basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Note: These estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of
estimated cancer deaths in 2002 by state. State estimates may not add to US total due to rounding.
22,600 ) 31,600
NM
7,100
MO
28,600
MN
20,800
ME
7,000
NV
9,500
4,400
WY
2,300
WA
25,600
MA
31,700
■ MD 4,100
23,500
ncei
Cancer: Basic Facts 1
Age-Adjusted Cancer Death Rates, Males by Site, US, 1930-1998* 2
Age-Adjusted Cancer Death Rates, Females by Site, US, 1930-1998* 3
Estimated New Cancer Cases and Deaths by Gender, US, 2002* 4
Estimated New Cancer Cases by Site and State, US, 2002* 5
Estimated Cancer Deaths for Selected Cancer Sites by State, US, 2002* 6
Cancer Incidence Rates by Site and State, US, 1994-1998* 7
Cancer Death Rates by Site and State, US, 1994-1998* 8
Selected Cancers 9
Leading Sites of New Cancer Cases and Deaths — 2002 Estimates* 10
How to Estimate Cancer Statistics Locally, 2002* 13
Probability of Developing Invasive Cancers Over Selected Age Intervals, by Sex, US, 1996-1998* 14
Five-Year Relative Survival Rates by Stage at Diagnosis, 1992-1997* 17
Trends in Five-Year Relative Survival Rates by Race and Year of Diagnosis, US, 1974-1997* 18
Summary of American Cancer Society Recommendations for Early Detection of Cancer
in Asymptomatic People* 19
Special Section: Colorectal Cancer and Early Detection 20
Cancer in Minorities 28
Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1992-1998* 28
Tobacco Use 29
Nutrition and Physical Activity 33
Environmental Cancer Risks 35
The American Cancer Society 36
Sources of Statistics 43
Age Adjustment to the Year 2000 Standard 44
* Indicates a figure or table
National Home Office: American Cancer Society, Inc., 1599 Clifton Road, NE, Atlanta, GA
30329-4251, (404) 320-3333
National Media Office: 1180 Avenue of the Americas, New York, NY 10036, (212) 382-2169
©2002, American Cancer Society, Inc. All rights reserved, including the right to reproduce this publication
or portions thereof in any form.
For written permission, address the Legal Department of the American Cancer Society, 1599 Clifton Road,,
NE, Atlanta, GA 30329-4251.
What is Cancer?Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is caused by both external factors (tobacco, chemicals, radiation, and infectious organisms) and internal factors (inherited mutations,- hormones, immune conditions, and mutations that occur from metabolism). Causal factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years often pass between exposures or mutations and detectable cancer. Cancer is treated by surgery, radiation, chemotherapy, hormones, and immunotherapy.Can Cancer Be Prevented?All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The American Cancer Society estimates that in 2002 about 170,000 cancer deaths are expected to be caused by tobacco use, and about 19,000 cancer deaths may be related to excessive alcohol use, frequently in combination with tobacco use.Scientific evidence suggests that about one-third of the 555,500 cancer deaths expected to occur in 2002 will be related to nutrition, physical inactivity, obesity, and other lifestyle factors and could also be prevented. Certain cancers are related to infectious exposures, e.g., hepatitis B virus (HBV), human papillomavirus (HPV), human immunodeficiency virus (HIV), helicobacter, and others, and could be prevented through behavioral changes, vaccines, or antibiotics. In addition, many of the more than 1 million skin cancers that are expected to be diagnosed in 2002 could have been prevented by protection from the sun’s rays.Regular screening examinations by a health care professional can result in the detection of cancers of the breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin at earlier stages, when treatment is more likely to be successful. Self-examinations for cancers of the breast and skin may also result in detection of tumors at earlier stages. Cancers that can be detected by screening account for about half of all new cancer cases. The 5- year relative survival rate for these cancers is about 82%. If all of these cancers were diagnosed at a localized stage through regular cancer screenings, 5-year survival would increase to 95%.Who Is at Risk of Developing Cancer?Anyone. Since the occurrence of cancer increases as individuals age, most cases affect adults beginning in middle age. About 77% of all cancers are diagnosed at ages 55 and older. Cancer researchers use the word risk in different ways. Lifetime risk refers to the probability that an individual, over the course of a lifetime, will develop cancer or die from it. In the US, men have a little less than 1 in 2 lifetime risk of developing cancer; for women the risk is a little more than 1 in 3.Relative risk is a measure of the strength of the relationship between risk factors and the particular cancer It compares the risk of developing cancer in persons with a certain exposure or trait to the risk in persons who do not have this exposure or trait. For example, male smokers have a 20-fold relative risk of developing lung cancer compared with nonsmokers. This means that they are about 20 times more likely to develop lung cancer than nonsmokers. Most relative risks are not this large. For example, women who have a first-degree (mother, sister, or daughter) family history of breast cancer have about a 2-fold increased risk of developing breast cancer compared with women who do not have a family history. This means that women with a first-degree family history are about two times more likely to develop breast cancer than women who do not have a family history of the disease.All cancers involve the malfunction of genes that control cell growth and division. About 5% to 10% of cancers are clearly hereditary, in that an inherited faulty gene predisposes the person to a very high risk of particular cancers. The remainder of cancers are not hereditary, but result from damage to genes (mutations) that occurs throughout our lifetime, either due to internal factors, such as hormones or the digestion of nutrients within cells, or external factors, such as tobacco, chemicals, and sunlight.How Many People Alive Today Have Ever Had Cancer?The National Cancer Institute estimates that approximately 8.9 million Americans with a history of cancer were alive in 1997. Some of these individuals were con- ' sidered cured, while others still had evidence of cancer and may have been undergoing treatment.How Many New Cases Are Expected to Occur This Year?About 1,284,900 new cancer cases are expected to be diagnosed in 2002. Since 1990, about 16 million newCancer Facts & Figures 2002 1
cancer cases have been diagnosed. These estimates do not include carcinoma in situ (noninvasive cancer) of any site except urinary bladder, and do not include basal and squamous cell skin cancers. More than 1 million cases of basal and squamous cell skin cancers are expected to be diagnosed this year.How Many People Are Expected to Die of Cancer This Year?This year about 555,500 Americans are expected to die of cancer, more than 1,500 people a day. Cancer is the second leading cause of death in the US, exceeded only by heart disease. In the US, 1 of every 4 deaths is from cancer.What Percentage of People Survive Cancer?The 5-year relative survival rate for all cancers combined is 62%. After adjusting for normal life expectancy (factors such as dying of heart disease, accidents, and diseases of old age), the 5-year relative survival rate represents persons who are living five years after diagnosis, whether disease-free, in remission, or under treatment with evidence of cancer. While 5-year relative survival rates are useful in monitoring progress in the early detection and treatment of cancer, they do not represent the proportion of people who are cured permanently, since cancer can affect survival beyond five years after diagnosis.Although these rates provide some indication about the average survival experience of cancer patients in a given population, they are less informative when used to predict individual prognosis and should be interpreted with caution. First, 5-year relative survival rates are based on patients who were diagnosed and treated at least eight years ago and do not reflect recent advances in treatment. Second, information about detection methods, treatment protocols, additional illnesses, and behaviors that influence survival are not taken into account in the estimation of survival rates. (For more information about survival rates, see Sources of Statistics on page 43.)Age-Adjusted Cancer Death Rates,* Males by Site, US, 1930-199880 |—-------------------------------------------------------------------------------------------1930 1940 1950 1960 1970 1980 1990*Per 100,000, age-adjusted to the 1970 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. 1 Rates for cancers of the liver, lung & bronchus, and colon & rectum are affected by these coding changes.Source: US Mortality Public Use Data Tapes 1960-1998, US Mortality Volumes 1930-1959,National Center for Health Statistics, Centers for Disease Control and Prevention, 2001. American Cancer Society, Surveillance Research, 20022 Cancer Facts & Figures 2002
How is Cancer Staged?
Staging is the process of describing the extent or spread
of the disease from the site of origin. It is essential in
determining the choice of therapy and assessing prognosis.
A cancer’s stage is based on the primary tumor’s
size and location in the body and whether it has spread
to other areas of the body. A number of different staging
systems are used to classify tumors. The TNM staging
system assesses tumors in three ways: extent of the primary
tumor (T), absence or presence of regional lymph
node involvement (N), and absence or presence of distant
metastases (M). Once the T, N, and M are determined,
a "stage” of I, II, III, or IV is assigned, with stage I
being early stage and IV being advanced. Summary staging
(in situ, local, regional, and distant) is useful for
descriptive and statistical analysis of tumor registry
data. If cancer cells are present only in the layer of cells
where they developed and they have not spread, the
stage is in situ. If cancer cells have spread beyond the
original layer of tissue, the cancer is invasive. See Five-
Year Relative Survival Rates* by Stage at Diagnosis,
1992-1997, page 17, for a description of the other summary
stage categories.
What Are the Costs of Cancer?
The National Institutes of Health estimate overall costs
for cancer in the year 2001 at $156.7 billion: $56.4 billion
for direct medical costs (total of all health expenditures);
$15.6 billion for indirect morbidity costs (cost of lost
productivity due to illness); and, $84.7 billion for indirect
mortality costs (cost of lost productivity due to premature
death). Lack of health insurance and other barriers
to health care prevent many Americans from receiving
optimal health care.
According to 1999 data, about 16% of Americans under
age 65 have no health insurance, and about 26% of older
persons have only Medicare coverage. During 1998 and
1999, almost 18% of Americans aged 18 to 64 years
reported not having a regular source of health care.
Also, 5.7% of 18- to 64-year-old adults say cost is a barrier
to obtaining needed health care in the previous year.
Age-Adjusted Cancer Death Rates,* Females by Site, US, 1930-1998
80 i-----------------------------------------------—---------------------------------------------------------
60
oc
ra
01
ra
E
£ 40
sQ. o_
*Per 100,000, age-adjusted to the 1970 US standard population. t Uterus cancer death rates are for uterine cervix and uterine corpus combined.
Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung & bronchus, and colon & rectum are
affected by these coding changes..
Source: US MortalityPublic Use Data Tapes 1960-1998, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2001. American Cancer Society, Surveillance Research, 2002
Cancer Facts & Figures 2002 3
—
A Estimated New Cancer Cases and Deaths by Gender, US, 2002*
fej HI Estimated New Cases Estimated New Deaths
Both Sexes Male Female Both sexes Male Female
All Sites 1,284,900 637,500 647,400 555,500 288,200 267,300
Oral cavity & pharynx 28,900 18,900 10,000 7,400 4,900 2,500
■ I'-'-* Tongue 7,100 4,700 2,400 1,700 1,100 600
Mouth 9,800 5,200 4,600 2,000 1,100 900
Pharynx 8,600 6,500 2,100 2,100 1,500 600
Other oral cavity 3,400 2,500 900 1,600 1,200 400
;t?v ' ’ Digestive system 250,600 130,300 120,300 132,300 70,800 61,500 Illi Esophagus 13,100 9,800 3,300 12,600 9,600 3,000
1 | Stomach 21,600 13,300 8,300 12,400 7,200 5,200
V* M Small intestine 5,300 2,500 2,800 ■ 1,100. 600 500
v z ~, Colon 107,300 50,000 57,300 48,100 23,100 25,000 Rectum 41,000 22,600 18,400 8,500 4,700 3,800
Anus, anal canal, & anorectum 3,900 1,700 2,200 500 200 300
Liver & intrahepatic bile duct 16,600 11,000 5,600 14,100 8,900 5,200 i 5 Gallbladder & other biliary 7,100 3,400 3,700 3,500 1,300 2,200
Pancreas 30,300 14,700 15,600 29,700 14,500 15,200 Bw£; Other digestive organs 4,400 1,300 3,100 1,800 700 1,100
Respiratory system 183,200 100,700 82,500 161,400- 94,100 67,300
. ;, ■■ 1 Larynx
Lung & bronchus
8,900 6,900 2,000 3,700 2,900 800
169,400 90,200 79,200 154,900 89,200 65,700
Other respiratory organs . 4,900 3,600 1,300 2,800 2,000 800
Bones & joints 2,400 1,300 1,100 1,300 700 600
Soft tissue (including heart) 8,300 4,400 3,900 3,900 2,000 1,900
Skin (excluding basal & squamous) 58,300 32,500 25,800 9,600 6,200 3,400
Melanoma-skin 53,600 30,100 23,500 7,400 4,700 2,700
Other non-epithelial skin 4,700 2,400 2,300 2,200 1,500 700
Breast 205,000 1,500 203,500 40,000 400 39,600
Genital system _' 279,100 197,700 81,400 57,100 30,900 26,200
Uterine cervix 13,000 13,000 4,100 4,100
Uterine corpus 39,300 39,300 6,600 6,600
Ovary 23,300 23,300 13,900 , 13,900
Vulva 3,800 3,800 800 800
Vagina & other genital, female 2,000 2,000 800 800
Prostate 189,000 189,000 30,200 30,200
Testis 7,500 7,500 400 400
Penis & other genital, male 1,200 1,200 200 ' 200
Urinary system 90,700 62,200 28,500 24,900 16,200 8,700
Urinary bladder 56,500 41,500 15,000 12,600 8,600 4,000
Kidney & renal pelvis 31,800 19,100 12,700 11,600 7,200 4,400
Ureter & other urinary organs 2,400 1,600 800 700 400 300
Eye & orbit 2,200 1,100 1,100 200 100 100
Brain & other nervous system 17,000 9,600 7,400 13,100 7,200 5,900
Endocrine system 22,700 6,000 16,700 2,300 . 1,000 1,300
Thyroid 20,700 4,900 15,800 1,300 500 800
Other endocrine 2,000 1.100 900 1.000 500 500
Lymphoma ■ 60,900 31,900 ' 29,000 25,800 13,500 12,300
Hodgkin's disease 7,000 3,700 3,300 1,400 800 600
Non-Hodgkin's lymphoma 53,900 28,200 25,700 24,400 12,700 11,700
Multiple myeloma 14,600 7,800 6,800 10,800 5,500 , 5,300
Leukemia 30,800 17,600 13,200 21,700 12,100 9,600
Acute lymphocytic leukemia 3,800 2,200 1,600 1,400 800 600
Chronic lymphocytic leukemia 7,000 4,100 2,900 4,500 2,600 , 1,900
Acute myeloid leukemia 10,600 5,900 4,700 7,400 4,000 3,400
Chronic myeloid leukemia 4,400 2,500 1,900 2,000 1,100 900
Other leukemia 5,000 2,900 2,100 6,400 3,600 2,800
Other & unspecified primary sites 30,200 14,000 16,200 43,700 22,600 21,100
* Excludes basal and squamous cell skin cancers and in situ Carcinomas except urinary bladder. Carcinoma in situ of the breast accounts for about 54,300 new cases
annually, and melanoma in situ accounts for about 34,300 new cases annually;
Estimates of new cases are based on incidence rates from the NCI SEER program 1979-1998. ©2002, American Cancer Society; Inc,, Surveillance Research
4 Cancer Facts & Figures 2002
Estimated New Cancer Cases by Site and State, US, 2002*
Non-
State
Female Uterine Colon & Uterine Lung & Hodgkin's Urinary
All sites Breast Cervix Rectum Corpus Leukemia Bronchus Melanoma Lymphoma Prostate Bladder
Alabama 22,600 3,100 200 2,200 600 500 3,200 900 800 ■ 3,900 800
Alaska 1,600 300 10 200 f 200 100 TOO ' 100 TOO
Arizona 22,100 3,500 200 2,400 600 500 2,900 1,200 000 3,300 1,000
Arkansas 14,200 2,000 200 1,500 400 300 2,200 500 600 2,300 500
California 119,900 19,900 1,400 12,900 3,700 3,000 14,300 5,300 5,100 17,300 5,600
' Colorado 14,500 2,400 100 1,600 400 400 1,600 800 700 2,200 600
Connecticut 16,100 2,600 100 1,800 500 400 2,000 600 700 2,400 800
Delaware . 4,100 600 100 400 100 100 600 200 100 600 300
Dist. of Columbia 2,700 . 600 40 300 100 300 t '500 100
Florida 92,200 13,100 900 10,400 2,600 2,200 13,000 4,100 3,900 13,600 4,300
Georgia 31,600 5,200 400 3,200 1,000 700 4,400 1,300 1,100 4,800 i,ioo
Hawaii 4,700 700 30 500 100 100 600 100 200 700 100 Idaho 5,200 900 40 600 100 100 600 300 200 900 ■ • 300 Illinois 57,400 9,700 700 6,800 . 1,800 1,400 7,400 2,200 2,400 8,500 2,500 Indiana 30,000 4,600 300 3,600 900 700 4,300 1,300 1,200 4,400 1,300
Iowa 14,800 2,400 100 2,000 500 400 1,900 600 600 2,400 600
Kansas 12,300 1,800 100 1,400 300 300 1,700 600 500 1,900 500 Kentucky 21,100 .". 3,100 300 , 2,300 500 400 3,400 900 800 2,700 800
Louisiana ■ 21,900 :. 3,500 200 2,600 600 500 2,900 700 800 3,400 700
Maine 7,000 1,000 100 800 200 100 1,000 300 300 800 400
Maryland 23,500 4,100 300 . 2,900 700 500 3,200 800 900 3,400 1,100
Massachusetts 31,700 4,700 200 3,800 900 700 4,000 1,400 1,400 4,600 1,700
Michigan 45,800 7,300 400 5,300 1,500 1,000 6,100 1,700 2,100 6,700 2,100
Minnesota 20,800 3,200 200 ' 2,300 700 600 2,500 900 1,100 3,400 1,000 Mississippi 14,400 2,200 200 1,500 300 300 2,100 500 500 2,500 500
Missouri 28,600 4,000 300 3,300 900 700 4,200 1,300 1,100 3,900 . 1,100 Montana 4,400 600 40 500 100 100 . 600 200 200 800 200
Nebraska 7,700 1,200 100 1,100 200 200 1,000 300 300 1,000 '300
Nevada ■ 9,500 1,300 100 1,200 200 200 1,400 500 ■ 300 1,400 400
New Hampshire 5,800 800 40 700 200 100 800 300 200 700 ' 300
New Jersey 41,100 6,900 400 4,900 1,600 1,100 4,900 1,800 1,900 5,700.. 2,100 New Mexico 7,100 1,200 100 800 200 200 800 400 200 1,200 ' 300
New York 83,700 14,700 1,000 10,400 3,400 2,000 10,000 2,800 3,400 11,800 4,300
North Carolina 38,200 5,900 400 4,200 1,200 ■ 900 5,500 1,500 1,400 5,600 1,500
North Dakota 3, WO 500 • 30 400 100 100 300 100 100 400 200
Ohio 58,700 9,500 600 7,200 1,900 1,400 7,900 2,300 2,600 8,100 2,700 Oklahoma 16,900 2,700 200 2,000 400 400 2,500 900 700 2,100 700 Oregon 16,800 , 2,600 100 1,800 ' 500 400 2,200 800 700 2,800 ' 800 Pennsylvania 68,900 11,000 600 8,700 2,300 1,600 8,700 2,700 3,000 10,300 3,300 Rhode Island 5,600 800 100 700 200 100 800 200 200 800 300
South Carolina 19,500 3,100 200 2,200 600 400 2,600 700 700 3,100 800 .
South Dakota 3,700 500 20 500 100 100 400 ■ 200 200 600 100 Tennessee 29,100 4,400 400 3,100 700 700 4,400 1,400 ■ 1,200 3,900 1,000 Texas 79,700 13,100 1,000 9,500 2,5.00 . 1,900 10,800 3,600 3,400 11,700 3,000 Utah . 5,900 1,100 40 700 200 200 500 400 300 1,300 300
Vermont 2,900 400 40 400 100 Boo 400 200 100 400 100
Virginia 31,300 5,000 300 3,500 1,000 700 4,200 1,300 1,200 4,700 1,200
Washington 25,600 3,700 200 2,700 - 700 700 ' 3,400 1,300 1,100 3,300 1,100 West Virginia 11,000 1,500 10.0 1,300 400 300 1,700 400 400 1,400 500 - Wisconsin 25,300 3,900 200 2,900 800 700 3,000 1.100 1,300 4,000 1,200 Wyoming 2,300 300 20 300 100 100 300 100 100 400 100
United States 1,284,900 203,500 13,000 148,300 39,300 30,800 169,400 53,600 53,900 189,000 56,500
*Rounded to nearest 100. Excludes basa andsquamous cell skti cancers and !n sittl carcinomas except urinary bladder. tEstimate is 50 01; fewer cases.
Note: "feg estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of estimated cancer
deaths in 2002 by state. State estimates may not add to US total due to rounding.
©2002, American Cancer Society, Inc. Surveillance Research
Cancer Facts & Figures 2002 5
Estimated Cancer Deaths for Selected Cancer Sites by State., US, 2002*
NonHodgkin's
State All sites Lymphoma Ovary Pancreas Prostate
Brain/
Nervous
System
Female
Breast
Colon &
Rectum Leukemia Liver
Lung &
Bronchus
Alabama 9,800 200 600 800 400 300 2,900 400 200 500 600
Alaska 700 100 100 t . + 200 t ■ + + t
Arizona 9,600 200 700 900 400 200 2,700 500 200 500 500
Arkansas . 6,200 200 400 600 200 200 2,000 300 100 300 400
California 51,800 1,500 3,900 4,900 2,100 1,800 13,100 2,300 1,400 2,800 2,800
Colorado 6,300 200 500 600 300 100 1,500 300 200 400 400
Connecticut 7,000 100 500 700 300 200 1,800. 300 200 400 400
Delaware 1,800 t 100 200 1.00 t 500 100 t 100 TOO
Dist. of Columbia 1,200 ■ fi 100 100 + + 300 t t 100 ■ 100
Florida 39,900 900 2,600 4,000 1,600 1,000 11,900 1,800 1,000 2,100 2,200
Georgia 13,700 300 1,000 1,200 500 300 4,000 500 400 700 800
1 Hawaii 2,000 t 100 200 100 100 500 100 t 100 100
Idaho 2,300 100 200 200 100 t 600 TOO 100 100 100
Illinois 24,800 500 1,900 2,600 1,000 600 6,700 1,100 600 1,300 1,400
Indiana 13,000 300 900 1,400 500 300 4,000 600 300 600 700
Iowa 6,400 200 500 800 300 100 1,700 300 200 300 400
Kansas 5,300 100 400 500 200 100 1,500 200 100 300 300
Kentucky 9,100 200 600 900 300 200 3,100 400 200 400 400
Louisiana 9,500 200 .700 1,000 . 300 300 2,700 400 200 500 500
Maine 3,000 100 ■ 200 300 100 100 900 100 100 200 100
Maryland 10,200 200 800 1,100 400 200 2,900 400 200 600 500
Massachusetts 13,700 300 900 1,500 500 300' .3,600 600 300 800 700
Michigan 19,800 400 1,400 2,000 .-, 700 500 5,500 900 500 1,100 1,100
Minnesota 9,000 200 600 900 400 200 2,300 500 200 500 500
Mississippi 6,200 200 400 . 600 200 200 1,900 200 100 300 400
Missouri 12,300 300 800 1,300 500 300 3,800 500 300 600 600
Montana 1,900 t 100 200 100 + 500 100 TOO 100 100
. Nebraska 3,300 100 200 400 200 100 900 200 100 200 200
Nevada 4,100 100 300 500 100 100 1,300 100 100 200 200
New Hampshire 2,500 100 200 300 100 TOO 700 100 100 100 100
New Jersey 17,800 400 1,400 1,900 800 500 4,500 800 500 1,000 900.
New Mexico 3,000 100 200 300 100 100 . 700 100 100 200 200
New York 36,200 800 2,900 4,000 1,400 1,000 9,100 1,500 900 2,200 1,900
North Carolina 16,500 400 1,200 1,600 600 300 5,000 600 400 800 900
North Dakota 1,300 ift+SI 100 100 100 t 300 100 100 100
Ohio 25,400 600 1,900 2,700 1,000 500 7,300 1,200 600 1,300 1,300
Oklahoma 7,300 100 50.0 700 300 ■- 200 2,300 300 100 300 300
Oregon 7,300 ' 200 500 700 300 100 2,000 300 200 400 500
| Pennsylvania 29,800 600 2,200 3,300 1,100 700 8,000 1,400 700 1,600 1,600
| Rhode Island 2,40® 100 200 300 TOO 100 700 100 100 TOO 100
South Carolina 8,400 200 600 800 300 200 2,400 300 200 500 500
South Dakota 1,600 100 100 200 TOO if 400 TOO 100 TOO 100
Tennessee 12,600 300 900 1,200 500 300 4,000 500 300 600. 600
Texas 34,500 900 2,600 3,600 1,300 1,200 9,900 1,500 800 1,800 1,900
; Utah 2,500 100 200 300 1.00 100 400 100 100 100 200
Vermont 1,300 t 100 200 t + 400 100 t 100 TOO
i Virginia 13,500 300 1,000 1,400 500 300 3,800 600 300 700 800
| Washington 11,100 300 700 1,000 500 300 3,100 500 ■ 300 600 500
West Virginia 4,700 100 300 500 200 100 1,500 200 100 200 200
Wisconsin 11,000 300 800 1,100 500 200 2,800 600 300 600 600
Wyoming 1,000 + 100 100 IKK t 200 t t fcWSj 100
!. United States 555,500 13,100 39,600 56,600 21,700 14,100 154,900 24,400 13,900 29,700 30,200
‘Rounded to nearest 100. Excludes in situ carcinomas except urinary bladder, tEstimate is 50 or fewer deaths.
Note: State estimates may not add up to US total due to rounding.
Source: US Mortality Public Use Data Tapes, 1960-1999, National Center for Health Statistics. ©2002, American Cancer Society, Inc., Surveillance Research
6 Cancer Facts & Figures 2002
Cancer Incidence Rates by Site and State, US, 1994-1998*
Non-Hodgkin's
All Sites Breast Colon & Rectum Lung & Bronchus Lymphoma Prostate Urinary Bladder
State Male Female Female Male Female Male Female Male Female Male Male Female
Alabama 334.7 246.8 79.7 29.0 21.0 84.5 35.8 11.8 8.2 69.2 17 3.8
Alaska 419.2 362.8 114.1 32.3 . 36.8 74.9 52.6 18.5 13.1 120.2 30.2 8.6
Arizona* 406.5 313.9 103.4 45.0 31.6 66.8 41.8 15.9 ' 11.4 117.3 29.5 8
Arkansas* ■ fee ■' — Be II-te i — — -— — — —■ —
California* 441.9 343.2 111.5 48.2 34.1 65.8 43.0 19.2 12.2 131.2 27.2 6.9
Colorado* 423.6 324.8 108.8 44.5 32.7 56.9 35.0 17.2 12.3 133.1' 27.8 7.4
Connecticut* 492.9 379.9 121.6 57.3 41.3 | 75.4 48.5 20.6 14.4 141.3 35.6 10.1
Delaware* 500.4 375.6 117.3 57.9 41.3 95.4 57.4 17.8 13.7 146.6 32 8.9
Dist. of Columbia 606.9 374.1 121.7 57.4 44.4 98.1 45.5 20.5 11.3 221.3 20.6 6.8
Florida* 494.6 366.1 105.9 58.7 42.0 91.0 53.0 19 12.5 131.1 31.8 8.7
Georgia . 365.1 261.2 86.0 37.3 27.1 72.8 33.5 12.8 8.7 107.5 ' 19.6 5
Hawaii* 391.4 315.8 107.4 55.5 35.1 59.5 30.6 15.7 11.1 99.2 17 4.9
Idaho* 418 323.4 105.1 43.5 32.4 60.8 36.4 17.4 13.5 128.1 29.4 6.8
Illinois* 469.1 353.2 110.3 56.0 40.8 85.3 46.2 18.1 12.8 129.4 29.6 8.0
Indiana 410.3 323 102.1 ‘ 52.1 37.5 85.8 44.1 16.2 12.2 99.9 27.9 7.6
Iowa* 459 349 108.7 59.1 43.0 80.8 40.3 18.5 14.2 127.7 29.8 6.7
Kansas* — — — — — — — — — — — —
Kentucky* 487.1 354.8 101.9 56.1 40.7 121.7 58.5 18.1 12.7 112.4 28.3 7.5
Louisiana* 495.2 319.9 98.1 55.7 37.6 101.3 45.3 17 12 143.1 26 6.7
Maine — — — 1 — — — ■ -t-=£s SJiSu — — —
Maryland 519.2 374.2 119.6 ’ 57.0 42.2 88.7 51.2 18.2 12.2 163.2 30.8 9
Massachusetts 488.5 365.7 120.5 59.0 40.2 76.4 47.9 18.5 12.9 146.4 35.4 10.4
Michigan 499.4 358.7 109.9 53.6 37.7 86.4 48.6 18.6 13.6 154.8 32.2 8.4
MinnesotaSP 453.5 336.5 111.3 51.0 36.9 62.8 37.0 20.6 14.1 149.5 29.3 7.5
Mississippi 383.2 253.7 82.4 47.1 31.4 84.1 33.5 12.7 10.2 109.9 19.3 3.9
Missouri* 464.3 352.7 108.7 57.0 39.8 95.6 51.6 18.8 12.6 118.2 28.2 7.1
Montana* 419.6 323.9 106.3 46.5 34.5 71.3 45.5 16.4 12.9 132.7 28.1 7.1
Nebraska* 446 334.5 1085 56.2 38.2 ; 73.9 36.8 18.5 12.8 133.6 26.3 6.7
Nevada 360.3 307.2 86.6 44.7 32.8 80.1 58.3 13 9.1 76.1 27.6 7.1
New Hampshire* 467.5 359.3 115.7 57.5 40.4 77.0 49.5 17.1 12.1 , 128.8 37 10
New Jersey* 513.4 377.3 116.4 62.7 43.6 78.7 46.4 , 21.1 14.8 .155.9 34.7 9.4
New Mexico* 392.7 301.4 99.7 41.2 29.7 52.8 31.4 15.0 10.2 : 124.1 21.7 6.4
New York 461.7 360.4 110.7 57.8 41.7 75.7 44.9 19.9 13 ■ 13.0 31.1 ' 8.8
North Carolina* 441.8 308.8 101.8 47.1 33.5 93.9 41.0 15.3 10.9 124.3 25.7 6.4
North Dakota 447.8 311.4 100.4 57.0 38.2 64.1 35.2 18.6 10.2 144.0 32.1 7.1
Ohio 431.2 341.0 107.8 53.1 38.7 83.8 . 47.1 18 12.5 111.5 30.4 7.9
Oklahoma* — —. ■— — — — — —. — — Be.
Oregon 436.3 354.2 119.0 45.7 32.7 72.7 49.7 17 12.5 126.8 31.7 8.6
Pennsylvania* 485.4 352.6 108.4 61.1 42.4 82.6 43.1 19.2 13.4 138.8 35.0 9.1
Rhode Island* 526.3 388.3 114.9 61.8 43.6 ; 91.4 53.3 21 15.4 142.9 40.8 10.7
South Carolina 469.7 321 103.0 52.6 35.5 87.0 40.4 14.6 10.7 143.4 25.8 6.2
South Dakota* -= Sh=sa — — — — — — i . feS==s ■ — —
Tennessee t— ■■ — — — — — —
Texas ? 445.2 316.6 98.2 49.0 33.5 87.1 43.4 17.3 11.9 123.2 23.3 5.8
Utah* 385.8 286.1 97.8 38.9 29.3 . 35.6 19.0 17.9 11.9 145.4 23.7 5.5
Vermont* — — — --- r — — —i — —
Virginia 404.8 297.9 99.5 46.1 34.3 , 75.9 38.6 14.6 10.5 119.3 ■ 23.7 6.6
Washington ; 463.7 371.7 120.4 48.7 35.6 73.5 50.3 20.5 13.8 . 136.0 32.2 7.9
West Virginia* 458.3 346.1 96.3 53.7 40.1 104.4 54.6 16.7 12.8 ; 111.0 31 8.9
Wisconsin* 468.4 351.5 110.1 58.7 42.1 74.3 42.9 19 13.5 138.0 30.2 8.2
Wyoming* 423.8 316.5 1 97.5 44.8 33.3 61-3 39.5 14.4 12.6 146.0 27.6 7.7
United States 1 468.5 352.8 114.3 . 52.2 37.5 72.6.. 43.5 19-8 13 142.0 28.8 7-6
*Per 100,000 persons, age-adjusted to the 1970 U.S. standard population. Not all states submitted data for all years. tThis state's registry has been recognized by
NAACCR to meet the following data quality standards: data for all years 1994-1998; a NAACCR estimate of 0.1 % duplicate records or fewer, resolution of errors
detected using an EDITS software program; and a NAACCR,jStimate of at least 90% completeness;, * This state's registry did not submit Widence data to the North
American Association of Central Cancer Registries (NAACCR) for 1994-1998.
Sources: Cancer in North America, 1994-98, Volume One: Incidence, North American Association of Central Cancer Registries. US Incidence: SEER Cancer Statistics
Review, 1973-1998, Surveillance, Epidemiology, and End Results Program, Division of Cancer Control and Population Sciences, Nationa Cancer Insititute, 2001.
American Cancer Society, Surveillance Research, 2002
Cancer Facts & Figures 20*32 7
Cancer Death Rates by Site and State, US, 1994-1998*
Non-Hodgkin's
All Sites Breast Colon & Rectum Lung & Bronchus Lymphoma_______Pancreas Prostate
*Per 100,000, agd-adjusted to the 1970 US standard population.
Source: US Mortality Public Use Data Tapes 1960-1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.
American Cancer Society, Surveillance Research, 2002
State Male Female Female Male Female Male Female Male Female Male Female Male
Alabama 237.5 138.1 22.1 18.7 12.7 84.4 32.2 8.3 5.0 10.4 7.1 28.2
Alaska 185.7 138.4 20.7 18.3 14.7 61.2 39.6 7.4 4.6 9.8 6.9 17.3
Arizona 181.8 125.8 21.4 17.4 11.9 57.1 31.9 8.1 5.4 8.9 6.6 21.2
Arkansas 232.2 138.9 22.1 19.7- 14.1 93.0 36.8 9.0 5.3 10.2 7.6 25.5
California 179.2 132.3 23.3 17.6 12.3 53.0 32.9 7.9 5.2 9.0 7.1 20.8
Colorado 169.3 118.5 20.0 17.1 11.9 46.6 25.9 7.7 5.7 9.1 6.5 21.4
Connecticut 193.8 137.9 25.1 19.9 13.4 57.9 33.9 8-5 6.0 10.3 7.8 21.3
Delaware 231.4 158.6 26.7 21.6 16.8 79.4 42.8 8.3 5.7 9.5 7.8 26.9
Dist. of Columbia 268.2 165.2 33.2 23.9 17.5 76.1 35.8 7 .'9 3.8 11.7 8.6 40.1
Florida ' 200.1 134.2 23.2 19.1 13.2 67.9 36.2 8.7 5.3 9.6 6.9 21.5
Georgia 227.8 136.0 23.7 18.4 , 13.0 83.2 33.1 7.5 4.9 9.3 6.9 29.4
Hawaii 157.5 105.2 17.1 16.9 10.1 46.2 23.1 7.1 5.1 8.9 6.7 15.2
Idaho j ■ 175.9 122.7 22.0 17.0 •11.7 51.2 27.8 8.4 5.7 8.6 5.7 24.3
Illinois 214.1 144.0 26.0 22.8 . 15.1 69.8 34.8 8.9 5.7 10.2 7.3 24.1
Indiana 218.9 145.2 24.7 21.7 15.6 79.1 37.5 9.0 6.0 10.2 7.1 24.1
Iowa 193.4 130.6 23.1 21.4 15.3 64.5 30.5 8.7 6.3 9.0 6,8 23.1
Kansas 192.0 130.1 22.7 19.2 12.9 65.3 31.8 8.3 5.8 9.6 7.0 22.0
Kentucky 245.3 150.1 23.8 22.9 15.6 99.4 44.2. 8.9 5.8 10.0 6.8 24.1
Louisiana 248.7 150.4 25.6 23.1 15.1 87.6 37.0 9.1 5.8 121 8.0 29.2
Maine 222.5 150.8 23.8 22.2 16.0 73.8 41.5 9.5 6.1 10.4 7-4 23.6
Maryland 222.1 150.6 26.4 23.5 16.0 72.4 38.6 8.2 5.2 10.5 7.8 26.9
Massachusetts 211.5 145.5 25.8 23.1 15.5 63.8 36.7 9.1 5.8 10.1 7.6 22.7
Michigan 207.1 141.1 24.8 21.2 13.9 68.9 35.5 8.8 6.3 9.8 7.3 24.0
Minnesota 186.9 130.4 23.2 19.1 12.7 53.1 29.8 9.5 6.4 9.9 . 7.0 24.7
Mississippi 247.4 137.9 23.3 20.4 13.5 91.9 32.8 7.6 5.2 11.3 7.6 30.8
Missouri 216.0 143.0 23.9 21.1 14.7 79.0 .38.1 8.9 5.7 9.0 7.2 22.4
Montana 188.9 129.8 22.1 18.8 11.7 56.6 33.5 8.5 5.6 9.6 6.6 24.5
Nebraska 188.0 125.4 23.2 22.3 14.3 ; 61.2 28.3 8.0 5.1 9.6 6.1 20.2
Nevada 209.6 153.2 22.7 21.5 14.2 68.3 46.7 8.1 5.2 9.9 7.7 23.0
New Hampshire 213.2 152.1 24.6 21.7 16.6 65.7 40.0 9.8 6.0 10.4 7.7 22.8
New Jersey 210.8 150.6 27.2 23.9 16,1 62.9 35.2 9.4 6.1 ■ 10.1 ■ 8.1 24.1
New Mexico 172.8 122.1 21.7 17.5 11.6 45.8 25.8 6.7 4.8 8.6 7.1 23.3
New York 199-1 141.4 26.7 . 22.6 15.5 59.6 31.9 9.1 5.7 10.3 7.7 23.0
North Carolina 226.1 135.1 23.8 20.0 14.1 83.4 32.4 7.7 5.2 10.2 7.2 28.1
North Dakota 1871 124.5 22.5 21.5 13.4 55.4 26.7 7.7 5.8 9.0 5.9 25.5
Ohio 218.3 147.4 25.6 22.8 15.5 75.1 37.5 9.3 6.3 9.4 7.3 ; 24.4
Oklahoma 211.7 137.6 23.7 19.4 13.4 81.2 37.0 8.6 5.7 9.0 6.6 21.3
Oregon 192.8 141.1 23.2 18.5 12.6 62.8 39.0 8.8 5.8 8.7 7.6 23.8
Pennsylvania 215.5 143.8 25.8 23.3 15.9 69.2 33.2 8.9 6.0 9.8 7.1 24.1
Rhode Island 221.9 147.5 26.2 24.4 14.7 74.2 ’ 37.9 9.9 6.2 11.1 7.9 23.8
South Carolina 229.5 137.0 23.7 21.3 13.9 79.7 31.6 7.7 4.9 10.3 8.2 30.4
South Dakota 190,8 125.0 20.9 20.8 14.7 59.2 26.6 9.4 ' 5.6 8,6 6.3 24.4
Tennessee 237.0 142.8 24.3 21.2 14.5 92.7 36.2 8.9 5.8 10.7 7.2 25.1
Texas 207.8 133.1 22.4 19.7 13.0 71.1 33.3 8.4 5.5 9.6 6.9 24.1
Utah 143.7 102.3 20.6 14.5 O1-2 28.6 14.0 8.1 5.4 7.4 5.0 25.2
Vermont 206.5 143.5 23.4 22.1 16.4 65.9 35.6 10.1 5.2 10.3 6.1 23.7
Virginia 220.2 141.4 ; 24.9 20.5 14.8 76.0 35.2 8.0 5.4 9.9 6.9 27.3
Washington 187.2 137.6 22.8 17.8 12.6 59.2 37.8 8.2 5.8 9.4 7.4 21.2
West Virginia '■ 229.4 . 150.1 22.9 21.4 15.7 86.7 41.7 8.7 5.8 9.1 6.4 22.5
Wisconsin 196.0 133.9 23.0 20.2 13.5 57.0 30.0 9.1 5.9 9.8 7.1 24.8
Wyoming 182.6 136.1 23.2 18.5 156 / 53,3 31-4 6.6 6.3 8.1 6.5 25.9
United States .. 206.0 138.6 24.2 20.5 14.1 68.0 34.3 8.6 5.6 9.7 7.2 23.7
B Cancer Facts & Figures 2002
BreastNew Cases: An estimated 203,500 new invasive cases of breast cancer are expected to occur among women in the United States during 2002. After increasing about 4.5% per year in the 1980s, breast cancer incidence rates among white women continued to increase more slowly through 1998. About 1,500 new cases of breast cancer are expected in men in 2002.In addition to invasive breast cancer, 54,300 new cases of in situ breast cancer are expected to occur among women during 2002. Of these, approximately 88% will be ductal carcinoma in situ (DCIS). The increase in detection of DCIS cases is a direct result of increased use of mammography screening, which is also responsible for detection of invasive cancers, at a less advanced stage than might have occurred otherwise.Deaths: An estimated 40,000 deaths (39,600 women, 400 men) are anticipated from breast cancer in 2002. Breast cancer ranks second among cancer deaths in women. According to the most recent data, mortality rates declined significantly during 1992-1998, with the largest decreases in younger women, both white and black. These decreases are probably the results of both earlier detection and improved treatment.Signs and Symptoms: The earliest sign of breast cancer is an abnormality that shows up on a mammogram before it can be felt by the woman or her health care provider. When breast cancer has grown to the point where physical signs and symptoms exist, these may include a breast lump, thickening, swelling, distortion, or tenderness; skin irritation or dimpling; and nipple pain, scaliness, ulceration, or retraction. Breast pain is commonly due to benign conditions and is not usually the first symptom of breast cancer.Risk Factors: The risk of breast cancer increases with age. Risk is higher in women who have a personal or family history of breast cancer, biopsy-confirmed atypical hyperplasia, increased breast density, a long menstrual history (menstrual periods that started early and ended late in life), obesity after menopause, recent use of oral contraceptives or postmenopausal estrogens and progestin, who have never had children or had their first child after age 30, or who consume alcoholic beverages. Worldwide, breast cancer incidence rates appear to correlate with variations in diet, especially fat intake, although the specific dietary factors that affect breast cancer have not been firmly established. Vigorous physical activity and maintenance of a healthy body weight are associated with lower risk. Most data indicate tamoxifen decreases breast cancer risk and preliminary data suggest another selective estrogen- receptor modulator, raloxifene, does also. The inherited susceptibility genes, BRCA1 and BRCA2, account for approximately 5% of all cases. General screening of the population for mutations of these genes is not recommended.Early Detection: Mammography is especially valuable as an early detection tool because it can identify breast cancer at an early stage before physical symptoms develop. Numerous studies have shown that early detection saves lives and increases treatment options. The declines in breast cancer mortality have been attributed, in large part, to the regular use of screening mammography. The American Cancer Society recommends that women age 40 and older have an annual mammogram, an annual clinical breast examination by a health care professional (close to and preferably before the scheduled mammogram), and perform monthly breast selfexamination. Women ages 20-39 should have a clinical breast examination by a health care professional every three years and should perform breast self-examination monthly.When a woman has a suspicious lump or other abnormality on an initial mammogram, further mammographic testing can help determine whether additional tests are needed. Mammography alone does not provide a sufficient assessment. All suspicious lumps should be biopsied for a definitive diagnosis.Treatment: Taking into account the medical circumstances and the patient’s preferences, treatment may involve lumpectomy (local removal of the tumor) and removal of the lymph nodes under the arm; mastectomy (surgical removal of the breast) and removal of the lymph nodes under the arm; radiation therapy; chemotherapy; or hormone therapy. Often, two or more methods are used in combination. Numerous studies have shown that, for early-stage disease, long-term survival rates after lumpectomy plus radiotherapy are similar to survival rates after modified radical mastectomy. Patients should discuss possible options for the best management of their breast cancer with their physicians. Significant advances in reconstruction techniques provide several options for breast reconstruction immediately after mastectomy.Treatment of ductal carcinoma in situ (DCIS) includes local excision, radiation, and/or tamoxifen. Treatment of DCIS is important to prevent tumor progression.Cancer Facts & Figures 2002 9
Leading Sites of New Cancer Cases and Deaths—2002 Estimates*
Cancer Cases by Site and Sex Cancer Deaths by Site and Sex
Male Female Male Female
Prostate - Breast- Lunt hus Lung & bronchus
189,000(30%) 203,500 (31 %) 89&00(31%) 65,700,(25%)
Lung & bronchus Lung & bronchus Prostate Breast
90,200(14%) 79,200’(12%) 30,200(11%) 39,600 (15%)
Colon & rectum Colon & rectum Colon & rectum Colon & rectum
72,600(11%) 75,700.(12%) 27,800;,(10%) 28,800(11%)
Urinary bladder Uterine corpus Pancreas Pancreas
41,500'-(7%) 39,300(6%) 14,500(5%) 15,200(6%)
Melanoma of the skin Non-Hodgkin'slymphoma Non-Hodgkin's lymphoma Ovary
30,100 (5%) 25,700(4%) 12,700(5%) 13,900 (5%)
Non-Hodgkin's lymphoma Melanoma of the skin Leukemia Non-Hodgkin's lymphoma
28,200(4%) 23,500(4%) 12,100(4%) 11(700(4%)
' Kidney Ovary. Esophagus Leukemia
19,100.(3%) 23,300.(4%) 9,600(3%) 9,600(4%)
Oral-cavity Thyroid Liver . Uterine-corpus
18,900(3%) .. 15(800.(2%) 8,900(3%) 6,600 (2%)
Leukemia Pancreas Urinary bladder 17,6o|l|^>) Brain 15,600(2%) 8,600^,) 5,900(2%)
Pancreas Urinary bladder Kidney Multipleimyeloma
14,700(2%) ' 15(000(2%) 7,200 (3%) 5,300 (2%)
All Sites All Sites.. All Sites Alf.Sites;-
637,500 (100%) 647,400(100%) 288,200 (100%) 267,300(100%)
‘Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder.
Percentages may not total 100% due to rounding. ©2002, American Cancer-Society Inc.,. Surveillance Research
Survival: The 5-year relative survival rate for localized
breast cancer has increased from 72% in the 1940s to
96% today. If the cancer has spread regionally, however,
the rate is 78%, and for women with distant metastases
the rate is 21%. Survival after a diagnosis of breast
cancer continues to decline beyond five years. Survival
at 10 years or more is also stage dependent, with the best
survival observed in women diagnosed with early stage
disease.
For more information about breast cancer, please
inquire about the American Cancer Society publication
and Web site posting of Breast Cancer Facts & Figures
2001-2002 (8610.01).
Childhood Cancer
New Cases: An estimated 9,100 new cases are expected
to occur among children aged 0-14 in 2002. Childhood
cancers are rare.
Deaths: An estimated 1,400 deaths are expected to
occur among children aged 0-14 in 2002, about one-third
of them from leukemia. Despite its rarity, cancer is the
chief cause of death by disease in children between ages
1 and 14. Mortality rates have declined 50% since 1973.
Early Detection: Cancers in children often are difficult
to recognize. Parents should see that their children have
regular medical checkups and should be alert to any
unusual symptoms that persist. These include: an
unusual mass or swelling; unexplained paleness and loss
of energy; sudden tendency to bruise; a persistent, localized
pain or limping; prolonged, unexplained fever or
illness; frequent headaches, often with vomiting; sudden
eye or vision changes; and excessive, rapid weight loss.
Childhood cancers include:
* Leukemia which accounts for about 30% of cases in
children ages 0-14 (see Leukemia).
« Osteosarcoma (2.7%), a bone cancer which may cause
no pain at first; swelling in the area of the tumor is
often the first sign.
• Ewing’s sarcoma (1.8%), another type of cancer that
arises in bone.
° Neuroblastoma (7.3%), a cancer of the sympathetic
nervous system which can appear anywhere but usually
occurs in the abdomen as a swelling.
10 Cancer Facts & Figures 2002
• Rhabdomyosarcoma (3.4%), the most common soft
tissue sarcoma, can occur in the head and neck area,
genitourinary area, trunk, and extremities.
• Brain and intraspinal cancers (21%) which in early
stages may cause headaches, nausea, vomiting;
blurred or double vision, dizziness, and difficulty in
walking or handling objects.
• Non-Hodgkin’s lymphomas (4.0%) and Hodgkin’s
disease (4.4%), cancers that involve the lymph nodes,
but also may invade bone marrow and other organs.
They may cause swelling of lymph nodes in the neck,
armpit, or groin. Other symptoms may include general
weakness and fever.
® Retinoblastoma (2.8%), an eye cancer, usually occurs
in children under age 4. When detected early, cure is
possible with appropriate treatment.
• Wilms’ tumor (5.9%), a kidney cancer, may be recognized
by a swelling or lump in the abdomen.
Treatment: Childhood cancers can be treated by a combination
of therapies chosen based on the specific type
and stage of the cancer. Treatment is coordinated by a
team of experts including oncologic physicians, pediatric
nurses, social workers, psychologists, and others
who assist children and their families.
Survival: Five-year survival rates vary considerably,
depending on the site: all sites, 77%; bone cancer, 73%;
neuroblastoma, 71%; brain and central nervous system,
69%; Wilms’ tumor (kidney), 92%; Hodgkin’s disease,
92%; and acute lymphocytic leukemia, 85%.
Colon and Rectum
See special section, pages 20-27.
Leukemia
New Cases: An estimated 30,800 new cases are expected
in 2002, approximately evenly divided between acute
leukemia and chronic leukemia. Although often thought
of as primarily a childhood disease, leukemia is diagnosed
ten times more often in adults than in children.
Acute lymphocytic leukemia accounts for approximately
2,000 of the leukemia cases among children. In
adults, the most common types are acute myeloid
leukemia (approximately 10,600 cases) and chronic lymphocytic
leukemia (approximately 7,000 cases).
Incidence of acute myeloid leukemia increased by 1.8%
per year among males during 1992-1998, with most of
the increase occurring in the elderly, possibly attributable
to cigarette smoking.
Deaths: An estimated 21,700 deaths in 2002.
Signs and Symptoms: Fatigue, paleness, weight loss,
repeated infections, bruising easily, and nosebleeds or
other hemorrhages. In children, these signs can appear
suddenly. Chronic leukemia can progress slowly with
few symptoms.
Risk Factors: Leukemia affects both sexes and all ages.
Causes of most leukemias are unknown. Persons with
Down syndrome and certain other genetic abnormalities
have higher incidence rates of leukemia. Leukemia
is caused by excessive exposure to ionizing radiation
and to certain chemicals such as benzene, a commercially
used toxic liquid that is present in gasoline and
cigarette smoke. Leukemia also may occur as a side
effect of cancer treatment. Certain leukemias and
lymphomas are caused by a retrovirus, human T-cell
leukemia/lymphoma virus-I (HTLV-I).
Early Detection: Because symptoms often resemble
those of other, less serious conditions, leukemia can be
difficult to diagnose early. When a physician does suspect
leukemia, diagnosis can be made using blood tests
and bone marrow biopsy.
Treatment: Chemotherapy is the most effective method
of treating leukemia. Various anticancer drugs are used,
either in combinations or as single agents. Transfusions
of blood components and antibiotics are used as
supportive treatments. Under appropriate conditions,
bone marrow transplantation may be useful in treating
certain leukemias.
Survival: The 1-year relative survival rate for patients
with leukemia is 64%. Survival decreases to 46% five
years after diagnosis, primarily due to the poor survival
of patients with certain types of leukemia, such as acute
myeloid leukemia. There has been a dramatic improvement
in survival for patients with acute lymphocytic
leukemia from a 5-year relative survival rate of 38% in
the mid-1970s to 63% in the mid-1990s. Survival rates for
children with acute lymphocytic leukemia have
increased from 53% to 85% over the same time period.
Lung and Bronchus
New Cases: An estimated 169,400 new cases in 2002,
accounting for about 13% of cancer diagnoses. The
incidence rate is declining significantly in men, from a
high of 86.5 per 100,000 in 1984 to 69.8 in 1998. In the
1990s, the increase among women reached a plateau,
with incidence in 1998 at 43.4 per 100,000.
Deaths: An estimated 154,900 deaths in 2002, accounting
for 28% of all cancer deaths. During 1992-1998,
mortality from lung cancer declined-significantly (1.9%
Cancer Facts & Figures 2002 11
per year) among men, while rates for women continued to increase, but at a much slower pace (0.8% per year). Since 1987, more women have died each year of lung cancer than breast cancer, which, for over 40 years, had been the major cause of cancer death in women. Decreasing lung cancer incidence and mortality rates most likely result from decreased smoking rates over the past 30 years. However, decreasing smoking patterns among women lag behind those of men. Declines in adult tobacco use have slowed, as have declines in mortality under 45 years old; tobacco use among youth increased considerably during the 1990s except in states with vigorous tobacco control programs.Signs and Symptoms: Persistent cough, sputum Streaked with blood, chest pain, and recurring pneumonia or bronchitis.Risk Factors: Cigarette smoking is by far the most important risk factor in the development of lung cancer. Other risk factors include exposure to certain industrial substances, such as arsenic; some organic chemicals; occupational or environmental exposures to radon and asbestos, particularly among smokers; radiation exposure from occupational, medical, and environmental sources; air pollution; tuberculosis; and for nonsmokers, environmental tobacco smoke.Early Detection: Early detection has not yet been proven to improve survival. Chest x-ray, analysis of cells contained in sputum, and fiberoptic examination of the bronchial passages have shown limited effectiveness in early lung cancer detection. Newer tests such as low- dose helical CT scans and molecular markers in sputum can detect lung cancer earlier, and the effect of this on survival is being evaluated.Treatment: Treatment options are determined by the type and stage of the cancer and include surgery, radiation therapy, and chemotherapy. For many localized cancers, surgery is usually the treatment of choice. Because the disease has usually spread by the time it is discovered, radiation therapy and chemotherapy are often needed in combination with surgery. Chemotherapy alone or combined with radiation is the treatment of choice for small cell lung cancer; on this regimen, a large percentage of patients experience remission, which in some cases is long lasting.Survival: The 1-year relative survival rate for lung cancer has increased from 34% in 1975 to 41% in 1997, largely due to improvements in surgical techniques. However, the 5-year relative survival rate for all stages combined is only 15%. The survival rate is 48% for cases detected when the disease is still localized. Only 15% of lung cancers are diagnosed at this early stage.LymphomaNew Cases: An estimated 60,900 new cases in 2002, including 7,000 cases of Hodgkin’s disease and 53,900 cases of non-Hodgkin’s lymphoma. Since the early 1970s, incidence rates for non-Hodgkin’s lymphoma (NHL) have nearly doubled. However, during 1992-98, incidence rates have stabilized, except among black females. Overall, incidence rates for Hodgkin’s disease have declined since the late 1980s.Deaths: An estimated 25,800 deaths in 2002 (non- Hodgkin’s lymphoma, 24,400; Hodgkins disease, 1,400).Signs and Symptoms: Enlarged lymph nodes, itching, fever, night sweats, fatigue, and weight loss. Intermittent fever can last for several days or weeks.Risk Factors: Risk factors are largely unknown but in part involve reduced immune function and exposure to certain infectious agents. Persons with organ transplants are at higher risk due to altered immune function. Human immunodeficiency virus (HIV) and human T-cell leukemia/lymphoma virus-I (HTLV-I) are associated with increased risk of non-Hodgkin’s lymphoma. Burkitt’s lymphoma in Africa is partly caused by the Epstein-Barr virus. Other possible risk factors include occupational exposures to herbicides and perhaps other chemicals.Treatment: Hodgkins disease: chemotherapy alone or with radiotherapy is useful for most patients. Non- Hodgkin’s lymphoma: in the early stage, localized lymph node disease can be treated with radiotherapy. Patients with later-stage disease are treated with chemotherapy or with chemotherapy plus radiation depending on the specific type of non-Hodgkin’s lymphoma. New treatment programs using highly specific monoclonal antibodies directed at lymphoma cells, and high-dose chemotherapy with bone marrow transplantation, are being tested in selected patients who relapsed after standard treatment.Survival: Survival rates vary widely by cell type and stage of disease. The 1-year relative survival rates for Hodgkin’s disease and non-Hodgkin’s lymphoma are 93% and 75%, respectively; the 5-year rates are 83% and 53%. Ten years after diagnosis, the relative survival rates for Hodgkins and non-Hodgkin’s disease decline to 74% and 43%; and the 15-year survival rates are 66% and 37%, respectively.12 Cancer Facts & Figures 2002
How to Estimate Cancer Statistics Locally, 2002
Multiply community population by:
To obtain the estimated number of... All Sites Female Breast* Colon & Rectum Lung Prostate
New cancer cases 0.0046 0.0014 0.0005 0.0006 0.0014
Cancer deaths 0.0020 0.0003 0.0002 0.0006 0.0002
People who will eventually develop cancer 0.4059 0.1324 0.0578 0.0673 0.1603
People who will eventually die of cancer 0.2132 0.0320 0.0234 0.0546 0.0328
*For female breast cancer, multiply by female population and for prostate cancer, multiply by male population.
Note: These calculations provide only a rough approximation of the number of people in a specific community who may develop or die of cancer. These estimates
should be used with caution because they do not reflect the age or racial characteristics of the population, access to detection and treatment, or exposure to risk
factors. Many states have cancer registries which count the number of cancers that occur in localities throughout the state. The American Cancer Society reconF' ’
mends using data from these registries, when it is available, to more accurately estimate Ideal cancer statistics.
Source: DevCan Software, Version 4.1; NCI, Surveillance, Epidemiology, arid End Results Program., 1973-1998. Division of Cancer Control and Population Sciences,
National Cancer Institute, 2001.
American Cancer Society, Surveillance Research, 2002
Oral Cavity and Pharynx
New Cases: An estimated 28,900 new cases in 2002.
Incidence rates are more than twice as high in men as
in women and are greatest in men who are over age 40.
During 1984-1998, the incidence rate of oral cancers
declined by about 1.3% per year.
Deaths: An estimated 7,400 deaths in 2002. Mortality
rates have been decreasing since the late 1970s.
Signs and Symptoms: A sore that bleeds easily and
does not heal; a lump or thickening; a red or white patch
that persists. Difficulties in chewing, swallowing, or
moving tongue or jaws are often late symptoms.
Risk Factors: Cigarette, cigar, or pipe smoking; use of
smokeless tobacco; excessive consumption of alcohol.
Early Detection: Cancer can affect any part of the oral
cavity, including the lip, tongue, mouth, and throat..
Dentists and primary care physicians can identify
abnormal changes in oral tissues and detect cancer at an
early, curable stage.
Treatment: Radiation therapy and surgery are standard
treatments. In advanced disease, chemotherapy may be
useful as an adjunct to surgery.
Survival: For all stages combined, about 84% of oral
cavity and pharynx cancer patients survive 1 year after
diagnosis. The 5-year and 10-year relative survival rates
are 54% and 39%, respectively.
Ovary
New Cases: An estimated 23,300 new cases in the
United States in 2002. It accounts for nearly 4% of all
cancers among women and ranks second among
gynecologic cancers, following cancer of the uterine
corpus. During 1992-1998, ovarian cancer incidence
declined at a rate of 1.3% per year.
Deaths: An estimated 13,900 deaths in 2002. Ovarian
cancer causes more deaths than any other cancer of the
female reproductive system.
Signs and Symptoms: The most common sign is
enlargement of the abdomen, which is caused by accumulation
of fluid. Abnormal vaginal bleeding is rarely a
symptom. In women over 40, vague digestive disturbances
(stomach discomfort, gas, distention) that persist
and cannot be explained by any other cause may
indicate the need for an evaluation for ovarian cancel;
including a thorough pelvic examination.
Risk Factors: Risk for ovarian cancer increases with age
and peaks in the late 70s. Women who have never had
children are more likely to develop ovarian cancer than
those who have. Pregnancy arid the use of oral contraceptives
appear to reduce the risk of developing ovarian
cancer Women who have had breast cancer or have a
family history of breast or ovarian cancer are at
increased risk. Mutations in BRCA1 or BRCA2 have been
observed in these families. Another genetic syndrome,
hereditary non-polyposis colon cancer, also has been
associated with endometrial and ovarian cancer.
Incidence rates are highest in industrialized countries
other than Japan.
Early Detection: Periodic, thorough pelvic exams are
important. The Pap test, useful in detecting cervical
cancer, rarely uncovers early ovarian cancer. Transvaginal
ultrasound and a tumor marker, CA125, may
help in diagnosis but are not used for routine screening.
Treatment: Surgery, radiation therapy, and chemotherapy
are treatment options. Surgery usually includes the
removal of the uterus (hysterectomy), and one or both
ovaries and fallopian tubes (salpingo-oophorectomy). In
some very early tumors, only the involved ovary will be
removed, especially in young women who wish to have
Cancer Facts & Figures 2002 13
...M
n
Probability of Developing Invasive Cancers Over Selected Age Intervals, by Sex, US, 1996-1998*
Birth-39 40-59 60-79 Birth to Death
*For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 1996-1998. The 1 in statistic and the inverse of the percentage may
hot be equivalent due to rounding.. t Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. ^Includes invasive and in situ
cancer cases.
Source: DevCan, Probability of Developing or Dying of Cancer Software, Version 4.1. Feuer EJ, Wun LM, National Cancer Institute, 20.01.
All Sitest Male
Female
1.45 (1 in 69)
1.92 (1 in 52)
8.33 (1 in 12)
9.09 (1 in 11)
32.3 (1 in 3).
20.0 (1 in 5)
43.48 (1 in 2)
38.25 (1 in 3)
Bladder! Male
Female
0.024 (1 in 4234)
Less than 1 in 10,000
0.42(1 in 236)
0.13 (1 in 760)
2.38 (1 in 42)
0.64(1 in 156)
3.45 (1 in 29)
1.12 (1 in 89)
Breast Female 0.44 (1 in 229) 4.17 (1 in 24) 7.14 (1 in 14) 12.5 (1 in 8)
Colon & Male 0.07 (1 in 1508) 0.87 (1 in 115) 4.00 (1 in 25) 5.88 (1 in 17)
Rectum Female 0.06 (1 in 1719) 0.69 (1 in 145) 3.03 (1 in 33) 5.55 (1 in 18)
Leukemia Male
Female
0.16 (1 in 627)
0.12 (1 in 810)
0.21 (1 in 483)
0.15 (1 in 671)
0.81 (1 in 124)
0.47 (1 in 212)
1.43 (1 in 70)
1.04 (1 in 96)
Lung & Male 0.03 (1 in 3060) 1.12 (1 in 89) 5.88 (1 in 17) 7.69 (1 in 13)
Bronchus. Female 0.03 (1 in 3099) 0.86 (1in 116) 4.00 (1 in 25) 5.88(1 in 17)
Melanoma Male 0.13 (tin 769) 0.50 (1 in 199) 0.97 (1 in 103) 1.72 (1 in 58)
of Skin . Female 0.19 (1 in 508) 0.38 (1 in 261) 0.49 (1 in 201) 1.22 (1 in 82)
Non-Hodgkin's Male 0.17 (1 in 591) 0.48 (1 in 208) 1.23 (1 in 81) 2.08 (1 in 48)
Lymphoma Female 0.08(1 in 1311) 0.32(1 in 317) 0.98 (1 in 102) 1.75 (1 in 57)
Prostate Male Less than 1 in 10,000 2.08 (1 in 48) 12.5 (1 in 8) 16.67 (1 in 6)
Uterine Cervix Female 0.18 (1 in 567) 0.35 (1 in 288) 0.28 (1 in 354) 0.85 (1 in 117)
Uterine Corpus Female 0.05 (1 in 2097) 0.72 (1 in 138) 1.64(1 in 61) 2.70 (1 in 37)
American Cancer Society, Surveillance Research, 2002
children. In advanced disease, an attempt is made to
remove all intra-abdominal disease to enhance the
effect of chemotherapy.
Survival: Eighty percent of new ovarian cancer patients
survive 1 year after diagnosis; the 5-year relative survival
rate for all stages is 52%. If diagnosed and treated while
the disease is localized, the 5-year survival rate is 95%;
however, only about 26% of all cases are detected at the
localized stage. Five-year relative survival rates for
women with regional and distant disease are 81% and
29%, respectively.
Pancreas
New Cases: An estimated 30,300 new cases in the
United States in 2002. Over the past 15 to 25 years, rates
of pancreatic cancer have declined slowly in men and
women.
Deaths: An estimated 29,70.0 deaths in 2002. Among
men the death rate increased from 1930 to 1972, then
declined by 0.8% per year from 1973-1986, and by 0.4%
per year through 1998. In contrast, rates among women
increased by 0.6% per year from 1973-1984, and
remained relatively stable thereafter.
Signs and Symptoms: Cancer of the pancreas generally
develops without early symptoms. If a cancer develops
in an area of the pancreas near the common bile duct,
its blockage may lead to jaundice (a noticeable yellowing
of the skin due to pigment accumulation). Sometimes
this symptom allows the tumor to be diagnosed at an
early stage.
Risk Factors: Cigarette and cigar smoking increase the
risk of pancreatic cancer; incidence rates are more than
twice as high for smokers as for nonsmokers. Risk also
appears to increase with obesity, physical inactivity,
chronic pancreatitis, diabetes, and cirrhosis. Pancreatic
cancer rates are higher in countries whose populations
eat a diet high in fat.
Early Detection: At present, only biopsy yields a certain
diagnosis. Because of the “silent” course of the disease,
the need for biopsy may become obvious only with
advanced disease. Researchers are focusing on ways to
diagnose pancreatic cancer before symptoms occur.
Treatment: Surgery, radiation therapy, and chemotherapy
are treatment options that can extend survival
and/or relieve symptoms in many patients, but seldom
produce a cure. Clinical trials with several new agents
may offer improved survival and should be considered
an option.
Survival: For all stages combined, the 1-year relative
survival rate is only 21%, and the 5-year rate is about 5%.
14 ' Cancer Facts & Figures 2002
ProstateNew Cases: An estimated 189,000 new cases in the US during 2002. Prostate cancer incidence rates remain significantly higher in black men than in white men. Between 1988 and 1992, prostate cancer incidence rates increased dramatically, due to earlier diagnosis in men without symptoms, using the prostate-specific antigen (PSA) blood test. Prostate cancer incidence rates subsequently declined and have leveled off, especially in the elderly. Rates peaked in 1992 among white men and in 1993 among black men.Deaths: An estimated 30,200 deaths in 2002, the second leading cause of cancer death in men. Although mortality rates are declining among white and black men, rates in black men remain more than twice as high as rates in white men.Signs and Symptoms: Weak or interrupted urine flow; inability to urinate, or difficulty starting or stopping the urine flow; the need to urinate frequently, especially at night; blood in the urine; pain or burning on urination; continual pain in lower back, pelvis, or upper thighs. Most of these symptoms are nonspecific and are similar to those caused by benign conditions.Risk Factors: The incidence of prostate cancer increases with age; more than 70% of all prostate cancers are diagnosed in men over age 65. Black Americans have the highest prostate cancer incidence rates in the world; the disease is common in North America and Northwestern Europe and is rare in Asia, Africa, and South America. Recent genetic studies suggest that strong familial predisposition may be responsible for 5%-10% of prostate cancers. International studies suggest that dietary fat may also be a risk factor.Early Detection: The prostate-specific antigen (PSA) test and the digital rectal examination should be offered annually beginning at age 50 to men who have a life expectancy of at least 10 years. Men at high risk (African-American men and men who have a first- degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45. Patients should be given information about the benefits and limitations of testing.Treatment: Depending on age, stage of the cancer, and other medical conditions of the patient, surgery and radiation should be discussed with the patient’s physician. Hormonal therapy and chemotherapy or combinations of these options might be considered for metastatic disease. Hormone treatment may control prostate cancer for long periods by shrinking the size of the tumor, thus relieving pain and other symptoms. Careful observation without immediate active treatment (“watchful waiting”) may be appropriate, particularly for older individuals with low-grade and/or early-stage tumors.Survival: Eighty-three percent of all prostate cancers are discovered in the local and regional stages; the 5-year relative survival rate for patients whose tumors are diagnosed at these stages is 100%. Over the past 20 years, the survival rate for all stages combined has increased from 67% to 96%. Relative survival after a diagnosis of prostate cancer continues to decline with longer followup. According to the most recent data, relative 10-year survival is 75%, and 15-year survival is 54%.SkinNew Cases: More than 1 million cases of highly curable basal cell or squamous cell cancers occur annually. The most serious form of skin cancer is melanoma, which is expected to be diagnosed in about 53,600 persons in 2002. During the 1970s, incidence rate of melanoma increased rapidly at about 6% per year. Since 1981, however, the rate of increase slowed to about 3% per year. Melanoma is a disease of whites, and rates are more than 10 times higher in whites than in blacks. Other important forms of skin cancer include Kaposi’s sarcoma, which commonly occurs among homosexual patients with AIDS, and cutaneous T-cell lymphoma.Deaths: An estimated 9,600 deaths this year, 7,400 from melanoma and 2,200 from other skin cancers. Melanoma mortality for the more recent period is increasing slightly in white men, while it has stabilized among white women.Signs and Symptoms: Any change on the skin, especially in the size or color of a mole or other darkly pigmented growth or spot. Scaliness; oozing, bleeding, or change in the appearance of a bump or nodule; the spread of pigmentation beyond its border; a change in sensation, itchiness, tenderness, or pain.Risk Factors: Excessive exposure to ultraviolet radiation; fair complexion; occupational exposure to coal tar, pitch, creosote, arsenic compounds, or radium; family history; and multiple or atypical nevi (moles).Prevention: Limit or avoid exposure to the sun during the midday hours (10 a.m.-4 p.m.). When outdoors, cover as much skin as possible. Wear a hat that shades the face, neck, and ears, and a long-sleeved shirt and long pants. Wear sunglasses to protect the skin around the eyes, Use a sunscreen with a solar protection factorCancer Facts & Figures 2002 15
(SPF) of 15 or higher. Because of the possible link between severe sunburns in childhood and greatly increased risk of melanoma in later life, children, in particular, should be protected from the sun.Early Detection: Recognition of changes in skin growths or the appearance of new growths is the best way to find early skin cancer. Adults should practice skin self-exam regularly. Suspicious lesions should be evaluated promptly by a physician. Basal and squamous cell skin cancers often take the form of a pale, waxlike, pearly nodule, or a red, scaly, sharply outlined patch. A sudden or progressive change in a mole’s appearance should be checked by a physician. Melanomas often start as small, mole-like growths that increase in size and change color. A simple ABCD rule outlines the warning signals of melanoma: A is for asymmetry: one half of the mole does not match the other half: B is for border irregularity: the edges are ragged, notched, or blurred: C is for color: the pigmentation is not uniform, with variable degrees of tan, brown, or black: D is for diameter greater than 6 millimeters: Any sudden or progressive increase in size should be of concern.Treatment: Treatment for basal cell cancer and squamous cell cancer includes surgery in 90% of cases, radiation therapy, electrodessication (tissue destruction by heat), cryosurgery (tissue destruction by freezing), and laser therapy for early skin cancer. For malignant melanoma, the primary growth must be adequately excised, and it may be necessary to remove nearby lymph nodes. Removal and microscopic examination of all suspicious moles is essential. Advanced cases of melanoma are treated with radiation therapy, immunotherapy, or chemotherapy.Survival: For basal cell or squamous cell cancers, cure is highly likely if detected and treated early. Melanoma can spread to other parts of the body quickly. When detected in its earliest stages and treated properly, however, it is highly curable. The 5-year relative survival rate for patients with melanoma is 89%. For localized melanoma, the 5-year relative survival rate is 96%; survival rates for regional and distant stage diseases are 61% and 12%, respectively. About 82% of melanomas are diagnosed at a localized stage.Urinary BladderNew Cases: An estimated 56,500 new cases in 2002. During 1992-1998, bladder cancer incidence rates declined slightly but significantly in both men and women. Overall, bladder cancer incidence is about four times higher in men than in women, and about two times higher in whites than in blacks.Deaths: An estimated 12,600 deaths in 2002. Between the early 1970s and the late 1980s, mortality rates for bladder cancer decreased significantly in both whites and blacks; during the 1990s, mortality rates continued to decline among blacks, but remained fairly constant among whites.Signs and Symptoms: Blood in the urine; usually associated with increased frequency of urination.Risk Factors: Smoking is the greatest risk factor for bladder cancer. Smokers experience twice the risk of nonsmokers. Smoking is estimated to be responsible for about 47% of bladder cancer deaths among men and 37% among women. People living in urban areas and workers in dye, rubber, or leather industries also have a higher risk.Early Detection: Bladder cancer is diagnosed by examination of cells in the urine and examination of the bladder wall with a cystoscope, a slender tube fitted with a lens and light that can be inserted through the urethra.Treatment: Surgery, alone or in combination with other treatments, is used in more than 90% of cases. Superficial, localized cancers may be treated by administering immunotherapy or chemotherapy directly into the bladder. Chemotherapy alone or with radiation before cystectomy (bladder removal) has improved some treatment results.Survival: When diagnosed at a localized stage, the 5-year relative survival rate is 94%; 74% of cancers are detected this early. For regional and distant stages, 5-year relative survival rates are 48% and 6%, respectively. Beyond five years, survival continues to decline with 76% of patients surviving 10 years after diagnosis, and 66% surviving 15 years.Uterine CervixNew Cases: An estimated 13,000 cases of invasive cervical cancer are expected to be diagnosed in 2002. Incidence rates have decreased steadily over the past several decades. In 1994-1998, the incidence rate in black women (11.3 per 100,000) was higher than the rate in white women (7.0 per 100,000). As Pap screening has become more prevalent, preinvasive lesions of the cervix are detected far more frequently than invasive cancer.Deaths: An estimated 4,100 cervical cancer deaths in 2002. Mortality rates have also declined sharply over the16 Cancer Facts & Figures 2002
Five-Year Relative Survival Rates* by Stage at Diagnosis, 1992-1997
Local
%
Regional
%
Distant
% ■ Site
All Stages
%
Local
%
Regional
%
Distant
% Site
All Stages
%
Breast (female) 8'6 96 78 21 Ovary 52 95 81 29 B ■
Colon & rectum 61 90 64 8 Pancreas 4 16 7 2 I Esophagus it 27 13 2 Prostatet 96 100 — 34 - Kidney 62 89 61 9 Stomach 22 59 22 2
Larynx 65 83 50 38 Testis 95 99 95 1 76 . if
I Liver 6 14 6 2 Thyroid 91 99 94 42 f ? ALung
& bronchus 15 48 21 3' Urinary bladder 81 94 48 6 M B Melanoma 89 96 61 12 Uterine cervix 70 92 49 15
Oral cavity 56 82 46 21 Uterine corpus 84 96 63 26
* Rates are adjusted for normal life expectancy and are based oh cases diagnosed from 1992-1997, followed through 1997.
local and regional stages combined.
tThe rate for local stage represents
Local: An invasive malignant cancer confined entirely to the organ of origin. Regional: A malignant cancer that 1) has extended beyond the limits oi
origin directly into surrounding organs or tissues; 2) involves regional lymph nodes by way of lymphatic system; or 3) has both regional extension and
of regional lymph nodes. Distant: A malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension
tinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes.
the organ of '■
involvement
or by discon-
Source: Surveillance, Epidemiology, and End Results Program, 1973
MD 2001.
-1998, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda,
American Cancer Society Surveillance Research, 2002
past several decades. Since 1982, cervical cancer mortality
rates have declined on average by about 1.6% per year.
Signs and Symptoms: Abnormal vaginal bleeding or
spotting; abnormal vaginal discharge. Pain and systemic
symptoms are late symptoms of the disease.
Risk Factors: Cervical cancer risk is closely linked to
sexual behavior and to sexually transmitted infections
with certain types of human papilloma virus. Women
who have sex at an early age, many sexual partners, or
have partners who have had many sexual partners are at
higher risk of developing the disease. Cigarette smoking
is another factor associated with cervical cancer.
Early Detection: The Pap test is a simple procedure
that can be performed by a health care professional as
part of a pelvic exam. A small sample of cells is collected
from the cervix, transferred to a slide, and examined
under a microscope. This test should be performed
annually with a pelvic exam in women who are, or have
been, sexually active or who have reached age 18. After
three or more consecutive annual exams with normal
findings, the Pap test may be performed less frequently
at the discretion of the physician.
Treatment: For preinvasive lesions, changes in the
cervix may be treated by cryotherapy (the destruction of
cells by extreme cold), by electrocoagulation (the
destruction of tissue through intense heat by electric
current), by laser ablation, or by local surgery. Invasive
cervical cancers generally are treated by surgery or radiation,
or both, as well as chemotherapy in some cases.
Survival: Survival for patients with preinvasive lesions
is nearly 100%. Eighty-nine percent of cervical cancer
patients survive 1 year after diagnosis, and 70% survive
5 years. When detected at an early stage, invasive cervical
cancer is one of the most successfully treatable
cancers with a 5-year relative survival rate of 92% for
localized cancers. Whites are more likely than blacks to
have their cancers diagnosed at this early stage. Fifty-six
percent of invasive cervical cancers among white
women and 44% of cancers among black women are
diagnosed at a localized stage.
Uterine Corpus (Endometrium)
New Cases: An estimated 39,300 cases of cancer of the
uterine corpus (body of the uterus), usually of the
endometrium or lining of the uterus, are expected to be
diagnosed in 2002. Incidence rates are higher among
white women (22.9 per 100,000) than among black
women (15.7 per 100,000).
Deaths: An estimated 6,600 deaths in 2002. Although
incidence rates are higher among white women than
black women, the relationship is reversed for mortality
rates. Black women have mortality rates that are nearly
twice as high as rates among white women (5.7 per
100,000 compared to 3.1 per 100,000).
Signs and Symptoms: Abnormal uterine bleeding or
spotting. Pain and systemic symptoms are late
symptoms.
Cancer Facts & Figures 2002 17
Trends in Five-Year Relative Survival Rates* by Race and Year of Diagnosis, US, 1974-1997
White Black AH Races
Site
Relative 5-Year Survival Rate (%) Relative 5-Year Survival Rate (%) Relative 5-Year Survival Rate (%)
1974-76 1983-85 1992-97 1974-76 1983-85 1992-97 1974-76 1983-85 1992-97
All Sites 51 54 63+ 39 40 52+ 50 52 62+
31 + 27 32 39+ 22 27 32+
Breast (female) 75 7Q 87t 63 63' 72+ 75 78 86+
ozT 46 49 51 + 50 58 61 +
tsopnaqus 4 6 9+ 5 8 14+
Hodgkin's disease 69 78 78+ 71 79 83+
Kidney □z 621 49 55 60+ 52 56 62+
Larynx DO 60 55 53 66 67 65
Leukemia 4bT 31 33 . 38 34 41 45+
Liver 6+ 1 4 4 4 6 6+
Lunq & bronchus 15+ 12 11 12 12 14 15+.
Melanoma 85 67+ 74§ 61 + 80 85 89+
Multiple myeloma 27 zoT 27 31 31 24 28 29+
Non-Hodgkin's lymphoma 48 54 54t 49 . 45 43+ 47 54 53+
Oral cavity 55 55 58+ 36 35 34 53 53 56+
Ovary 37 40 52+ 41 41 51 + 37 41 52+
Pancreas 3 3 4+ 3 5 4 3 3 4+
Prostate 68 76 97+ 58 64 92+ 67 75 96+
Rectum 49 56 62+ 4'2 44 52+ 49 55 61 +
Stomach 15 16 ■ 21 + 17 19 20 15 17 22+
Testis 79 ■ 91 95+ 76+ 88+ 88 79 91 95+
Thyroid 92 93 95+... 88 92 94 92 93 95+
Urinary bladder 74 78 82+ 48 59 65+ 73 78 81 +
Uterine cervix 70 71 72+ 64 60 58 69 69 70
Uterine corpus 89 85 86+ 61 54 59 88 83 84+
‘Rates are adjusted for normal life expectancy and are based on cases diagnosed from 1974-76, 1983-85, and in 1992. tthe difference in rates between 1974-76
and 1992-97 is statistically significant (p <0.05). tThe standard error of the survival rate is between 5 and 10 percentage points. § The standard error of the survival
rate is greater than 10 percentage points.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1998, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda
MD 2001.I
American Cancer Society Surveillance Research, 2002
Risk Factors: High cumulative exposure to estrogen is
the major risk factor for the most common type of
cancer of the uterine corpus. Estrogen-related exposures
including estrogen replacement therapy, tamoxifen,
early menarche, late menopause, never having children,
and a history of failure to ovulate have all been shown to
increase risk. Progesterone plus estrogen replacement
therapy (called hormone replacement therapy, or HRT)
is believed to largely offset the increased risk related to
HRT using only estrogen. Research has not implicated
estrogen exposures in the development of the other
types of uterine, corpus cancer, which are more aggressive
and have a poorer prognosis. Other risk factors
for uterine corpus cancer include infertility, diabetes,
gallbladder disease, hypertension, and obesity. Pregnancy
and the use of oral contraceptives appear to
provide protection against endometrial cancer. Hereditary
non-polyposis colon cancer, a genetic syndrome,
also has been associated with endometrial and ovarian
cancer
Early Detection: Most endometrial cancer is diagnosed
at an early stage because of post-menopausal bleeding.
Beginning at age 35, women with or at risk for hereditary
non-polyposis colon cancer (HNPCC) should be offered
endometrial biopsy annually to screen for endometrial
cancer.
Treatment: Uterine corpus cancers are usually treated
with surgery, radiation, hormones, and/or chemotherapy
depending on the stage of disease.
Survival: The 1-year relative survival rate for endometrial
cancer is 93%. The 5-year relative survival rate is
96%, 63%, and 26%, if the cancer is diagnosed at local,
regional, and distant stages, respectively. Relative survival
rates for whites exceed those for blacks by about 15
percentage points at every stage.
18 Cancer Farts & Figures 2002
Summary of American Cancer Society Recommendations for Early Detection of Cancer j
in Asymptomatic People
Site Recommendation I
Breast Women 40 and older should have an annual mammogram, an annual clinical breast examination
(CBE) by a health care professional, and should perform monthly breast self-examination (BSE). Ideally,
the CBE should occur before the scheduled mammogram. Women ages 20-39 should have a CBE by
a health care professional every three years and should perform BSE monthly.
Colon &
Rectum
Beginning at age 50, men and women should follow one of the examination schedules below:
• A fecal occult blood (FOBT) test every year, or
• A flexible sigmoidoscopy (FSIG) every five years, or
• Annual fecal occult blood test and flexible sigmoidoscopy every five years.* * i
• A double-contrast barium enema every five to 10 years. |
• A colonoscopy every 10 years.
*Combined testing is preferred over either annual FOBT dr FSIG every 5 years, alone. People who
are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing
schedule.
Prostate The PSA test and the digital rectal examination should be offered annually, beginning at age 50, to
men who have a life expectancy of at least 10 years. Men at high risk (African-American men and
men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer
at an early age) should begin testing at age 45. Information should be provided to patients about
what is known and what is uncertain about the benefits and limitations of early detection and treatment
of prostate cancer, so that they can make an informed decision.
Uterus Cervix: All women who are or have been sexually active or who are 18 and older should have an
annual Pap test and pelvic examination. After three or more consecutive satisfactory examinations
with normal findings, the Pap test may be performed less frequently. Discuss the matter with your
physician.
Endometrium: The American Cancer Society recommends that all women should be informed about
the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected
bleeding or spotting to their physicians. Annual screening for endometrial cancer with endometrial
biopsy beginning at age 35 should be offered to women with or at risk for hereditary nonpolyposis
colon cancer (HNPCC).
Cancer-related
Checkup
A cancer-related checkup is recommended every 3 years for people aged 20 to 39 years and every
year for people age 40 and older. This exam should include health counseling and, depending on a
person's age, might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes,
testes, and ovaries, as well as for some nonmalignant diseases.
ACS guidelines for early cancer detection are assessed annually in order to identify whether there is new scientific evidence
sufficient to warrant a re-evaluation of current recommendations. If new evidence is sufficiently compelling to
consider a change or clarification in a current guideline, or the development of a new guideline, a formal procedure is
initiated. Guidelines are formally evaluated every 5 years regardless of whether or not new evidence suggests a change
in the existing recommendation. There are nine steps in this procedure, and these “guidelines for guideline development”
were formally established to provide a specific methodology for science and expert judgment to form the underpinnings
of specific statements and recommendations from the ACS. These procedures constitute a deliberate process
to insure that all ACS recommendations have the same methodological and evidence-based process at their core. This
process also employs a system for rating strength and consistency of evidence that is similar to that employed by the
Agency for Health Care Research and Quality (AHCRQ) and US Preventive Services Task Force (USPSTF).
©2002, American Cancer Society, Inc;
Cancer Facts & Figures 2002 19
ing pre-cancerous polyps4 or can diagnose early disease at a stage when it can be effectively cured. Despite the effectiveness and cost-effectiveness of several existing screening tests,3 the use of these tests for preventionremains extremely low.In the United States, cancers of the colon and rectum combined (colorectal) are the third most common site of new cases and deaths in both men and women. There will be an estimated 148,300 new cases and 56,600 deaths from the disease in 2002. An individual’s lifetime risk of developing colorectal cancer in the United States is nearly 6%, with over 90% of cases occurring after age 50.1 Colorectal cancer death rates decreased by 1.8% per year from 1992-1998.6Many of the new cases and deaths from colorectal cancer are preventable by improvements in nutrition and physical activity and by timely use of existing colorectal cancer screening tests.3 Screening can prevent the occurrence of colorectal cancer by detecting and removThis special section provides an overview of colorectal cancer and the strategies presently available to combat it.incidence and MortalityAge: Anyone can get colorectal cancer, but it usually strikes men and women over the age of 50 (Figure 1).Sex: The incidence rate of colorectal cancer is similar among men and women of equivalent age until age 50; it then becomes higher in men than in women (Figure l).2 Because women live longer than men, the total number of cases and deaths is higher in women than men.Race/Ethnicity: Colorectal cancer incidence and mortality rates vary substantially by race and ethnicity (Table 1). Both incidence and death rates are highest‘Incidence and'rrjorta ity rates are age-adjusted to the 1970 US standard.Source: SEER Cancer Statistics Review, 1973-1998, Surveillance, Epidemiology, and End Results Program,Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.American Cancer Society, Surveillance Research, 200220 Cancer Facts & Figures 2002
Table I1. Incidence and Mortality Rates*
from Colorectal Cancer by Race and Ethnicity,
1992-1998, Men and Women Combined
Race/ethnic group Incidence Mortality
Black 50.1 22.8
White 42.9 "I6.8
Asian/Pacific Islander 38.2 10.7
American Indian/Alaska Native 28.6 10.3
Hispanic 28.4 10.2
‘Rate per 100,000, age-adjusted to the 1970 US standard population.
Source: NCI Surveillance, Epidemiology, and End Results Program,
in blacks, intermediate in whites and Asian/Pacific
Islanders, and lowest in American Indian/Alaska
Natives and Hispanics. In 1998, the death rate from
colorectal cancer in blacks was more than twice the rate
in Hispanics and American Indian/Alaska Natives.
Trends over Time: Colorectal cancer incidence rates
increased from 1973-1985 (particularly in men),
decreased through 1995, and then remained level or
increased slightly (in women) through 1998 (Figure 2).
The recent flattening trends or upturn in incidence may
reflect increased screening. Mortality rates from colorectal
cancer have steadily declined among women since
about 1950, and among men since approximately 1985
(Figure 2). From 1992-1998, the decrease in death rates
was larger in white males (2.1% per year) and white
females (1.9%) than in black males (0.9%) or black
females (0.6%).6
Risk Factors and Prevention
Approximately 90% of all colorectal cancer cases and
deaths are thought to be preventable, based on temporal
and international variations7 and existing approaches
to prevention and early detection.8 Screening tests that
detect occult blood in the stool or identify adenomatous
polyps can prevent the occurrence of colorectal cancers
by allowing the detection and removal of pre-cancerous
lesions before they undergo malignant transformation.
*Per 100,000 age-adjusted to the 1970 US standard population.
Source: NCI, Surveillance, Epidemiology, and End Results Program, 2001. US Mortality Public Use Data Tapes
1960-1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.
American Cancer Society, Surveillance Research, 2002
Cancer Facts & Figures 2002 21
Table 2. Risk Factors for Colorectal Cancer
Relative Risk L < '4'
Q
illll
Family history (first degree relative)
Physical inactivity (less than 3 hours per week)
: Inflammatory bowel disease
i (physician diagnosed Crohn's disease,
ulcerative colitis or pancolitis)
Obesity
Red meat
Smoking
Alcohol (more than 1 drink/day)
High vegetable consumption (5 or more
servings per day)
Oral contraceptive use (5 or more years of use)
Estrogen replacement (5 or more years of use) .
Multivitamins containing folic acid
1.8
1.7
1.5
1.5
|.5
1.5
1.4
0.7
0.7
0.8
0.5
Modifiable factors are :n bold text.
Adapted, with permission from Colditz et al (2000).12
The following are internet resources of interest on colorectal
risk: http://www.yourcancerrisk.harvard.edu/ and
http ://w ww. cancer, org
cancer
Other factors thought to influence the development of
colorectal cancer are listed in Table 2. Potentially modifiable
factors include healthy dietary patterns, regular
physical activity, and avoidance of obesity and smoking.
Accumulating research also suggests that aspirin-like
drugs, post-menopausal hormones, folic acid, calcium
supplements, selenium, and vitamin E may ultimately
help to prevent colorectal cancer. At present, the
American Cancer Society does not recommend any supplements
to prevent colorectal cancer because of uncertainties
about their effectiveness, appropriate dose, and
potential toxicity.
Other non-modifiable risk factors for colorectal cancer
include a strong family history of colorectal cancer or
adenomatous polyps in a first-degree relative (in a
parent or sibling before age 60 or in two first-degree
relatives of any age), a personal history of colorectal
cancer, polyps, or chronic inflammatory bowel disease,
or a family history of hereditary colorectal cancer
syndrome (e.g., familial adenomatous polyposis or
hereditary non-polyposis colorectal cancer).9 For persons
with any of these known risk factors, screening
should be considered earlier than age 50. However,
almost 75% of all colon cancer cases occur in people
with no known predisposing factors,10"11 mostly after
age 50.1
Current Recommendations for
Prevention
The current American Cancer Society recommendations
for nutrition and physical activity are relevant to
colorectal cancer prevention.
1. Eat a variety of healthful foods, with an emphasis on
plant sources.
2. Adopt a physically active lifestyle.
3. Maintain a healthful weight throughout life.
4. If you drink alcoholic beverages, limit consumption.
Colorectal Cancer Screening
Several existing screening regimens have been proven to
be effective in reducing mortality from colorectal cancer.
These allow detection and removal of adenomatous
polyps before they become cancerous and the removal of
early-stage colorectal cancer when the disease is still
highly curable. Tumors detected because of bleeding or
pain have .usually progressed beyond localized stage,1
Current tests include:
Fecal Occult Blood Test (FOBT): Cancers and some
large polyps bleed intermittently into the intestine. The
FOBT detects hidden or occult’ blood in a stool sample.
Individuals receive a test kit to take home along with
dietary instructions. FOBT consists of six small stool
samples, with two samples each taken from three consecutive
bowel movements.13 Upon completing the test,
patients return the kit to the physician for evaluation.
Studies have proven that regular use of this screening
method saves lives and can reduce the incidence of
colorectal cancer.14
Flexible sigmoidoscopy: A slender, flexible, hollow,
lighted tube is inserted through the rectum into the
colon to search for cancer or polyps. The sigmoidoscope
is around 2 feet long and, at its maximum insertion, can
only reach about half of the colon.13 If there is a polyp or
tumor present, the patient must be referred for colonoscopy
so that the entire colon can be examined.
Colonoscopy: Like the sigmoidoscopy, this procedure
allows for direct visual examination of the colon and
rectum. A colonoscope is similar to the sigmoidoscope,
but its greater length allows the doctor to view the entire
colon.13 If a polyp is found, the physician may remove it
by passing a wire loop through the colonoscope to cut
the polyp from the wall of the colon using an electric
current.
22 Cancer Facts & Figures 2002
Things to Consider When Deciding with Your Doctor Which Test Is Right for You:
Performance Characteristics/ Cost
Test Advantages & Complexity* Limitations Ranget
Fecal Occult
Blood Test
• No bowel preparation
• Sampling is done at home
• Low cost
• Proven effective in clinical trials
• No risk of bowel tears or
infections
Intermediate
for cancer
Lowest
complexity
• Will miss most polyps and some cancers
• May produce false-positive test results
• Pre-test dietary limitations needed
• Must be done every year
• More effective when combined with
a flexible sigmoidoscopy every five years
• Additional procedures necessary if
abnormalities are detected
Lowest
cost:
under !
$20
Flexible
Sigmoidoscopy
• Fairly quick, few complications
• Minimal bowel preparation
• Done every five years
• Minimal discomfort
« Does not require a specialist
High for up
to half of
i the colon
Intermediate
complexity
• Usually views only about a third of the colon
• Cannot remove all polyps
• Very small risk of infection or bowel tear
• More effective when combined with
annual fecal occult blood testing
• Additional procedures needed if
abnormalities are detected
Mid low
cost:
between
$150 to
$200
Double
contrast
Barium
Enema
• Can usually view entire colon
• Few complications
• Done every five years
• No sedation needed
High
High
complexity
• Can miss some small polyps and. cancers
• Full bowel preparation needed
• Some false-positive test results
’ Additional procedures necessary if
abnormalities are detected
Mid to |
high cost:
■ between
$300 to
$400
Colonoscopy • Can usually view entire colon
• Can biopsy and remove polyps
• Done every 1.0 years
• Can diagnose other disease
Highest
Highest
complexity
• Can miss small polyps
• Full bowel preparation needed
• Can be expensive
• Sedation of some kind usually needed
• You may miss a day of work
• Potential risk of bowel tears or infections
High cost:
at least
$1,000
‘Complexity involves patient preparation, inconvenience, facilities and equipment needed, and patient discomfort.9 .
tCosts for tests are 'conservative' estimates only and will vary greatly by state and health insurance.
Barium enema with air contrast: This procedure,
which allows complete radiological examination of the
colon, is also called a double-contrast barium enema.13
Barium sulfate is introduced into the colon and allowed
to spread throughout the colon to partially fill and open
up the colon. The colon is then filled with air so that it
can expand and increase the quality of x-rays that are
taken.
Digital Rectal Exam: A physician inserts a gloved
finger into the rectum to feel for anything that is irregular
or abnormal. Often, a single stool sample is also
collected and placed on an FOBT card for further examination.
13 This method of FOBT is not recommended.
Other screening tests still under development: The
sensitivity of colorectal cancer screening is expected
to increase with improved methods of FOBT testing
in combination with immunochemical testing. Newer
screening methods, such as genetic-based fecal
screening and virtual colonoscopy, are still under
development.1
American Cancer Society Guidelines
on Screening and Surveillance for the
Early Detection of Colorectal Adenomas
and Cancer13
Beginning at age 50, both men and women should follow
one of these five screening options:
• Yearly fecal occult blood test (FOBT) plus flexible
sigmoidoscopy every 5 years*
• Flexible sigmoidoscopy every 5 years
• Yearly fecal occult blood test (FOBT)t
• Colonoscopy every 10 years
• Double-contrast barium enema every 5 years
*The combination of FOBT and flexible sigmoidoscopy is preferred
over either test alone.
t A digital rectal exam (DRE) test can detect cancers of the
rectum but not colon.
Cancer Facts & Figures 2002 23
Any of these five options can be useful in screening for
colorectal cancer in average-risk adults. Each of these
tests has strengths and limitations related to accuracy,
potential for prevention, costs, and risks. A colonoscopy
is considered the gold standard because of its ability to
visualize, sample, and/or remove lesions from the entire
colon. Positive results from any of the other four options
should be followed with a colonoscopy for more complete
diagnostic evaluation. If a screening colonoscopy
test is not available or feasible, or is not acceptable to the
patient, any of the other alternative options can be used.
Individual patients should be given information to make
an informed decision when choosing a screening test.
For high-risk people, colorectal cancer screening should
begin before age 50 and be repeated more often. People
are considered at increased risk if they have any of the
following colorectal cancer risk factors:
* A strong family history of colorectal cancer or polyps
(cancer or polyps in a first-degree relative occurring
before age 60 or in two first-degree relatives at any
age). Note: a first-degree relative is defined as a parent,
sibling, or child.
• Families with hereditary colorectal cancer syndromes
(familial adenomatous polyposis and hereditary nonpolyposis
colon cancer)
• A personal history of colorectal cancer or adenomatous
polyps, or
• A personal history of chronic inflammatory bowel
disease.
Approximately 15% to 20% of colorectal cancers occur
among people at “increased risk” (approximately twice
average risk).9
Awareness and Utilization of Screening
for Colorectal Cancer
Despite the proven effectiveness and availability of
various colorectal cancer screening tests, many adults,
ages 50 and older, are not regularly screened.15 Only 44%
of BRFSS respondents ages 50 and older reported
receiving FOBT and/or sigmoidoscopy or colonoscopy
within the previous one or five years respectively in 1999
compared with approximately 41% reporting these tests
within the corresponding periods in 1997.15 Prevalence
rates are especially low among individuals who are
50-64 years old, have lower incomes, little or no health
care coverage, and fewer years of education.16 Table 3
(below) shows the most current prevalence rates of
colorectal cancer screening exams by gender, age, and
race/ethnicity.
Table 3. Colon and Rectum Cancer Screening, Adults 50 and Older, US*, 1999
% Recent Sigmoidoscopy/
%
Recent Fecal Occult Blood Testt Colonoscopy*
Total% Male% Female % Total % Male % Female
Age
50-59 15.6 13.4 17.6 26.2 28.8 23.8 K % 60-69 23.3 21.4 24.8 37.2 41.9 33.4
1 iBifi s 70-79 26.0 25.1 26.6 40.9 45.7 37.5
80-84 24.0 22.8 24.7 39.1 40 34.5
85+ 17.3 16.0 17.9 30.6 33.9 29.2
Race/Ethnicity
White 21.2 19.4 22.7 33.9 37.3 31.1
Black 20.5 17.7 22.6 32.8 38.3 28.9
Asian/Pacific Islander 8.8 7.5 10.4 •31.4 38.8 21.9
American Indian/Alaska Native 17.6 13.6 21.2 34.0 31.7 36.3
Hispanic 11.7 10.9 12.3 29.5 31.4 27.9
BW
® ...B
Non-Hispanic 21.5 19.4 23.1 34.0 37.7 31.0
‘Includes the 50 states and District of Columbia. ‘A fecal occult blood test within the last year. tA sigmoidoscopy or colonoscopy within the preceding E - ■. V.-H five years.
/ ", Source: Behavioral Risk Factor Surveillance System CD-ROM 1999, National Center for bisease Prevention and Health Promotion, Centers for Disease
Control and Prevention, 2000.
American Cancer Society, Surveillance Research, 2002
in
24 Cancer Facts' & Figures 2002
Figure 3. Percent of CoIorectai Cancer Cases.
Diagnosed by Stage and Race, US, 1992-1997
A consequence of the low level of colorectal screening is
that only 37% of cases are diagnosed when the disease is
still localized (Figure 3). Later diagnosis results in a
substantially lower 5-year relative survival rate than
would occur if patients were diagnosed when disease
was still localized (Figure 4).
There are several factors contributing to the low
prevalence of colorectal cancer screening.17 First is the
limited communication between physicians and their
patients about colorectal cancer.18 Second, patients
may be unaware of the benefits of screening unless
their health provider discusses it with them; however
doctors may be unlikely to suggest screening unless the
patient asks about it.19 Third, while some colorectal
cancer screening tests may be covered by some private
health insurance, benefits are highly variable, depending
on the tests involved. Medicare now ensures that all
beneficiaries aged 50 and older can receive colorectal
screening as part of their benefit package, including a
screening colonoscopy.2
The Signs of Colorectal Cancer
Most colorectal cancers begin as a polyp, a small, noncancerous
growth in the wall of the colon. Over time,
however, some polyps grow larger and become malignant.
As polyps grow, they can bleed or obstruct the
intestine. Early colon cancer often has no symptoms.
See your doctor if you have any of these warning
signs:
• Bleeding from your rectum
• Blood in your stool or in the toilet after you have a
bowel movement
• A change in the shape of your stool
• Cramping pain in your lower stomach
• A feeling of discomfort or an urge to have a bowel
movement when there is no need to have one
Other conditions can cause these same symptoms. You
should be checked by your doctor to find the reason for
your symptoms.
Source: Screening for Colorectal Cancer — March 15, 2000
—American Academy of Family Physicians; accessed
http://www.aaip.org/afp/20000315/1773ph.html
Localized
Regional
Distant
Unstaged
‘Rates are based on the follow-up of patients through 1997.
Source: SEER Cancer Statistics Review, 1973-1998,
Surveillance, Epidemiology, and End Results Program, Division of Cancer
Control and Population Sciences, National Cancer Institute, 2001.
Figure 4. 5-Year Relative Survival Rates by Stage
at Diagnosis and Race, 1992-1997
‘Rates are based on data from the population-based registries in Connecticut,
New Mexico, Utah, Iowa, Hawaii, Atlanta, Detroit, Seattle-Puget Sound, and
San Francisco-Oakland. Rates are based on follow-up of patients through 1997.
Source: SEER Cancer Statistics Review, 1973-1998,
Surveillance, Epidemiology, and End Results Program, Division of Cancer
Control and Population Sciences, National Cancer Institute, 2001.
Cancer Facts & Figures 2002 25
Treatment and SurvivalThe survival of patients with colorectal cancer is best when the disease is diagnosed early. Treatment is readily available, but when the cancer is not found at a localized stage, treatment is less effective. The 1- and 5-year survival rates for patients with colon and rectum cancer are 81% and 61%, respectively, for all races combined.5 If the cancer is detected early, however, the 5-year survival is approximately 90%. Only 37% of cancers are found at this stage. When the cancer has spread regionally to involve adjacent organs or lymph nodes, survival drops to 64%, and it is drastically lower after the cancer has metastasized (8%) (Figure 4). Currently, colorectal cancer treatment options include surgery, radiation, and chemotherapy. Surgery is the most common form of treatment.20 Radiation and chemotherapy are forms of adjuvant therapy (drugs or radiation used after surgery to destroy cancer cells that were left behind or that have spread to other parts of the body).Surgery: If colon cancer is detected at an early stage, the patient can undergo a polypectomy (removal of the polyps containing the cancer) or a local excision (removal of the cancer and a small margin of tissue). In instances where the cancer is large or invades surrounding tissue or lymph nodes, the individual will most likely have a segmental resection (removal of the cancer, some colon tissue, and the lymph nodes). A colostomy (an opening in the abdomen to allow the elimination of body wastes) is performed if the physician is unable to reconnect the parts of the colon after surgery.20Rectal cancers that have not reached advanced stages and are located near the anus can be treated with polypectomy or local excision.20 Local excision is used to remove invasive cancers, as well as some surrounding tissue, by cutting through all the layers of the rectum. Stage II and III cancers can be removed by a bowel resection to remove the tumor, as well as the colon, rectum, prostate or bladder, depending on where the cancer has spread.20Radiation: Radiation therapy is used primarily to treat rectal rather than colon cancer.21 The goal of this treatment is to prevent metastatic disease caused by the rapid spread of cancer cells that are often missed during surgery. This form of therapy also is used to control the symptoms and pain associated with locally advanced cancers, but it has not been shown to successfully improve survival rates.Chemotherapy: Even though the majority of patients (nearly 80%) with colon cancer experience complete clearance of their disease after surgery, about 40% will develop recurrence. Chemotherapy is administered to eradicate any remaining cancer cells and to prevent recurrent disease.22 Fluorouracil (5-FU) is the most common drug used to treat colorectal cancers, and is used in conjunction with medicines such as levamisole and leucovorin.21 A new drug, irinotecan (CPT-II), has been approved for the adjuvant treatment of colon cancer, and may be an effective second-line therapy for patients whose metastatic tumors do not respond to 5-FU.23Organizations such as the American Cancer Society continue to support efforts to increase awareness among individuals (aged 50 and older) to take advantage of available colorectal cancer screening tests. March is now recognized as Colorectal Cancer Awareness Month. No matter how widespread mass education efforts are, physicians must stress to their patients the importance of early detection for colorectal cancer The ACS and CDC are involved in efforts to promote colon cancer screening nationwide by educating providers and the public about the benefits and availability of current screening procedures. In 1997, the ACS, together with CDC and other partners, formed a collaborative group called the National Colorectal Cancer Roundtable to discuss strategies for educating health care providers and the public about the importance of colorectal screening. The organization seeks to involve state health departments, professional organizations, medical societies, federal agencies, consumers, cancer survivors, managed care organizations, private industry, health educators, and the medical media.!6 Cancer Facts & Figures 2002
References
1. Burt, RW. Colon cancer screening. Gastroenterology.
2000;119:837-53.
2. Ries LAG, Wingo PA, Miller DS, Howe HL, Weir HK,
Rosenberg HM, Vernon SW, Cronin K, Edwards BK. The Annual
report to the Nation on the Status of Cancer, 1973-1997, with a
Special Section on Colorectal Cancer. Cancer. 2000;88:2398-
2424.
3. Frazier A, Colditz G, Fuchs C, Kurtz K. Cost-effectiveness of
screening for colorectal cancer in the general population. JAMA,
2000;284:1954-1961.
4. Winawer S, Zauber A, Ho M, O’Brien M, Gottlieb L, Sternberg
5. Waye J, Schapiro M, Bond J, Panish J. Prevention of colorectal
cancer by colonoscopic polypectomy. The National Polyp Study
Workgroup. NEngl J Med. 1993;329:1977-1981.
5. Ries L, Eisner M, Kosary C, Hankey B, Mille, B, Clegg L,
Edwards B. SEER Cancer Statistics Review, 1973-1998. Bethesda,
MD: National Cancer Institute; 2001.
6. Howe H, Wingo P, Thun M, Ries L, Rosenberg H, Feigal E,
Edwards B. Annual report to the nation on the status of cancer
(1973 through 1998), featuring cancers with recent increasing
trends. J Natl Cancer Inst. 2001;93:824-842.
7. Doll R, Peto R. The Causes of Cancer. New York: Oxford
University Press, 1981.
8. Colditz G, Dejong, W, Hunter D, Trichopoulos D, Willet W.
Harvard Report on Cancer Prevention. Cancer Causes & Control
1996;7(SuppL):Sl-S55.
9. Winawer S, Fletcher R, Miller L, Godlee F, Stolar M, Mulrow C,
Woolf S, Glick S, Ganiats T, Bond J, Rosen L, Zapka J, Olsen S,
Giardiello F, Sisk J, Van Antwerp R, Brown-Davis C, Marciniak D,
and Mayer R. Colorectal cancer screening: clinical guidelines
and rationale. Gastroenterology. 1997;112:594-642.
10. Askling j, Dickman P, Karlen P, Brostrom O, Lapidus A,
Lofberg R, Ekbom A. Family history as a risk factor for colorectal
cancer in inflammatory bowel disease. Gastroenterology.
2001;120(6):1356-1362.
11. Fuchs C, Giovannucci E, Colditz G, Hunter D, Speizer F,
Willett W. A prospective study of family history and the risk of
colorectal cancer. NEngl J Med. 1994;331:1669-1674.
12. Colditz G, Atwood K, Emmons R, Monson W, Willet W,
Trichopoulos D, Hunter D. Harvard Report on Cancer
Prevention Volume 4: Harvard Cancer Risk Index. Cancer
Causes & Control 2000;11:477-488.
13. Smith RA, von Eschenbach AC, Wender R, Levin B, Byers T,
Rothenberger D, Brooks D, Creasman W, Cohen C, Runowicz C,
Cokkinides V, Eyre H. American Cancer Society Guidelines for
the Early Detection of Cancer: Update of Early Detection
Guidelines for Prostate, Colorectal, and Endometrial Cancers.
CA Cancer] Clin. 2001;51:38-75.
14. Mandel J, Church T, Bond J, Ederer F, Geisser M, Mongin S,
Snover D, Schuman L. The Effect of Fecal Occult-Blood
Screening on the Incidence of Colorectal Cancer N Engl J Med.
2000;343:1603-1607.
15. Centers, for Disease Control and Prevention. Trends in
Screening for Colorectal Cancer, U.S., 1997 and 1999. Morb
Mortal WklyRep. 2001;50:162-166.
16. Centers for Disease Control and Prevention. Screening for
Colorectal Cancer—United States, 1997. Morb Mortal WklyRep.
1999;48:116-121.
17. Vernon S. Participation in colorectal cancer screening: a
review. J Natl Cancer Inst. 1997;89:1406-1422.
18. Hawley S, Levin B, Vernon S. Colorectal cancer screening by
primary care physicians in two medical care organizations.
Cancer Detect Prev. 2001;25:309-318.
19. Pignone M, Bucholtz D, and Harris R. Patient preferences for
colon cancer screening. / Gen Intern Med. 1999;14:432-7.
20. Physician Data Query: Colon Cancer Treatment for Health
Professionals. National Cancer Institute. Available at:
. Accessed August
14,2001.
http://cancernet.nci.nih.gov/treatment.html
21. Macdonald JS. Adjuvant therapy of colon cancer. CA Cancer
J Clin. 1999;49:202-219.
22. Midgley R, Kerr D. Colorectal Cancer. Lancet, 1999:353:391-
399.
23. Moore H, Haller D. Adjuvant Therapy of Colon Cancer.
Seminars in Oncology, 1999;26:545-555.
Cancer Facts & Figures 2002 27
Overall, black Americans are more likely to develop and
die from cancer than persons of any other racial and
ethnic group. During 1992-1998, the average annual
incidence rate for all cancer sites was 445.3 per 100,000
persons among blacks, 401.4 per 100,000 for whites,
283.4 per 100,000 for Asian/Pacific Islanders, 270.0 per
100,000 in Hispanics, and 202.7 per 100,000 in American
Indians/Native Alaskans. The death rate for all cancers
combined is also about 33% higher in black than white
Americans. Average annual cancer mortality rate from
1992-1998 for all sites combined was 218.2 per 100,000
for blacks, 164.5 per 100,000 among whites, 105.4 per
100,000 among American Indians/Native Alaskans,
102.6 per 100,000 among Hispanics, and 101.2 per
100,000 among Asian/Pacific Islanders.
Despite these high rates, both incidence and mortality
from all cancers combined decreased more among black
men than other racial and ethnic groups between 1992-
1998. During these same years, cancer incidence rates
decreased by 2% per year among Hispanics, by 1.7%
among blacks, and by 1.2% among whites, while it
remained relatively stable among American Indians/
Native Alaskans and Asian/Pacific Islanders. Similarly,
the mortality rate for all cancer sites decreased annually
by 1.3% among blacks, 1.2% among Asian/Pacific
Islanders, 1.1% among whites, and 0.9% among
Hispanics; and it leveled off among American
Indian/Native Alaskans.
Comparisons of cancer rates between racial and ethnic
groups, particularly those involving groups other than
whites or blacks, should be interpreted with caution
because misclassification of race on medical records,
death certificates, and the census can reduce the accuracy
of reported rates. For more information about
cancer in minority populations, ask about the American
Cancer Society publication and Web site posting of
Cancer Facts & Figures for African Americans (8614.01).
Incidence and Mortality Rates* by Site, Race, and Ethnicity, US, 1992-1998
Incidence White Black
Asian/
Pacific Islander
American Indian/
Alaskan Native Hispanict
All Sites
Males 470.4 596.8 327.7 227.7 319.7
Females 354.4 337.6 252.1 186.3 237.7
Total 401.4 445.3 283.4 202.7 270.0
Breast (female) 115.5 ' 101.5 78.1 50.5 68.5
Colon & rectum
Males 51.4 57.7 47.3 33.5 35.2
Females 36.3 44.7 31.0 24.6 23.2
Total 42.9 50.1 38.2 28.6 . 28.4
Lung & bronchus
Males 69.6 K107.2 51.9 44.3 36.0
Females 43.6 45.7 22.7 20.6 18.7
Total 54.7 71.6 35.5 31.0 26.0
Prostate 144.6 234.2 82.8 47.8 103.4
Mortality White Black
Asian/
Pacific Islander
American Indian/
Alaskan Native Hispanict
All Sites
Males 203.2 297.7 125.6 125.3 128.8
Females 138.0 166.6 82.4 90.8 84.3
Total 164.5 218.2 101.2 1.05.4 102.6
Breast (female) 24.3... 31.0 11.0 12.4 14.8
Colon & rectum
MaffiCT 20.6 27.3 ffl|2.9 11.9 SK3.0
Females 13.9 19.6 8.9 8.9 8.0
Total 16.8 22.8 10.7 10.3 10.2
Lung & bronchus
Males 67.8 96.2 33.8 41.8 30.5
Females 34.6 33.6 15.1 20.9 10.9
Total 48.8 59.1 23.3 30.1 19.3
Prostate 22.4 53.1 9.8 14.0 gS|5.9
*Per 100,0.00, age-adjusted to the 1970 US standard population. tHispanics are not mutually exclusive from whites, blacks, Asian/PaCififtslanders, and
A’hercan Indian/Aiaskan Natives. Note: Incidence data arefrom the 11 SEER areas; mortality data are from all states except data for Hispanics; data for
Hispanics include deaths that occurred in all states except Connecticut, Louisiana, New Hampshire, and Oklahoma.
Source: Surveillance, Epidemiology, and End Results Program, 1973-98, Division of Cancer Control and Population Sciences, National Cancer Institute,
Bethesda, MD, 2001. Mortality derived from data originating from the National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.
American Cancer Society, Surveillance Research, 2002
28 Cancer Facts & Figures 2002
Smoking is the most preventable cause of death in our
society. During 1995, approximately two million people
in developed countries died prematurely because of
smoking.1 Tobacco use is responsible for nearly one in
five deaths in the United States.2 Based on data from the
American Cancer Society’s Cancer Prevention Study II,
it is estimated that 430,700 US deaths per year were
attributable to smoking during 1990-1994.3 Approximately
half of all continuing smokers die from diseases
caused by smoking.1 Of these, approximately half die in
middle age (35-69), losing an average of 20 to 25 years of
life expectancy.1
Lung cancer mortality rates are about 22 times higher
for current male smokers and 12 times higher for current
female smokers compared with lifelong neversmokers.
4 In addition to being responsible for 87% of
lung cancers, smoking is also associated with cancers of
the mouth, pharynx, larynx, esophagus, pancreas, uterine
cervix, kidney, and bladder.4 Smoking accounts for at
least 30% of all cancer deaths, is a major cause of heart
disease, cerebrovascular disease, chronic bronchitis, and
emphysema, and is associated with gastric ulcers.4
Trends in Smoking
• Cigarette smoking among adults aged 18 and over
declined 40% between 1965 and 1990 —from 42% to
25%. Smoking prevalence among adults showed modest
declines between 1990 and 1999.5
• Between 1978 and 1995, cigarette smoking prevalence
declined for whites (34% to 26%), blacks (37% to 27%),
Hispanics (30% to 19%), and Asian and Pacific
Islanders (24% to 15%). Among American Indians and
Alaska Natives, smoking prevalence did not change for
men from 1983 to 1995 or for women from 1978 to
1995.0
• Although cigarette smoking became prevalent among
men before women, the gender gap narrowed in the
mid-1980s and has remained constant.7
• Between 1983 and 1999, smoking among college graduates
decreased almost 50% from 21% to 11%, but
among adults without a high school education the
percentage decreased only 22% from 41% to 32%.5
• Per capita consumption of cigarettes continues to
decline. After peaking at 4,345 cigarettes per capita in
1963, consumption among Americans 18 years and
older decreased 52% to an estimated 2,103 cigarettes
per capita in 2000. 8-9
• From 1991 to 1999, current cigarette smoking among
US high school students increased significantly from
28% in 1991 to 35% in 1999. However, a recent study
suggests this increasing trend may have leveled or
possibly begun to decline.10
• In 1997, nearly one-half (48%) of male students and
more than one-third (36%) of female students
reported using some form of tobacco — cigarettes,
cigars, or smokeless tobacco — in the past month.
The percentages for male students declined slightly to
44% and remained nearly the same (37%) for female
students in 1999. A12
Profile of Smokers
Over 80% of adult smokers surveyed in 1991 had begun
smoking by age 18. In addition, 35% had become daily
smokers by age 18.13 Among adults in 1999, national
data showed:14
• An estimated 47 million US adults were current
smokers.
• Men were more likely to smoke (26%) than women
(22%).
• Cigarette smoking was highest among American
Indians and Alaska Natives (41%) and lowest among
Asians and Pacific Islanders (15%).
• Adults who earned a General Education Development
Diploma (44%) and high school dropouts (38%) have
high percentages of cigarette smoking.
Among US high school students in 1999, national data
showed:12
• One quarter (25%) of high school students smoked a
whole cigarette before age 13.
• More than one-third (35%) of high school students
were current cigarette smokers (smoked at least one
cigarette in the past month); white (39%) and
Hispanic (33%) students were more likely to smoke
cigarettes currently than black (20%) students.
• Seventeen percent of high school students smoked
cigarettes on at least 20 of the 30 days preceding the
survey; white (20%) students were more likely to
smoke cigarettes frequently than Hispanic (10%) and
black (7%) students.
Smokeless Tobacco
In 1986, the US Surgeon General concluded that the use
of smokeless tobacco is not a safe substitute for smoking
cigarettes or cigars, as these products cause various
Cancer Facts & Figures 2002 29
cancers and non-cancerous oral conditions, and can
lead to nicotine addiction.15
• Oral cancer occurs several times more frequently
among snuff dippers compared with non-tobacco
users.15
• The risk of cancer of the cheek and gums may increase
nearly 50-fold among long-term snuff users.15
• According to the US Department of Agriculture, US
output of moist snuff has risen over 40% in the past
decade from 46 million pounds in 1989 to an estimated
66 million pounds in 1999A16
• Nationwide, 14% of US male high school students were
currently using chewing tobacco or snuff in 1999. In
1999, white male students (19%) were more likely to
use smokeless tobacco than Hispanic (6%) and black
(3%) male students.12
• Among adults aged 18 and older, national data showed
6% of men and 1% of women were current users of
chewing tobacco or snuff. Among men, American
Indian and Alaska Natives (8%) and whites (7%) were
more likely to use smokeless tobacco than blacks (3%),
Hispanics (2%), and Asian and Pacific Islanders (1%).5
Cigars
The consumption of large cigars and cigarillos has been
increasing since 1993. An estimated 3.7 billion large
cigars and cigarillos were expected to be consumed in
2000. Small cigar production increased from 1.5 billion
pounds in 1997 to an estimated 2.6 billion pounds in
2000.9
• In 1998, the median percentage of adults aged 18 years
and older who have smoked cigars in the past month
was 5%. More men than women smoked cigars in the
past month in all 50 states.12
• Nationwide, 18% of US high school students (Grades 9
to 12) had smoked cigars, cigarillos, or little cigars on
at least one of the past 30 days. Male students (25%)
were more likely than female students (10%) to smoke
cigars currently. White male students (28%) were
significantly more likely than black male students
(16%) to report current cigar use.12
• Nationwide, 6% of US middle school students (Grades
6 to 8) had smoked cigars on at least one of the past 30
days; male students (8%) were more likely than female
students (4%) to smoke cigars currently.18
Beginning in 2001, seven major cigar manufacturers will
provide five health warnings, which will rotate on labels
on cigars sold in the US. The companies agreed to the
warnings in June 2000 to settle a lawsuit brought by the
Federal Trade Commission for failure to warn consumers
of the dangers of cigar smoking. Cigar smoking
has health consequences and hazards similar to those of
cigarettes and smokeless tobacco such as:19
• Cancer of the lung, oral cavity, larynx, and esophagus
with risk of dying 2 to 10 times higher in smokers
compared with nonsmokers.
• Cancer of the pancreas (probably).
Smoking Cessation
In 1990, the US Surgeon General outlined the benefits of
smoking cessation:20
• People who quit, regardless of age, live longer than
people who continue to smoke.
• Smokers who quit before age 50 halve their risk of
dying in the next 15 years compared with those who
continue to smoke.
• Quitting smoking substantially decreases the risk of
lung, laryngeal, esophageal, oral, pancreatic, bladder,
and cervical cancers.
• Quitting lowers the risk for other major diseases
including coronary heart disease and cardiovascular
disease.
Among adults 18 and older in 1999, national data
showed:14
• About 41% of current smokers had stopped smoking
for at least one day during the preceding 12 months
because they were trying to quit.
• About 23% of US adults (approximately 46 million
adults: 26 million men and 20 million women) were
former smokers.
Among adolescent smokers aged 12 to 19 years in 1989,'
approximately 16% had successfully quit smoking for 30
days in 1993.21 In this study, successful quit attempts did
not vary by age, gender, or ethnicity. Predictors of successful
quitting among adolescents include less frequent
smoking, longer past quit attempts, personal beliefs
about future smoking patterns, mother’s smoking
status, and lower depression score.21
A recent US Surgeon General’s report on reducing
tobacco use outlines the components of comprehensive
tobacco control. Health education combined with social,
economic, and regulatory approaches is essential to
counterbalance the tobacco industry’s advertising and
promotion and to foster non-smoking environments.22
30 Cancer Facts & Figures 2002
Secondhand Smoke
Secondhand smoke, or environmental tobacco smoke
(ETS), contains numerous human carcinogens for which
there is no safe level of exposure. Scientific consensus
groups have repeatedly reviewed the data on ETS. These
include the US Environmental Protection Agency,23
California Environmental Protection Agency,24 and the
National Institute of Environmental Sciences’ National
Toxicology Program.25 Public policies to protect people
from secondhand smoke are based on the following
detrimental effects of ETS:
• Each year, about 3,000 nonsmoking adults die of lung
cancer as a result of breathing secondhand smoke.23
• ETS causes an estimated 35,000 to 40,000 deaths from
heart disease in people who are not current smokers.26
• ETS causes coughing, phlegm, chest discomfort, and
reduced lung function in nonsmokers.23
• Each year, exposure to secondhand smoke causes
150,000 to 300,000 lower respiratory tract infections
(such as pneumonia and bronchitis) in US infants and
children younger than 18 months of age. These infections
result in 7,500 to 15,000 hospitalizations every
year.23
• Secondhand smoke increases the number of asthma
attacks and the severity of asthma in about 200,000 to
1 million asthmatic children.23
• Secondhand smoke contains over 4,000 substances,
more than 40 of which are known or suspected to
cause cancer in humans and animals and many of
which are strong irritants.23
Worldwide Tobacco Use
While smoking rates are slowly declining in the United
States and most other high-income countries, they have
been steadily growing in developing nations. According
to the World Health Organization:27
• Based on current smoking patterns, smoking eventually
will kill about 500 million people alive in the world
today.
• Tobacco-caused deaths are expected to increase from
about 4 million per year today to about 10 million per
year by the 2030s, with 70% of those deaths occurring
in developing nations. This is a higher death toll than
is expected from malaria, maternal and major childhood
conditions, and tuberculosis combined.
• Smoking rates are increasing in developing nations at
a rate of about 3.4% per year.
• Prevalence rates among men in developing countries
are about 48%; rates among women are substantially
lower, but increasing.
• The estimated 1.2 billion smokers in the world today
consume an average 14 cigarettes per day.
Costs of Tobacco
Tobacco costs to our society are best measured by the
number of people who die or suffer illness each year
because of its use. Annual medical costs of smoking
constitute 6% to 8% of American personal health
expenses, but may be as high as 12%.28 One study
showed direct health care expenditures caused directly
by smoking totaled $50 billion, and 43% of these costs
were paid by government funds, including Medicaid and
Medicare in 1993.29 These estimates of medical and
other costs from tobacco may be low since costs associated
with diseases caused by environmental tobacco
smoke, burns from tobacco-related fires, or perinatal
care for low-birthweight infants of mothers who smoke
and indirect costs, such as work loss, bed-disability days,
and loss in productivity, were not included.29 As a result,
the total economic burden of cigarette smoking may be
more than $100 billion.29 A recent study showed total US
medical expenditures attributable to smoking maybe as
high as an estimated $54 billion in 1993 with $12 billion
in ambulatory care, $3 billion in prescription drugs, $16
billion in hospital care, $15 billion in nursing homes,
which translates to $279 in health care costs per adult.30
The impact of cigarette smoking on state Medicaid and
Medicare budgets varies among states, ranging from
$1.9 billion in New York to $11.4 million in Wyoming for
Medicaid and $1.5 billion in California to $8 million in
Alaska for Medicare.31-32
References
1. Peto R, Lopez AD, Boreham J, Thun M, Heath C, Jr. Mortality
from Smoking in Developed Countries 1950-2000. New York:
Oxford University Press; 1994.
2. McGinnis JM, Foege WH. Actual causes of death in the United
States. JAMA. 1993;270:2207-12.
3. Centers for Disease Control and Prevention. Cigarette smoking-
attributable mortality and years of potential life lost—
United States, 1984. Morb Mortal WklyRep. 1997;46:444-450.
4. US Department of Health and Human Services. Reducing the
Health Consequences of Smoking: 25 Years of Progress. A Report
of the Surgeon General Atlanta, GA: US Department of Health
and Human Services, Public Health Service, Centers for Disease
Control and Prevention, Center for Chronic Disease Prevention
and Health Promotion, Office on Smoking and Health; 1989.
Cancer Facts & Figures 2002 31
5. National Center for Health Statistics. Health, United States,
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6. US Department of Health and Human Services. Tobacco Use
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Pacific Islanders, and Hispanics: A Report of the Surgeon
General Atlanta, GA: US Department of Health and Human
Services, Centers for Disease Control and Prevention, National
Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health; 1998.
7. US Department of Health and Human Services. Women and
Smoking: A Report of the Surgeon General. Atlanta, GA: US
Department of Health and Human Services, Centers for Disease
Control and Prevention, National Center for Chronic Disease
Prevention and Health Promotion, Office of Smoking and
Health; 2001.
8. Giovinio GA, Schooley MW, Zhu B-P, Chrismon JH, Tomar SL,
Peddicord JP, et al. Surveillance for Selected Tobacco-Use
BehaviorsK United States, 1900-1994. Morb Mortal Wkly Rep
CDC Surveill Summ. 1994;43(SS-3).
9. US Department of Agriculture. Tobacco Situation and
Outlook Report. Washington, DC: US Department of
Agriculture, Market and Trade Economics Division, Economic
Research Service; 2001.
10. Centers for Disease Control and Prevention. Trends in
Cigarette Smoking Among High School Students —United
States, 1991-1999. Morb Mortal WklyRep. 2000;49:755-758.
11. Centers for Disease Control and Prevention. Tobacco use
among high school students—United States, 1997. Morb Mortal
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12. Centers for Disease Control and Prevention. Youth Risk
Behavior Surveillance—United States, 1999. Morb Mortal Wkly
Rep CDC Surveill Summ. 2000;49(SS-5).
13. US Department of Health and Human Services. Preventing
Tobacco Use Among Young People: A Report of the Surgeon
General Atlanta, GA: U.S. Department of Health and Human
Services, Public Health Service, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health; 1994.
14. Centers for Disease Control and Prevention. Cigarette
Smoking Among Adults — United States, 1999. Morb Mortal
Wkly Rep. 2001;50:869-873.
15. US Department of Health and Human Services. The Health
Consequences of Using Smokeless Tobacco: A Report of the Advisory
Committee to the Surgeon General. Atlanta, GA: US Department
of Health and Human Services, Public Health Services,
National Institutes of Health, National Cancer Institute; 1986.
16. US Department of Agriculture. Tobacco Situation and
Outlook Report. Washington, DC: US Department of
Agriculture, Market and Trade Economics Division, Economic
Research Service; 1999.
17. Centers for Disease Control and Prevention. State-Specific
Prevalence of Current Cigarette and Cigar Smoking Among
Adults —United States, 1998. Morb Mortal Wkly Rep.
1999;48:1034-1039.
18. Centers for Disease Control and Prevention. Tobacco Use
Among Middle and High School Students — United States, 1999.
Morb Mortal Wkly Rep. 2000;49:49-53.
19. Shanks TG, Burns DM. Disease Consequences of Cigar
Smoking. In: Burns D, Cummings KM, Hoffman D, editors.
Cigars: Health Effects and Trends, Monograph No. 9. Bethesda,
MD: US Department of Health and Human Services, National
Institutes of Health, National Cancer Institute; 1998.
20. US Department of Health and Human Services. The Health
Benefits of Smoking Cessation. Atlanta, GA: US Department of
Health and Human Services, Public Health Service, Centers for
Disease Control and Prevention, Center for Chronic Disease
Prevention and Health Promotion, Office on Smoking and
Health; 1990.
21. Zhu SH, Sun J, Billings SC, Choi WS, Malarcher A. Predictors
of Smoking Cessation in US Adolescents. Am J Prev Med.
1999;16:202-207.
22. US Department of Health and Human Services. Reducing
Tobacco Use: A Report of the Surgeon General Atlanta, GA: US
Department of Health and Human Services, Public Health
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Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health; 2000.
23. US Environmental Protection Agency. Respiratory Health
Effects of Passive Smoking: Lung Cancer and Other Disorders.
Washington DC: US Environmental Protection Agency; 1992.
(Report# EPA/600/6-90/006F)
24. California Environmental Protection Agency, Office of
Environmental Health Hazard Assessment Health Effects of
Exposure to Environmental Tobacco Smoke: Final Report. Sacramento,
CA: California Environmental Protection Agency; 1997.
25. National Institute of Environmental Sciences, National
Toxicology Program. 9th Report on Carcinogens. Research
Triangle Institute, NC: National Institute of Environmental
Sciences; 2000.
26. Steenland K. Passive smoking and the risk of heart disease.
JAMA. 1992;267:94-9.
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Making a Difference. Geneva, Switzerland: World Health
Organization; 1999.
28. Warner KE, Hodgson TA, Carroll CE. Medical costs of smoking
in the United States: estimates, their validity, and their
implications. Tobacco Control 1999;8:290-300.
29. Bartlett JC, Miller LS, Rice DP, Wax WB. Centers for Disease
Control and Prevention. Medical-care expenditures attributable
to cigarette smoking—United States, 1993. Morb Mortal Wkly
Rep. 1994;44:469-472.
30. Miller VP, Ernst C, Collin F. Smoking-attributable medical
care costs in the USA. Soc Sci Med. 1999;48:375-391.
31. Miller LS, Zhang X, Novotny T, Rice DP, Max W. State estimates
of Medicaid expenditures attributable to cigarette smoking,
fiscal year 1993. Public Health Rep. 1998;113:140-151.
32. Zhang X, Miller LS, Max W, Rice DP. Costs of smoking to the
Medicare program, 1993. Health Care Fin Rev. 1999;20:179-196.
32 Cancer Facts & Figures 2002
Recommendations for
individual Choices
1. Eat a variety of healthful foods, with an
Scientific evidence suggests that about one-third of the
cancer deaths that occur in the US each year are due to
nutrition and physical activity factors, including obesity.
For the majority of Americans who do not use tobacco,
dietary choices and physical activity are the most important
modifiable determinants of cancer risk.
Evidence also indicates that although inherited genes
do influence cancer risk, heredity alone explains only a
fraction of all cancers. The majority of the variation in
cancer risk among populations and among individuals
is due to factors that are not inherited; behavioral factors
such as cigarette smoking, certain dietary patterns, and
physical activity can substantially affect one’s risk of
developing cancer. These factors modify the risk of
cancer at all stages of its development. The introduction
of a healthy diet and regular physical activity at any time
from childhood to old age can promote health and
impact cancer risk.
Based on its review of the scientific evidence, the
American Cancer Society updated its nutrition and
physical activity guidelines in 2001. Changes from the
Society’s 1996 guidelines include increased emphasis on
the role of physical activity and weight control in reducing
cancer risk. Because healthful individual behaviors
are most likely to occur when there is social and
environmental support in communities, these 2001
guidelines include, for the first time, an explicit
Recommendation for Community Action to facilitate
healthful food choices and opportunities for physical
activity in schools, worksites, and communities.
The Society’s recommendations are consistent in principle
with the 2000 Dietary Guidelines for Americans, and
recommendations of other agencies for general health
promotion and for the prevention of coronary heart
disease, diabetes, and other diet-related chronic conditions.
Although no diet can guarantee full protection
against any disease, the Society believes that the following
recommendations offer the best nutrition and physical
activity information currently available to help
Americans reduce their risk of cancer.
emphasis on plant sources.
• Eat five or more servings of vegetables and fruit each
day.
• Choose whole grains in preference to processed
(refined) grains and sugar.
• Limit consumption of red meats, especially high fat
and processed meats.
• Choose foods that help maintain a healthful weight.
There is strong scientific evidence that healthful dietary
patterns, in combination with regular physical activity,
are needed to maintain a healthful body weight and to
reduce cancer risk. Many epidemiologic studies have
shown that populations that eat a diet high in vegetables
and fruit and low in animal fat, meat, and/or calories
have reduced risk of some of the most common cancers.
The scientific study of nutrition and cancer is highly
complex, and many important questions remain unanswered.
It is not presently clear how single nutrients,
combinations of nutrients, overnutrition and energy
imbalance, or the amount and distribution of body fat at
particular stages of life affect one’s risk of specific
cancers. Until more is known about the specific components
of diet that influence cancer risk, the best advice
is to emphasize whole foods and the consumption of a
mostly plant-based diet.
2. Adopt a physically active lifestyle.
e Adults: Engage in at least moderate activity for 30
minutes Or more on 5 or more days of the week;
45 minutes or more of moderate to vigorous activity
on 5 or more days per week may further enhance
reductions in the risk of breast and colon cancer.
• Children and adolescents: Engage in at least 60 minutes
per day of moderate-to-vigorous physical activity
at least 5 days per week.
Scientific evidence indicates that physical activity may
reduce the risk of certain cancers as well as provide
other important health benefits. Regular physical activity
contributes to the maintenance of a healthy body
weight by balancing caloric intake with energy expenditure.
Other mechanisms by which physical activity may
help to prevent certain cancers may involve both direct
Cancer Facts & Figures 2002 33
and indirect effects. For colon cancer, physical activity accelerates the movement of food through the intestine, thereby reducing the length of time that the bowel lining is exposed to potential carcinogens. For breast cancer, vigorous physical activity may decrease the exposure of breast tissue to circulating estrogen. Physical activity may also affect cancers of the colon, breast, and other sites by improving energy metabolism and reducing circulating concentrations of insulin and related growth factors. Physical activity helps to prevent Type II diabetes, which is associated with increased risk of cancers of the colon, pancreas, and possibly other sites. The benefits of physical activity go far beyond reducing the risk of cancer. They include prevention of heart disease, high blood pressure, diabetes, falls, osteoporosis, stress, and depression.3. Maintain a healthful weight throughout life.• Balance caloric intake with physical activity.® Lose weight if currently overweight or obese.Overweight and obesity are associated with increased risk for cancers at several sites: breast (among postmenopausal women, and especially those who gain weight through adulthood), colon, endometrium, adenocarcinoma of the esophagus, and kidney. The best way to achieve a healthful body weight is to balance energy intake (food intake) with energy expended (physical activity). Excess body fat can be reduced by restricting caloric intake and increasing physical activity. Caloric intake can be reduced by decreasing the sizes of food portions and limiting the intake of calorie-dense foods (e.g., those high in fat and refined sugars such as fried foods, cookies, cakes, candy, ice cream, and soft drinks). Such foods should be replaced with more healthful vegetables and fruit, whole grains, and beans. Because overweight in youth tends to continue throughout life, the increasing prevalence of overweight and obesity in pre-adolescents and adolescents may increase incidence of cancer in the future. For these reasons, efforts to establish a healthful weight and healthful patterns of weight gain should begin in childhood.4. If you drink alcoholic beverages, limit consumption.People who drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women. Alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. For each of these cancers, risk increases substantially with intake of more than 2 drinks per day. Alcohol consumption combined with tobacco increases the risk of cancers of the mouth, larynx, and esophagus far more than the independent effect of either drinking or smoking. Regular consumption of even a few drinks per week has been associated with an increased risk of breast cancer in women. The mechanism for an effect of alcohol on breast cancer is not known with certainty, but may be due to alcohol-induced increases in circulating estrogens or other hormones in the blood, reduction of folic acid levels, or to a direct effect of alcohol or its metabolites on breast tissue.Some groups of people should not drink alcoholic beverages at all. These include children and adolescents; individuals of any age who can not restrict their drinking to moderate levels; women who are or may become pregnant; individuals who plan to drive or operate machinery or who take part in other activities that require attention, skill, or coordination; and individuals taking prescriptions or over-the-counter medications that can interact with alcohol.ACS Recommendation' forCommunity ActionPublic, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors.• Increase access to healthful foods in schools, worksites, and communities.* Provide safe, enjoyable, and accessible environments for physical activity in schools, and for transportation and recreation in communities.The American Cancer Society guidelines relate to individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or interferes with healthy behaviors. Therefore, this key recommendation for community action accompanies the four guidelines for individual choices for nutrition and physical activity to reduce cancer risk. This recommendation for community action underscores the importance of community measures to support healthy behaviors by increasing access to healthful food choices and opportunities to be physically active.34 Cancer Facts & Figures 2002
Environmental factors, defined broadly to include smoking, diet, and infectious diseases as well as. chemicals and radiation, cause an estimated three-quarters of all cancer deaths in the United States. Among these factors, tobacco use, unhealthy diet, and physical inactivity have a greater affect on individual cancer risk than do trace levels of pollutants in food, drinking water, and air. However, the degree of risk from pollutants depends on the concentration, intensity, and duration of exposure. Substantial increases in risk have been shown in settings where workers have been exposed to high concentrations of ionizing radiation, certain chemicals, metals, and other substances, as well as among radiation victims, and patients treated with drugs or therapies later found to be carcinogenic.Even low-dose exposures that pose only small risk to individuals can still cause substantial ill health across an entire population if the exposures are widespread. For example, secondhand tobacco smoke increases risk in large numbers of people who do not smoke but are exposed to others’ smoke. Strong regulatory control and attention to safe occupational practices, drug testing, and consumer product safety play an important role in reducing risk of cancer from environmental exposures. Additional information on environmental factors associated with cancer risks can be found at several Web sites, including www.atsdr.cdc.gov,www.epa.gov, www.niehs.nih.gov,www.osha.gov, and www.who.int.Risk AssessmentThe risk assessment process evaluates both the cancercausing potential of a substance as well as the levels of the substance in the environment and the extent to which people are actually exposed. However, the process is not perfect. For most potential carcinogens, data are only available from high-dose experiments in animals or highly exposed occupational groups. To use such information to set human safety standards, regulators must extrapolate from animals to humans and from high- dose to low-dose conditions. Because both extrapolations involve much uncertainty, as does the effect of mixtures of chemicals and of especially susceptible subgroups of the population, risk assessment generally makes conservative assumptions to err on the side of safety. For cancer safety standards, acceptable risks are usually limited to those that increase risk by no more than one case per million persons over a lifetime.Safety standards developed in this way for chemical or radiation exposures are the basis for federal regulatory activities at the Food and Drug Administration, the Environmental Protection Agency, and the Occupational Safety and Health Administration. The application of laws and procedures by which standards are implemented and risks are controlled is called risk management.ChemicalsVarious chemicals (for example, benzene, asbestos, vinyl chloride, arsenic, aflatoxin) show definite evidence of causing cancer in humans; others are considered probable human carcinogens based on evidence from animal experiments (for example, chloroform, dichloro- diphenyl-trichloroethane [DDT], formaldehyde, polychlorinated biphenyls [PCBs], polycyclic aromatic hydrocarbons). Often in the past, direct evidence of human carcinogenicity has come from studies of workplace conditions involving sustained, high-dose exposures. For some exposures (asbestos and radon), the risks are greatly increased when combined with tobacco smoking.RadiationThe only types of radiation proven to cause human cancer are high-frequency ionizing radiation (IR) and ultraviolet (UV) radiation. Exposure to sunlight (UV radiation) causes almost all cases of basal and squamous cell skin cancer and is a major cause of skin melanoma. Disruption of the earth’s ozone layer by pollution (the “ozone hole”) may cause rising levels of UV radiation.Evidence that high-dose IR (x-rays, radon, etc.) causes cancer comes from studies of atomic bomb survivors, patients receiving radiotherapy, and certain occupational groups, Such as uranium miners. Virtually any part of the body can be affected by IR, but especially bone marrow and the thyroid gland. Diagnostic medical and dental x-rays are set at the lowest dose levels possible to minimize risk without losing image quality and medical usefulness. Radon exposures in homes can increase lung cancer risk, and cigarette smoking greatly increases the effect of radon exposure in lung cancer risk. Fortunately, there are tests which can be used to detect high levels of radon. Remedial actions may be needed if radon levels are too high.Unproven RisksPublic concern about cancer risks in the environment often focuses on unproven risks or on situations in which known carcinogen exposures are at such low levels that risks are negligible, for example:Cancer Facts & Figures 2002 35
Pesticides. Many kinds of pesticides (insecticides, herbicides, etc.) are widely used in agriculture in the production of the food supply. High doses of some of these chemicals have been shown to cause cancer in animals, but the very low concentrations found in some foods have not been associated with increased cancer risk. In fact, people who eat more fruits and vegetables, which may be contaminated with trace amount of pesticides, generally have lower cancer risks than people who eat few fruits and vegetables. Workers exposed to higher levels of pesticides, in industry or farming, may be at higher risk of certain cancers. Environmental pollution by pesticides such as DDT, which is now banned but was used in agriculture in the past, degrade slowly and can lead to accumulation in body fat. These residues have been suggested as a possible risk factor for breast cancer, although study results have been largely negative.Continued research regarding pesticide use is essential for maximum food safety, improved food production through alternative pest control methods, and reduced pollution of the environment. In the meantime, pesticides play a major role in sustaining our food supply. When properly controlled, the minimal risks they pose are greatly overshadowed by the health benefits of a diverse diet rich in foods from plant sources.Non-ionizing radiation. Electromagnetic radiation at frequencies below ionizing and ultraviolet levels has not been proven to cause cancer. Some studies suggest an association with cancer, but most of the now-extensive research in this area does not. Low-frequency radiation includes radiowaves, microwaves, and radar, as well as power frequency radiation arising from the electric and magnetic fields associated with electric currents, cellular phones, and household appliances.Toxic wastes. Toxic wastes in dump sites can threaten human health through air, water, and soil pollution. Many toxic chemicals contained in such wastes can be carcinogenic at high doses, but most community exposures appear to involve very low or negligible dose levels. Clean-up of existing dump sites and close control of toxic materials in the future are essential to ensure healthy living conditions.Nuclear power plants. Ionizing radiation emissions from nuclear facilities are closely controlled and involve negligible levels of exposure for communities near the plants. Reports about cancer case clusters in such communities have raised public concern, but studies show that clusters do not occur more often near nuclear plants than they do by chance elsewhere.In 1913, ten physicians and five laymen founded the American Society for the Control of Cancer. Its stated purpose was to disseminate knowledge about the symptoms, treatment, and prevention of cancer; to investigate conditions under which cancer was found; and to compile statistics about cancer. Later renamed the American Cancer Society, Inc., the organization now includes more than three million friends and volunteers working to conquer cancer.Organization: The American Cancer Society, Inc., consists of a National Society with 17 chartered Divisions throughout the country, and a local presence in most communities.The National Society: A National Assembly provides basic representation from the Divisions and additional representation on the basis of population. The Assembly elects a volunteer Board of Directors, which sets strategic goals for the Society, ensures management accountability, and provides stewardship of donated funds. The National Society is responsible for overall planning and coordination of the Society’s programs for cancer information delivery, cancer control and prevention, advocacy, and resource development. The National Society also provides technical help and materials for Divisions and local offices and administers its research program.The Divisions: These are governed by Division Boards of Directors comprised of both medical and lay volunteers throughout the US and Puerto Rico. The Society’s 17 Divisions are responsible for program delivery in then- regions.36 Cancer Facts & Figures 2002
Local offices: Local offices are organized to deliver cancer control programs at the community level. Descriptions of some of the Society’s major programs follow.Advocacy and Public PolicyCancer is a political, as well as a medical, social, psychological, and economic issue. Every day legislators make decisions that impact the lives of millions of Americans who have been touched by cancer. To affect those decisions positively, the Society has identified advocacy as part of its mission and as one of its top corporate priorities and works nationwide to promote beneficial policies, laws, and regulations for those affected by cancer.Advocacy prioritiesCancer is a personal, tangible, and powerful issue for millions of Americans. They want our political leaders to implement public policies that will combat this disease and improve the lives of cancer patients, survivors, and families. For this reason, the American Cancer Society is dedicated to working with policymakers to enact laws and policies that will advance our fight against cancer. Together with its research, education, prevention, and cancer control initiatives, the Society strives to advocate for and strengthen our nation’s laws and regulations in a way that will:• Increase investments for cancer research, prevention, early detection, and care;• Increase access to quality cancer care, screening, prevention, and awareness efforts;• Reduce health disparities among minorities and the medically underserved; and,• Reduce and prevent suffering from tobacco-related illness.The American Cancer Society has identified areas where federal, state, and local government leaders can allocate additional resources to help reduce the number of individuals being diagnosed with and dying from cancer. These steps begin with cancer research, prevention, early detection, treatment, and care. Additional investments in research are needed to answer the public’s call to propel today’s knowledge toward the next level of cancer breakthroughs. Ry increasing the resources we dedicate to cancer research, our scientific knowledge will advance and we can increase our nation’s capacity to prevent this disease. Complementing this, policymakers should also fund efforts to apply research findings so that what is learned at the laboratory bench reaches the bedside. Urging legislative bodies to fund these efforts moves everyone that much closer to our ultimate goal—to defeat cancer.The American Cancer Society also calls on policymakers to increase access to quality cancer care, screening, prevention, and awareness programs. Results from a January 2001 poll by the Henry J. Kaiser Family Foundation indicate that Americans understand the importance of these efforts and want their public leaders to increase access to health care for the uninsured and provide more public health programs to prevent disease. Local, state, and federal government leaders must act to help remove administrative, financial, and other barriers that impede access to important cancer fighting tools-such as cancer screenings and clinical trials. In addition, the Society seeks to limit the negative impact the illness or its treatment can have on a patient’s physical, psychological, and social state, including efforts to protect quality of life and ensure a patient’s life is not overcome by pain. As part of meeting this critical goal, the Society supports and encourages national, state, and local efforts to prevent and ameliorate pain and suffering in people with cancer and to improve their quality of life.Reducing health disparities among minorities and the medically underserved remains a major priority for the American Cancer Society. Individuals who are poor, have no health insurance, have lower levels of education, or are members of racial or ethnic minority groups are more likely to develop and die of cancer than members of other groups. We cannot begin to reduce overall cancer incidence and mortality until we make substantial inroads into improving access to cancer care for these groups. Creative interventions are needed to overcome the numerous barriers — including socioeconomic, cultural, linguistic, geographic—to care that threaten our ability to effectively reach and serve these populations. Policymakers at the local, state, and federal levels must provide adequate resources for culturally competent programs that work to reduce and eliminate the unequal burden of cancer, remove barriers that impede access to cancer care and prevention, and improve general access to health care for those communities at greatest risk for cancer.The American Cancer Society is firmly committed to reducing and preventing suffering from tobacco-related illness. The Society will continue our efforts to hold the tobacco industry accountable for its actions and to press for policies that will reduce the enormous cancer burden tobacco use causes. Policymakers at all levels of government can take steps to help smokers while alsoCancer Facts & Figures 2002 37
reaching out to our children so they never start. A comprehensive
approach, in which a number of anti-tobacco
efforts work simultaneously, is proving to be the most
effective way to bring smoking rates down. First and
foremost, the Society believes the FDA must have strong
oversight of the tobacco industry. The Society is also
urging lawmakers to adopt public policies that can help
smokers quit by offering, Medicare, Medicaid, and
Maternal and Child Health coverage for smoking cessation
programs. Properly implemented cessation programs
will save substantial numbers of lives and dollars
by reducing the burden of smoking-related illnesses. In
addition, the Society supports efforts to increase the
federal tobacco tax. Increasing taxes on tobacco products
is a proven means of reducing consumption.
Finally, the Society supports increased funding for effective
local, state, and federal tobacco control programs.
Our society is filled with a steady stream of tobacco
industry advertising and promotional efforts touting
tobacco as glamorous, socially acceptable, and normal.
A successful anti-tobacco campaign must have the
breadth and the funding available to counter the industry’s
messages and change the image of smoking as an
accepted social norm.
Advocacy successes
American Cancer Society advocacy initiatives rely on
the combined efforts of a community-based grassroots
network of Society volunteers, health care professionals,
cancer survivors, and other partners. In the past year,
the American Cancer Society-through its local, state,
and federal efforts-has successfully influenced or supported
policies, laws, and regulations to:
* Increase investments in cancer research at the
National Institutes of Health (NIH) and the National
Cancer Institute (NCI), including maintaining the
critical effort now underway to fulfill Congress’s
pledge to double NIH funding by 2003 and fully fund
the NCI Director’s bypass budget;
* Improve our ability to apply the knowledge gained
from research by increasing funding for critical,
cancer-related programs provided through the
Centers for Disease Control and Prevention (CDC),
including tripling the funding for the CDC’s colorectal
cancer awareness program and securing the first-ever
significant increase for the cancer registries program;
* Ensure access to clinical trials through Medicare and
private health insurance at the state level;
• Advance state and federal legislation that eliminates
barriers to effective cancer screening tests, including
extending Medicare coverage of colonoscopy benefits
to average-risk beneficiaries;
• Guarantee the inclusion of strong patient protections
and access to clinical trials in the versions of the
Patients’ Bill of Rights passed by the House and the
Senate;
• Support and expand local, state, and federal programs
that increase awareness and prevention of cancer,
including securing the enactment of the Breast and
Cervical Cancer Treatment Act, prompting states to
participate fully in order to ensure underserved
women receive treatment upon diagnosis;
• Ensure resources for culturally effective programs that
address the unequal burden of cancer and improve
access to cancer prevention, early detection, and
treatment for medically underserved communities,
including securing enactment of legislation to create a
Center for Research on Minority Health and Health
Disparities at NIH;
• Advance state and local measures that reduce tobacco
consumption, ensure minors cannot access tobacco
products, and restrict smoking in public places;
• Secure funding through the state tobacco settlement
agreement for comprehensive tobacco control programs
at the local and state level.
Cancer Information
Providing the public with accurate, up-to-date information
on cancer is a priority for the American Cancer
Society. The Society provides information on all aspects
of cancer through a variety of channels including
printed materials, a toll-free national cancer information
center, and a Web site.
National Cancer Information Center—
1-800-ACS-2345
People facing cancer need clear, reliable information in
order to understand their disease and make informed
decisions about their health. Trained cancer information
specialists are available 24 hours a day, seven days a
week to answer questions about cancer, link callers with
resources in their communities, and provide information
on local events. Cancer information specialists
answer calls in both English and Spanish, and callers
who speak languages other than English and Spanish
can also be assisted through translation services provided.
The National Cancer Information Center includes
38 Cancer Facts & Figures 2002
an email response center staffed by cancer information
specialists who respond to questions and comments
submitted through the Society’s Web site.
American Cancer Society Web Site —
www.cancer.org
The American Cancer Society’s Web site is an important
extension of the Society’s mission to provide lifesaving
information to the public. The user-friendly site
includes an interactive cancer resource center containing
in-depth information on every major cancer type.
Information is also available in Spanish. Through the
Web site, visitors can order American Cancer Society
publications, gain access to daily cancer-related articles,
and find additional online and offline resources. Other
useful sections on the Web site include a directory of
medical resources, links to other sites organized by
cancer type or topic, resources for media representatives,
and information on the Society’s research grants
program, advocacy efforts, and special events.
Publications
The Society publishes a large number of patient education
brochures and pamphlets, consumer and clinical
books, and professional journals for patients, families,
and health care professionals. These include books on
specific cancer types, psychosocial, quality-of-life and
caregiving issues, and prevention; cookbooks; and textbooks
and other specialized cancer-related topics for
health care professionals. Four clinical journals {Cancer,
Cancer Cytopathology, CA-A Cancer Journal for
Clinicians, and Cancer Practice) are also available. For
more information, call 1-800-ACS-2345, or visit our
online bookstore at www.cancer.org.
Community Cancer Control
Community cancer control encompasses activities at
the local, state, regional, or national level, which have a
positive impact on the entire spectrum of prevention,
early detection, effective treatment, survival, and quality
of life related to cancer. Across the country, the Society
seeks to fulfill its mission to save lives and diminish suffering
from cancer through community-based programs
aimed at reducing the risk of cancer, detecting cancer as
early as possible, ensuring proper treatment, and
empowering people facing cancer to cope with the
disease and maintain the highest possible quality of life.
Prevention
Primary cancer prevention means taking the necessary
precautions to prevent the occurrence of cancer in the
first place. The Society’s prevention programs focus primarily
on tobacco control, the relationship between diet
and physical activity and cancer, promoting coordinated
school health, and reducing the risk of skin cancer.
Programs are designed to help adults and children make
health-enhancing decisions and act on them.
The Society has joined other health, education, and
social service agencies to promote comprehensive
school health education and National School Health
Education Standards. Comprehensive school health
education is a planned health education curriculum for
pre-school to Grade 12. The Standards describe for
schools, parents, and communities how to create an
instructional program that will enable students to
become healthy and capable of academic success.
The Society s school health education programs emphasize
the importance of developing good health habits
and can be an integral part of a comprehensive school
health education curriculum.
Specific programs that the Society has developed to
strengthen schools’ ability to teach cancer prevention
include conducting a National School Health
Coordinator Leadership Institute, creation of a series of
social marketing campaigns on the benefits of school
health, and coordinating the development of a Healthy
Kids Network of parents and community members in
support of school health and cancer prevention.
The American Cancer Society works collaboratively
with our national partners to implement comprehensive
tobacco control programs. The Society advocates for
social environmental change at the national, state, and
community levels that prevents youth from starting to
use tobacco and provides support for those who wish to
stop smoking.
Tobacco control efforts include:
• Strong, meaningful FDA regulation of all tobacco
products
• Reducing tobacco advertising and promotion directed
at youth
• Increased funding to support comprehensive tobacco
control programs
• Reducing environmental tobacco smoke exposure
• Support for coordinated school-based education
programs
« Accessible cessation programs for those who wish to
quit
Cancer Facts & Figures 2002 39
• Tobacco tax increases to offset health care costs associated with tobacco use• Support for a global partnership to reduce tobacco- related death and diseaseThe Society promotes its skin protection message through a variety of media and education activities, as well as through the 33 member organizations of the American Cancer Society Skin Protection Federation. This coalition includes nonprofit organizations, government agencies, and corporations that have a combined constituency of over 100 million adults and children. The purpose of the coalition is to accelerate promotion of the American Cancer Society’s guidelines for skin cancer prevention, and to provide a forum for member organizations to share information and strategies that increase awareness about skin protection and encourage more people to adopt skin protection behaviors.With possibly over 60% of cancers preventable and due to lifestyle behaviors like smoking, sun exposure, and poor diet that often begin in childhood, children and youth are an important audience for cancer prevention. The Society, together with the Centers for Disease Control and Prevention (CDC) and a host of other education, health, and social service agencies, has identified schools as a key system for impacting cancer prevention. By strengthening the 15,000 school districts in the US and helping them to deliver strong, coordinated school health programs and effective school health education, the American Cancer Society has the ability to impact over 45 million school children.Detection and TreatmentThe Society also seeks, through the dissemination of its early cancer detection guidelines and its cancer detection and advocacy programs, to ensure that cancer is diagnosed at the earliest possible stage when there is the greatest chance of successful treatment. American Cancer Society guidelines for early cancer detection are reviewed annually to ensure that recommendations to the public and health care providers are based on the most current scientific evidence. Currently, the Society has early detection recommendations for cancers of the breast, cervix, colon and rectum, prostate, and endometrium, and general recommendations for a cancer- related checkup (for more information, see Summary of American Cancer Society Recommendations for the Early Detection of Cancer in Asymptomatic People). The Society works in partnership with many public and private organizations in diverse settings to increase awareness about breast cancer, and the importance of early detection, and to overcome the barriers to regular mammography use.The Society, in partnership with the CDC, is leading a national initiative to increase colorectal cancer screening, which is currently underutilized by adults. In addition to public outreach campaigns and initiatives targeting health care providers, the ACS and CDC have established the National Colorectal Cancer Roundtable, bringing leading government agencies, professional and medical organizations, and advocacy and patient groups together to identify collective strategies and opportunities to increase screening for colorectal cancer. The availability of genetic testing for inherited risk for cancer has raised a complex set of questions about the medical, psychosocial, ethical, legal, policy, and quality- of-life implications about the use of genetic information. The Society is working with other national organizations to address these issues through advocacy and educational initiatives. As the delivery of health care continues to change, the Society is working with partners in all sectors of the health care system to ensure that all individuals are offered a full range of preventive services to enable them to reduce their risk of getting cancer or to find their cancer at an early, treatable stage, and that persons with cancer receive the highest quality care.Patient ServicesThe Society offers a range of practical and emotional support for patients, their families, their caregivers, and their community from the time of diagnosis throughout life.Cancer Survivors Network: The Cancer Survivors Network (CSN) is a new, interactive electronic support service created by and for cancer survivors and their families. In the privacy of their own homes, they can access the free service either by telephone or the Internet 24 hours a day, 7 days a week. Both the telephone and the Web site contain approximately 150 hours of prerecorded personal stories and discussions among survivors or family caregivers. Additionally, the Web community has many interactive features designed to help users find and connect with one another to share experiences and support. Login at www.cancer.org or call toll free 1-877-333-4673 (HOPE).Reach to Recovery: Reach to Recovery is an American Cancer Society program designed to help people cope with their breast cancer experience. This program has40 Cancer Facts & Figures 2002
provided more than 30 years of service, in the fight against breast cancer. Reach to Recovery volunteers are breast cancer survivors who are trained to offer support at various points along the breast cancer continuum: diagnosis; decisionmaking about treatment; dealing with treatment and its side effects; returning to a full, active life; or confronting any long-term effects-includ- ing a possible recurrence of the disease.*‘tlc”: A service offering of the Society, “tic” is a “maga- log” designed to provide needed medical information and special products for women newly diagnosed with breast cancer and breast cancer survivors. The magalog features articles that focus on medical questions specific to breast cancer, and also has a Question & Answer section. “Tic” features a variety of hats, honeys, caps, turbans, hairpieces, swimwear, bras, prostheses, and breast forms. Many products are also appropriate for any woman experiencing treatment-related hair loss. Free copies are available by calling 1-800-850-9445.Look Good...Feel Better: In partnership with the Cosmetic, Toiletry and Fragrance Association Foundation and the National Cosmetology Association, this free program is designed to teach women cancer patients beauty techniques to help restore their appearance and self-image during chemotherapy and radiation treatments.Man to Man: This group program provides information about prostate cancer and related issues for men and their partners in a supportive atmosphere. Some areas offer Side by Side, a group program for the partners of men with prostate cancer, and/or a visitation program in which a trained prostate cancer survivor provides support to a man newly diagnosed with prostate cancer. Children’s Camps: In some areas, the Society sponsors camps for children who have, or have had, cancer. These camps are equipped to handle the special needs of children undergoing treatment.Hope Lodge: Housing is provided in some areas through funds raised specifically to purchase a dwelling to house patients during their treatment; 17 lodges are in operation.I Can Cope: This patient and family cancer education program consists of a series of classes, often held at a local hospital. Doctors, nurses, social workers, and community representatives provide information about cancer diagnosis and treatment, as well as assistance in coping with the challenges of a cancer diagnosis.Pain controlCancer pain management is a serious public health problem and a major priority for the Society. Approximately 50%-70% of people with cancer experience some degree of pain. Less than half of them get adequate relief of their pain; and this negatively impacts their quality of life. Through service, collaboration, education, advocacy, and research, the Society is working aggressively to eliminate barriers to cancer-related pain relief across the survivorship continuum. Tools are being enhanced and expanded that educate the public, patients, families, and health care providers about the availability of treatments that effectively manage most cancer pain.ResearchThe research program consists of three components: extramural grants, intramural epidemiology and surveillance research, and the intramural behavioral research center. As the largest source of private, not-for-profit cancer research funds in the US, the Society dedicated more than $119 million to research and health professional training in 2000, with less than 5% of that amount going toward the operating expenses of the research program. Since 1946, when the Society awarded its first research grants, we have invested more than $2.3 billion in research. The investment has paid rich dividends: the 5-year survival rate has almost tripled since 1946, and the new case rates and death rates from cancer have declined each year since 1990. Indeed, Society-supported researchers have contributed to most of the advances that, for the first time, make the conquest of cancer a feasible goal.Extramural GrantsThe American Cancer Society’s extramural grants program supports the best research at more than 150 of the top US medical schools and universities across a wide range of health care disciplines critically important to the control of cancer. Grant applications solicited through a nationwide competition are subjected to a rigorous external peer review, ensuring that only the best research is funded, wherever it may be. The lion’s share of our research budget is dedicated to funding investigators at the beginning of their research careers, a time when they are less likely to receive funding from the federal government. Strong emphasis is placed on research needs that are unmet by other funding organizations, such as our current targeted research area of cancer in the poor and underserved. The success of theCancer Facts & Figures 2002 41
Society’s research program is exemplified by the fact
that 32 Nobel Prize winners received grant support from
the Society early in their careers.
Epidemiology and Surveillance Research
Intramural epidemiologic research at the Society evaluates
trends in cancer incidence and mortality, cancer
risk factors, and cancer patient care, and studies the
causes and prevention of cancer in large prospective
studies. In addition to Cancer Facts & Figures, the
department provides descriptive cancer statistics in several
other publications including Cancer Statistics,
Breast Cancer Facts & Figures, and Cancer Facts &
Figures for African Americans. Trends and patterns in
cancer risk factors such as tobacco use, nutrition, and
physical activity are presented in Cancer Prevention and
Early Detection Facts & Figures. This publication serves
as a resource for ACS Divisions to assess progress
toward the Society’s goals. For the past four years, the
department has collaborated with the National Cancer
Institute, the Centers for Disease Control and
Prevention, including the National Center for Health
Statistics, and the North American Association of
Central Cancer Registries to produce the annual Report
to the Nation on progress related to cancer prevention
and control in the United States.
The department also analyzes patterns of cancer causation
in large prospective studies. Three such studies
have been undertaken over the past 50 years:
• Hammond-Horn (188,000 men studied from 1952-
1955)
• Cancer Prevention Study I (1 million people studied
from 1959-1972 in 25 states)
• Cancer Prevention Study II (CPS II, a continuing study
of 1.2 million people enrolled in 1982 by 77,000 volunteers
in 50 states)
About 102 scientific publications based on CPS-II have
examined the contribution of lifestyle (smoking, nutrition,
weight, etc.,) family history, illnesses, medications,
and environmental exposures to various cancers.
Mortality follow-up of all CPS II cohort members
remains active. In addition, cancer incidence follow-up
and periodic updating of exposure information occurs
in the CPS II Nutrition Cohort, a subgroup of 184,000
men and women.
In 1998, the CPS II LifeLink Cohort was established to
obtain blood samples from 40,000 to 50,000 surviving
members of the CPS II Nutrition Cohort residing in
urban and suburban areas. These blood samples are
being stored in liquid nitrogen for future epidemiologic
investigations, including the role of nutritional,
hormonal, and genetic factors in the development of
cancer and other diseases. Additional information
about the Cancer Prevention Studies is available at
www.cancer.org, including copies of questionnaires and
publication citations.
Behavioral Research Center
The Center was established in 1995 to conduct original
behavioral and psychosocial cancer research, provide
consultation to other parts of the Society, and facilitate
the transfer of behavioral and psychosocial research and
theory to improve cancer control policies. Among the
ongoing research projects of the Center are:
• A nationwide, longitudinal study of 100,000 adult
cancer survivors to determine the unmet psychosocial
needs of survivors and their significant others, to identify
factors that affect their quality of life, to evaluate
programs intended to meet their needs, and to examine
late effects, including second cancers.
• A cross-sectional study of 30,000 cancer survivors two,
five, and 10 years after initial diagnosis and treatment.
This study will evaluate the psychological needs,
adjustment, and quality of life of longer-term cancer
survivors.
• A study of the knowledge, attitudes, and behaviors of
a managed-care population regarding colorectal
cancer screening.
• A longitudinal study of the use of stage-based smoking
cessation materials implemented in conjunction with
the Society’s Cancer Control Department and the
National Cancer Information Center.
• A study to examine health care professionals’ awareness,
referral patterns, and attitudes toward various
cancer information and support services.
• Data from the health-related quality-of-life surveys
that are conducted by the Department of Health and
Human Services’ Health Care Financing Administration
(HCFA) are being provided to the BRC for
statistical analysis on those cancer survivors who
receive Medicare-managed care.
• A directory of professionals involved in the behavioral,
psychosocial, and policy research aspects of cancer is
being revised. This directory allows users to locate
professionals with a particular expertise or interest.
42 Cancer Facts & Figures 2002
Cancer Deaths. The estimated numbers of US cancer deaths
are calculated by fitting the numbers of cancer deaths for 1979
through 1999 to a statistical model which forecasts the numbers
of deaths that are expected to occur in 2002. The estimated
numbers of cancer deaths for each state are calculated similarly,
using state level data. For both the US and state estimates, data
on the numbers of deaths are obtained from the National Center
for Health Statistics (NCHS) at the Centers for Disease Control
and Prevention.
We discourage the use of our estimates to track year-to-year
changes in cancer deaths because the numbers can vary considerably
from year to year, particularly for less common cancers
and for smaller states. Mortality rates reported by NCHS are
generally more informative statistics to use when tracking
cancer mortality trends.
Mortality Rates. Mortality rates or death rates are defined as
the number of people per 100,000 dying of a disease during a
given year In this publication, mortality rates are based on
counts of cancer deaths compiled by NCHS for 1930 through
1998 and population data from the US Bureau of the Census.
Unless otherwise indicated, death rates in this publication are
age-adjusted to the 1970 US standard population, to allow comparisons
across populations with different age distributions.
New Cancer Cases. The estimated numbers of new US cancer
cases are calculated by estimating the numbers of cancer cases
that occurred each year from 1979 through 1998 and fitting
these estimates to a statistical model which forecasts the numbers
of cases that are expected to occur in 2002. Estimates of the
numbers of cancer cases for 1979 through 1998 are used rather
than actual case counts because case data are not available for
all 50 states. The estimated numbers of cases for 1979 through
1998 are calculated using cancer incidence rates from the
regions of the United States included in the National Cancer
Institutes Surveillance, Epidemiology, and End Results (SEER)
program and population data collected by the US Bureau of the
Census.
State case estimates are calculated by apportioning the total US
Case estimates for 2002 by state, based on the state distribution
of estimated cancer deaths for 2002.
Like the method used to calculate cancer deaths, the methods
used to estimate new US and state cases for the upcoming year
can produce numbers that vary considerably from year to yeai;
particularly for less common cancers and for smaller states. For
this reason, we discourage the use of our estimates to track
year-to-year changes in cancer occurrence. Incidence rates
reported by SEER are generally more informative statistics to
use when tracking cancer incidence trends for the United
States, and rates from state cancer registries are useful for tracking
local trends.
Incidence Rates. Incidence rates are defined as the number
of people per 100,000 who develop disease during a given time
period. For this publication, incidence rates were calculated
using data on cancer cases collected by the SEER program and
population data collected by the US Bureau of the Census. State
incidence rates presented in this publication are published in
the North American Association of Central Cancer Registries’
publication Cancer Incidence in North America, 1994-1998.
Incidence rates for the United States were originally published
in SEER Cancer Statistics Review, 1973-1998. Unless otherwise
indicated, incidence rates in this publication are age-adjusted
to the 1970 US standard population, to allow comparisons
across populations that have different age distributions.
Survival. Five-year relative survival rates are presented in this
report for cancer patients diagnosed between 1992 and 1997,
followed through 1997. Relative survival rates are Used to adjust
for normal life expectancy (and events such as death from heart
disease, accidents, and diseases of old age). These rates are calculated
by dividing observed 5-year survival rates for cancer
patients by 5-year survival rates expected for people in the general
population who are similar to the patient group with
respect to age, gender, race, and calendar year of observation. All
survival statistics presented in this publication were originally
published in SEER Cancer Statistics Review, 1973-1998.
Probability of Developing Cancer. Probabilities of developing
cancer are calculated using DevCan (Probability of Developing
Cancer Software) developed by the National Cancer Institute.
These probabilities reflect the average experience of people in
the United States and do not take into account individual
behaviors and risk factors. For example, the estimate of 1 man
in 13 developing lung cancer in their lifetime is a low estimate
for smokers and a high estimate for nonsmokers.
Additional Information. More information on the methods
used to generate the statistics for this report can be found in the
following publications:
A. For information on data collection methods used by the
National Center for Health Statistics: National Center for Health
Statistics. Vital Statistics of the United States, 2000, Vol II,
Mortality, Part A. Washington: Public Health Service. 2000, or
visit the NCHS Web site at www.cdc.gov/nchs.
B. For information on data collection methods used by the
National Cancer Institute’s Surveillance, Epidemiology and End
Results Program: Ries LAG, Eisner MP, Kosary CL, et al. (eds.).
SEER Cancer Statistic Review, 1973-1998. National Cancer
Institute. Bethesda, MD, 2001 or visit the SEER Web site at
http://seer.cancer.gov.
C. For information on the methods used to estimate the numbers
of new cancer cases and deaths: Wingo PA, Landis S, Parker
S, Bolden S, Heath CW. Using cancer registry and vital statistics
data to estimate the number of new cancer cases and deaths in
the Unites States for the upcoming year J Reg Management
1998;25(2):43-51.
D. For information on the methods used to calculate the
probability of developing cancer: Feuer EJ, Wun L-M, Boring CC
et al. The lifetime risk of developing breast cancer. JNCI 1993;
85:892-897.
Cancer Facts & Figures 2002 43
Age Adjustment to the Year 20'00' StandardEpidemiologists use a statistical method called “age-adjustment” to compare groups of people with different age compositions. For example, without adjusting for age, it would be inaccurate to compare the cancer rates of the state of Florida, which has a large elderly population, to that of Alaska, which has a younger population. This is especially true when examining cancer rates, since cancer is generally a disease of older people. Without adjusting for age, it would appear that the cancer rates for Florida are much higher than Alaska. However, once the ages are adjusted, it appears their rates are similar.Starting with Cancer Facts & Figures 2003, we will use the most recent US census (2000) as the baseline for our ageadjustment. This is a change from previous issues and other statistics we have published. Prior to this, most of our statistics were based on the 1970 census, although some were based on the 1940 census or the 1980 census. This change brings us into alignment with federal agencies that publish statistics. This new standard population will apply to data from calendar year 1999 and forward. The change will also require a recalculation of age-adjusted rates for previous years to allow valid comparisons between current and past years.The purpose of shifting to the Year 2000 Standard is to more accurately reflect contemporary incidence and mortality rates, given the aging of the US population. On average, Americans are living longer because of the decline in infectious and cardiovascular diseases. Our longer life span is allowing us to reach the age where cancer and other chronic diseases become more common. Using the Year 2000 Standard in age-adjustment instead of the 1970 or 1940 standards allows age-adjusted rates to be closer to the actual, unadjusted rate in the population.The impact on a particular cancer of changing to the Year 2000 Standard will vary depending on the ages at which that particular cancer generally occurs. For all cancers combined, average annual age-adjusted incidence rate for 1994-98 will increase approximately 20% when adjusted to the Year 2000 compared to the Year 1970 Standard. For cancers, such as colon cancer, that occur mostly at older age, the Year 2000 Standard will increase incidence by up to 25%, whereas for cancers such as acute lymphocytic leukemia, the new standard will decrease the incidence by about 7%. These changes are caused by the increased representation of older ages (for all cancer and prostate cancer) or by the decreased representation of younger ages (for acute lymphocytic leukemia) in the Year 2000 Standard compared to the Year 1970 Standard.It is important to note that in no case will the actual number of cases/deaths or age-specific rates change; only the age-standardized rates which are weighted to the different age-distribution.44 Cancer Facts & Figures 2002
Chartered Divisions of the
ACS-California Division, Inc.
1710 Webster Street
Oakland, CA 94612
(510) 893-7900 (O)
(510) 835-8656 (F)
ACS-Eastern Division, Inc.
(LI, NJ, NYC, NYS, Queens,
Westchester)
6725 Lyons Street
East Syracuse, NY 13057
(315) 437-7025 (O)
(315) 437-0540 (F)
ACS-Florida Division, Inc.
(including Puerto Rico operations)
3709 West Jetton Avenue
Tampa, FL 33629-5146
(813)253-0541 (0)
(813) 254-5857 (F)
ACS-Puerto Rico
Calle Alverio #577
Esquina Sargento Medina
Hato Rey, PR 00918
(787) 764-2295 (O)
(787) 764-0553 (F)
ACS-Great Lakes Division, Inc.
(MI, IN)
1755 Abbey Road
East Lansing, MI 48823-1907
(517) 332-2222 (O)
(517) 333-4656 (F)
ACS-Heartland Division, Inc.
(KS, MO, NE, OK)
1100 Pennsylvania Avenue
Kansas City, MO 64105
(816) 842-7111 (O)
(816) 842-8828 (F)
ACS-Illinois Division, Inc.
77 East Monroe Street
Chicago, IL 60603-5795
(312) 641-6150 (O)
(312) 641-3533 (F)
American Cancer Society, Inc.
ACS-Mid-Atlantic Division, Inc.
(DC, DE, MD, VA, WV)
8219 Town Center Drive
Baltimore, MD 21236-0026
(410) 931-6850 (0)
(410) 931-6879 (F)
ACS-Mid-South Division, Inc.
(AL, AR, KY, LA, MS, TN)
1100 Ireland Way
Suite 300
Birmingham, AL 35205-7014
(205) 930-8860 (O)
(205) 930-8877 (F)
ACS-Midwest Division, Inc.
(IA, MN, SD, WI)
8364 Hickman Road
Suite D
Des Moines, IA 50325
(515)253-0147 (0)
(515) 253-0806 (F)
ACS-New England Division, Inc.
(CT, ME, MA, NH, RI, VT)
30 Speen Street
Framingham, MA 01701-9376
(508) 270-4600 (0)
(508) 270-4699 (F)
ACS-Northwest Division, Inc.
(AK, MT, OR, WA)
2120 First Avenue North
Seattle, WA 98109-1140
(206) 283-1152 (O)
(206) 285-3469 (F)
ACS-Ohio Division, Inc.
5555 Frantz Road
Dublin, OH 43017
(614) 889-9565 (O)
(614) 889-6578 (F)
ACS-Pennsylvania Division, Inc.
(PA, Phil)
Route 422 and Sipe Avenue
Hershey, PA 17033-0897
(717) 533-6144 (O)
(717) 534-1075 (F)
ACS-Rocky Mountain Division, Inc.
(CO, ID, ND, UT, WY)
2255 South Oneida
Denver, CO 80224
(303) 758-2030 (0)
(303) 758-7006 (F)
ACS-Southeast Division, Inc.
(GA, NC, SC)
2200 Lake Boulevard
Atlanta, GA 30319
(404) 816-7800 (0)
(404) 816-9443 (F)
ACS-Southwest Division, Inc.
(AZ, NM, NV)
2929 East Thomas Road
Phoenix, AZ 85016
(602) 224-0524 (O)
(602) 381-3096 (F)
ACS-Texas Division, Inc.
(including Hawaii Pacific operations)
2433 Ridgepoint Drive
Austin, TX 78754
(512) 919-1800 (O)
(512) 919-1844 (F)
ACS-Hawaii Pacific
2370 Nuuanu Avenue
Honolulu, HI 96817
(808)595-7500 (O)
(808)595-7502 (F)
©2002, American Cancer Society, Inc.02-250M-NO. 5008.021.800.ACS.2345www.cancer.orgHope.Progress. Answers.
CDC - Office of Women's Health - National Women's Health Week - Leading Causes of E... Page 1 of 2
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Health Week
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Health Information Center
All Females by Age Group $*■
Cause of Death Percent*
1. Heart Disease 29.9
2. Cancer 21.8
3. Stroke 8.4
4. Chronic lower respiratory diseases 5.1
5. Diabetes 3.1
6. Influenza and pneumonia 3.0
7. Alzheimer's disease 2.9
8. Unintentional injuries 2.8
9. Kidney disease 1.6
10. Septicemia 1.4
*Percent of total deaths due to the cause indicated.
Some terms in the leading causes of death table have been
shortened from those used in the National Vital Statistics Report.
Below is a listing of the shortened terms used in the table and
their unabridged equivalents used in the report.
Save the Dates!
National Men's
Health Week
June 9-15, 2003
National Health
Observances 2003
Promote a health issue
around one of these
special days, weeks, or
months.
SHORTENED TERMS UNABRIDGED TERMS
Cancer Malignant neoplasms
Diabetes Diabetes mellitus
Heart disease Diseases of heart
Kidney disease Nephritis, nephrotic syndrome and
nephrosis
Stroke Cerebrovascular diseases
Unintentional
injuries
Accidents (unintentional injuries)
U. S Department of HeaHh
and Human Services
http://www.cdc.gov/od/spotlight/nwhw/lcod.htm 3/16/03
Leading Causes of Death by Age Group, All Females, United States - 2000*
Age Group
Rank 1-4 5-9 10-14 15-19 20-24 25-34 35-44 ' 45-54 V. 55-64 65 + 65-74 75-84 \ 85 + / All Ages
XvX*. Unintentional
injuries
33.8%
Unintentional
injuries
40.4%
Unintentional
injuries
342%
Unintentional
injuries
51.7%
Unintentional
injuries
37.9%
Unintentional
injuries
21.6%
Cancer
28.2%
Cancer
39.7%
Cancer
41.6%
Heart disease
33.1%
Cancer
34.5%
Heart disease
30.6%
Heart disease
38.9%
Heart disease
29.9%
2 Congenital
malformation
11.0%
Cancer
15.7%
Cancer
14.0%
Homicide
7.8%
Homicide
10.0%
Cancer
16.4%
Unintentional
injuries
12.2%
Heart disease
15.9%
Heart disease
20.6%
Cancer
19.0%
Heart disease
24.7%
Cancer
22.0%
Stroke
11.1%
Cancer
21,8%
3 Cancer
8.7%
Congenital
malformation
6.6%
Congenital
malformation
6.2%
Cancer
7.7%
Cancer
9.0%
Heart disease
8.2%
Heart disease
12.0%
Unintentional
injuries
5.4%
Chronic
lower
respiratory
diseases
5.3%
Stroke
9.4%
Chronic
lower
respiratory
diseases
7.7%
Stroke
9.2%
Cancer
9.9%
Stroke
8.4%
4 Homicide
7.3%
Homicide
4.5%
Homicide
5.0%
Suicide
7.0%
Suicide
6.9%
Suicide
6.8%
HIV disease
4.5%
Stroke
4.6%
Stroke
4.6%
Chronic
lower
respiratory
diseases
5.5%
Stroke
6.0%
Chronic
lower
respiratory
diseases
6.6%
Alzheimer’s
disease
4.9%
Chronic
lower
respiratory
diseases
5.1%
5 ' Heart disease
3.4%
Heart disease
3.0%
Heart disease
4.1%
Heart disease
4.0%
Heart disease
5.4%
HIV disease
6.6%
Suicide
4.5%
Diabetes
3.6%
Diabetes
4.4%
Alzheimer’s
disease
3.5%
Diabetes
4.4%
Diabetes
3.5%
Influenza and
pneumonia
4.6%
Diabetes
3.1%
6 Influenza and
pneumonia
2.3%
Benign
neoplasms
2.1%
Suicide
3.9%
Congenital
malformation
2.3%
Congenital
malformation
1.9%
Homicide
6.4%
Stroke
4.0%
Chronic liver
disease
2.8%
Unintentional
injuries
2.4%
Influenza and
pneumonia
3.4%
Kidney
disease
1.8%
Alzheimer’s
disease
" 3.1%
Chrome
lower
respiratory
diseases
3.5%
Influenza and
pneumonia
3.0%
7 ” Septicemia
2.1%
Chronic
lower
respiratory
diseases
1.6%
Chronic
lower
respiratory
diseases
2.3%
Influenza and
pneumonia
0.8%
Pregnancy
complications
1.8%
Stroke
2.3%
Chronic liver
disease
3.3%
Chronic
lower
respiratory
diseases
2.7%
Chronic liver
disease
1.8%
Diabetes
3.0%
Influenza and
pneumonia
1.6%
Influenza and
pneumonia
2.8%
Diabetes
2.1%
Alzheimer’s
disease
2.9%
8 Stroke
1.3%
Influenza and
pneumonia
1.4%
Stroke
1.9%
Stroke
0.8%
(8)Stroke
1.5%
Diabetes
2.0%
Homicide
2.8%
Suicide
2.1%
Kidney
disease
1.5%
Kidney
disease
1.7%
Unintentional
injuries
1.6%
Kidney
disease
1.7%
Unintentional
injuries
1.6%
Unintentional
injuries
2.8%
9 Perinatal
conditions
1.3%
Septicemia
1.0%
Benign
neoplasms
1.2%
Chronic
lower
respiratory
diseases
0.7%
(8)HIV
disease
1.5%
Congenital
malformation
1.6%
Diabetes
2.4%
HIV disease
1.4%
Septicemia
1.4%
Unintentional
injuries
1.6%
Septicemia
1.5%
Unintentional
injuries
1.6%
Kidney '
disease
1.6%
Kidney
disease
1.6%
10
Chronic
lower
respiratory
diseases
1.1%
Stroke
0.9%
Influenza and
pneumonia
1.2%
(lO)Anemias
0.5%
10) Pregnancy
complications
0.5%
Influenza and
pneumonia
1.3%
Pregnancy
complications
1.4%
Chronic
lower
respiratory
diseases
1.5%
Septicemia
1.3%
Influenza and
pneumonia
1.2%
Septicemia
1.5%
Chronic liver
disease
1.1%
Septicemia
1.5%
Septicemia
1.4%
Septicemia
1.4%
'Percentages represent total deaths in the age group due to the cause indicated. Numbers in parentheses indicate tied rankings.
Some terms have been shortened from those used in the National Vital Statistics Report See the next page for a listing of the shortened terms in the table and their unabridged equivalents.
To learn more, including the leading causes of death by age and race/ethnicity, visit “Deaths: Leading Causes for 2000” at http://www.cdc.gov/nchs/releases/02facts/final2000.htm (HHS, CDC, NCHS).
Shortened Terms and Unabridged Equivalents
for Leading Causes of Death
Due to limited space, some terms in the leading causes of death table have been shortened from those used in the National
Vital Statistics Report. Below is a listing of the shortened terms used in the table and their unabridged equivalents used in the
report.
SHORTENED TERMS
Benign neoplasms
Cancer
Chronic liver disease
Congenital malformation
Diabetes
Heart disease
HIV disease
Homicide
Hypertension
Kidney disease
Perinatal conditions
Pregnancy complications
Stroke
Suicide
Unintentional injuries
UNABRIDGED TERMS
In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior
Malignant neoplasms
Chronic liver disease and cirrhosis
Congenital malformations, deformations and chromosomal abnormalities
Diabetes mellitus
Diseases of heart
Human immunodeficiency virus (HIV) disease
Assault (homicide)
Essential (primary) hypertension and hypertensive renal disease
Nephritis, nephrotic syndrome and nephrosis
Certain conditions originating in the perinatal period
Pregnancy, childbirth and the puerperium
Cerebrovascular diseases
Intentional self-harm
Accidents (unintentional injuries)
USATODAY.com - Blacks suffer most from managed care Page 1 of2
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11/28/2002 - Updated 09:27 PM ET
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By LYCOS
^ARCHIVES
Blacks suffer most from managed care
By Julianne Malveaux
Why do African Americans have a cancer death rate about
35% higher than that of white Americans? Why do more
than 75% of AIDS cases in women and children occur
among African Americans and Latinos? Why do African-
American children have higher rates of asthma and
juvenile diabetes than white children?
Researchers cite income, stress and health practices as
some of the reasons for the differences. But the Institute of
Medicine said that African Americans and Latinos also
experience a different quality of health care than whites do.
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Managed care needs to take some blame for the disparities in access and
quality of care available to minorities. While corporate executives line their
pockets with double-digit insurance-premium increases, their companies
shift more costs on to the consumer. Some consumers cope by seeing
doctors less, especially if they can't afford rising co-payments. The
outcome: a life expectancy gap of about seven years between whites and
African Americans.
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Research shows that some African Americans mistrust doctors, and they
get better care from African-American physicians. But 4% of physicians
are African American, and many have difficulty working with managedcare
organizations, partly because of the neighborhoods they practice in
and partly because they resist pressures to treat patients in the average 10
minutes some managed-care groups suggest.
A Kaiser/Harvard School of Public Health Survey indicated 39% of all
Americans say managed care plans do a "bad job" serving consumers. And
a survey of 361 family physicians indicated that 42% reported bad patient
outcomes because of managed care business practices. Face it, managed
care is about the bottom line, not about quality health care.
Recently, a group of HMOs launched an initiative to substitute over-thecounter
medicines for prescription drugs. While HMOs will save, patients
will spend more for drugs usually covered by insurance. The switch,
particularly among asthma sufferers, disproportionately affects African
http://www.usatoday.eom/news/opinion/editorials/2002-11 -28-oped-malveaux_x.htm 3/16/03
USATODAY.com - Blacks suffer most from managed carePage 2 of 2Americans.When we speak about a health care crisis, generally we focus on the 41 million Americans who lack insurance. We also need to take a look at those who, thanks to managed care, have only limited access to quality health care. This issue affects eveiyone enrolled in managed health plans, but the burden on African Americans seems heavier. When profit, not heath care, is the bottom line, what do we expect?Julianne Malveaux is a syndicated columnist.MatchxonAre you matching'Front Page News Money Sports Life Tech Weather Marketplace USA TODAY Travel USA TODAY Job CenterTerms of service Privacy Policy How to advertise About us © Copyright 2003 USA TODAY, a division of Gannett Co. Inc.http://www.usatoday.com/news/opinion/editorials/2002-11 -28-oped-malveaux_x.htm3/16/03
The Impact of HIV InfectionThe hiv/aids epidemic continues to be a major health crisis facing the African-American community.■ Although African Americans make up about 12 percent of the U.S. population, they accounted for half of the new hiv cases reported in the United States in 2001.1■ Overall, it is estimated that half of new hiv infections occur among teenagers and young adults aged 25 years and younger.2 Numerous studies suggest that African-American young people represent the majority of these infections.3,4,5Cumulative Toll: Disease and DeathIn addition to experiencing historically higher rates of hiv infection, African Americans continue to face challenges in accessing health care, prevention services, and treatment.■ African Americans have accounted for nearly 315,000, or 35 percent, of the more than 816,000 aids cases reported since the beginning of the epidemic.1 By the end of December 2001, more than 168,000 African Americans had died from aids.1■ In 2001, African Americans accounted for about 21,000, or 49 percent, of the more than 43,000 new aids cases reported among adults.1 aids is the leading cause of death among African-American women ages 25-34 and African-American men ages 35-44. aids is among the top three causes of death for African-American men ages 25-54 and African-American women ages 35-44.6REPORTED MV CASES DY RACE, 200150% African Americans29% Whites19% Latinos2% Other* From 33 states with confidential Hiv reporting systems that meet CDC standards] ** Asian/Pacific Islander and Alaska natives each represent less than 1% of reported cases; 1% is race/ethnicity unknown
CDC FACT SHEET
A Serious Health Crisis
In the early 1980s, hiv/aids was primarily considered a gay
white disease in the U.S. Today, however, the epidemic has
expanded and the disease is also a major health problem in
the African-American community, where men and women
of every age and sexual orientation are affected.
Men
■ 32 percent of African-American men who have sex with men
were found to be infected with hiv in a recent six-city study of
men ages 23-29 years, compared to 14 percent of Latinos and
7 percent of whites in the study.5
■ While information on recent hiv infection is limited, available
data suggest that the leading cause of hiv infection among
African-American men is sexual contact with other men,
followed by injection drug use and heterosexual contact.1
Women
■ African-American women accounted for nearly 64 percent of
hiv cases reported among women in 2001.7
■ The rate of hiv infection among African-American women,
ages 20 to 44, in 25 states with longstanding hiv reporting,
was 80.1 per 100,000 population from 1994 to 1998—four
times higher than the rates among Latina women of the
same age, and more than 16 times higher than the rates
among white women.7
■ While information on recent hiv infection is limited, available
data suggest that the leading cause of hiv infection among
African-American women is heterosexual contact, followed
by injection drug use.1
REPORTED
NW CASES
BY GENDER
Ml RACE1’''"
* From 33 states with confidential
hiv reporting systems that meet
cdc standards
** AsianZPacific Islander and Alaska
natives each represent less than
1% of reported cases; 1% Is race/
2 ethnicity unknown
F A C T S _ H _ E E TYouth■ A cdc study of Job Corps entrants ages 16-21 found that, compared to their white counterparts, African-American women were seven times more likely to be infected with hiv, and African- American men were four times more likely to be infected.3■ Fourteen percent of young African-American men who have sex with men were infected with hiv, nearly four times the rate of their white counterparts, in a five-year study of almost 3,500 gay and bisexual men ages 15 to 22 in seven US. cities between 1994 and 1998.4Higher Risk for HIV-Related Illness and DeathIn 2001, the aids rate among African Americans was nearly ten times the rate reported among whites.1■ From 1996 to 1998, overall aids incidence (the number of people with hiv who progress to aids each year) declined rapidly, falling 38 percent among whites but only 24 percent among African Americans, aids deaths during those years showed a similar pattern, declining nearly 60 percent among whites and only 44 percent among African Americans. Since 1998, the falling rates of aids cases and deaths have stalled among all races.1■ In addition to historically higher rates of infection, a recent cdc study of 9,113 patients in 11 U.S. cities found that Hiv-infected African Americans were less likely than infected whites to receive the powerful new combination treatments for hiv.8
African Americans Contend with Multiple HIV Risk FactorsRace and ethnicity are not, themselves, risk factors for hiv infection. However, African Americans are more likely to face challenges associated with risk for hiv infection, including:■ Poverty. Nearly one in four African Americans lives in poverty.9 Although poverty itself is not a risk factor, studies have found a direct relationship between higher aids incidence and lower income.11 A variety of socioeconomic problems associated with poverty directly or indirectly raise hiv risks, including limited access to quality health care and higher levels of substance abuse.■ Denial and Discrimination. Although a growing number of African Americans are responding to the hiv/Aids crisis in their community, others have been slow to join the effort. One reason is that some African-American communities are reluctant to acknowledge sensitive issues, such as homosexuality and drug use, that are associated with hiv Infection. The cost of denial can be great. For example, studies show that a significant number of African-American men who have sex with men identify themselves as heterosexual.11-32 As a result, they may not relate to prevention messages crafted for gay men. Without frank and open discussion of hiv risks, many African Americans will not getthe information and support they need to protect themselves and their partners from hiv.■ Partners at Risk. African-American women are most likely to be infected with Hiv as a result of sex with men.7 They may not be aware of their male partners’ possible risks for Hiv infection (such as unprotected sex with multiple partners, bisexuality or injection drug use).13 Women who suspect that their partners are at risk for hiv infection may be reluctant to try to negotiate condom use for various and complex reasons. For example, some women may not insist on condom use out of fear that the man will physically abuse them or withdraw financial support.14■ Substance Abuse. Injection drug use is the second leading cause of hiv infection for both African-American men and women. But sharing needles is not the only hiv risk related to substance abuse. Both casual and chronic substance abusers are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol.15fl std Connection. For many of the same reasons noted above, African Americans have the highest std rates in the nation. Compared to whites, African Americans are 27 times more likely to have gonorrhea and 16 times more likely to have syphilis.15 In part because of physical changes caused by std infection, including genital lesions that can serve as a portal of entry for hiv, the presence of certain STDs can increase by three- to five-fold the chances of contracting hiv.17 Similarly, since co-infection with hiv and another std can cause increased hiv shedding, a person who is co-infected has a greater chance of spreading hiv to others.37
Prevention Is the Key to Curtailing the EpidemicCDC is committed to working with communities to slow the spread of hiv among African Americans. Of the $744 million that CDC received for domestic hiv/aids prevention in 2001, over 40 percent supported activities targeted to reduce hiv/aids among African Americans.The vast majority of cdc’s hiv prevention budget flows to communities to fund programs for those at increased risk for Hiv. CDC is working in partnership with African-American communities to ensure that appropriate Hiv prevention programs are designed for and delivered to high-risk African Americans. CDC funds hundreds of community-based organizations across the nation to reach African Americans with Hiv prevention programs. Four examples are outlined below:■ A prevention program in Indiana, which serves the general African-American population, identifies community leaders and trains them to be “community conversationalists.” Community conversationalists discuss hiv and syphilis prevention with African-American men and women in non-traditional settings, such as beauty salons and barber shops, churches, social clubs, laundromats, public housing communities and bars. Outreach workers distribute flyers and posters throughout the community and have encouraged many liquor stores to distribute prevention information with eveiy purchase. Estimates show that about 2,000 African Americans receive prevention information from this program each week.■ A New Orleans-based hiv prevention program, which was designed to reach young African- American men who have sex with men, has recruited and trained more that 90 prevention peer educators. These peer educators do street outreach in the French Quarter and conduct venue-based outreach at bars and community centers throughout the city. Additionally, peer educators host regular community awareness sessions, health fairs and support groups. The program also sponsors a “safe house” where young men can seek confidential and discreet hiv counseling, testing and referral services.■ An hiv prevention initiative for low-income African-American women in urban Detroit focuses on the psychological issues that prevent women from insisting that their male partners adopt safer sexual practices. Project participants attend four two-hour classes aimed at giving them the confidence to say “no sex without a condom.” Since 1996, more than 400 women have been through the program.■ A prevention program in Chicago works to reduce the risk of hiv among African Americans living in shelters and other transitional living facilities throughout the greater Chicago area. The program trains shelter staffers and volunteers to be Hiv and std prevention peer educators and provides personalized hiv counseling, testing and referral services for those at risk for Hiv. The program also conducts group education classes that discuss risk reduction strategies, substance abuse education and behavior modification techniques.5
1 cdc. hiv/aids Surveillance Report. 2001;13(2)
2 P. Rosenberg et al. Declining Age at Hiv Infection in the United States. New End J Med 1994;330:789-790.
3 L. Valleroy, D. MacKellar, J. Karon, R. Janssen et al. hiv Infection in Disadvantaged Out-of-School Youth:
Prevalence for U.S. Job Corps Entrants, 1990 through 1996. J Acquired Immune Deficiency Syndromes
1998;19:67-73.
4 L. Valleroy, D. MacKellar, J. Karon et al. hiv Prevalence and Associated Risks in Young Men Who Have
Sex With Men. jama 2000;284(2): 198-204.
5 cdc. hiv Incidence Among Young Men Who Have Sex With Men—Seven U.S. Cities, 1994-2000. mmwr
2001;50:440-444.
6 National Center for Health Statistics. National Vital Statistics Report. 2002,50(16)
7 L. Lee, P. Fleming. Trends in Hiv Diagnoses Among Women in the United States, 1994-1998. jama
2001;56(3):94-99. ‘
8 A. McNaghten et al. Inequities Between Gender and Racial Groups in Prescription of Highly Active
Antiretroviral Therapy, cdc, Atlanta, GA. Abstract ThPeB5286. XIII International Conference on aids.
Durban, 2000.
9 U.S. Census Bureau. Poverty Status of the Population in 1999 by Age, Sex, and Race and Hispanic Origin.
March 2000.
10 T. Diaz, S. Chu, J. Buehler, et al. Socioeconomic Differences Among People with aids: Results from a
Multistate Surveillance Project. Am J Preu Med 1994; 10(4):217-222.
11 cdc. hiv/aids Among Racial/Ethnic Minority Men Who Have Sex with Men—United States, 1989-1998.
mmwr 2000; 49:4-11.
12 cdc. hiv/std Risks in Young Men Who Have Sex With Men Who Do Not Disclose Their Sexual
Orientation—Six U.S. Cities, 1994—2000. mmwr 2003; 52;81—100.
13 S. Hader, D. Smith, J. Moore,- S. Holmberg, hiv Infection in Women in the United States: Status at the
Millennium, jama 2001 ;285(9): 1186-1192.
14 H. Amaro. Love, Sex and Power: Considering Women’s Realities in hiv Prevention. American Psychologist
1995;50(6):437-447.
15 B. Leigh, R. Stall. Substance Use and Risky Sexual Behavior for Exposure to hiv: Issues in Methodology,
Interpretation and Prevention. American Psychologist 1993;48(10): 1035-1045.
16 cdc. Sexually Transmitted Disease Surveillance 2001.
17 D. Fleming, J. Wasserheit. From Epidemiological Synergy to Public Health Policy and Practice;
The Contribution of Other Sexually Transmitted Diseases to Sexual Transmission of hiv Infection.
SexTransm Inf 1999;175:3-17.
Diabetes in African Americans rage i oriz
Publications
NIDBK Home
Diabetes in
i. African Americans
< 'A ^TMZ' /‘IS
• What Is Diabetes?
• How Many African Americans Have Diabetes?
*1 .What Risk FactorsElncrease the Chance of Devefophig Type
2 Diabetes?
• How Does Diabetes Afferit African American Ch^gen?»
•, HowDoes Diabete^ffec? African Americah,Womera||
During Pregnancy?
• How Do Diabetes Complications Affect African
Americans?
• DoeS': Diabetes Cause Excess Deaths in /African Americans?
• How Is NIDDK /Addressing the Problem of Diabetes in
African Americans?
Today, diabetes mellitus is one of the most serious health
challenges facing the United States. The following statistics
illustrate the magnitude of this disease among African Americans.
• 2.8 million African Americans have diabetes.1
• On average, African Americans are twice as likely to have
diabetes as white Americans of similar age.1
» Approximately 13 percent of all African Americans have
diabetes.1
• African Americans with diabetes are more likely to develop
diabetes complications and experience greater disability
from the complications than white Americans with diabetes.
• Death rates for people with diabetes are 27 percent higher
for African Americans compared with whites.
What Is
Diabetes?
Diabetes mellitus is a group of diseases characterized by high
levels of blood glucose. It results from defects in insulin secretion,
http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm 3/16/03
Diabetes in African AmericansPage 2 of 12insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take measures to reduce the likelihood of such occurrences.Most African Americans (about 90 percent to 95 percent) with diabetes have type 2 diabetes. This type of diabetes usually develops in adults and is caused by the body's resistance to the action of insulin and to impaired insulin secretion. It can be treated with diet, exercise, diabetes pills, and injected insulin. A small number of African Americans (about 5 percent to 10 percent) have type 1 diabetes, which usually develops before age 20 and is always treated with insulin.Diabetes can be diagnosed by three methods:• A fasting plasma glucose test with a value of 126 milligrams/deciliter (mg/dL) or greater.• A nonfasting plasma glucose value of 200 mg/dL or greater in people with symptoms of diabetes.• An abnormal oral glucose tolerance test with a 2-hour glucose value of 200 mg/dL or greater.Each test must be confirmed, on another day, by any one of the above methods. The criteria used to diagnose diabetes were revised in 1997.2How Many African Americans Have Diabetes?Figure 1 shows the prevalence for African American men and women based on the NHANES IH survey conducted in 1988-94.2 The proportion of the African American population that has diabetes rises from less than 1 percent for those aged younger than 20 years to as high as 32 percent for women age 65-74 years.Overall, among those age 20 years or older, the rate is 11.8 percent for women and 8.5 percent for men.About one-third of total diabetes cases are undiagnosed among African Americans. This is similar to the proportion for other racial/ethnic groups in the United States.1National health surveys during the past 35 years show that the percentage of the African American population that has been diagnosed with diabetes is increasing dramatically.- The surveys in 1976-80 and in 1988-94 measured fasting plasma glucose and thus allowed an assessment of the prevalence of undiagnosed diabetes as well as of previously diagnosed diabetes. In 1976-80, total diabetes prevalence in African Americans ages 40 to 74 years was 8.9 percent; in 1988-94, total prevalence had increased to 18.2http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.hfrn3/16/03
uiaoetes in Aincan Americansrage 3 orizpercent--a doubling of the rate in just 12 years.2Prevalence in African Americans is much higher than in white Americans. Among those ages 40 to 74 years in the 1988-94 survey, the rate was 11.2 percent for whites, but was 18.2 percent for African Americans.Figure 1. - Prevalence of diagnosed and undiagnosed diabetes in African Americans, U.S., 1988-94.Note: Diabetes includes both previously diagnosed diabetes and undiagnosed diabetes (fasting plasma glucose greater than 126 mg/dl).What Risk Factors Increase the Chance of Developing Type 2 Diabetes?The frequency of diabetes in African American adults is influenced by the same risk factors that are associated with type 2 diabetes in other populations. Two categories of risk factors increase the chance of developing type 2 diabetes. The first is genetics. The second is medical and lifestyle risk factors, including impaired glucose tolerance, gestational diabetes, hyperinsulinemia and insulin resistance, obesity, and physical inactivity.Genetic Risk FactorsThe common finding that "diabetes runs in families" indicates that there is a strong genetic component to type 1 and type 2 diabetes. Many scientists are now conducting research to determine the genes that cause diabetes. For type 1 diabetes, certain genes related to immunology have been implicated. For type 2 diabetes, there seem to be diabetes genes that determine insulin secretion and insulin resistance. Some researchers believe that African Americans inherited a "thrifty gene" from their African ancestors. Years ago, this gene enabled Africans, during "feast and famine"http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Diabetes m African Americansrage 4 ot izcycles, to use food energy more efficiently when food was scarce. Today, with fewer such cycles, the thrifty gene that developed for survival may instead make the person more susceptible to developing type 2 diabetes.Medical Risk FactorsPrediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)In some people, blood glucose levels are higher than normal but not high enough for them to be diagnosed with diabetes. These individuals are described as having prediabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (EFG). People with prediabetes are at higher risk of developing type 2 diabetes than people with normal glucose tolerance. Rates of IGT among adults ages 40 to 74 years in the NHANES HI survey were similar for African Americans (13 percent) and white (15 percent) Americans.5Gestational Diabetes (GDM)About 2 to 5 percent of pregnant women develop mild abnormalities in glucose levels and insulin secretion and are considered to have gestational diabetes. Although these women's glucose and insulin levels often return to normal after pregnancy, as many as 50 percent may develop type 2 diabetes within 20 years of the pregnancy.Hyperinsulinemia and Insulin ResistanceHigher-than-normal levels of fasting insulin, called hyperinsulinemia, are associated with an increased risk of developing type 2 diabetes. Hyperinsulinemia often predates diabetes by several years. Among people who did not have diabetes in the NHANES HI survey, insulin levels were higher in African Americans than in whites, particularly African American women, indicating their greater predisposition for developing type 2 diabetes.5 Another study showed a higher rate of hyperinsulinemia in African American adolescents compared with white American adolescents/ObesityOverweight is a major risk factor for type 2 diabetes. The NHANES surveys found that overweight is increasing in the United States, both in adolescents and in adults. Figure 2 illustrates these data and also shows that African American adults have substantially higher rates of obesity than white Americans/5http://www.niddk.jnih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Diabetes in African AmericansPage 3 of 12In addition to the overall level of obesity, the location of the excess weight is also a risk factor for type 2 diabetes. Excess weight earned above the waist is a stronger risk factor than excess weight carried below the waist. African Americans have a greater tendency to develop upper-body obesity, which increases their risk of diabetes.Although African Americans have higher rates of obesity, researchers do not believe that obesity alone accounts for their higher prevalence of diabetes. Even when compared with white Americans with the same levels of obesity, age, and socioeconomic status, African Americans still have higher rates of diabetes. Other factors, yet to be understood, appear to be responsible.Figure 2. - Time trends in the percentage of adolescents and adults in the U.S, who are overweight, U.S., 1988-94.Physical ActivityRegular physical activity is a protective factor against type 2 diabetes and, converse!^lack of physical activity is a risk factor for developing diabetes. Researchers suspect that a lack of exercise is one factor contributing to the high rates of diabetes in African Americans. In the NHANES III survey, 50 percent of African American men and 67 percent of African American women reported that they participated in little or no leisure time physical activity.2How DoesAfrican American children seem to have lower rates of type 1 diabetes than white American children. Researchers tend to agreehttp://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Diabetes in African AmericansPage 6 of 12Diabetes AffectAfricanAmericanChildren?that genetics probably makes type 1 diabetes less common among children with African ancestry compared with children of European ancestry. However, recent reports indicate an increasing prevalance of type 2 diabetes in children, especially in those with African American, American Indian, or Hispanic family background.—How Does Diabetes Affect African American Women During Pregnancy?Gestational diabetes, in which blood glucose values are elevated above normal during pregnancy, occurs in about 2 percent to 5 percent of all pregnant women. Perinatal problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar) are higher in these pregnancies. The women generally return to normal glucose values after childbirth. However, once a woman has had gestational diabetes, she has an increased risk of developing gestational diabetes in future pregnancies. In addition, experts estimate that about half of women with gestational diabetes develop type 2 diabetes within 20 years of the pregnancy.Several studies have shown that the occurrence of gestational diabetes in African American women may be 50 percent to 80 percent more frequent than in white women.How Do Diabetes Complications Affect African Americans?Compared with white Americans, African Americans experience higher rates of diabetes complications such as eye disease, kidney failure, and amputations. They also experience greater disability from these complications. Some factors that influence the frequency of these complications, such as high blood glucose levels, abnormal blood lipids, high blood pressure, and cigarette smoking, can be influenced by proper diabetes management.Eye DiseaseDiabetic retinopathy is a deterioration of the blood vessels in the eye that is caused by high blood glucose. It can lead to impaired vision and, ultimately, to blindness. The frequency of diabetic retinopathy is 40 percent to 50 percent higher in African Americans than in white Americans, according to NHANES Hl data.11 Retinopathy may also occur more frequently in African Americans than in whites because of their higher rate of hypertension. Although blindness caused by diabetic retinopathy is believed to be more frequent in African Americans than in whites, there are no valid studies that compare rates of blindness between the two groups.Kidney Failurehttp ://www.niddk.nih. gov/health/ diabetes/pubs/afam/afam.htm3/16/03
Diabetes in African AmericansPage 7 of 12African Americans with diabetes experience kidney failure, also called end-stage renal disease (ESRD), about four times more often than diabetic white Americans.12 In 1995, there were 27,258 new cases of ESRD attributed to diabetes in African Americans.1^ Diabetes is the leading cause of kidney failure and accounted for 43 percent of the new cases of ESRD among African Americans during 1992-1996. Hypertension, the second leading cause of ESRD, accounted for 42 percent of cases. In spite of their high rates of ESRD, African Americans have better survival rates after they develop kidney failure than white Americans.12AmputationsBased on the U.S. hospital discharge survey, there were about 13,000 amputations among African American diabetic individuals in 1994, which involved 155,000 days in the hospital.14 African Americans with diabetes are much more likely to undergo a lower- extremity amputation than white or Hispanic Americans with diabetes. The hospitalization rate of amputations for African Americans was 9.3 per 1,000 patients in 1994, compared with 5.8 per 1,000 white diabetic patients. However, the average length of hospital stay was lower for African Americans (12.1 days) than for white Americans (16.5 days).Does Diabetes Cause Excess Deaths in African Americans?Diabetes was an uncommon cause of death among African Americans at the turn of the century. By 1994, however, death certificates listed diabetes as the seventh leading cause of death for African Americans. For those age 45 years or older, it was the fifth leading cause of death.14Death rates (mortality) for people with diabetes are higher for African Americans than for whites. Figure 3 shows death rates for whites and African Americans with diabetes in a national survey of people first studied in 1971-1975 whose mortality was confirmed through 1992-1993.— The overall mortality rate was 20 percent higher for African American men and 40 percent higher for African American women, compared with their white counterparts.Figure 3. - Mortality rates in African American and white diabetic men and women in a sample of the U.S. population, 1971-1993.http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Diabetes in African AmericansPage 8 of 12Age in 1971-75How Is NIDDK Addressing the Problem of Diabetes in African Americans?Within many African American communities around the country, NIDDK supports centers that provide nutrition counseling,: exercise, and screening for diabetes complications. These centers are called Diabetes Research and Training Centers.PreventionIn 1996, NIDDK launched its Diabetes Prevention Program (DPP). The goal of this research effort was to learn how to prevent or delay type 2 diabetes in people with impaired glucose tolerance (IGT), a strong risk factor for type 2 diabetes.The findings of the DPP, which were released in August 2001, showed that people at high risk for type 2 diabetes could sharply lower their chances of developing the disease through diet and exercise. In addition, treatment with the oral diabetes drug metformin also reduced diabetes risk, though less dramatically. These results were so striking that the DPP's external data monitoring board advised ending the trial early.—Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5 to 7 percent of their body weight. Participants randomized to treatment with metformin reduced their risk of getting type 2 diabetes by 31 percent.http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Uiabetes in African Americansrage y orizOf the 3,234 participants enrolled in the DPP, 45 percent were from minority groups that suffer disproportionately from type 2 diabetes: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians. The trial also recruited other groups known to be at higher risk for type 2 diabetes, including individuals age 60 and older, women with a history of gestational diabetes, and people with a first-degree relative with type 2 diabetes. Participants ranged from age 25 to 85, with an average age of 51.Lifestyle intervention successfully reduced the risk of getting type 2 diabetes for both men and women, and across all the ethnic groups. It reduced the development of diabetes in people age 60 and older by 71 percent. Metformin was also effective in men and women and in all the ethnic groups, but was relatively ineffective in the older volunteers and in those who were less overweight.Researchers will continue to analyze the data to determine whether the interventions reduced cardiovascular disease and atherosclerosis, major causes of death in people with type 2 diabetes. The DPP is the first major trial to show that diet and exercise can effectively delay diabetes in a diverse American population of overweight people with IGT.National Diabetes Education ProgramNIDDK and the Centers for Disease Control and Prevention are jointly sponsoring the National Diabetes Education Program (NDEP). Its goal is to reduce the death and disability associated with diabetes and its complications. The NDEP conducts ongoing diabetes awareness and education activities for people with diabetes and their families. Special efforts are being made to address the needs of certain ethnic groups that are hardest hit by diabetes, including African Americans, Hispanic Americans, Asian Americans, Pacific Islanders, and American Indians. Through these efforts, the NDEP hopes to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and, ultimately, prevent the onset of diabetes.Points to Remember• 2.8 million African Americans have diabetes.• On average, African Americans are twice as likely to have diabetes as white Americans of similar age.• The highest incidence of diabetes in. African Americans occurs between 65 and 74 years of age. Twenty-five percent of these individuals have diabetes.http.7/www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm3/16/03
Diabetes in African Americans Page 10 ot 12
• Obesity is a major medical risk factor for diabetes in African
Americans, especially for women. Some diabetes may be
prevented with weight control through healthy eating and
regular exercise.
• African Americans have higher incidence of and greater
disability from diabetes complications such as kidney
failure, visual impairment, and amputations.
• People at high risk for type 2 diabetes, including African
Americans, can prevent or delay diabetes with modest
weight loss and regular exercise.
References 1. National Diabetes Information Clearinghouse. National diabetes
statistics. NIH publication 02-3892. Fact sheet. Available at:
.
Accessed April 4, 2002.
www.niddk.nih.gov/health/diabetes/pubs/dmstats/dmstats.htm
2. American Diabetes Association. Report of the Expert
Committee on the Diagnosis and Classification of Diabetes
Mellitus. Diabetes Care 20:1183-1197, 1997.
3. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes,
impaired fasting glucose, and impaired glucose tolerance in U.S.
adults: the Third National Health and Nutrition Examination
Survey, 1988-94. Diabetes Care 21:518-524, 1998.
4. Tull ES, Roseman JM. Diabetes in African Americans. Chapter
31 m Diabetes in America. 2nd ed. (NEH Publication No. 95-1468,
pp. 613-630). Bethesda, MD: National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health;
1995. Available at: http://www.niddk.nih.gov/health/diabetes/dia/.
5. Harris MI. Unpublished data from the Third National Health
and Nutrition Examination Survey, 1988-94.
6. Jiang X, Srinivasan SR, Radhakrishnamurthy B, Dalferes ER,
Berenson GS. Racial (African American-white) differences in
insulin secretion and clearance in adolescents: the Bogalusa heart
study. Pediatrics 97:357-360, 1996.
7. Kuzmarski RJ, Flegal KM, Campbell SM, Johnson CL.
Increasing prevalence of overweight among US adults: the
National Health and Nutrition Examination Surveys, 1960 to 1991.
JAMA 272:205-211, 1994.
8. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM,
Johnson CL. Overweight prevalence and trends for children and
http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm 3/16/03
Diabetes m Atncan Americans rage 11 oi tz
adolescents.'Arch Pediatr Adolesc Med 149:1085-1091, 1995.
9. Crespo CJJKeteyian SJ, Heath GW, Sempos CT. Leisure-time
physical activity among US adults. Arch Intern Med 156:93-98,
1996.
10. Ludwig DS, Ebbeling CB. Type 2 diabetes mellitus in
children. JAMA 286:1427-1430, 2001.
11. Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is
the risk of diabetic retinopathy greater in non-Hispanic African
Americans and Mexican Americans than'in hon-Hispanicjvhites
with type 2 diabetes: a US population study. Diabetes Carej
81:1230-1235, 1998.
12. Cowie CC, Port FK,Wolfe RA, Savage PJ, Moll PP,
Hawthorne VM. Disparities in incidence of diabetic end-stage
renal disease by race and type of diabetes. ^ewEngl J Med
321:1074-107911989.
13. ^U.S. Renal Data System. USRDS 199^ Annual Data Report.
Bethesda, MD: National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health; 1997.
14. Getss^LS (editor). Diabetes Surveillance 7 Atlanta:
Renters for Disease Control and Prevention; 1997.
15. Gu K, Cowie CC; Harris MI. Mortality in adults with and
without diabetes in a national cohort of the US population, 1971 -
^Diabetes Care 21:1 ^8-1145,’1998.
16. Diabetes Prevention Program Research Group. Reduction in
the incidence of type 2 diabetes with lifestyle intervention orj
metformin. A Ewg/ J Med 346:393-403, 2002.
Statistics in this fact sheet were derived from NEDDK’s fact sheet
^National Diabetes Statistics.
Additional
Resources
National Diabetes Information Clearinghouse
|T Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301T654-3327
Fax: (301) 907-8906
Email: ndic@info.niddk.nih.go^B
Weight-control Information Network
1 Win Way
Bethesda, MD 20892-366^
http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm B/16/03
Diabetes in African Americans Page 12 of 12
Phone: 1-800-WIN-8098 or (301) 951-1120
Fax: (301) 951-1107
Email: win@info.niddk.nih.gov
American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: (800) 232-3472
Fax: (703) 549-6995
Internet: www.diabetes.org
National Diabetes Information
Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Email: ndic@info.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC) is a
service of the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK). The NIDDK is part of the National
Institutes of Health under the U.S. Department of Health and
Human Services. Established in 1978, the clearinghouse provides
information about diabetes to people with diabetes and to their
families, health care professionals, and the public. NDIC answers
inquiries, develops and distributes publications, and works closely
with professional and patient organizations and Government
agencies to coordinate resources about diabetes.
Publications produced by the clearinghouse are carefully reviewed
by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users
of this e-pub to duplicate and distribute as many copies as desired.
Publications
NIDDK Home
NIH Publication No. 02-3266
May 2002
http://www.riiddk.nih.gov/health/diabetes/pubs/afam/afamJitm 3/16/03
American nung Associations ract dneet - Airican Americans ana Juung uisease rage i oiJ
LUNG CANC_4 JU
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Association® Fact c. Sigil Oil Sheets African «Moreinfo iom»
Americans and Lung
Disease
January 2001
African Americans presently constitute approximately 12 percent of
the U.S. population. The high incidence of lung cancer in African
Americans is associated with a higher prevalence of smoking and
occupational exposures. For other lung diseases such as pneumonia
and influenza, socioeconomic factors such as poverty contribute to
differences seen between blacks and whites in the occurrence of
these diseases.
• Although African Americans represent only 12 percent of the
population, more than 24 percent of all asthma deaths are in African
Americans. In 1998, an estimated 1.7 million diagnosed Black
Americans had an asthma attack. The asthma attack prevalence rate
among Blacks was more than 31 percent higher than that for Whites.
• In 1998, 24.7 percent of African Americans smoked; more than
45,000 African Americans die from smoking-related diseases
annually. While African Americans smoke fewer cigarettes per day
than whites, on average, they tend to smoke brands with higher
nicotine levels.
• If current patterns continue, an estimated 1.6 million African
Americans who are now under the age of 18 will become regular
smokers. About 500,000 of those smokers will die of a smokingrelated
disease.
• The incidence rate of lung cancer for African American males is
more than 54% higher than that of white men. The lung cancer
mortality rate in African American males is almost 42% higher than
that of white males. Females of both races have similar rates.
http://www.lungusa.org/diseases/africanlim.g_factsheet.html 3/16/03
American Lung Association®) Pact Sheet - African Americans and Lung Disease rage 2 or j
• African Americans are nearly eight times more likely to contract
active tuberculosis than are whites.
• Some years ago, after generations of decline, the number of cases
of tuberculosis began to rise. Between 1985 and 1992, TB cases in
African Americans increased 29 percent. However after the
institution of enhanced TB control programs, by 1996, TB cases in
African Americans had declined to below their 1985 level.
• In 1999, the total number of new tuberculosis cases among nonHispanic
African Americans was 5,552. While African Americans
represent 12 percent of the American population, they accounted for
32 percent of the tuberculosis cases.
• Influenza immunization rates in African Americans are about half
that of the white population.
• Lungs are affected considerably by environmental factors.
Approximately 86 percent of African Americans live in urban
increasing,their exposure to a considerable amount of environmental
pollutants.
• Minority groups have been traditionally overexposed to
occupational respiratory hazards. Occupational lung disease is the
number one work-related illness in the US. African Americans are
less likely to hold managerial or professional positions and have
traditionally been more likely than whites to hold "dirty" and
dangerous jobs such as in the asbestos, textile, coal and silica
mining industries, each of which is associated with respiratory
disease. In addition, the effects of many of these toxic dusts are
exaggerated by smoking.
• Of the 16,432 AIDS related deaths in 1998, almost 34 percent
were in African American men, and 15 percent were in African
American women. AIDS is the leading cause of death in African
Americans aged 25-44. Because the HIV infection weakens the
immune system, the higher incidence of opportunistic diseases such
as tuberculosis and pneumocystis carinii pneumonia can be linked to
the increase in HIV cases.
• Sarcoidosis is a disease of the lungs in which small areas of
inflamed cells, granulomas, appear. It affects African Americans
more than whites in the United States, and the disease is usually
more severe in African Americans than whites. The prevalence of
sarcoidosis is more than eight times greater in African Americans
than whites. Although sarcoidosis is not a common cause of death, in
1998 the mortality rate for African Americans was 12 times greater
than for whites.
• Sarcoidosis also reduces a person's reactivity to tuberculin, the
active factor in the common skin test for tuberculosis. It therefore
affects a person's lung health by making a tuberculosis infection
more difficult to detect.
http://www.lungusa.org/diseases/africanlung_factsheet.html 3/16/03
American Lung Association® Fact Sheet - African Americans and Lung Disease Lage 3 ot 5
• Chronic obstructive pulmonary disease (COPD), which includes
emphysema and chronic bronchitis, killed 4,039 African American
men and 3,166 African American women in 1998.
• In 1998, the age adjusted death rate of Sudden Infant Death
Syndrome (SIDS), or Crib Death, per 100,000 live births was 149.2
for black infants and 57.7 for white infants.
• For more information call the American Lung Association at 1-800-
LUNG-USA (1-800-586-4872), or visit our web site at
http://www.lungusa.org.
For more information call the American Lung Association® at 1-800-LUNG-USA (1-800-
586-4872), or visit our web site at http://www.lungusa.org.
View American Lung Association Nationwide Research Awardees for
2001-2002
Related links on the Web
These sites aije not part of The American Lung Association web site, and we have no control
over their content or availability.
CPC Report on Minorities and Tobacco Use
SIDS Network
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promote lung health.
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African-Americans & Asthma
Asthma has a significant impact on African Americans. Not only
do African Americans have a higher asthma prevalence rate
than Caucasians1, but they are also more likely to be
hospitalized1 or die due to their asthma.1 Below are some key
statistics about the impact of asthma on the African-American
community.
KEY STATISTICS
Prevalence
• Asthma affects slightly more African Americans than
Caucasians. In 1999, the lifetime prevalence rate was 15
percent higher among African Americans than among
Caucasians.2
• In 1999, an estimated 1.5 million diagnosed African
Americans had an asthma attack; the asthma attack
prevalence rate among African Americans was more than
22 percent higher than it was for Caucasians.2
Morbidity
• African Americans have more than four times the
asthma-related emergency department visits than other
races, 3 and African Americans are three to four times
more likely than Caucasians to be hospitalized for
asthma.1
• African-American children are three to four times more
likely than Caucasian children to be hospitalized for
treatment of asthma.4
Mortality
• Although African Americans represent only 12 percent of
the U.S. population, they account for more than 24
percent of all asthma-related deaths.5
• African Americans are three times more likely than
http://207.200.4.8/texaslung/FactSheets/afiicanamericansandasthma.htm 3/16/03
African-Americans & Asthma Page 2 of 2
Caucasians to die from asthma.2
• As of 1999 African-American women had the highest
asthma mortality rates, compared to African-American
men and to men and women of other ethnic groups.2
###
References
1. National Institute of Allergy and Infectious Diseases, National
Institutes of Health. Asthma: A Concern for Minority Populations:
Fact Sheet.
2. American Lung Association, Epidemiology and Statistics Unit.
Trends in Asthma Morbidity and Mortality. February 2002.
3. American Lung Association. 2000 Minority Lung Disease Data.
Focus: Asthma.
4. American Lung Association. Public Policy Brief: Key Facts About
Asthma. 2001.
5. American Lung Association. Fact Sheet: African Americans and
Lung Disease. August 28, 2002.
Our mission as to fight lung disease and protect the lung health of all Texans.
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Data and Statistics - State-by-State Lung Disease Trend Report, April 2001 Page 1 of 8
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Introduction (1)
Lung disease is not only a fatal condition. Lung disease can be
chronic, making each breath barely possible and a constant struggle
to stay alive from moment to moment. More than 25 million
Americans are now living - painfully - with chronic lung disease.
Anticipated Changes to Future Reports
State-by-State Lung
Disease Trend Report
Every year, close to 361,000 Americans die of lung disease. Lung
disease is ranked as America's third cause of death, responsible for
one in seven deaths. The lung disease death rate is climbing, while
the rates for America's first and second ranked causes of death,
heart disease and cancer, have dropped. The age adjusted heart
disease death rate, for example, fell by 36.6 percent between 1979
and 1998. During that same period, the lung disease death rate rose
by 19.3 percent.
The Best Practices and Program Services Division has prepared the
attached series of tables delineating state-specific mortality,
incidence and vaccination for lung diseases. Prevalence rates by
geographic region and tobacco use by state are also shown. Data are
approved for each of the fifty states and the District of Columbia.
These tables should be useful in describing the impact of lung
disease on your state. Before using these data, please review
Appendix I concerning these state-specific statistics.
Beginning with 1999 mortality data, the population standard used for
calculating age-adjusted death rates will be changed from the 1940
population to the projected population of the year 2000. The
changing of this standard will have three important outcomes: (i)
provide age-adjusted rates that are less divergent from crude rates
(ii) ensure that all government agencies use the same standard and
(Hi) correct the public perception that age adjustment to the 1940
population provides out-of-date statistics. Use of the year 2000
standard will place more weight on death rates at older ages and
http ://www. lungusa.org/data/s2s/s2s.html 3/16/03
Data and Statistics - State-by-State Lung Disease Trend Report, April 2001Page 2 of8less weight on death rates at younger ages. Because most lung disease rates increase with age, death rates using the new standard will be higher than those using the old standard.In addition, starting with 1999 data, the tenth revision of international classification of diseases (ICD-10) will replace ICD-9 in coding and classifying mortality data from death certificates. The ICD are periodically revised to incorporate changes in the medical field. The Tenth Revision (ICD-10) differs from the Ninth Revision (ICD-9) in a number of respects although the overall content is similar: (I) ICD-10 is printed in a three-volume set compared with ICD-9's two- volume set, (ii) ICD-10 has alphanumeric categories rather than numeric categories, (Hi) some chapters have been rearranged, some titles have changed, and conditions have been regrouped, (iv) ICD- 10 has almost twice as many categories as ICD-9 and (v) some changes have been made in the coding rules for mortality. One way in which these changes in coding rules will affect lung disease mortality rates is as follows: if a physician codes a death as pneumonia but the patient had an underlying chronic disease, then the primary cause of death would be the chronic disease, not the latter as with ICD-9. Therefore, pneumonia rates will decline considerably while chronic disease rates would increase, causing a break in the trends.Mortality TrendsTable 1 delineates the age-adjusted death rates in all races for the most common types of lung disease. In 1998, Louisiana reported the highest age adjusted death rates for TB at 0.5 per 100,000 persons, while Indiana, Michigan, New Jersey, Ohio, Pennsylvania and Virginia reported the lowest death rates with 0.2 per 100,000 persons for TB. The age adjusted death rate for the U.S. was 0.2 per 100,000 persons. In 1998, the overall mortality rate of lung cancer in the U.S. was 37.0 per 100,000 persons. During that year, Kentucky had the highest death rate and Utah had the lowest death rate for lung cancer (52.3 per 100,000 persons and 16.6 per 100,000 persons, respectively). The highest age adjusted death rate for pneumonia and influenza was reported in Mississippi (17.1 per 100,000 persons), while the lowest was reported in Alaska and New Hampshire (8.4 and 8.5 per 100,000 persons, respectively). Overall in 1998, the death rate for pneumonia and influenza in the United States was 13.2 per 100,000 persons. The age adjusted death rate for COPD in the U.S. was 19.9 per 100,000 persons in 1998. Nevada had the highest death rate reported with 30.6 per 100,000 persons and Hawaii reported the lowest death rate with 9.2 per 100,000. The age adjusted death rate for asthma in the U.S. was 1.4 per 100,000 persons in 1998. The District of Columbia had the greatest reported death rate of 4.0 per 100,000 persons in 1998. Iowa had the lowest with 0.9 per 100,000 persons.Overall, the highest death rate for lungi disease was reported in Kentucky (94.0 per 100,000 persons) and the lowest death rate for lung disease was reported in Utah (46.3 per 100,000 persons). It is not surprising that smoking prevalence in adults was second highest, with the exception of Nevada, in the tobacco growing state ofhttp://www.lungusa.org/data/s2s/s2s.html3/16/03
Data and Statistics - State-by-State Lung Disease Trend Report, April 2001Page 3 of 8Kentucky (29.7%) and lowest in the religious state of Utah (13.9%).The number of deaths by state is displayed in Tabie 2. The greatest number of deaths due to TB was reported from California (168) and Texas (108). The state with the fewest number of TB deaths was Wyoming with a total of 0. Lung cancer caused the greatest number of deaths in California (13,562) and Florida (11,465) and the fewest number of deaths in Alaska (197) and Wyoming (225). California was the state with the most deaths attributable to pneumonia and influenza, while Alaska had the least (13,378 and 52 deaths, respectively). COPD caused the most deaths in California (11,632) and the least in Alaska (103). California (709) and New York (419) had the highest number of deaths due to asthma. Alaska, Wyoming and Vermont experienced fewer than 10 deaths due to asthma in 1998.Overall in 1998, California (39,512), Florida (23,862), New York (22,965), and Texas (20,848) had the greatest number of deaths attributable to lung disease. Alaska (363) and Wyoming (615) had the smallest number of deaths from lung disease in 1998.Race-Specific MortalityTabie 3 displays the age-adjusted death rates by race for various lung diseases in 1998. Unfortunately, lung disease mortality disproportionately affects blacks. With the exception of COPD, blacks die more frequently from the various lung diseases than whites. In 1998, blacks had an age-adjusted death rate for TB that was 90% greater than their white counterparts. Illinois had the highest TB death rate in blacks with 1.5 per 100,000 persons, while California had the lowest with 0.8 per 100,000 persons. The highest state TB death rate in whites was reported in Texas at 0.4 per 100,000 persons. Florida and Ohio had the lowest TB death rate in whites with 0.1 per 100,000 persons. In 1998, blacks had an age-adjusted death rate that was 22% higher than whites for lung cancer. Iowa had the highest death rate for blacks (68.4 per 100,000 persons) while Kentucky had the highest for whites (52.1 per 100,000 persons). Colorado had the lowest death rate in blacks (26.4 per 100,000 persons) while Utah had the lowest death rate in whites (16.6 per 100,000 persons).For pneumonia and influenza, blacks had an age-adjusted death rate that was 35% greater than for whites. California had the highest reported death rate for blacks and whites, with 24.3 per 100,000 persons and 17.7 per 100,000 persons, respectively. Colorado reported the lowest death rate in blacks (12.5 per 100,000 persons) while Alaska reported the lowest death rate in whites (6.6 per 100,000 persons). For asthma, blacks had an age-adjusted death rate that was 192% greater than whites. Illinois (7.5 per 100,000 persons) had the highest death rates for asthma in blacks while Florida reported the lowest with 2.4 per 100,000 persons. In whites, Idaho and New Mexico had the highest death rates (1.8 per 100,000 persons) and Pennsylvania had the lowest death rate (0.7 per 100,000 persons).http://www.lungusa.org/data/s2s/s2s.html3/16/03
In contrast, blacks had an age adjusted death rate that was 33% less than that of whites for COPD. The age adjusted death rate for COPD was highest in Delaware and West Virginia (22.9 per 100,000 persons) for the black population and in Colorado and Wyoming (27.6 per 100,000 persons) for whites. The age adjusted death rate for COPD was lowest in Connecticut (7.6 per 100,000 persons) for blacks and in the District of Columbia (11.6 per 100,000 persons) for whites.Overall, the age-adjusted death rate for lung disease was 13% greater in blacks than in whites. Iowa (117.4 per 100,000 persons) and Kentucky (94.1 per 100,000 persons) had the highest death rates for blacks and whites, respectively. New Mexico had the lowest death rates for blacks (48.7 per 100,000 population), while the Utah had the lowest rates for whites (46.5 per 100,000 persons).The number of deaths for blacks and whites for the various lung diseases in 1998 are shown in Tabie 4 and Table 5. Although, blacks have higher death rates, the number of deaths in whites is at least double to that of blacks. The difference between races may vary by state.Sex Specific MortalityTable 6 displays the age-adjusted death rates by sex for various lung diseases in 1998. Except for asthma, the age adjusted death rates for the various lung diseases are higher in males than in females.The death rate in males for tuberculosis is 100% greater than that in females. Interpretation of age adjusted death rates for tuberculosis by state is difficult because most of the rates represent fewer than 20 deaths. The death rate in males for lung cancer is 83% greater than that in females. Mississippi had the highest death rate in males (74.7 per 100,000 persons) while Nevada had the highest death rate in females (37.3 per 100,000). Utah has the lowest death rate in males and females, 22.2 per 100,000 persons and 11.9 per 100,000 persons, respectively. The death rate attributable to pneumonia and influenza is highest in Mississippi (21.8 per 100,000 persons) for males and in California (15.3 per 100,000 persons) for females. It was lowest in Alaska (8.7 per 100,000 persons) for males and lowest in New Hampshire (6.7 per 100,000 persons) for females. The age adjusted death rate for pneumonia and influenza is 48% higher in males than in females. For COPD, the age-adjusted death rate is 50% higher in males than in females. Tennessee has the highest death rate for males at 35.0 per 100,000 persons, while Nevada has the highest death rate for females at 28.6 per 100,000 persons. Hawaii had the lowest death rate for both sexes, 12.4 per 100,000 persons for males and 6.5 per 100,000 persons for females.In contrast, the age-adjusted death rates for asthma were 20% lower in males than in females. New Mexico reported the highest death rate for males with 2.0 per 100,000 persons, while Minnesota reported the lowest death rate of 0.7 per 100,000 persons. In females the highest death rates were reported in Illinois and in Louisiana (2.1 per 100,000 persons) while the lowest was reported from Kansas (0.8 per 100,000 persons).http://www.lungusa.org/data/s2s/s2s.html3/16/03
Data and Statistics - State-by-State Lung Disease t rend Report, April 2UU1Page boi8Overall, Mississippi had the highest age adjusted death rates from lung diseases in males. The age-adjusted death rate was 130.6 per 100,000 persons. Nevada had the highest age adjusted death rates from lung diseases in females. The age-adjusted death rate was 78.2 per 100,000 persons. Utah had the lowest age adjusted death rates from lung diseases for males and females, 59.3 per 100,000 persons and 35.6 per 100,000 persons, respectively.The number of deaths by sex for the various lung diseases is shown in Table 7■ Males had greater number of deaths for all of the lung diseases except for asthma and pneumonia and influenza.Pneumonia and Influenza Vaccination Rates By State (2)Table 8 shows the state-specific percentages for men and women aged 65 and older who have ever received a pneumococcal vaccination, and the percentages of those who received the influenza vaccine in 1997 and in 1999. A national objective for the year 2010 is to increase influenza and pneumococcal vaccination levels to > 90% among persons aged > 65 years and older. To monitor the states' progress towards achieving this objective, data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The median percentage of influenza vaccination was 67.4%, but there was wide variation among the states. The District of Columbia reported the lowest rate with 54.3%, while Colorado reported the highest percentage at 74.4%. The median percentage for pneumococcal vaccination was much lower at 54.9%. Again, there was a wide range among the states; Louisiana reported the lowest percentage (32.2%) and Arizona reported the highest (59.4%).Medicare (Part B) pays 100 percent for pneumococcal vaccination and its administration if it is ordered by a physician. The emergence of serious drug-resistant pneumococci accentuates the urgent need for pneumococcal immunization. Most adults need to receive the pneumococcal vaccination only once. Those patients at high risk should consult their physicians to find out if they will need a second vaccination. In addition, Medicare (Part B) recently added vaccination against influenza to its list of reimbursable services. With clear and striking evidence of the effectiveness of the vaccine in reducing hospitalizations and deaths and in producing direct cost savings, providers and patients alike should take steps to ensure that people at high risk should receive the influenza vaccine each year. The best time to receive an influenza vaccination is in the months of October and November.National Health Interview SurveyEach year trained interviewers of the U.S. Bureau of the Census for the National Center for Health Statistics conduct a complex, multistage, probability sample survey known as the National Health Interview Survey. Information is collected during in home interviews of the civilian noninstitutionalized U.S. population on a variety of health issues such the prevalence of selected chronic conditions. Estimates of these health characteristics are shown for various groups in the population. However, estimates are not provided for http://www.lungusa.org/data/s2s/s2s.html 3/16/03
Data and Statistics - State-by-State Lung Disease Trend Report, April 2001Page 6 of 8individual states. Instead, the rates are classified into four geographic regions- Northeast, Midwest, West, and South(3).In 1997 the National Health Interview Survey staff redesigned its questionnaire. All questions now ask for a medical diagnosis instead of self-report. This had made it impossible to compare the estimates with that of previous years. In addition, information on acute lung diseases are not currently available.Chronic Lung Disease Prevalence Rates by Geographic RegionTable 9 displays chronic lung disease prevalence rates by geographic region. The West had the highest attack prevalence rate for asthma (42.2 per 1000 persons per year) while the Midwest had the lowest prevalence rate for asthma (35.3 per 1000 persons per year). The South had the highest annual prevalence rate for chronic bronchitis (52.9 per 1000 persons per year) while the West had the lowest prevalence rate (38.1 per 1000 persons). Lastly, the Midwest had the highest lifetime prevalence rate of emphysema (15.7 per 1000 persons per year) while the Northeast had the lowest prevalence rate (10.9 per 1000 persons).Tuberculosis Incidence by StateThe TB cases and case rates per 100,000 persons by race and state for 1999 are shown in Table 10. Hawaii reported the highest incidence rate (4) at 15.5 per 100,000 persons in 1999. Other states with high incidence rates include the District of Columbia, California and New York; these rates per 100,000 are 13.5, 10.9 and 10.1, respectively. California had the greatest number of cases (3,606), followed by New York (1,837), Texas (1,649) and Florida (1,277). Wyoming had the lowest incidence rate (0.6 per 100,000 persons) and the least number of cases (3).Louisiana and Texas had the highest case rate with 4.4 per 100,000 persons and Wyoming had the lowest case rate (0.2 per 100,000 persons) and the least number of cases (1) in whites. California had the greatest number of cases in whites - 449.Blacks had the highest TB case rate in Minnesota with 63.9 per 100,000 persons. The lowest case rate was reported in Alaska, Idaho, Montana, New Mexico, Vermont, and Wyoming - 0.0 per 100,000 persons. New York had the greatest number of cases in blacks - 672.Lung Cancer Incidence by StateThe American Cancer Society estimates that there will be 164,100 new cases of lung cancer in 2000. Table 11 displays the estimated number of new cases in each state. It is estimated that California, Florida and Texas will have more than 10,000 cases per state, while Alaska, DC, Hawaii, Montana, North Dakota, South Dakota, Utah, Vermont and Wyoming will have fewer than 500 new cases per state.http://www.lungusa.org/data/s2s/s2s.html3/16/03
Data and Statistics - State-by-State Lung Disease Trend Report, April 2001Page 7 of 8Lung cancer average annual age adjusted incidence rates by sex for 1993 to 1997 from registries in North America are shown in Table 12. The cancer registry in Kentucky had the highest incidence rates for males and females, at 121.5 per 100,000 persons and 56.8 per 100,000 persons, respectively. Utah had the lowest incidence rates for males and females with 35.9 per 100,000 persons and 18.2 per 100,000 persons, respectively. The lung cancer age adjusted incidence rates was 77% greater in males than in females for the United States between 1993 and 1997.State-level Prevalence of Tobacco UseTables 13, 14 and 15 display state-specific smoking prevalence for cigarettes, cigars and smokeless tobacco, respectively. The Center for Disease Control coordinates state surveillance of tobacco use through the Behavior Risk Factor Surveillance system. Table 16 shows the percentage of mothers who smoked during pregnancy for the years 1990 to 1996.Data on cigarette smoking were provided from all 50 states and the District of Columbia in 1999. Smoking has declined consistently in some states and has remained fairly constant in others. The median prevalence of regular cigarette smoking was 27.4% in 1984 and 22.7% in 1999. In 1999, smoking prevalence was highest in Nevada (31.5%) and lowest in Utah (13.9%).Data on ever- and past month- cigar smoking was provided from all 50 states for 1998. The median prevalence of ever cigar smoking was 39.0% and past month cigar smoking was 5.2%. Ever cigar smoking rates were highest in Alaska (52.0%), Wisconsin (49.7%) and Nevada (48.6%) and lowest in Arizona (14.8%). Past-month cigar smoking was highest in Nevada (7.4%), and Indiana (7.3) and lowest in Arizona (1.4%).Data on smokeless tobacco use were provided from 19 states in 1999. Ever-smokeless tobacco use rates were highest in West Virginia (28.5%) and lowest in Arizona (4.7%). Current use of smokeless tobacco was highest in West Virginia (30.2%) and lowest in New York (10.3%).In 1996, 46 states, the District of Columbia, and New York City (accounting for 79% of live births in the United States) reported tobacco use on the birth certificate. Data were not provided by all counties, or were not provided in the necessary format by California, Indiana, the remained of New York State, and South Dakota. That year close to 14% of mothers smoked during pregnancy.REFERENCESAPPENDIX I: TECHNICAL NOTEShttp://www.lungusa.org/data/ s2s/s2s.html3/16/03
Data and Statistics - State-by-State Lung Disease Trend Report, April 2001Page 8 of 8Th® mission ©f the American Lang Association as to prevent lung disease and promote lung health,.Store | Donate | History j Links j Treatment Options | Site index | Contact Asthma | Tobacco Control | Air Quality | Diseases A to Z | Occupational Health | School Programs Programs & Events i Wall of Remembrance | Living With Lung Disease | Data & Statistics | ResearchAdvocacy | Volunteer | Jobs j Press Center | Ask ALA | Publications | EspanolThe information contained in this American Lung Association® website is not a substitute for medical advice or treatment, and the ALA recommends consultation with your doctor or health care professional.© 2002 American Lung Association®. All rights reserved. Privacy Pcijic’7 and Terms Of Use.LUNG CANI TOOLSAMERICAN LUNG ASSOCIATION®State of the Air 2002ww.stateoftheaar.orqhttp://www.lungusa.org/data/s2s/s2s.html3/16/03
High Blood Pressure Statistics Page 1 of 1
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High blood pressure (hypertension) killed 44,619 Americans in 2000.
• About 50 million Americans aged 6 and older have high blood
pressure. (Based on National Health and Nutrition Examination
Survey III [NHANES III, 1988-91], Centers for Disease Control and
Prevention/National Center for Health Statistics.)
• One in five Americans (and one in four adults) has high blood
pressure.
• Of those people with high blood pressure, 31.6 percent don't know
they have it.
• Of all people with high blood pressure, 14.8 percent aren't on
therapy (special diet or drugs), 26.2 percent are on inadequate
therapy, and 27.4 percent are on adequate therapy.
• The cause of 90-95 percent of the cases of high blood pressure isn't
known; however, high blood pressure is easily detected and usually
controllable.
• From 1990 to 2000 the death rate from high blood
pressure increased 21.3 percent, but the actual number of deaths
rose 49.1 percent.
• Non-Hispanic blacks are more likely to suffer from high blood
pressure than are non-Hispanic whites.
• People with lower educational and income levels tend to have
higher levels of blood pressure.
• In 2000 the death rates per 100,000 population from high blood
pressure were 13.2 for white males, 46.3 for black males, 13.1 for
white females and 40.8 for black females.
. fifLAT£o/r
Links on This
High Blood Pre
Drug therapy c
lifestyle change
with very high <
reduce heart af
percent and ca
more than 40 p
read more,,.
Related AHA publications:
• Targeting the Facts... heart disease, stroke and risks
• Understanding and Controlling Your High Blood Pressure (also in
Spanish)
• High Blood Pressure in African Americans
• Biostatistical Fact Sheets
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©2002 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
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1 ----------------'--x
{ Make the Llnk!\
i \ Pat lent Page/
; High Blood Pressure and Diabetes
I
I What is high blood pressure?
I High blood pressure, also called hypertension,
I means that the force of the blood inside your
I blood vessels is too high. High blood pressure
I makes the heart work too hard and can
I increase your risk for heart attack and stroke.
I
1 What does high blood pressure
have to do with diabetes?
I
I People with diabetes are more likely to have
I high blood pressure. In fact, almost two out of
I three adults with diabetes have high blood
I pressure. Both high blood pressure and
I diabetes increase your risk of heart disease,
stroke, eye problems, kidney problems, and
nerve disease. So if you have both, you have
an even greater risk for other health problems.
J What’s the target blood pressure
I for people with diabetes?
For most people with diabetes, keeping blood
1 pressure below 130/80 will help prevent
problems. You’ll hear your blood pressure
reading said as two numbers, such as “one-thirty
over eighty” The first number is the pressure
I as your heart beats and pushes blood into the
I blood vessels. The second number is the
I pressure when your heart rests between beats.
III
If my blood pressure is too high,
what can I do to lower it?
If you have diabetes and high blood pressure,
you can take steps to lower your blood
pressure.
► Use a meal plan
► Eat less salt
► Exercise
► Take blood pressure medicine
Several medicines can lower blood pressure.
Some blood pressure medicines have been
shown to protect your kidneys from disease and
to reduce your chance for having a heart attack
or stroke. Talk with your health care provider
about the best medicine for you. Often, more
than one medicine may be needed to lower your
blood pressure.
High Blood Pressure At-a-Glance
► High blood pressure can make the heart
work too hard. It raises your risk for
heart disease, stroke, eye problems,
kidney problems, and nerve disease.
► High blood pressure is common in
people who have diabetes.
► If you have high blood pressure, talk with
your health care provider about how to
lower it. Meal planning, exercise, and
medicines can help.
I
Make The Link! Diabetes"6^ Ste
An initiative of the
A American
Diabetes
______ Association*
Cura • Caro • Commllmont" ©AMERICAN
COLLEGE of
CARDIOLOGY
High Blood Pressure and Diabetes
Make the Link! \
\ Patient Page/'
How will I know if my blood
pressure is OK?
Have your health care provider check your
blood pressure at every office visit.
How can keeping my ABCs of
diabetes on target help me stay
healthy?
Keeping your ABCs of diabetes on target can
help you lower your risk of heart disease and
stroke.
A is for A-l-C, a blood sugar check that tells
you your average blood sugar for the past
two to three months.
Suggested target: below 7
B is for blood pressure.
Suggested target: below 130/80
C is for cholesterol. It tells you how much of
the fat that clogs blood vessels is in your
blood.
Suggested LDL target: below 100
I’m not sure I can handle all this...
It’s hard enough to deal with diabetes every day
Worrying about high blood pressure may make
you feel overwhelmed. If this happens, talk to
someone. You could call a friend or family
member, or talk with someone on your health
care team. Support groups can help, too. To
find a support group in your area, or for more
information about high blood pressure and
diabetes, call the American Diabetes Association
at 1-800-342-2383.
My Health Care Professional
My Blood Pressure
Long-term goal for my blood pressure:_____________________________________________________
Date
Blood pressure
My Action Plan:
1 _______________________________________________________________________________________
2 _______________________________________________________________________________________
3 _______________________________________________________________________________________
4 _______________________________________________________________________________________
5 _______________________________________________________________________________________
Make The Link! Diabetes"//
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1-800-DIABETES (342-2383)
www. diabetes, org
American Heart g’ < Association.Statistical Fact Sheet — PopulationsFighting Heart Disease and StrokeAfrican Americans and Cardiovascular DiseasesLeading Causes of Death for Black Males United States: 2000Note: Total CVD - Cardiovascular diseases including congenital cardiovascular defects. Using “Diseases of the Heart, and Stroke,” which do not constitute total CVD, the percentaqe would be 30.8.Source: CDC/NCHS.Leading Causes of Death for Black Females United States: 2000Note: Total CVD - Cardiovascular diseases including congenital cardiovascular defects. Using “Diseases of the Heart, and Stroke,” which do not constitute total CVD, the percentage would beSource: CDC/NCHS.©2003, American Heart Association.For more information, call 1-800-AHA-USA1
African Americans and Cardiovascular Diseases2Deaths From Cardiovascular Diseases and Cancer for Black Males by AgeUnited States: 2000a Total CVD □ CancerNote: Total CVD = Cardiovascular diseases and congenital cardiovascular defects.Source: CDCINCHS.Deaths From Cardiovascular Diseases and Cancer for Black Females by AgeUnited States: 2000AgesH Total CVD ■ CancerNote: Total CVD = Cardiovascular diseases and congenital cardiovascular defects. Source: CDC/NCHS.Note: U.S. government agencies and population surveys use the terms “blacks” and “nonHispanic blacks.” Death rates are age-adjusted per 100,000 population, based on the 2000 U.S. standard. Some data are reported according to ICD/9 codes and some use ICD/10 codes.
African Americans and Cardiovascular Diseases 3
Cardiovascular Disease (CVD) <icd/io codes 100-199, Q20-Q28) (icd/9 codes 390-459,745-747)
• Among non-Hispanic blacks age 20 and older, the following have CVD:
— 40.5 percent of men.
39.6 percent of women.
Estimates are age-adjusted. (NHANES hi [1988-94], cdc/nchs)
• In 2000 CVD caused the deaths of
SBR 48,708 black males.
■ 57,063 black females.
• The 2000 overall death rate from CVD was 343.1. Death rates for blacks were
jUjH 509.6 for males.
397.1 for females.
• Age-adjusted death rates for “Diseases of the Heart” from 1990 to 1998 declined 11 percent
for non-Hispanic blacks. (Healthy People statistical notes, No.23, NCHS, Jan.2002)
• Black and Mexican-American women have higher CVD risk factors than white women of
comparable socioeconomic status (SES). (NHANES hi [1988-94], cdc/nchs, jama. 1998;28O:356-
362)
Coronary Heart Disease (CHD) (icd/io codes 120-125) (icd/9codes410-414,429.2)
• Among non-Hispanic blacks age 20 and older, the following have CHD:
— 7.1 percent of men.
— 9.0 percent of women.
Estimates are age-adjusted. (NHANES ill [1988-94], CDC/NCHS)
• The annual rates per 1,000 population of new and recurrent heart attacks in black men are
— 16.3 for ages 65-74.
— 54.9 for ages 75-84.
— 40.8 for age 85 and older.
For black women the rates are
— 13.3 for ages 65-74.
— 18.3 for ages 65-74.
— 14.1 for age 85 and older.
(CHS, NHLBI)
• In 2000 CHD caused the deaths of
— 24,625 black males.
— 26,640 black females.
• The 2000 overall CHD death rate was 186.9. Death rates for blacks were
— 262.4 for males.
— 187.5 for females.
• In 2000 myocardial infarction (Ml) (heart attack) caused the deaths of 9,045 black males and
10,067 black females.
African Americans and Cardiovascular Diseases 4
Angina Pectoris (icd/w code 120) (icd/9 code 413)
• Angina (chest pain or discomfort caused by reduced blood supply to the heart muscle) is
more common in women than in men. Among non-Hispanic blacks age 20 and older,
— 3.1 percent of men have angina.
— 6.2 percent of women have angina.
Estimates are age-adjusted. (NHANES hi [1988-94], cdc/nchs)
• The annual rates per 1,000 population of new and recurrent episodes of angina for black
men are
— 26.1 for ages 65-74.
— 52.2 for ages 75-84.
— 43.5 for age 85 and older.
For black women the rates are
— 29.4 for ages 65-74.
BBS 37.7 for ages 75-84.
— 15.2 for age 85 and older.
(CHS, NHLBI)
Age-Adjusted Death Rates for Coronary Heart Disease, Stroke, and Lung and
Breast Cancer for White and Black Females
United States: 2000
a White Females □ Black Females
Source: CDCINCHS.
Stroke (ICD/10 codes I60-I69) (ICD/9 codes 430-438)
• Among non-Hispanic blacks age 20 and older, the following have had a stroke:
— 2.5 percent of men.
— 3.2 percent of women.
Estimates are age-adjusted, (nhanes hi [1988-94], cdc/nchs)
• The age-adjusted stroke incidence rates (per 100,000) for first-ever strokes are
— 323 for black males.
— 260 for black females.
African Americans and Cardiovascular Diseases 5
• Blacks have almost twice the risk of first-ever stroke compared with whites. (Various studies,
NINDS)
• In 2000 stroke caused the deaths of
— 8,026 black males.
— 11,195 black females.
• The 2000 overall death rate for stroke was 60.8. Death rates for blacks were
— 87.1 for males.
— 78.1 for females.
• Racial and ethnic minority populations in some age groups have a higher relative risk of
stroke death when compared with the U.S. non-Hispanic white population. Among nonHispanic
blacks, the relative risk is
— 4 times higher at ages 35-54.
— 3 times higher at ages 55-64.
— almost 2 times higher at ages 65-74.
— 1.2 times higher at ages 75-84.
— slightly lower at age 85 and older.
(MMWR, Vol. 49, No. 5, Feb. 11,2000, CDC/NCHS)
• Between 1980 and 1999, the hospital discharge rates for stroke increased for blacks and
whites. The in-hospital mortality rates were similar and decreased for both black and white
patients. Generally, the risk of a stroke hospitalization was greater for blacks than for whites
by more than 70 percent. (Neuroepidemiology. 2002;21:131-141)
High Blood Pressure (HBP) (icd/io codes 110-115) (icd/9 codes 401-404)
• Among non-Hispanic blacks age 20 and older, the following have HBP (defined as systolic
pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher, or taking
antihypertensive medicine):
— 36.7 percent of men.
— 36.6 percent of women.
Estimates are age-adjusted, (nhanes hi [1988-94], cdc/nchs)
• The prevalence of HBP among blacks and whites in the Southeastern United States is
greater and death rates from stroke are higher than among those in other regions.
• The prevalence of high blood pressure in African Americans in the United States is among
the highest in the world.
• Within the African-American community, rates of hypertension vary substantially.
— Those with the highest rates are more likely to be middle aged or older, less educated,
overweight or obese, physically inactive, and to have diabetes.
— Those with the lowest rates are more likely to be younger, but also overweight or obese.
— Those with uncontrolled HBP who are not on antihypertensive medication tend to be
male, younger and have infrequent contact with a physician.
(NHANES III [1988-94], PrevMed. 2002;35:303-312)
African Americans and Cardiovascular Diseases 6
Age-Adjusted Prevalence Trends for High Blood Pressure, Ages 20-74 by
Race/Ethnicity, Sex and Survey
United States: 1976-80 and 1988-94
White Men White Black Men Black
Women Women
■ 1976-80 □ 1988-94
Source: NHANESII (1976-80) and NHANES III (1988-94), CDCINCHS. Data based on multiple
measures of blood pressure.
• Compared with white women, black women have an 85 percent higher rate of ambulatory
medical care visits for hypertension. (Utilization of Ambulatory Medical Care by Women: U.S., 1997-98,
NCHS, 2001)
• Compared with whites, blacks develop HBP earlier in life and their average blood pressures
are much higher. As a result, compared with whites, blacks have a 1.3 times greater rate of
nonfatal stroke, a 1.8 times greater rate of fatal stroke, a 1.5 times greater rate of heart
disease death and a 4.2 times greater rate of end-stage kidney disease.(JNC v and vi)
• Mean systolic blood pressure for black women ages 25-64 by educational attainment is,
. — less than 9 years of education, 130.8.
— 9-11 years of education, 123.6.
— 12 years of education, 120.8.
more than 12 years of education, 117.0.
(NHANES III [1988-94], CDC/NCHS)
• As many as 30 percent of all deaths in hypertensive black men and 20 percent of all deaths
in hypertensive black women may be attributable to HBP.(jnc v and VI)
• In 2000 HBP caused the deaths of
— 4,670 black males.
— 5,912 black females.
• The 2000 overall death rate from HBP was 16.2. Death rates for blacks were
— 46.3 for males.
— 40.8 for females.
African Americans and Cardiovascular Diseases 7
End-Stage Renal Disease (ESRD) (icD/wcodeNi8.o)
• Blacks and Native Americans have much higher rates of ESRD than whites and Asians.
Blacks represent 32 percent of treated ESRD patients.
Arteries, Diseases Of (ICD/10 codes I70-I79) (ICD/9 codes 440-448) (Includes peripheral vascular disease)
• Deep vein thrombosis — Medicare recipients age 65 and older reported 30-day case fatality
rates in patients with pulmonary embolism (PE). Overall, blacks had higher fatality rates
than whites (16.1 percent vs. 12.9 percent).
Cardiomyopathy (icd/i0 code 142) (icd/9 code 425)
• Mortality from cardiomyopathy is highest in older persons, men and blacks. (Framingham Heart
Study, NHLBI)
Congenital Cardiovascular Defects (icd/w codes 020-028) (icd/9 codes 745-747)
• The 2000 overall death rate for congenital cardiovascular defects was 1.6. Death rates for
blacks were
— 2.1 for males.
— 1.8 for females.
• 2000 crude infant death rates (under 1 year) were
— 45.7 for white babies.
— 62.8 for black babies.
Congestive Heart Failure (CHF) (icd/w code 150.0) (icd/9 code428.0)
• Among non-Hispanic blacks age 20 and older, the following have CHF:
— 3.5 percent of men.
— 3.1 percent of women.
Estimates are age-adjusted. (NHANES hi [1988-94], cdc/nchs)
• The annual rates per 1,000 population of new and recurrent CHF events for black men are
— 21.1 for ages 65-74.
— 52.0 for ages 75-84.
— 66.7 for age 85 and older.
For black women the rates are
— 18.9 for ages 65-74.
— 33.5 for ages 75-84.
— 48.4 for age 85 and older.
(CHS, NHLBI)
In 2000 CHF caused the deaths of
— 1,701 black males.
— 2,726 black females.
African Americans and Cardiovascular Diseases 8
• The 2000 overall death rate from CHF was 18.7. Death rates for blacks were
— 20.4 for males.
— 19.3 for females.
Rheumatic Fever/Rheumatic Heart Disease (RF/RHD) (icd/io codes 100-109)
(ICD/9 codes 390-398)
• The incidence of rheumatic fever remains higher in blacks, Puerto Ricans, Mexican
Americans and American Indians.
• In 2000 rheumatic fever and rheumatic heart disease caused the deaths of
— 79 black males.
186 black females.
• The 2000 overall death rate from RF/RHD was 1.3. Death rates for blacks were
— 0.7 for males.
— 1.2 for females.
Tobacco Smoke
• From 1980 to 2001, the percentage of high school seniors who smoked in the past month
decreased 3.3 percent.
— For whites it increased 10.0 percent.
— For blacks there was a 48.8 percent decrease.
(Health United States 2002, CDC/NCHS)
• Among blacks or African Americans age 18 and older, it’s estimated that the following
smoke:
— 26.1 percent of men.
— 20.8 percent of women.
(Health United States, 2002, CDC/NCHS)
• 37 percent of non-Hispanic black adults who don’t use tobacco reported exposure to
environmental tobacco smoke at home or at work. (NHANES hi [1988-91], cdc/nchs)
• Among non-Hispanic blacks ages 18-24 with less than 12 years of education,
— 26.7 percent of men smoke.
— 34.3 percent of women smoke.
Among those with 12 years of education,
— 24.1 percent of men smoke.
— 14.1 percent of women smoke.
Among those with more than 12 years of education,
— 16.4 percent of men smoke.
— 12.8 percent of women smoke.
(NHANES II! [1988-94], CDC/NCHS)
African Americans and Cardiovascular Diseases 9
• Current cigarette smoking among black women ages 25-64 by educational attainment is
— 32.6 percent of those with under 9 years of education.
— 49.2 percent of those with 9-11 years of education.
— 34.6 percent of those with 12 years of education.
— 23.5 percent of those with more than 12 years of education.
(NHANES III [1988-94], CDC/NCHS)
High Blood Cholesterol and Other Lipids
• Among children and adolescents ages 4-19 years, non-Hispanic black children and
adolescents have significantly higher mean total cholesterol, LDL cholesterol and highdensity
lipoprotein (HDL) cholesterol (good cholesterol) levels when compared with nonHispanic
white and Mexican-American children and adolescents, (nhanes hi [1988-941
CDC/NCHS)
• Among children and adolescents ages 4-19, the mean total blood cholesterol level is 165
mg/dL. For boys it's 163 mg/dL and for girls it’s 167 mg/dL. For non-Hispanic blacks, it’s
— 168 mg/dL for boys.
— 171 mg/dL for girls.
(NHANES [1999-2000], CDC/NCHS)
• In 2000, 50 million adult men and 55 million adult women had total blood cholesterol levels
of 200 mg/dL or higher. In adults, total cholesterol levels of 240 mg/dL or higher are
considered high risk. Levels from 200 to 239 mg/dL are considered borderline-hiqh risk
(NHANES III [1988-94], CDC/NCHS)
• Among non-Hispanic blacks ages 20-74, the following have total blood cholesterol levels of
200 mg/dL or higher:
— 45 percent of men.
—- 46 percent of women.
Of these, the following have levels of 240 mg/dL or higher:
— 15 percent of men.
— 18 percent of women.
Estimates are age-adjusted, (nhanes hi [1988-94], cdc/nchs)
• Among non-Hispanic blacks age 20 and older, the following have an LDL cholesterol of 130
mg/dL or higher:
— 46.3 percent of men.
— 41.6 percent of women.
Of these, an LDL cholesterol of 160 mg/dL or higher is found in
— 19.3 percent of men.
— 18.8 percent of women.
Low-density lipoprotein (LDL) or bad” cholesterol levels of 130-159 mg/dL are considered
borderline high. Levels of 160-189 mg/dL are classified as high, and levels of 190 mg/dL or
higher are very high. Estimates are age-adjusted, (nhanes ill [1988-94], cdc/nchs)
African Americans and Cardiovascular Diseases10• Among non-Hispanic blacks age 20 and older, the following have an HDL cholesterol less than 40 mg/dL:— 24.3 percent of men.Egg 13.0 percent of women.High-density lipoprotein (HDL) or “good" cholesterol levels of less than 40 mg/dL are associated with a higher risk of coronary heart disease. Estimates are age-adjusted (NHANES III [1988-94], CDC/NCHS)Age-Adjusted Prevalence of Americans Age 20 and Older With LDL Cholesterol of 130 mg/dL or Higher by Race/Ethnicity and Sex United States: 1988-94Whites Blacks Americans■ Men □ WomenSource: NHANES III (1988-94), CDC/NCHS.Age-Adjusted Prevalence of Americans Age 20 and Older With HDL Cholesterol of 40 mg/dL or Lower by Race/Ethnicity and Sex United States: 1988-94■ Men ■ WomenSource: NHANES III (1988-94), CDCINCHS.
African Americans and Cardiovascular Diseases 11
Physical Inactivity
• Leisure-time physical inactivity is more prevalent among women than men, among nonHispanic
blacks and Hispanics than non-Hispanic whites, among older than younger adults
and among the less affluent than the more affluent. (CDC/nchs)
• Among non-Hispanic blacks in grades 9-12, the following report participation invigorous
activity during the past seven days:
-— 72.4 percent of males.
— 47.8 percent of females.
The following report participation in moderate activity during the past seven days:
— 23.7 percent of males.
^9 16.5 percent of females.
(YRBS [2001], CDC/NCHS)
• Among non-Hispanic blacks age 18 and older, the following report no leisure-time physical
activity:
^9 44.1 percent of men.
55.2 percent of women.
(NHIS [1997-98], CDC/NCHS)
Prevalence of Moderate or Vigorous Physical Activity in Americans Age 20 and
Older by Sex, Race/Ethnicity and BMI*
United States: 1988-94
BMI indicates body mass index: weight in kilograms divided by height in meters squared (kg/m2).
Source: NHANES III (1988-94), CDC/NCHS.
African Americans and Cardiovascular Diseases 12
Overweight and Obesity
• Among non-Hispanic black American children ages 6-11, the following are overweight, using
the 95th percentile of body mass index (BMI) values on the CDC 2000 growth chart:
— 17.1 percent of boys.
KgjS22.2 percent of girls.
(NHANES [1999-2000], CDC/NCHS)
• Among non-Hispanic black adolescents ages 12-19, the following are overweight, using the
95th percentile of BMI values on the CDC 2000 growth chart:
— 20.7 percent of boys.
— 26.6 percent of girls.
(NHANES [1999-2000], CDC/NCHS)
• Among non-Hispanic blacks age 20 and older, the following are overweight or obese,
defined as a BMI of 25.0 kg/rrfand higher:
— 60.7 percent of men.
— 77.3 percent of women.
Of these, the following are obese, defined as a BMI of 30.0 kg/rrfand higher:
— 28.1 percent of men.
— 49.7 percent of women.
Estimates are age-adjusted. (Nhanes [1999-2000], cdc/nchs)
Diabetes MellitUS (ICD/10 codes E10-E14) (ICD/9 code 250)
• The risk of diabetes for Mexican Americans and non-Hispanic blacks is almost twice that for
non-Hispanic whites, (nhanes hi [1988-94], cdc/nchs)
• Among non-Hispanic blacks age 20 and older, the following have physician-diagnosed
diabetes:
— 7.6 percent of men.
— 9.5 percent of women.
Estimates are age-adjusted, (nhanes hi [1988-94], cdc/nchs)
• Among non-Hispanic blacks age 20 and older, the following have undiagnosed diabetes,
using American Diabetes Association criteria of fasting plasma glucose of 126 mg/dL or
more:
— 2.8 percent of men.
— 4.7 percent of women.
Estimates are age-adjusted, (nhanes ill [1988-94], cdc/nchs)
• Among non-Hispanic blacks age 20 and older, the following have pre-diabetes, using
American Diabetes Association criteria of fasting plasma glucose of 110 to less than 126
mg/dL:
— 8.0 percent of men.
— 6.8 percent of women.
Estimates are age-adjusted, (nhanes ill [1988-94], cdc/nchs)
African Americans and Cardiovascular Diseases 13
• In 2000 diabetes mellitus caused the deaths of
— 4,771 black males.
HE’ 7,250 black females.
• The 2000 overall death rate from diabetes mellitus was 25.2. Death rates for blacks were
— 47.8 for males.
— 50.4 for females.
Age-Adjusted Prevalence of Physician-Diagnosed Diabetes in Americans Age 20
and Older by Sex and Race/Ethnicity
United States: 1988-94
® Non-Hispanic Whites B Non-Hispanic Blacks □ Mexican Americans^
Source: NHANES III (1988-94), CDCINCHS.
Nutrition
• The average daily intake of total fat in the United States is 81.4 grams (g). For non-Hispanic
blacks the average is 82.0 grams:
— 94.6 g for males.
— 71.2 g for females.
(NHANES III [1988-94], CDC/NCHS)
• The average daily intake of saturated fat in the United States is 27.9 grams. For non-
Hispanic blacks the average is 27.5 grams:
— 31.7 g for males.
— 23.8 g for females.
(NHANES III [1988-94], CDC/NCHS)
• The recommended daily intake of dietary cholesterol for adults is less than 300 milligrams
(mg). The average daily intake of dietary cholesterol in the United States is 269.6 mg. For
non-Hispanic blacks the average is 297.9 milligrams:
— 358.8 mg for males.
— 245.6 mg for females.
(NHANES III [1988-94], CDC/NCHS)
African Americans and Cardiovascular Diseases14• The recommended daily intake of dietary fiber is 25 grams or more. Americans consume a daily average of 15.6 grams of dietary fiber. For non-Hispanic blacks the average is 13.4 grams:— 15.0 g for males.— 12.0 g for females.(NHANES III [1988-94], CDC/NCHS)Source FootnotesBRFSS - Behavioral Risk Factor Surveillance SystemCDC/NCHS - Centers for Disease Control and Prevention/National Center for Health StatisticsCHS - Cardiovascular Health Study (1988 to date)JNC V - Fifth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood PressureJNC VI Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood PressureMMWR — Morbidity and Mortality Weekly ReportNHANES III (1988-91) - National Health and Nutrition Examination Survey III, Phase INHANES III (1988-94) - National Health and Nutrition Examination Survey IIINHIS - National Health Interview SurveyNHLBI - National Heart, Lung, and Blood InstituteYRBS — Youth Risk Behavior Surveillance
High Blood Pressure and Kidney Disease Page 1 of 5
High Blood Pressure
and Kidney Disease
Publications • What is high blood pressure?
• How does high blood pressure hurt my kidneys?
NIDDK Home , How will I know whether I have high blood pressure?
• How will I know whether I have kidney damage?
• How can I prevent high blood pressure from damaging my
kidneys?
• Are there medicines that can help?
• What groups are at risk for kidney failure related to high
blood pressure?
• Hope Through Research
• For More Information
Your kidneys play a key role in keeping your blood pressure in a
healthy range, and blood pressure, in turn, can affect the health of
your kidneys. High blood pressure, also called hypertension, can
damage the kidneys.
What is high
blood pressure?
Blood pressure measures the
force of blood against the walls
of your blood vessels. Blood
pressure that remains high over
time is called hypertension.
Extra fluid in your body
increases the amount of fluid in
your blood vessels and makes
your blood pressure higher.
Narrow or clogged blood vessels
also raise blood pressure.
Am mint
of blood Diameter of Blood
in vessel bloodvessel pressure
Hypertension can result from too
much fluid in normal blood vessels
or from normal fluid in narrow
blood vessels.
If you have high blood pressure,
see your doctor regularly.
http://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm 3/16/03
High Blood Pressure and Kidney DiseasePage 2 of 5How does high blood pressure hurt my kidneys?How will I know whether I have high blood pressure?How will I know whether I have kidney damage?How can I prevent high blood pressure from damaging my kidneys?High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It's a dangerous cycle.High blood pressure is one of the leading causes of kidney failure, also commonly called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or go on dialysis. Every year, high blood pressure causes more than 15,000 new cases of kidney failure in the United States.Most people with high blood pressure have no symptoms. The only way to know whether your blood pressure is high is to have a health professional measure it. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Your blood pressure is considered normal if it stays below 130/85 (expressed as "130 over 85"), but recent studies suggest that people with kidney disease should keep their blood pressure even lower.Kidney damage, like hypertension, can be unnoticeable, detected only through medical tests. Blood tests will show whether your kidneys are removing wastes efficiently. Your doctor may refer to tests for serum creatinine and BUN, which stands for blood urea nitrogen. Having too much creatinine and urea nitrogen in your blood is a sign that you have kidney damage.Another sign is proteinuria, or protein in your urine. Proteinuria has also been shown to be associated with heart disease and damaged blood vessels. (For more information, see the NIDDK fact sheet on proteinuria.)If you have kidney damage, you should keep your blood pressure well below 130/85. The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure at or below 130/85, or even below 125/75 when protein in the urine exceeds 1 gram per 24 hours.li ........ =ilhttp://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm3/16/03
High Blood Pressure and Kidney DiseasePage 3 of 5Are there medicines that can help?Many people need medicine to control high blood pressure. A group of medications called ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and have an added protective effect on the kidney in people with diabetes. Additional studies have shown that ACE inhibitors also reduce proteinuria and slow the progression of kidney damage in people who do not have diabetes. You may need to take a combination of two or more blood pressure medicines to reach 125/75.What groups are at risk for kidney failure related to high blood pressure?All racial groups have some risk of developing kidney failure from high blood pressure. African Americans, American Indians, and Alaska Natives, however, are more likely than whites to have high blood pressure and to develop kidney problems from it—even when their blood pressure is only mildly elevated. In fact, African Americans ages 25 to 44 are 20 times more likely than whites in the same age group to develop hypertension-related kidney failure.People with diabetes also have a substantially increased risk forhttp://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm3/16/03
High Blood Pressure and Kidney Disease Page 4 of 5
developing kidney failure. People who are at risk both because of
their race and because of diabetes should have early management
of high blood pressure.
The National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK), also part of NIH, is sponsoring a study to find
effective ways to prevent high blood pressure and kidney failure in
African Americans.
Hope Through
Research
In recent years, researchers have learned a great deal about kidney
disease. NIDDK sponsors several programs aimed at
understanding kidney failure and finding treatments to stop its
progression.
NIDDK's Division of Kidney, Urologic, and Hematologic
Diseases supports basic research into normal kidney function and
the diseases that impair normal function at the cellular and
molecular levels, including diabetes, high blood pressure,
glomerulonephritis, and polycystic kidney disease.
For More
Information
American Kidney Fund
6110 Executive Boulevard, Suite 1010
Rockville, MD 20852
Phone: 1-800-638-8299 or (301) 881-3052
Email: helpline@akfinc.org
Internet: www.akfinc.org
National Heart, Lung, and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
Email: NHLBIinfo@rover.nhlbi .nih, gov
Internet: www.nhlbi.nih.gov
National Kidney Foundation
30 East 33 rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Email: info@kidney.org
Internet: www.kidney, org
National Kidney and Urologic Diseases Information
http://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm 3/16/03
High Blood Pressure and Kidney DiseasePage 5 of 5Clearinghouse3 Information Way Bethesda, MD 20892-3580 Email: nkudic@info.niddk.nih.govThe National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Vito M. Campese, M.D., University of Southern California, and Matthew Weir, M.D., University of Maryland.This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.PublicationsNIDDK HomeNIH Publication No. 01-4572 July 2001Posted: August 2001http://www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm3/16/03
MEDLINEplus: Treat Blacks Earlier for Hypertension, Experts Say Page 1 of2
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HEALTH MMFORMAHOlN
Treat Blacks Earlier for Hypertension, Experts Say
Reuters Health
Tuesday, March 11, 2003
NEW YORK (Reuters Health) - Black Americans are at greater risk of dangerous high blood pressure than whites,
and should be treated earlier to help prevent heart attack or stroke, according to a new set of expert guidelines
released Monday.
The International Society on Hypertension in Blacks (ISHIB) now recommends that African-American patients begin
anti-hypertensive treatments when their blood pressure reaches 130/80 mm Hg-a full 10 points lower than the
previous standard of 140/90 mm Hg, recommended by the federal government in 1997.
Blood pressures below 120/80 mm Hg are considered within a normal, healthy range.
"On average, one African American dies from high blood pressure every hour, yet barely a quarter of hypertensive
African Americans has the disease under control," ISHIB president Dr. John Flack said in a statement.
Experts now estimate that one in every three African Americans is hypertensive, with blacks more likely to develop
the condition earlier and progress more rapidly to severe high blood pressure than their white peers.
With this in mind, drug interventions aimed at black Americans should be administered "early and persistently," the
ISHIB experts say. Their consensus statement is published this week in the journal Archives of Internal Medicine.
While combination drug therapy may be required to push blood pressure to manageable levels, doctors should also
urge patients to take up heart-healthy lifestyles, such as diets high in fruits and vegetables and low in salt and fat,
daily exercise and quitting smoking, the experts say.
According to Flack, his group issued the guidelines "to give health care providers the tools to manage high blood
pressure appropriately in African Americans and save lives."
The recommendations are endorsed by the American Heart Association, the Association of Black Cardiologists, the
Consortium for Southeastern Hypertension Control and the National Medical Association.
SOURCE: Archives of Internal Medicine 2003;163:521-524,525-541.
Copyright 2002 Reuters. Reuters content is the intellectual property of Reuters. Any copying, republication or redistribution of Reuters content,
including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for
any errors or delays in content, or for any actions taken in reliance thereon. Reuters, the Reuters Dotted Logo and the Sphere Logo are registered
trademarks of the Reuters group of companies around the world.
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MEDLINEplus: Poverty Tied to Disability Among US Black Children Page 1 of2
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Poverty Tied to Disability Among US Black Children
Reuters Health
By Charnicia E. Huggins
Tuesday, March 11, 2003
NEW YORK (Reuters Health) - Black children in the U.S. are more likely than white children to have their play and
other activities restricted because of some chronic condition, according to new study findings.
Yet the reason for this disparity seems to have more to do with family income than with race, a team of California
and New York researchers reports.
"If we as a nation want to reduce health disparities between black and white children, we need to address the
underlying inequities in family income," lead author Dr. Paul Newacheck, a professor of health policy at the
University of California, San Francisco, told Reuters Health.
Previous studies have also identified racial disparities in the health of Americans-disparities that have persisted for
40 years.
For example, African Americans are known to have lower life expectancies than whites, as well as higher death
rates for 13 of the 15 leading causes of death. Black children have higher rates of asthma than their white peers,
and are more likely to be born at a low weight or die in infancy.
In the current study, the investigators examined rates of disability-or limitations in activity caused by some chronic
condition-among black and white children.
They analyzed data on 400,000 children and adolescents, including nearly 23,000 disabled children, who were
involved in 14 annual editions of the ongoing National Health Interview Survey between 1979 and 2000.
Altogether, disability rates increased among both blacks and whites during the two decades. The increase was 77
percent among black children, however, in comparison to 47 percent among white children.
Further, by 1999-2000, black children were 13 percent more likely than their white peers to have their activities
limited for some health reason, Newacheck and his colleagues report in the March issue of the Archives of
Pediatrics and Adolescent Medicine.
However, the researchers found, the racial disparity "disappears entirely" when family income is taken into
consideration.
Black children were more likely to come from families with lower incomes, which possibly affected their access to
healthcare, their exposure to certain environmental triggers and their nutrition, Newacheck and his team speculate.
http://www.nlm.nih.gov/niedlmeplus/news/fullstory_l 1951 .html 3/16/03
MEDLINEplus: Poverty Tied to Disability Among US Black Children Page 2 of 2
"Low-income families face considerable disadvantages," Newacheck said. "Their children are more likely to live in
unsafe neighborhoods, have poor nutrition, and low-quality health services. All of these factors affect whether
children get illnesses and how severe they are."
To reduce the risk of disability among children, Newacheck advised parents to make sure their children develop
healthy lifestyles, including eating right, exercising and taking "common sense measures" such as wearing
seatbelts and bicycle helmets.
"Parents should also be sure their children receive regular check-ups," Newacheck added. "Early detection of
health problems can make a big difference in preventing severe health problems."
SOURCE: Archives of Pediatrics and Adolescent Medicine 2003;157:244-248.
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MEDLINEplus: Income Behind Racial Gap in Stroke Rates: Study Page 1 of2
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REUTERS
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Income Behind Racial Gap in Stroke Rates: Study
Reuters Health
By Martha Kerr
Tuesday, February 18, 2003
PHOENIX (Reuters Health) - African Americans are known to have a higher rate of stroke than whites, and
according to an analysis of a large national study, this difference can be explained by differences in income.
"Income explains the racial disparities, which I think is good news," Dr. Dawn M. Bravata of Yale University in New
Haven, Connecticut, told attendees of the American Stroke Association's 28th International Stroke Conference
during a panel discussion of the link between race and stroke.
If you can ameliorate whatever it is about being poor that increases stroke risk, you can equalize racial
differences," Bravata said.
Her statement is based on an analysis of data from the third National Health and Nutrition Examination Survey,
which involved 11,163 participants. Twenty-five percent were black and 6% had a history of stroke.
For both blacks and whites, income was strongly associated with stroke risk, Bravata reported. "It explains the
race/stroke phenomenon," she told Reuters Health. "The income/stroke relationship is about the same as diabetes
as a stroke risk factor."
Panel moderator Dr. Philip Gorelick of the Center for Stroke Research in Chicago commented that "privileged
blacks do almost as well as privileged whites-almost, but not quite." He told Reuters Health that "we need to get
away from this genetic fixation as the magic bullet to explain stroke."
"We see patterns of risk early on, even in childhood-increased pulse rates, increased body mass index, increased
cholesterol levels," he added, noting that these risk factors are frequently associated with lower socioeconomic
status. " We need to start there to decrease risk," he concluded.
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Related News:
• More news on African American Health
• More news on Stroke
http://www.nlm.nih.gov/medlmeplus/news/fiillstoiy_l 1703 html 3/16/03
MEDLINEplus: Healthcare, Teen Birth Rate Improving for US Blacks Page 1 of2
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Healthcare, Teen Birth Rate Improving for US Blacks
Reuters Health
By Jesse J. Logan
Thursday, February 27, 2003
NEW YORK (Reuters Health) - More African-American women are receiving early prenatal care and fewer are
having low birth weight babies, while the percentage of black teens giving birth is dropping, according to an analysis
of national statistics from 1990 to 2000 released Thursday.
Investigators from SUNY Downstate Medical Center in New York found blacks improved on several measures of
health in their analysis of data from the census and the US Centers for Disease Control and Prevention.
The data covered the nation's 100 biggest cities and their suburbs. The Robert Wood Johnson Foundation funded
the study.
While all five racial and ethnic groups studied showed a decline in the number of teens giving birth, black teens had
the largest drop-declining by close to 14% among African-American teens living in cities and 10 5% for suburban
residents.
And the greatest rise in the percentage of pregnant women receiving early prenatal care was seen among blacks
with an increase of nearly 20% in cities and 15% in suburbs.
"Although urban and suburban black populations continue to have some of the greatest health disparities compared
to whites, blacks made the most consistent improvements on key measures," Dr. Dennis Andrulis the study's lead
investigator, said in a teleconference. ’ }
In a statement Andrulis said the findings are "very good news," but that it's important to keep the results "in
perspective."
Despite the impressive gains, averages for city and suburban black residents remain well below those for whites
on virtually all measures," he said.
Whites continue to have the lowest rates of teen births and low birth weight babies, and have the highest
percentage of pregnant women receiving early prenatal care.
The study also found Hispanics showed the smallest declines in teen births, with moderate progress in improving
rates of early prenatal care. a
Andrulis said the research could be a guide for providing healthcare to those who need it most. For instance he
suggested that "bridging a cultural and language gap" in Hispanic communities where many people remain
uninsured might improve access to healthcare.
http://www.nlm.nih.gov/medlineplus/news/fullstory_l 1827.html 3/16/03
6 SAMPLE PRESS KITHealth Care for All Californians Act0 SAMPLE LEGISLATIVE FACT SHEETSChildren’s Health Long Term Care Health Insurance for Low-Income Children0 RESOURCE GUIDEAKA Day At The Capitol Planning GuideAKA DAY AT THE CAPITOL CARSON CITY, NEVADA March 18,2003
The Health Care for All Californians Act
Question and Answers on SB 921 (Kuehl)
Q. How does the bill control the growth in health care spending that has been spiraling
out of control?
• The first step is to eliminate administrative waste which amounts to about $14 billion
per year in California. This is done by creating a single insurance plan administered
by a single agency.
• The next step is to put all the health care dollars in one place and make all payments
out of one place. This is done by creating a state health care fund. The third step is to
use our purchasing power to win discounts on the price of pharmaceuticals and
medical equipment.
• Another important way to control growth of spending is to be sure everyone has a
doctor and gets preventive care. There are so many illnesses that can be prevented
and controlled if you see a doctor regularly. We will save money if we can use our
emergency rooms for real emergencies.
• Another important measure that will save money is to create a simple, centralized
claims and payment system, with one clear set of reimbursement rules.
• Coordinate major capital expenditures to be sure we build and buy only what we
really need.
• Create an annual health care budget and give the elected Commissioner authority to
enforce it.
• Allow medical professionals to establish best medical standards of care so people get
the right treatments at the right time.
• Develop comprehensive disease management programs.
• Regionalize specialty care and expensive technology.
• Use an evidence-based drug formulary to be sure that people get only safe drugs and
drugs that are known to be effective.
• Set up statewide healthcare databases so we can do statewide health care planning
and budgeting and we can identify causes of medical errors and make a plan to
eliminate them.
• Use simpler, standardized forms.
• Have a fully independent Inspector General for Health whose job it is to identify and
eliminate fraud.
• Perhaps most important is to have an open decision making process that involves
people from all aspects and all parts of the health care system; including consumers,
providers, administrators, policy experts and employers, unions and many more.
Q. Can you really offer everyone a full pharmaceutical benefit without a co-pay?
A. Yes. By using our purchasing power we can win large discounts on the costs of
pharmaceuticals. We will then be paying what the Europeans, Scandinavians,
Australians and Canadians pay for the same pharmaceuticals and, at those prices, pharmaceuticals are affordable.Q. Won’t drug discounts adversely affect pharmaceutical companies?A. No. There are 10 million Californians who now have no prescription drug benefits but who will have them under SB 921 (Kuehl). This expansion of the market offsets losses from lower prices.Q. Won’t lower drug prices hurt the ability of pharmaceutical companies to do research?A. No. Pharmaceutical companies don’t use profits to pay for research, so even if their profits were to drop from lower drug prices, it won’t affect research.Q. Why is your plan better than “pay or play”?A. They are both important plans that deserve serious consideration. I think a California single payer is the best way to go because it corrects the underlying structural problems that cause inefficiency and waste. It covers everyone and gives us the best tools to contain health care costs while still maintaining a first rate health care system. Only single payer will reduce the portion of our healthcare dollars directed to administrative costs from 23% to about 5%, thus freeing up funds for healthcare services and improved provider reimbursement. Only a California single payer plan will bring ballooning capital expenditures under control, cover every resident of our state, reduce expenditures for taxpayers, and give us freedom of choice with regard to our healthcare providers.Q. How many Californians have no health insurance?A. Approximately 7.3 million or about one in five Californians. That number will grow, however, because unemployment is going up.Q. Who doesn’t have health insurance?A. 85%-90% Californians without health insurance are working adults or their dependents. Only 6% of the uninsured are immigrants.Q. SB 921 (Kuehl) is a “single payer system”. Will we have the same problems the Canadians and the British are having with their single payer systems?A. No. The United States spends $5000 per person per year on health care. That’s twice as much as Canada and four times as much as Britain spends. If either country spent what we’re spending there would be no long waits for care. We spend a lot of that $5000 on inefficient administration, over-priced pharmaceuticals, unneeded capital expenditures, unnecessary emergency room and hospital care. This reform shifts these misspent dollars into direct health care services and provider reimbursement.
Q. Is this socialized medicine?A. No. Under socialized medicine the government owns all the health facilities and employs all the doctors and nurses and other health care workers. SB 921 (Kuehl) does not propose such a change. Health care providers will have to compete on the basis of quality, because the consumer will be free to choose her doctors. SB 921 (Kuehl) will establish a statewide system of claims and reimbursement administered by the State of California.Q. Won’t the health insurance industry be hurt by this reform?A. No. This reform has a place for the health insurance industry, its workforce and its infrastructure. While they would not sell health insurance policies (except for services not covered in the bill) there are other roles for them. For example, the Australian approach is interesting and we plan to look at it carefully. The health insurance industry formed a Commission and provides a variety of services to the Australian national health care system.Q. Can we afford this reform at a time of budget deficits?A. We can’t afford not to do this. Our plan protects our healthcare system against the ups and downs of our overall economy. SB 921 (Kuehl) does not involve any new spending and controls the growth of health care spending. Approximately 50% of health care is already paid for by taxes and that money would come into the California Health Care System under SB 921 (Kuehl). New taxes needed to fund the system would replace health insurance premiums, co-payments and deductibles. Reforms that seek to tinker with or slightly expand the present fractured system maintain our current expensive inefficiencies and would require that we spend more money to cover some additional people. That is what we cannot afford at a time of budget deficits.Q. But aren’t you talking about raising people’s taxes at a time when their income is dropping?A. Most families and all employers who provide health benefits would spend less than they now spend on premiums, deductible and co-pays or on bills from emergency rooms. As a state we will spend less, because each of us pays in costs that are passed-on because of use of emergency rooms for non-emergencies by people who have no insurance and the deterioration in public health do to the chronic lack of appropriate healthcare.Q. Does this reform ration health care?A. All health care systems ration care and consider it to be sensible health care planning. The question is: On what basis is care rationed and who makes the decisions? Today, insurance and pharmaceutical companies and HMOs ration care and medications to those who can afford them. Under SB 921 (Kuehl) care will be affordable for every Californian, health system planning will be done by a public, representative Health Policy
Board and care will only be “rationed” based on medical need as determined by your doctor.Q. Does SB 921 (Kuehl) cover undocumented immigrants?A. Yes. It costs California less to insure undocumented immigrants than to exclude them. People without health insurance don’t get preventive care and, consequently, use expensive emergency rooms and hospital care when they get sick. It is estimated that if every Californian got preventive care we could save between $3.2 and $4 billion dollars a year. Most undocumented Californians are employed in essential jobs and our immigrants pay $80,000 more in taxes and fees over a lifetime than they will receive in local, state and federal benefits in their lifetimes. And it’s good public health policy to insure the entire population. It helps control epidemics or outbreaks that could expose everyone to disease.Q. How will the plan help seniors .who already have health coverage through Medicare?A. Under SB 921 (Kuehl), seniors get benefits that Medicare doesn’t cover, such as full prescription drug coverage and dental coverage. For at least the first two years there will be no co payments or deductibles for ANY services. Seniors will spend less than they do now for health care. The Lewin Group estimated the average annual savings for seniors at around $1100 per year per household. Seniors with retirement health benefits who choose to retire out of state will be covered.Q. How will seniors be taxed under SB 921 (Kuehl)?A. If the federal government grants approval, the Medicare tax on Parts A and B that seniors pay now on their Social Security checks will cover their basic health tax under SB 921 (Kuehl). Like all Californians, if seniors have assets, such as a pension, they will pay a progressive and affordable surcharge on it. And like all other Californians they will pay a health tax on any tobacco products they use or alcohol they drink.Q. Will anyone lose benefits they now have?A. Except for cosmetic surgery for non-medical reasons, our intent is that no one should lose any benefit they now have. There are thousands of benefit packages today and we will have to explore them in the coming months and compare them to the benefits in the bill. We will adjust the bill accordingly.Q. Why are you excluding long term care when the Lewin Report says it’s affordable?A. We want to be fiscally prudent. We want to get the system going and get the single payer efficiencies in place. Then we will discuss long term care and other benefits. I fully expect we will be able to add long term care in the not too distant future.Q. Is this government-run health care?
A. No. A California single payer system will put medical decision making back in the hands of medical professionals and their patients, unlike today when doctors have to get permission to order a test or a treatment from an insurance administrator with little or no medical training. The bill creates a Medical Practice Standards Board made up of medical professionals and patients that will establish standards of care and an evidence-based formulary. And isn't it interesting that in a country where people are so suspicious of government that some of our most popular health programs are government programs, like Medicare, Veteran's Health Programs, Worker's Compensation and school nurse programs. What makes a government program unpopular is inadequate funding, complex eligibility rules, means testing, periodic eligibility lapses, poor provider participation, low provider reimbursement and the stigma of being "on welfare". A California single payer system will not have these problems.Q. Will single payer stifle innovation?A. No. What stifles innovation is lack of a market and lack of money. A California single payer system adds 7.3 million people who have health coverage and can use new health care technologies. We expect a proliferation of health care innovation.
Fact Sheet for SB 921The Healthcare for All Californians ActUniversal Health Coverage for All CaliforniansThe Health Care for All Californians Act would provide health insurance coverage to all Californians through a single insurance plan offered by the State of California and would control the growth of health care spending through a simplified administrative structure, consolidated financing and purchasing and state wide health planning.Universal Coverage: Eligibility is conferred based on residency, instead of randomly by employment. Residents traveling out of state are covered for up to 90 days. California retirees with vested benefits and/or paying applicable California health taxes are covered.Financing: THIS PLAN INVOLVES NO NEW SPENDING. The plan would be financed by a low percentage payroll tax on all employers, employees, the self-employed and recipients of unearned income, as well as a small tax on tobacco products and alcohol, which together replace private health insurance premiums. Federal, state and county monies now expended on health care would be consolidated, along with the taxes set out above, into a State Health Fund that is established in the California Treasury. There would be no co-payments or deductibles in the first two years of operation, after which the policy may be reviewed.Benefits: Coverage would include all care prescribed by a patient's health care provider that meets accepted standards of care and practice; including medical, mental health, surgical, podiatric inpatient and outpatient services; diagnostic testing; prescription drugs and medical equipment; dental and vision care; hospice care; emergency care including ambulance; skilled nursing care after hospitalization; substance abuse recovery programs, health education and self-help programs; translation services, including services for those with hearing and vision impairments; transportation needed to access covered services.Governance: The system would be governed by a state elected Commissioner of Health, who would head the State Health Agency. This agency would be assembled through the consolidation of the existing healthcare agencies. The Commissioner would additionally appoint a Deputy Commissioner of Health, establish the annual state health care budget and chair the Health Policy Board.— over —
Within the State Health Agency are:
■ Regional Health Care Agencies headed by Regional Directors appointed by the
Commissioner.
■ The Health Policy Board that sets broad health system policy, priorities and goals and
whose membership includes the Commissioner, the Deputy Commissioner, Regional
Health Directors, the Purchasing and Health Fund directors, Consumer Advocates,
the Director of Public Health, the Chief Medical Officer, members of the public,
providers, policy experts, labor leadership, and health industry representatives.
■ The Board of Medical Practice Standards, headed by a Chief Medical Officer who is
appointed by the Commissioner. The board recommends standards of care and
practice, develops an evidence-based pharmaceutical formulary and guidelines to
decrease medical errors.
■ The Office of Consumer Advocacy with a Director who is appointed by the
Commissioner. Consumer Advocates in each region have authority to receive and
resolve consumer complaints, and to participate in health system planning and
evaluation.
■ The Purchasing Fund, which implements bulk purchasing of pharmaceuticals and
durable and non-durable medical equipment and assures that all providers and
facilities benefit from price discounts.
■ The Health Fund, which receives all health care monies to be expended on health
care, manages the budget, receives and pays all claims for services.
■ The Office of Public Health at state and county levels to oversee population and
public health.
■ An independent Office of Inspector General for Health Care to oversee fraud
detection and prosecution.
Delivery of care:
■ All California licensed and accredited providers,, group practices, HMOs and
integrated health care systems may participate, subject to best medical practice and
cultural and linguistic standards.
■ All care would be compensated.
■ Everyone would have the ability to choose his or her personal health provider.
■ There would exist centers of excellence for high tech and specialty services.
■ There would be special programs to educate, recruit and retain nurses.
■ The plan would create financial incentives to provide high quality care, to encourage
practice in under-served areas, to promote the formation of comprehensive group
practices and to encourage general practitioners, internists and pediatricians (i.e.) to
serve as primary care doctors.
Transition: The plan would utilize a two year transition period, overseen by both a
transition commission (to be appointed by the Governor) and a public commission
composed of representatives for consumers, healthcare providers, policy experts,
businesses, labor, the public health community, the health care industry, hospitals,
clinics, health researchers and educators.
What is Single Payer?> Cost-effective, simplified finance and administrative framework for providing universal health coverage. Framework is adapted to a state or nation’s unique needs and resources.> State or nation establishes a health insurance plan that covers all residents.> Health Fund collects and disburses all health care dollars.> Purchasing Fund implements bulk purchasing and gets discounts on pharmaceuticals and durable medical equipment.> Plan administered by a single agency. Administration uses only l%-5% of the budget. Current administrative costs are between 27%-30%.> Billions of dollars are saved by finance, purchasing and administrative consolidation.> Savings are used for health care services and provider reimbursement.> Plan is financed by a progressive state tax and by federal dollars already spent on health care. New taxes replace health insurance premiums, co-payments and deductibles.> 95%-99% of each tax dollar goes to health care services and provider reimbursement. (Today only 67%-70% of each health care dollar goes to health care).— over —
> Medical decisions are made by medical providers and patients.> Patients choose their own providers.> Quality of care is improved through equitable distribution of resources, public participation in policy making, provision of preventive care to everyone, risk adjusted budgets that pay the true costs of care, integrated statewide health care data bases used to perform comprehensive planning, public access to non-confidential information, linkage of research and innovation to health care needs, use of evidence-based medical practices and pharmaceuticals, return of decision-making to providers and patients and a system of consumer advocates with authority to resolve complaints.After February 24, 2003 the single-payer healthcare bill being introduced by Senator Sheila Kuehl may be accessed online by visiting www.sen.ca.gov, clicking on "legislation" and searching "Healthcare for All Californians".For more information contact:The Senate Select Committee on Healthcare for All CaliforniansJudy Spelman - Consultant judy.spelman@sen.ca.gov (916)322-1680 (916) 322-9417 faxSara Rogers - Leg. Aide sara.rogers@sen.ca.gov (916) 445-1353 (916) 324-4823 fax
The Forgotten Domestic Crisiseljc Worknytimes.comOctober 13, 2002The Forgotten Domestic CrisisBy Marcia AngellIf it weren't for the steady beat of war drums, health care would be front and center in this fall's political debate. And war or no war, politicians will not be able to avoid it much longer. As John Breaux of Louisiana, long one of the most conservative Senate Democrats, recently told the press, "The system is collapsing around us."That is not hyperbole. Private health insurance premiums are rising at an unsustainable average of about 13 percent per year — and as much as 25 percent in some areas of the country. Coverage is shrinking, as more employers decide to cap their contributions to health insurance plans and workers find they cannot pay their rapidly expanding share. And with the rise in unemployment, more people are losing what limited coverage they had. Last month, the Census Bureau reported that nearly 1.5 million Americans lost their insurance in 2001.The fatal flaw in the system is that we treat health care as a commodity. That has been the case for a long time, but the effects were masked during the economic boom of the 1990's. Now, with the recession, the irrationality of that approach is exposed.When health care becomes a commodity, the criterion for receiving it is ability to pay, not medical need. Private insurers and providers compete with one another to avoid getting stuck with high-cost patients, so they can keep more of their revenues. But this game of hot potato takes a lot of oversight and paperwork. In fact, the hallmark of the system is the extent to which health funds are diverted to overhead and profits.Look at what happens to the health-care dollar as it wends its way from employers to the doctors and hospitals that provide medical services. Private insurers regularly skim off the top 10 percent to 25 percent of premiums for administrative costs, marketing and profits. The remainder is passed along a gantlet of satellite businesses — insurance brokers, disease-management and utilizationreview companies, lawyers, consultants, billing agencies, information management firms and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing and profits. As much as half the health-care dollar never reaches doctors and hospitals — who themselves face high overhead costs in dealing with multiple insurers.One more absurdity of our market-based system: the pressure is to increase total health-care expenditures, not reduce them. Presumably, as a nation we want to constrain the growth of health costs. But that's simply not what health-care businesses do. Like all businesses, they want more, not fewer, customers — but only if they can pay.Copyright 2002 The New York Times Company
The Forgotten Domestic CrisisAll piecemeal attempts to improve the system - while keeping it market-based - have run into the following dilemma: if access to services is expanded, costs rise; if costs are lowered, access is cut. That's the way it is. The only way to avoid this dilemma is to change the system entirely.What we need is a national single-payer system that would eliminate unnecessary administrative costs, duplication and profits. In many ways, this would be tantamount to extending Medicare to the entire population. Medicare is, after all, a government-financed single-payer system embedded within our private, market-based system. It's by far the most efficient part of our health-care system, with overhead costs of less than 3 percent, and it covers virtually everyone over the age of 65. Medicare is not perfect, but it's the most popular part of the American health-care system.Many people believe a single-payer system is a good idea, but that we can't afford it. The truth is that we can no longer afford not to have such a system. We now spend more than $5,000 a year on health care for each American — more than twice the average of other advanced countries. But nearly half that amount is wasted. We now pay for health care in multiple ways - through our paychecks, the prices of goods and services, taxes at all levels of government, and out-of-pocket fees. It makes more sense to pay only once, perhaps through a new tax on income earmarked for health care (in the same way Medicare is financed through payroll taxes).It is sometimes argued that innovative technologies would be scarce in a national single-payer system, so we would have long waiting lists. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems like Great Britain and Canada. But that's because they spend far less on health care than we do. If they were to put the same amount of money as we do into their systems, there would be no waits. For them, the problem is not the system; it's the money. For us, it's not the money; it's the system. We already spend enough for an excellent universal system.A single-payer system is not socialized medicine. Although a new national program — like Medicare — would be pubhcly financed, the doctors and hospitals would not work for the government, but would remain private. Some fear onerous government regulations from a national payment system, but surely nothing could be more onerous for patients and providers than the multiple, intrusive regulations imposed on them by the private insurance industry today.We Eve in a country that tolerates enormous disparities in income, material possessions and social privilege. That may be inevitable in a free-market economy. But those disparities should not extend to essential services Eke education, clean water and air and protection from crime, aU of which we already acknowledge are pubEc responsibiEties. The same should be true for medical care — particularly since we can well afford to provide it for everyone if we end the waste and profiteering of our market-based system.Marcia Angell the former editor in chief of the New England Journal of Medicine, is a senior lecturer in social medicine at Harvard Medical School.Copyright 2002 The New York Times Company
NEVADA WOMENB LOBBY[ Home ] [ Up ] [ ALERTS! ] [ About NWL ] [ Grassroots Lobby Days ] [ NV Women's Agenda ] [ NV Legislature ] [ Calendar ] [ National ] [Contents]Nevada Women’s Agenda - 2001Children’s HealthSubmitted by:The Maternal and Child Health Coalition of Nevada, a voluntary, independent coalition of public and private agencies that promote or provide maternal and child health services.The ProblemThe single most important task of any society is the care and nurturing of its children. The health and well being of children should be the measure of effectiveness of policies and the gauge of our priorities. Nevada ranks well nationally on some indicators (9th out of 51 in percentage of children living in poverty and 16th in infant mortality), but not so well on others (47th in percentage of children without health insurance and 45th in child immunizations for 2-year-olds). We need to provide universal basic child health care, including prevention and screening. These services are critical for the early detection and treatment of problems which have serious physical consequences for the child as well as economic implications. Similarly, routine educational messages (such as poison control, use of safety belts, and the importance of good nutrition) provided as part of routine health care are important prevention measures.Since infants develop in predictable ways, periodic health visits can identify developmental delays caused by poor nutrition, prenatal exposure to drugs or alcohol, birth defects, neglect, or illness. Early intervention can often prevent permanent damage from these conditions.Many children in Nevada lack continuous and regular access to primary health care. Increasing population, limited health care centers, and large numbers of uninsured children are ongoing problems. Nevada has made much progress for Medicaid providers by simplifying regulations and streamlining paperwork. However, more stringent eligibility criteria, reductions in federal block grants, limited numbers of physicians who provide services to Medicaid, and under-insured or uninsured clients, remain major barriers to care. Managed care options often restrict access to preventive health services by shorter visits and restrictive screening.The dramatic success of immunization programs clearly demonstrates why public officials should be promoters and supporters of a sustained, universal prevention and health maintenance approach for all children. Infections that routinely killed children 50 years ago are now only rarely seen. Since the immunizable diseases are most dangerous for the very young, every dollar spent on immunization given at well-child visits in the first two years of life saves $10 later in medical costs.http://www.nevadawomenslobby.org/About%20NWL/issues/childrenshealth.htm3/16/2003
v^imuicii 1 xxcaiiiix age Z, U1JCurrent ServicesSeveral important new services in Nevada have improved the health care situation for children and families. Nevada Check-Up provides low income families with health insurance fortheir children to age 19. (See article on page 58.) In addition, the Baby Your Baby campaign has expanded to help parents find a "medical home" for their children from birth to age 5.Routine immunizations are required for entry into Nevada schools and for children attending licensed child care. In 1991, only 35% of Nevada’s 2-year-olds seen in public health clinics were appropriately immunized. By 1999, this had increased to 73.4% as a result of various activities, including coordination with other programs, innovative scheduling, neighborhood locations, and public education campaigns. With federal (80%) and state (20%) funds, the Nevada immunization program provides free vaccines, which otherwise are very expensive, to public health clinics and private physicians.Early intervention services are available statewide for children birth to 3 years who have special needs and who qualify under the program guidelines.Gaps in ServicesIt is estimated that at least 23,000 children are likely to be eligible to enroll in Nevada Check Up. As of September, 2000, over 13,000 children were enrolled in the program, and it is estimated that there are sufficient funds to serve many more uninsured children each year.Nevada still has much work to do to meet or exceed The Healthy People 2010 goals of immunization levels of 90%-95%. We need to get complete information on the status of children not seen in the public health clinics, increase the percent of pediatricians and family practitioners who participate in the free vaccine program, and require that all insurance programs offer wellchild coverage or reimburse for immunizations.Community-based, low-cost clinics provide greater access to care. However, a recent report of the Children’s Defense Fund estimates that 20.4% of Nevada’s children (102,000) are uninsured, compared with the national average of 15.6%. Better information regarding how many children lack adequate health care is needed, but an increase in the number of children living in poverty and continuing use of emergency rooms for non-emergency problems point to the need for greater access. Children from poor families are particularly vulnerable, as many are unable to find physicians who will accept them as patients. This may be because of their inability to pay, or, for those on Medicaid or Nevada Check Up, low reimbursement rates, burden of paperwork, or a high rate of missed appointments.Many more services are needed to help families and children with special needs. In particular, parents need help in navigating the complex maze of services. Most programs require that families be without insurance for 6 months before they are eligible for assistance. For a child with a special health care need, even 1 month without insurance would be too long. Furthermore, even when insurance is available, it often does not cover the full range of the child’s needs, leaving families to pay large medical bills out of pocket.Nevada Can Do Better• Establish standards for minimum preventive and treatment services and require well-child carehttp2Awwwjievadawomenslobby.org/About%20NWL/issues/childrenshealth.htm3/16/2003
and immunizations as benefits under all health insurance packages offered in Nevada.• Fund activities to increase the numbers of primary care physicians who are providers of low cost immunizations.• Provide health insurance for every child that covers the full range of needs. Expand outreach efforts for Medicaid and Nevada Check Up.• Continue efforts to decrease administrative burdens and increase reimbursement rates to encourage providers to serve more low-income children and their families.• Fund accessible health and dental care, including mobile clinics.• Provide funding for "one stop shopping" support services (advocacy, referrals, education, transportation, translation, and home health care).• Support training programs for physicians, dentists, nurse practitioners, nurses, and physician assistants specializing in primary care and pediatrics.• Support universal hearing screening for newborns, and early intervention programs for developmentally delayed children from birth to three.• Increase staffing for immunization clinics and fund vaccine purchases.http://www.nevadawomenslobby.org/About%20NWL/issues/childrenshealth.htm3/16/2003
uong-1 erm warerage i ox jNEVADA WOMEN'S LOBBY[ Home ] [ Up ] [ ALERTS! ] [ About NWL ] [ Grassroots Lobby Days ] [ NV Women.’s...Agenda ] [ NV Legislature ] [ Calendar ] [ National ] [Contents]Nevada Women’s Agenda - 2001Long-Term CareSubmitted by:The American Association of Retired Persons (AARP) in Nevada, the leading organization for people aged 50 and older, serving their needs and interests through information and education, advocacy and community services.The ProblemNevada has the fastest growing senior population in the nation. Persons 65 and older and persons with disabilities generally tend to have the highest incidence of chronic illness and the greatest need for long-term care.People, too often, still equate long-term care only with nursing home care and are unaware of publicly and privately funded home and community based services, as well as opportunities to manage their own care. Access to long-term care services in any setting is severely restricted for many because of high costs coupled with limited public funding.As demand for long-term care grows, the marketplace is undergoing a major transformation. New forms of supportive housing such as assisted living and other adult residential settings have emerged as alternatives to nursing homes. The use of home-care, adult day care, and respite care services for family caregivers has surged dramatically.Most long-term care is provided by family members, of whom the majority are women; some of whom will leave employment to provide the care needed to keep a loved one in the home.Current ServicesThere has been a proliferation of the types and numbers of long-term care facilities offering services to persons whose needs do not require expensive medically-oriented, skilled nursing services. In existing regulations, these residential settings are loosely defined as "group homes," ranging from small "mom and pop" run facilities to large assisted living facilities, often managed by large out-of-state corporations. They provide living arrangements and basic personal care for individuals or couples whose needs range from minimal support to specialized management of Alzheimer’s Disease.http://www.nevadawomenslobby.org/About%20NWL/issues/longtermcare.htm3/16/2003
1VUXE,- X vxxxx ^CixGaps in ServicesPresent training requirements for employment and retention of caregivers in home-based programs and residential care facilities are not adequate. They include a requirement for at least eight hours of training within three months of employment in facilities which offer care for residents with Alzheimer’s. For employment in a residential facility for elderly and disabled persons, the requirement is for at least four hours of training in the first 60 days of employment. The current limited training requirements and the extensive period of time allowed before training standards need to be satisfied raise serious questions as to their adequacy.Currently, Nevadans access services based on their perception of needs and availability of services, not always certain these services are the most appropriate for their level of need. This may result in costly over-utilization of unnecessary, costly services, or under-utilization of services which could prevent unnecessary institutionalization. A single point-of-entry system through which individuals enter the state’s long-term care system could prevent this confusion. The responsibilities of such a system include providing information and referral on services in the community, directing people to appropriate home and community-based services, and allocating public long-term care funds. If effective, a single point-of-entry system can help conserve public funds and help people stay in their homes and communities as appropriate.Sally’s StorySally lived alone in a low-income housing apartment. She recently suffered a stroke and was hospitalized for paralysis on her left side. After two weeks in the hospital she was discharged to a nursing home for more rehabilitation and assistance with daily living. Medicare covered the costs of her nursing home care for intensive physical and occupational therapy, but after two weeks this coverage ended.The facility agreed she could be discharged and receive ongoing assistance and rehabilitation at home. Unfortunately, neither of her sons was able to help her due to their own family commitments. And because Medicare would cover only one of the two daily therapy sessions she needed each day, she could not afford to go home. Medicaid would cover her nursing home care, but not in-home care, so she was forced to stay in the nursing home.In reality, Sally could benefit from care in her home or in an assisted living setting. Because of lack of Medicaid funding for home or community-based services, she is forced to remain in the nursing home, the most costly level of care.Nevada Can Do Better• Continue the study of long-term care issues beyond the current legislative interim study.• Change regulations defining assisted living and other residential settings to require increased training levels for caregivers and set stronger standards of care.• Implement and evaluate pilot single point-of-entry systems to enhance access and appropriate utilization of services.• Change the eligibility for the Group Care Waiver to permit individuals at up to 300% of poverty tohttp://www.nevadawomenslobby.org/About%20NWL/issues/longtemicare.htm3/16/2003
JUUllg- 1 CIJL11 V_ztUCj ui jbe eligible for care in a non-medical residential home.• Extend Medicaid coverage to include home and community-based services when they are an effective alternative to nursing home care.http://www.nevadawomenslobby.org/About%20NWL/issues/longtermcare.htm3/16/2003
IJLCailll lll&UltUiUC, VzllllUXClljragu i ui jNEVADA WOMEN’S LOBBY[ Home ] [ Up ] [ ALERTS! ] [ About NWL ] [ Grassroots Lobby Days ] [ NV Women's Agenda ] [ NV Legislature ] [ Calendar ] [ National ] [Contents]Nevada Women's Agenda - 2001Health Insurance for Low-Income ChildrenSubmitted by:Great Basin Primary Care Association, Nevada Covering Kids Coalition, Nevada Health Care Reform Project.The ProblemNumerous surveys demonstrate that the number of uninsured children in Nevada is unacceptably high. When the state submitted its plan to the federal government for the State Children’s Health Insurance Program (i.e., Nevada /Check Up), it was based on estimates of 60,000 low-income Nevada children eligible for Medicaid or /Check Up. The Great Basin Primary Care Association’s recent study of the uninsured in Nevada (released 6/2000) showed more than 100,000 uninsured children, ages 0 through 18, in both 1998 and 1999.Nevada ■/Check Up caseload is growing. However, even with growth, only a small percentage of uninsured children are reached with this program. The state’s current work plan allows for an average of 15,000 children per month to be enrolled in Nevada /Check Up.Lack of insurance coverage for children translates into lack of access to primary and preventive health care. Routine well-child checkups are designed to assess a child’s growth and development, with the purpose of detecting any medical conditions or developmental delays early. Early detection is the most effective means of treating conditions in children and minimizing the risk of chronic health problems. Racial and ethnic minorities are over-represented in low-income and uninsured children, especially Nevada’s Hispanic population.Current ServicesNevada has a tremendous opportunity to increase access to health care for children through the Nevada /Check Up program. This program was created by Congress under Title XXI of the Social Security Act of 1997, and funds low-cost health insurance for children in families with incomes at or below 200% of the Federal Poverty Level. State funds in the Nevada /Check Up program are matched with federal funds at a rate of 35% state to 65% federal funding.Unfortunately, the number of children enrolling in Nevada /Check Up falls far behind estimates of the eligible children. Recent improvements in marketing and outreach have produced caseloadhttp://www.nevadawomenslobbv.org/About%20NWL/issues/healthinsurance.htm3/16/2003
tieann insurance, cmiorenrage z oijincreases. However, many families have missed the message that affordable health insurance is available to them. Attracting health care providers to serve Medicaid and Nevada •/Check Up clients is an ongoing struggle.Gaps in ServicesCertainly the largest gap in service is the low enrollment in the Nevada /Check Up Program, which means that tens of thousands of eligible children and families are not accessing the available health insurance. Ongoing efforts to expand program marketing, to increase outreach, and to eliminate barriers to enrollment are important to ensure the accessibility of this insurance program for children.Recruiting and retaining adequate numbers of physicians, dentists and other health care providers who accept patients covered by Medicaid and Nevada /Check Up is an ongoing problem, both in large cities and in Nevada’s rural and frontier areas. Nevada must address the issues preventing health care providers from accepting patients on public programs to ensure their coverage.Many children in low-income families, when enrolled in Nevada /Check Up, become the only insured members of their househplds. Expanding health insurance coverage to parents increases the likelihood that children will utilize health care services. The federal government accepts requests from states to expand their children’s health insurance program to cover the parents of eligible children. Nevada has not yet availed itself of this option.Adding presumptive eligibility to the Nevada /Check Up program would increase its effectiveness. This means that a child applying for services in the program is presumed to be eligible, and can receive services right away. Presumptive eligibility speeds up access to health care services and removes significant barriers from the application process.Many Nevada families are in and out of employer-sponsored insurance programs due to short term or seasonal jobs. With a six-month waiting period for children leaving private insurance to become eligible for Nevada /Check Up, children in such families remain uninsured. Reducing or eliminating the waiting period would help families to overcome a significant barrier to enrollment.Another significant gap in the Nevada /Check Up program is the lack of EPSDT services. EPSDT stands for Early and Periodic Screening, Diagnosis and Treatment, and is a screening program that checks all children for certain developmental problems, prescribes early treatment when problems are detected, and covers resulting disabilities when necessary. Including EPSDT services in Nevada /Check Up increases costs in the short term, as participating children receive more thorough medical evaluations under this program and treatments for certain conditions are covered. However, the savings in financial and human resources in the long run are significant, since problems are detected early and addressed while still treatable. If Nevada /Check Up is truly going to have an impact on the health status of Nevada’s next generation, then EPSDT services must be included in the program.Nevada Can Do Better• Provide presumptive eligibility for certain recipients of Nevada /Check Up and Medicaid, speeding up access to health care services.• Adopt innovative solutions to the challenge of health care provider participation in Medicaid andhttp://www.nevadawomenslobbv.org/About%20NWL/issues/healthinsurance.htm3/16/2003
rieann insurance, uniorenrage i oiiNevada -/Check Up, including licensing, reimbursement rates and processes.• Reduce or eliminate the waiting period for children leaving private health insurance to become eligible for Nevada /Check Up.• Request permission to expand eligibility for Nevada /Check Up to parents of eligible children.• Add EPSDT (Early and Periodic Screening, Diagnosis and Treatment) to the services provided by Nevada /Check Up.• Require the state to contract with community-based social and health services organizations to conduct targeted outreach to low-income families.• Support the statewide "Covering Kids" coalition in its efforts to:1) increase outreach and enrollment in Nevada /Check Up and Medicaid;2) simplify enrollment processes; and3) coordinate existing coverage programs for low income children.http://www.nevadawomenslobby.org/About%20NWL/issues/healthinsurance.htm3/16/2003
BBBiiI-:—' - -2 -------ktProduced by Marjorie H. Young forThe International Connection Committee Alpha Kappa Alpha Sorority, Inc.Norma S. White, Supreme BasileusDecember 1998Complimentary Printing MKO Graphics & Printers Malinda K. O’Neal, Owner 404-523-1560
PLANNING A SUCCESSFUL
“AKA DAY AT THE STATE CAPITOL”
CONTENTS
TOPIC PAGE(S)
International Connection Committee.......................................1
Letter from Committee Chairman.......................................... 2
Sample Schedule of Events ... ■.............................................3
Sample Luncheon Program ................................................4
Sample Letter to Chapters.............................................. 5-8
Sample Letter to Sponsor........................................................ 9
Sample Invitation to Legislators ........................ 10
Sample Media Release...........................................................10
Sample Resolution.................................................................11
Suggestions ...................................... .12
Planning Timetable . . ........ 13
Notes .......................................................................... 14-15
THE INTERNATIONAL CONNECTION COMMITTEE
1998 - 2000
North Atlantic Region
Lenora Gerald
Epsilon Pi Omega
Mid-Atlantic Region
Vivian Burke
Phi Omega
South Atlantic Region
Vertelle Middleton
Gamma Xi Omega
South Eastern Region
Edith Taylor-Langster
Kappa Lambda Omega
South Central Region
I. Gene Jones
Iota Xi Omega
Great Lakes Region
Nancy Quarles
Pi Tau Omega
Central Region
Jennelle Elder-Green
Epsilon Kappa Omega
Mid-Western Region
Betty Gause
Iota Zeta Omega
Far Western Region
Staajabu Heshimu
Epsilon Xi Omega
International Region
Frances Molloy
Mu Gamma Omega
Norma S. White
Supreme Basileus
Juanita On-
Chairman
1
Dear State Coordinator:
Thank you for joining us in “Blazing New Trails in Alpha Kappa
Alpha Public Policy.”
Supreme Basileus Norma S. White has extended the concept of
“AKA Day at the State Capitol” to all regions. Each year, in January,
Februaryor March, sorors will assemble at their state capitols to advocate
for policies that impact the quality of life in their respective states.
Many sorors have never participated in an advocacy day; therefore,
at the request of many of you, we are providing a planning guide for your
use. We expect that each coordinator will add her own special touch to her
state program; however, each program should include the seminar topic,
which will be the same for all regions. The topic for 1999 is “Busy citizens
Can Impact Public Policy.” AKA’s lead busy lives so we want to provide
ideas on how they can include advocacy in their schedules.
We anticipate that you will have a productive advocacy day, and
we would like to share your ideas with other states. Please send a copy of
your program, handouts and representative pictures to your International
Connection Representative.
Planning A Successful "AKA Day at the State Capitol” has been
developed and reproduced for the International Connection Committee by
Georgia State Connection Coordinator, Marjorie H. Young. Since 1994,
Soror Young, a member of Kappa Omega, has coordinated “AKA Day at
the State Capitol,” an annual advocacy day held at the state capital in
Atlanta. She has revised her original guide, Planning A Successful "AKA
Day at the State Capitol, ” for this committee. The committee wishes to
thank Soror Young, who has graciously agreed to serve as resource for this
program.
Our sincere thanks and best wishes for a successful day!
' SAMPLE SCHEDULE OF EVENTS
9:00 a.m. Reception, Assembly
9:30 a.m. Group Picture
10:00 a.m. Legislative Session: House and Senate Presentation
of Resolution
10:30 a.m. Seminar: Topic to be announced. Seminar
topic will be the same for all regions
12:00 p.m. Luncheon
2:00 p.m. Capitol Tour (On Your Own)
2 3
SAMPLE LUNCHEON PROGRAM
Presiding, State Connection Chairman
Greetings .................................State AKA Connection Chairperson
Regional Director
Highest Ranking African American Legislator
Chairperson, Legislative Black Caucus
Chairperson, Association of Black Elected Officials
Introduction of Legislature.........................................Soror Legislator
Invocation.......................................... Regional Director (If present)
LUNCH
Introduction of Speaker...................................................... Soror*
Speaker.................... Highest Ranking African American Legislator,
Soror Legislator or Key Community Leader
Presentation of Honorees ... Graduate and Undergraduate Sorors*
Salute to Honorees.................................................................... Singer
Special Presentations Graduate and Undergraduate Sorors*
Closing Remarks .......................... Regional Director
Note: Use graduate and undergraduate AKA Connection coordinators and
Basilei from chapters across the state on the program
SAMPLE LETTER TO CHAPTERS
(This sample includes an awards luncheon as an option.)
Dear Members of Alpha Kappa Alpha Sorority, fric.:
I am pleased to join Regional Director____________ in inviting you
to attend the _____ Annual AKA Day at the State Capitol on
We will begin the day at 9:00 a.m. The schedule is as follows:
9:00 a.m. Reception, Assembly, Location
(Directions will be posted)
9:30 a.m. Group Picture
10:00 a.m. Legislative Session
Seminar: TBA
12:00p.m. Luncheon and Forum ($25.00)
Garden Room
2:00 p.m. Capitol Tour
Please use the attached confirmation sheet to register your
participants. Make checks ($__ per person) for the luncheon payable
to___________Chapter and send by, day of week, date, along with
the enclosed confirmation sheet, to name and address.
This year, we would like to recognize African American women and
men who make things happen in their communities and across the
state. We are asking for nominations for the “Community Leaders:
Unsung Heroes Award.” A chapter may nominate an African
American woman or man who has had a significant impact on her or
his community or the state in one or more of the following areas:
Mobilizing communities for positive social change; political action
(assuring selection and election of representative candidates; voter
education; voter registration and getting the vote out); and improving
4 5
the quality of the lives of citizens at the local or state level. The
nominee should be very visible at the local or state level. The
nominee does not have to be a soror. This unsung hero should be one
that the community knows for her or his making a difference and for
getting things done, but has done so without a great deal of
recognition or reward. A nomination form is attached. Please return
by date to name at address.
Your nominee for the “Community Leaders Award” should also be
present at 9:00 a.m. She or he will be honored at the luncheon. We
are also trying to get the honorees recognized in the house and/or
senate chambers. As her or his sponsor, you will also need to register
her for AKA Day at the State Capitol.
Our Regional Director is requesting all chapters to encourage their
members to attend. The bigger the crowd, the better. Ataminimum,
we are requesting each chapter to send two representatives. Let’s
show our legislators that women of Alpha Kappa Alpha Sorority, Inc.
do care about the policies of this state and how opportunities and
resources are distributed. We are requesting that you wear pink
and/or green business attire. Please also make your legislator(s) aware
of AKA Day at the State Capitol and invite him or her to the
luncheon and forum.
We look forward to seeing you on date. If you have any questions,
please contact name at telephone number.
Sincerely,
State AKA Connection Coordinator
c: Regional Director
Regional Representative,
International Connection Committee
Return by _ to: AKA DAY AT THE STATE CAPITOL
Name MONDAY, FEBRUARY 17,1997
Address 9:00 A.M. - 2:00 P.M.
CHAPTER CONFIRMATION
Make checks Please type or print legibly,
payable to: Name
CHAPTER NAME________________________ ________
CHAPTER BASILEUS_________________ __________
AKA CONNECTION CHAIRPERSON____________
NAMES OF PERSONS WHO WILL ATTEND AND AMOUNT PAID
(LUNCHEON: $_ PER PERSON)
Please indicate legislators that will attend:
Number Attending:
Sorors
Nominee_____
Legislators____
(complimentary)
Total Number ______
Amount Enclosed____
Contact Person:
Name:_____________
Phone (H)_________
(W)
6 7
Community Leaders: Unsung Heroes
NOMINATION FORM
Please type or print legibly and return, along with $_ for luncheon, to: Soror
to name and address by date.
Name of
Nominee_________________ __ ________
Address
Telephone: Home_________________
Work _ ______________' _________________
Sponsoring Soror/Chapter
T elephone_________________ ______ ____________
Address___________________________________
Contributions to Community or State: State reason for
nominating this candidate and describe the impact she or he has made
at the local community or state level in one or more of the following
areas: mobilizing communities for positive social change; political
action (assuring selection and/or election of representative candidates;
voter education, voter registration and getting the vote out);
improving the quality of the lives of citizens at the local or state level.
Attach a biographical sketch of nominee.
SAMPLE LETTER TO SPONSOR
Date
Company Representative
Title
Name of Company
Address
City, State, Zip code
Dear M___________:
In follow-up to our conversation, we are asking your company to
sponsor the “AKA Day at the State Capitol” on______ . At this
event, we will honor African-American women and men who have
made significant contributions to their communities. We are
currently receiving nominations for women and men from across the
state to receive the “Community Leaders: Unsung Heroes” Award.
We have set a budget of $______ to provide the plaques for the
honorees, souvenirs, printed programs and complimentary lunches for
legislators, special guests, and honorees.
Thank you for your assistance. If you have any questions, please feel
free to contact me at_______ .
Sincerely,
AKA Connection Coordinator
c: Regional Director
8 9
SAMPLE INVITATION TO LEGISLATORS SAMPLE RESOLUTION
The Alpha Kappa Alpha Women of Name of State invite the
members of the Name of State Legislature to their Annual AKA Day
at the State Capitol Luncheon on Day, Date at Time in the____
Room of the Location.
NOTE: This invitation could be a flier that is placed in the legislators
mailbox one month before the event. It is placed in their box again one
week before the event. Sorors should also contact their local legislators at
their homes or offices. It helps attendance when legislators know that their
constituents will be at the capitol.
SAMPLE MEDIA RELEASE
Date:
Contact: Name, phone and fax number
Re: “AKA Day at the State Capitol”
Alpha Kappa Alpha women from across the state of_____ met at the
Capitol on date to celebrate “AKA Day at the State Capitol.” Name,
title in sorority reports, “Over number Alpha Kappa Alpha Women
were here to meet with legislators and to honor community leaders.
They discussed the following issues with legislators: Name the
specific issues.
Name honorees and their hometowns were honored as “Community
Leaders: Unsung Heroes.” These unsung heroes have made
significant contributions to their communities through mobilizing
communities for positive social change, voter education/registration,
or improving the quality of the lives of citizens at the local or state
level.
LC 24 0655
SENATE RESOLUTION 158
By: Senators Harbison
James of the 35th
of the 15th, Scott of the 36th
and others
A RESOLUTION
i
2
3456
Recognizing Alpha Kappa Alpha Sorority,
purposes.
Inc. ; and for other 20
WHEREAS, Alpha Kappa Alpha Sorority, Inc. , was founded’at 23
Howard university in Washington, D.C., in 1308, and this 24
Greek letter organization is the first
by African American college women; and
sorority established 25
7 WHEREAS, this sorority is an international organization with 27
8 approximately 200,000 members in 844 chapters extending 28
9 across the United States, the Bahamas, Bermuda, Great .29
10 Britain, Germany, Korea, and the Virgin Islands; 47 of these 30
11 chapters are located in communities and on college and
12 university campuses in the State of Georgia; and 31
13 WHEREAS, Alpha Kappa Alpha Sorority, Inc., is committed to ,33
14 community service and has made numerous contributions to the 34
15 educational, civic, and social life of Georgia's citizens; 35
16 and
17 WHEREAS, Dr. Lucretia Payton-Stewart, an outstanding 37
18 Georgian, is the South Atlantic Regional Director of this 38
19 great sisterhood and leads members of the sorority in 39
20 Georgia, Florida, and South Carolina in the implementation
21 of the current international program, "Building the Futures 40
22 The Alpha Kappa Alpha Strategy for Making the Net^Work 41
23 through Education, Health, Economics, Arts, the World 42
24 Community, and the Family"; and
25 WHEREAS, members in the State Of Georgia contribute 44
26 thousands of volunteer hours implementing service programs 45
27.. in their respective communities.
28 NOW, THEREFORE, BE IT RESOLVED BY THE SENATE that the 47
29 members of this body recognize the commitment of Dr. 48
30 Lucretia Payton-Stewart and the members of Alpha Kappa Alpha 49
31 Sorority, Inc., to community service and express special
32 appreciation for their service in the State of Georgia. 50
33 BE*- IT FURTHER RESOLVED that the Secretary of the Senate is 52
34 authorized and directed to transmit an appropriate copy of 53
35 this resolution to Dr. Lucretia Payton-Stewart. 54
10 11
SUGGESTIONSSUGGESTIONS, ContinuedThe state coordinator should keep the regional director and the international connection committee representative informed as the program is developed.The planning committee should include chapter connection chairmen.Invite all past and present members of the Directorate who reside in your state.Hold the event when the state legislature is in session, preferably the same time each year. President’s Day is a good time to hold this event if your legislature is in session. President’s Day is always on a Monday and many sorors don’t have to work on that day. At the event, announce next year’s AKA Day.Coordinate the planning of this event with a legislative contact (preferably, a soror). Your legislative contact can provide you with information on protocol in the chambers, in drafting and presenting proclamations, getting you access to the floor of the legislature, scheduling space at the capitol, helping to secure sponsors and in encouraging other legislators to participate.Use this event to discuss the topic that is designated by the International Connection Committee. Use legislators or their staff as presenters during the Legislative Issues Forum.During this event, teach sorors how to get their legislators off the senate or house floor. Have forms and instructions available so that they may practice. Have them contact their legislators to discuss an issue, remind them of the luncheon or to take pictures with them, etc.A luncheon is not necessary; however, if you choose to have a luncheon, make sure that you have a dynamic speaker or center it around awards presentations or something that will encourage participation of sorors and legislators.At registration, have a display set-up for legislators and others to see the sorority’s goals and accomplishments.The purpose of the day is to educate sorors. Provide sorors with handouts that display congressional and legislative districts; directories of elected officials; the roles of the legislature and congress; a list of government agencies and their roles; briefings on pending legislation, etc.PLANNING TIMETABLEThe 1999 event should be scheduled as soon as possible. It is suggested that six months be allowed for future events. Schedule the event by reserving space at the Capitol as soon as possible, at least 6 months prior to the event. Coordinate the planning of this event with the Regional Director and a legislative contact.Write potential sponsors three to six months prior to the event. Have your budget developed prior to seeking sponsors.Send out registration information to Chapters at least 60 - 90 days prior to the event.Schedule program participants as soon as possible. Keynote speakers should be confirmed at least 60 -90 days prior to event.1213
NOTESNOTES1415
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LINKS ON THIS PAGE
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Government Web Sites
Department of Health and Human Services (HHS)
http://www.os.dhhs.gov/
The Department of Health and Human Services (HHS) is the
United States government's principal agency for protecting the
health of all Americans and providing essential human services,
especially for those who are least able to help themselves. For
more women's health information, visit the HHS Office on
Women's Health, (http://www,4women.gov/)
• Agency for Healthcare Research and Quality (AHRQ)
http://www.ahcpr.gov/
The Agency for Healthcare Research and Quality (AHRQ)
was established in 1989 as the Agency for Health Care
Policy and Research. Reauthorizing legislation passed in
November 1999 establishes AHRQ as the lead Federal
agency on quality research. AHRQ, part of the U.S.
Department of Health and Human services, is the lead
agency charged with supporting research designed to
improve the quality of health care, reduce its cost, and
broaden access to essential services. AHRQ's broad
programs of research bring practical, science-based
information to medical practitioners and to consumers and
other health care purchasers. For more information, visit
AHRQ's women's health programs.
(http://www.ahcpr.gov/research/womenix.htm)
• Agency for Toxic Substances and Disease Registry (ATSDR)
http://www.atsdr.cdc.gov/
The mission of the Agency for Toxic Substances and
Disease Registry (ATSDR), as an agency of the U.S.
Department of Health and Human Services, is to prevent
exposure and adverse human health effects and diminished
quality of life associated with exposure to hazardous
substances from waste sites, unplanned releases, and
other sources of pollution present in the environment.
• Food and Drug Administration (FDA)
http://www.fda.gov/
http://www.cdc.gov/od/spotlight/nwhw/websites.htm 3/16/03
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The Food and Drug Administration (FDA) ensures that the
food we eat is safe and wholesome, that the cosmetics we
use won't harm us, and that medicines, medical devices,
and radiation-emitting consumer products such as
microwave ovens are safe and effective. FDA also oversees
feed and drugs for pets and farm animals. Authorized by
Congress to enforce the Federal Food, Drug, and Cosmetic
Act and several other public health laws, the agency
monitors the manufacture, import, transport, storage, and
sale of $1 trillion worth of goods annually, at a cost to
taxpayers of about $3 a person. For more information, visit
FDA's Women's Health page.
(http://www.fda.gov/womens/default.htm)
• Health Resources and Services Administration (HRSA)
http://www.hrsa.gov/
The Health Resources and Services Administration (HRSA)
directs national health programs which improve the health
of the Nation by assuring quality health care to
underserved, vulnerable and special-need populations and
by promoting appropriate health professions workforce
capacity and practice, particularly in primary care and
public health. For more information, visit the HRSA
Women's Health page. (http://www.hrsa.gov/WomensHealth/)
• Indian Health Service (IHS)
http://www.ihs.gov/
The Indian Health Service (IHS) is responsible for providing
federal health services to American Indians and Alaska
Natives. The provision of health services to members of
federally recognized tribes grew out of the special
government to government relationship between the
federal government and Indian tribes. The IHS is the
principal federal health care provider and health advocate
for Indian people, and its goal is to assure that
comprehensive, culturally acceptable personal and public
health services are available and accessible to American
Indian and Alaska Native people. The IHS currently
provides health services to approximately 1.5 million
American Indians and Alaska Natives who belong to more
than 550 federally recognized tribes in 34 states. For more
information, visit the IHS Women's Health page.
(http://www.ihs.gov/MedicalPrograms/MaternalChildHealth/
WomensHealth.asp)
• National Institutes of Health (NIH)
http://www.nih.gov/
Begun as a one-room Laboratory of Hygiene in 1887, the
National Institutes of Health (NIH) today is one of the
world's foremost biomedical research centers, and the
Federal focal point for biomedical research in the United
States. The NIH mission is to uncover new knowledge that
will lead to better health for everyone. NIH works toward
that mission by: conducting research in its own
laboratories; supporting the research of non-Federal
scientists in universities, medical schools, hospitals, and
research institutions throughout the country and abroad;
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helping in the training of research investigators; and
fostering communication of biomedical information. For
more information, visit the NIH Office of Research on
Women's Health page, (http://www4.od/nih.gov/orwh/)
• Office of Population Affairs (OPA)
http://www.hhs.gov/opa/
The Office of Population Affairs (OPA), within the Office of
Public Health and Science of the Department of Health and
Human Service, provides resources and policy advice on
population, family planning, reproductive health, and
adolescent pregnancy issues. OPA also administers two
grant programs, the national Family Planning Program,
authorized under Title X of the Public Health Service Act
(PHSA) and the Adolescent Family Life Program, authorized
under Title XX of the PHSA.
• Substance Abuse and Mental Health Services
Administration (SAMHSA)
http://www.samhsa.gov/
Substance Abuse and Mental Health Services
Administration's (SAMHSA) mission within the Nation's
health system is to improve the quality and availability of
prevention, treatment, and rehabilitation services in order
to reduce illness, death, disability, and cost to society
resulting from substance abuse and mental illnesses.
SAMHSA's mission is accomplished in partnership with all
concerned with substance abuse and mental illnesses.
Department of Veterans Affairs, Center for Women Veterans
http ://www. va ,g ov/wome nvet/pag e .cfm’pg=14
The Center for Women Veterans ensures women veterans have
access to VA benefits and services, that VA health care and
benefit programs are responsive to the gender-specific needs of
women veterans, and more.
U.S. Agency for International Development, The Office of Women
in Development (WID), Global Bureau
http://www.genderreach.com/
The Office of Women in Development (WID) was created to
ensure that USAID programs integrate women into the national
economies of developing countries, thereby improving the status
of women in these societies and increasing the effectiveness of
the development effort.
5
Non-Government Web Sites
Disclaimer: Links to non-Federai organizations found at this site are provided solely
as a service to our users. These links do not constitute an endorsement of these
organizations or their programs by CDC or the Federal Government, and none should
be inferred. The CDC is not responsible for the content of the individual organization
Web pages found at these links.
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American Cancer Society
http://www.cancer.org/
The American Cancer Society is the nationwide community-based
voluntary health organization dedicated to eliminating cancer as
a major health problem by preventing cancer, saving lives, and
diminishing suffering from cancer, through research, education,
advocacy, and service.
American College of Obstetricians and Gynecologists
http://www.acog.org/
With a membership of 40,000 physicians, the American College
of Obstetricians and Gynecologists is the nation's leading group
of professionals providing health care for women.
American Medical Women's Association
http://www.amwa-doc.org/index.html
The American Medical Women's Association is an organization of
10,000 women physicians and medical students dedicated to
serving as the unique voice for women's health and the
advancement of women in medicine.
American Menopause Foundation, Inc.
http://www.americanmenopause.org/
The American Menopause Foundation, Inc., is the only
independent not for profit health organization dedicated to
providing support and assistance on all issues concerning
menopause.
American Psychological Association
http://www.apa.org/
The American Psychological Association is a scientific and
professional organization that represents psychology in the
United States.
American Public Health Association
http: //www. a p ha. o rg/
The American Public Health Association is the oldest and largest
organization of public health professionals in the world.
Arthritis Foundation
http://www.arthritis.org/
The mission of the Arthritis Foundation is to improve lives
through leadership in the prevention, control, and cure of
arthritis and related diseases.
Association of Women's Health, Obstetric, and Neonatal Nurses
http://www.awhonn.org/
The Association of Women's Health, Obstetric and Neonatal
Nurses serves and represents more than 22,000 health care
professionals and focuses on three areas: childbearing and the
newborn; women's health across the lifespan, and professional
issues.
Boston Women's Health Book Collective
http://www.ourbodiesourselves.org/
The Boston Women's Health Book Collective is a nonprofit, public
interest women's health education, advocacy and consulting
organization.
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Chronic Disease Directors Women's Health Council (WHC)
http://www.ChronicDisease.org/whc/index.html
The mission of this Council is to help state agencies advance and
protect the health of women across the life span through chronic
disease prevention and control. The Women's Health Council
(WHC), one of four councils of the Association of State and
Territorial Chronic Disease Program Directors, was established in
December of 1995 to foster the public health agenda as it relates
to diseases and conditions most affecting women, and to
stimulate program activities that will prevent and control these
diseases/ conditions.
Endometriosis Association (EA)
http://www.endo-online.org/index.html
The Endometriosis Association (EA) is a non-profit, self-help
organization founded by women for women. The EA is dedicated
to providing information and support to women and girls with
endometriosis, educating the public as well as the medical
community about the disease, and conducting and promoting
research related to endometriosis.
HERS (Hysterectomy Educational Resources & Services]
Foundation
http://www.hersfoundation.com/
The HERS Foundation is an independent non-profit national and
international women's health education organization. It provides
full, accurate information about hysterectomy, its adverse effects
and alternative treatments.
Jacob's Institute of Women's Health (JIWH)
http://www.jiwh.org/
The American College of Obstetricians and Gynecologists
established the Jacob's Institute of Women's Health (JIWH) to
promote the study and reporting of women's health issues at the
interface of medicine and the social sciences.
March of Dimes
http://www.modimes.org/
The mission of the March of Dimes is to improve the health of
babies by preventing birth defects and infant mortality.
National Alliance of Breast Cancer Organizations
http://www.nabco.org/
The National Alliance of Breast Cancer Organizations is the
leading non-profit information and education resource on breast
cancer and a network of over 400 member organizations
nationwide.
National Asian Women's Health Organization
http://www.nawho.org/
The National Asian Women's Health Organization was founded in
1993 to serve as a catalyst for a powerful advocacy movement
that would inspire individuals to become active players in the
political decision-making that impacted their daily lives.
National Association for Women's Health (NAWH)
http://www.nawh.org/
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The National Association for Women's Health (NAWH) represents
organizations and individuals dedicated to improving the quality
of women's health by integrating the best of business, science,
policy and clinical practice.
National Black Women's Health Project
http://www.nationalblackwomenshealthproject.org/
The National Black Women's Health Project seeks to improve the
health of black women by providing wellness education and
services, health information, and advocacy.
National Women's Health Network
http://www.womenshealthnetwork.org/index.htm
The National Women's Health Network, a non-profit 501(c)(3)
organization, is the only national public interest membership
organization dedicated exclusively to women's health.
National Women's Health Resource Center
http://www.healthywomen.org/index.cfm
This non-profit organization, dedicated to helping women make
informed decisions about their health, encourages women to
embrace healthy lifestyles to promote wellness and prevent
disease.
North American Menopause Society
http://www.menopause.org/
The North American Menopause Society is the leading nonprofit
scientific organization devoted to promoting understanding of
menopause, and thereby improving the health of women through
midlife and beyond.
Older Women's League (OWL)
http://www.owl-national.org/
As the only national grassroots membership organization to focus
solely on issues unique to women as they age, OWL strives to
improve the status and quality of life for midlife and older
women.
Society for Women's Health Research
http://www.womens-health.org/
The Society for Women's Health Research is the nation's only
non-profit advocacy group whose sole mission is to improve the
health of women through research.
United Nations, Division for the Advancement of Women
http://www.un.org/partners/civil_society/m-women.htm
The Division for the Advancement of Women advocates
improvement of the status of the women of the world and the
achievement of their equality with men.
World Health Organization (WHO), Gender and Women's Health
Department
http://www.who.int/frh-whd/
World Health Organization (WHO), Reproductive Health and
Research
http://www.who.int/reproductive-health/
The objective of the World Health Organization (WHO) is the
attainment by all peoples of the highest possible level of health.
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