CANCER INCIDENCE IN MASSACHUSETTS在马萨诸塞州的癌症发病率

CANCER INCIDENCE IN MASSACHUSETTS在马萨诸塞州的癌症发病率 CANCER INCIDENCE IN MASSACHUSETTS 1999 – 2003: ITY AND TOWN SUPPLEMENT C Center for Health Information, Statistics, Research, and Evaluation Massachusetts Department of Public Health December 2006 CANCER INCIDENCE IN MASSACHUSETTS 1999 – 2003: ITY AND TOWN SUPPLEMENT C Mitt Romney, Governor Kerry Healey, Lieutenant Governor Timothy R. Murphy, Secretary of Health and Human Services Paul J. Cote, Jr., Commissioner of Public Health Gerald F. O?Keefe, Associate Commissioner, Center for Health Information, Statistics, Research, and Evaluation Susan T. Gershman, MS, MPH, PhD, CTR, Director, Massachusetts Cancer Registry Center for Health Information, Statistics, Research, and Evaluation Massachusetts Department of Public Health ACKNOWLEDGMENTS This report was prepared by Susan T. Gershman, Director, Massachusetts Cancer Registry, and Massachusetts Cancer Registry staff and consultants. Special thanks to Bertina Backus and Annie MacMillan for their diligent work in the preparation of this report. Thanks are also given to Laurie MacDougall, M.S. Consultant, Richard Knowlton, and the staff of the Massachusetts Cancer Registry for their editing and data processing efforts. Massachusetts Cancer Registry Staff Susan T. Gershman, M.S., M.P.H., Ph.D., C.T.R., Director Troy C. Arthur, C.T.R., Cancer Registrar Bertina Backus, M.P.H., Epidemiologist Donna Barlow, L.P.N., C.T.R., Cancer Registrar Bruce Caldwell, Research Analyst/Geocoder Barbara J. Clark, C.M.A., Cancer Registrar Nancy Donovan, M.A., O.T.R., C.T.R., Cancer Registrar Patricia J. Drew, C.T.R., Cancer Registrar Loi Huynh, Software Developer Ben Jackson, Systems Analyst Regina Kenney, Data Acquisition Coordinator Mary Jane King, M.P.H., C.T.R., Acting Assistant Director of Registry Operations Richard Knowlton, M.S., Epidemiologist Ann MacMillan, M.P.H., Epidemiologist Ruth Maranda, L.P.N., C.T.R., Cancer Registrar Mary Mroszczyk, C.T.R., Geocoding/Special Projects Coordinator Sadie Phillips-Scott, Administrative Assistant Judith Raymond, C.T.R., Cancer Registrar Pamela Shuttle, C.T.R, R.H.I.T., Cancer Registrar Hung Tran, Software Developer Donna J. Vincent, R.H.I.A., Geocoder Massachusetts Cancer Registry Advisory Committee Nancy Mueller, Sc.D., Chair Suzanne Condon, M.S. Frederick Li, M.D. Regina Mead J. David Naparstek, Sc.M., C.H.O. Philip Nasca, Ph.D. Susan O'Hara, C.T.R. Robert Osteen, M.D. David Ozonoff, M.D., M.P.H. Carol Rowan-West, M.P.H. Lawrence Shulman, M.D. Carol Venuti, C.T.R. The data in this report are intended for public use and may be reproduced without permission. Proper acknowledgment of the source is requested. For further information, please contact the following: Massachusetts Cancer Registry .................................................. (617) 624-5642 Research and Epidemiology ........................................................ (617) 624-5635 Occupational Health Surveillance ................................................ (617) 624-5626 Center for Environmental Health ................................................. (617) 624-5757 Cancer Prevention and Control Initiative ...................................... (617) 624-5070 Massachusetts Department of Public Health website ................... We acknowledge the Centers for Disease Control and Prevention for its support of the staff and the printing and distribution of this report under cooperative agreement U55/CCU121937-04 awarded to the Massachusetts Department of Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. TABLE OF CONTENTS Page INTRODUCTION AND METHODS Introduction .............................................................................................. 1 Content ..................................................................................................................... 1 Comparison with Previous Reports ........................................................................... 1 Methods ............................................................................................................2 Data Collection .......................................................................................................... 2 Presentation of Data.................................................................................................. 3 Observed and Expected Case Counts ................................................................. 3 Standardized Incidence Ratios ............................................................................ 3 Statistical Significance and Interpretation of SIRs ................................................ 4 Example of Calculation of an SIR and its Significance ......................................... 5 Notes about Data Interpretation................................................................................. 6 Data Limitations ....................................................................................................... 6 Border Areas and Neighboring States ................................................................. 6 Cases Diagnosed in Non-Hospital Settings ......................................................... 6 City/Town Misassignment .................................................................................... 7 Small Numbers of Cases ..................................................................................... 7 TABLES Observed and Expected Counts, with Standardized Incidence Ratios, by Sex, for 351 Cities and Towns, 1999 - 2003 .......................................................... 8 APPENDICES APPENDIX I International Classification of Diseases for Oncology (Third Edition) Codes Used for This Report .................................................................................. 363 APPENDIX II Risk Factors for Selected Cancer Types ............................................................... 365 Reviewers of Risk Factors ..................................................................................... 376 APPENDIX III Massachusetts Department of Public Health Cancer Control Initiatives and Publications ........................................................... 377 INTRODUCTION Content The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 1999 through 2003. For each city and town, Standardized Incidence Ratios (SIRs) are presented for twenty-three types of cancer and for all cancer types combined. These ratios compare the cancer incidence experience of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: METHODS provides a detailed explanation of the data collection, data processing and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX I provides a listing of International Classification of Diseases for Oncology codes used for the preparation of this report. APPENDIX II provides a listing of risk factors for selected cancer types and a listing of the individuals who reviewed the risk factor list. APPENDIX III describes the Massachusetts Department of Public Health?s current cancer control initiatives, and provides a listing of recommended publications and ordering information. Comparison with Previous Reports This report updates previous annual reports published by the Massachusetts Cancer Registry (MCR). It is available on line at report, contact the MCR at: Massachusetts Cancer Registry Center for Health Information, Statistics, Research and Evaluation Massachusetts Department of Public Health th floor 250 Washington Street, 6 Boston, MA 02108-4619 telephone 617-624-5658; fax 617-624-5695 The preceding report 1998-2002 City and Town Supplement included data for diagnosis years 1998 through 2002. This report contains data for the diagnosis years 1999-2003. There have been no changes in this report?s format. 1 METHODS Data Collection Massachusetts cancer incidence data are collected by the Massachusetts Cancer Registry (MCR). The MCR is a population-based cancer registry that was established by state law in 1980 and began collecting data in January 1982. Currently, the MCR collects information on in situ and invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squamous cell carcinomas of the skin. The MCR collects reports of newly diagnosed cancer cases from all Massachusetts acute care hospitals and one medical practice association (76 reporting facilities). In the year 2001, the MCR started to collect reports from dermatologists? offices (230 offices) and dermatopathology laboratories (2 laboratories). In 2002, the MCR started to receive case reports from urologists? offices (currently 236 offices), two general laboratories, and one radiation treatment center. The MCR also collects information from reporting hospitals on cases diagnosed and treated in staff physician offices when this information is available. Not all hospitals report this type of case, however, and some hospitals report such cases as if the patients had been diagnosed and treated by the hospital directly. Collecting this type of data makes the MCR?s overall case ascertainment more complete. The cancer types most often reported to the MCR in this manner are prostate cancer and melanoma. To improve case completeness, this MCR report includes previously unreported cancer cases that have been discovered through death certificate clearance. This process identifies cancers mentioned on death certificates that were not previously reported to the MCR. In some instances, the MCR was able to obtain additional information on these cases through follow-up activities with hospitals, nursing homes and physicians? offices. In other instances, a cancer-related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. These “death certificate only” cancer diagnoses are, therefore, poorly documented, and have not been confirmed by review of complete clinical information. Such cases are included in this report, but they comprise less than 3% of all cancer cases for the years covered by this report. Each year, the North American Association of Central Cancer Registries (NAACCR) reviews cancer registry data for quality, completeness, and timeliness. For diagnosis years 1999-2002, the MCR's annual case count was estimated by NAACCR to be more than 95% complete each year. The MCR achieved the gold standard for this certification element, in addition to six other quality and timeliness elements for each year from 1999-2002. Certification results for the year 2003 have not yet been released. The NAACCR method requires comparison with national incidence and mortality data, which are not available yet for the year 2003. During the time period from 1999 to 2000, case reports were coded following the International Classification of Diseases for Oncology, Second Edition (ICD-O-2) system (1). The International Classification of Diseases for Oncology, Third Edition (ICD-O-3) was implemented in North America with cases diagnosed as of January 1, 2001 (2). For the data to be comparable, all cancer cases diagnosed prior to January 1, 2001, and coded in ICD-O-2, were converted to ICD-O-3, following the Surveillance, Epidemiology and End Results (SEER) rules of conversion (3). ICD-O-3 implementation led to some changes in cancer site definitions (See Appendix I for current definitions). The new edition (ICD-O-3) contains more 2 specific information about certain cancers. The most important changes between the second and the third editions include: , Certain hematopoietic diseases are now considered to be malignant, where previously they were classified as „uncertain whether benign or malignant.? , Some neoplasms (mainly ovarian tumors) previously coded as malignant now revert to „uncertain whether benign or malignant.? The Massachusetts data summarized in this report were drawn from cancer cases entered on MCR computer files before February 16, 2006 and from death certificate clearance activities completed in September 2005. The numbers presented in this report may change slightly in future reports, reflecting late reported cases or corrections based on subsequent details from the reporting facilities. Such changes might result in slight differences in numbers and rates in future reports of MCR data, reflecting the nature of population-based cancer registries that receive case reports on an ongoing basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 1999-2003. The Massachusetts data presented include invasive cancers only (except cancer of urinary bladder where in situ cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage, before they have spread, when they are limited to a small number of cells and have not invaded the organ itself. Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance, survival prognosis and types of treatment of the tumors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic techniques and treatment patterns. Presentation of Data Each city and town in Massachusetts is listed alphabetically in the TABLES section. The observed number of cases, the expected number of cases, the standardized incidence ratios, and 95% confidence intervals are presented for twenty-three main types of cancer and for all cancer types combined. The „all cancers combined? category includes the twenty-three main types presented in this report and other malignant neoplasms. This category is meant to provide a summary of the total cancer experience in a community. As different cancers have different causes, this category does not reflect any specific risk factor that may be important for this community. Observed and Expected Case Counts The observed case count (Obs) for a particular type of cancer in a city/town is the actual number of newly diagnosed cases among residents of that city/town for a given time period. A city/town's expected case count (Exp) for a certain type of cancer for this time period is a calculated number based on that city/town's population distribution (by sex and among eighteen age groups) for the time period 1999-2003, and the corresponding statewide average annual age-specific incidence rates. Standardized Incidence Ratios A Standardized Incidence Ratio (SIR) is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in a given time period compares with that of the state as a whole. , An SIR of exactly 100 indicates that a city/town?s incidence of a certain type of cancer is equal to that expected based on average age-specific incidence rates. 3 , An SIR of more than 100 indicates that a city/town's incidence of a certain type of cancer is higher than expected for that type of cancer based on statewide average annual age-specific incidence rates. For example, an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age-specific incidence rates. , An SIR of less than 100 indicates that a city/town's incidence of a certain type of cancer is lower than expected based on statewide average age-specific incidence rates. For example, an SIR of 85 indicates that a city/town?s cancer incidence is 15% lower than expected based on statewide average annual age-specific incidence rates. Statistical Significance and Interpretation of SIRs The interpretation of the SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases in the observed or expected number of cases. Two SIRs may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases, or 600 observed cases and 400 expected cases. Both represent a 50 percent excess of observed cases. However, in the first instance, one or two fewer cases would change the SIR a great deal, whereas in the second instance, even if there were several fewer cases, the SIR would only change minimally. When the observed and expected numbers of cases are relatively small, their ratio is easily affected by one or two cases. Conversely, when the observed and expected numbers of cases are relatively large, the value of the SIR is stable. A 95 percent confidence interval has been presented for each SIR in this report (when the observed number of cases is at least 5), to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report, the 95% confidence interval is the range of estimated SIR values that has a 95% probability of including the true SIR for a specific city or town. If the 95% confidence interval range does not include the value 100, then the number of observed cases is significantly different from the expected number of cases. „Significantly different? means there is at most a 5% chance that the difference between the number of observed and expected cancer cases is due solely to chance alone. If the confidence interval does contain the value 100, there is no significant difference between the observed and expected numbers. Statistically, the width of the interval reflects the size of the population and the number of events; smaller populations and smaller observed numbers of cases yield less precise estimates that have wider confidence intervals. Wide confidence intervals indicate instability, meaning that small changes in the observed or expected number of cases would change the SIR a great deal. 4 Examples: , SIR = 137.0; 95% CI (101.6 - 180.6) – the confidence interval does not include 100 and the interval is above 100, indicating that the number of observed cases is statistically significantly higher than the expected number. , SIR = 71.0; 95% CI (56.2 – 88.4) – the confidence interval does not include 100 and the interval is below 100, indicating that the number of observed cases is statistically significantly lower than the expected number. , SIR = 108.8 95% CI (71.0-159.4) the confidence interval DOES include 100 indicating that the number of observed cases is NOT significantly different from what is expected, and the difference is likely due to chance. When the interval includes 100, then the true SIR may be 100. Example of Calculation of an SIR and its Significance OBSERVED CASES X 100SIR =EXPECTED CASES The following example illustrates the method of calculation for a hypothetical town for one type of cancer and one sex for the years 1998-2002: Town X State Town X Town X Age* Age-Specific Expected Observed Group Population Incidence Rate Cases Cases (A) (B) (C) = (A) x (B) (D) 00-04 74,657 0.0001 7.47 11 05-09 134,957 0.0002 26.99 25 10-14 54,463 0.0005 27.23 30 15-19 25,136 0.0015 37.70 40 20-24 17,012 0.0018 30.62 30 UP TO 85+ 6,337 0.0010 6.34 8 Total: 136.35 144 Observed Cases (column D total) 144 X 100 XSIR == 100 = X 100, 106Expected Cases(column C total ) 136.35 Thus the SIR for this type of cancer in Town X is 106, indicating that the incidence of this cancer in Town X is 6% higher than the corresponding statewide average incidence for this cancer. However, the range for the 95% confidence interval (89-124) indicates that the true value may be as low as 89 or as high as 124. Also, since the range includes the value 100, it means that the observed number of cases is not significantly higher or lower than what is expected. Whenever the number of observed cases is less than five, the corresponding SIR is neither calculated nor tested for statistical significance. This is indicated with an SIR of "not calculated" (nc). However, the number of observed and expected cases is shown in these circumstances. 5 Notes about Data Interpretation The SIR is a useful indication of the disease categories that have relatively high or low rates for a given community. These statistics, however, should be used with care. Such statistics provide a starting point for further research and investigation into a possible health problem, but they do not by themselves confirm or deny the existence of a particular health problem. Many factors unrelated to disease etiology may contribute to an elevated SIR including demographic factors, changes in diagnostic techniques and data collection or recording methods over time, as well as the natural variation in disease occurrence. When reviewing the data tables, it is important to keep in mind that an SIR compares the observed cancer incidence in a particular community with the expected incidence based on statewide average annual age-specific incidence rates. This means that valid comparisons can only be made between a community and the state as a whole. SIRs for different cities and towns CANNOT and SHOULD NOT be compared to each other. (Comparisons between two communities would be valid only if there were no differences in the age and sex distributions of the two communities' populations.) Data Limitations It should be emphasized that apparent increases or decreases in cancer incidence over time might reflect changes in diagnostic methods or case reporting rather than true changes in cancer incidence. Four other limitations must be considered when interpreting cancer incidence data for Massachusetts cities and towns: under-reporting in areas close to neighboring states; under-reporting for cancers that may not be diagnosed in hospitals; cases being assigned to incorrect cities/towns, and standardized incidence ratios based on small numbers of cases. Border Areas and Neighboring States Some areas of Massachusetts appear to have low cancer incidence, but this may be the result of under-reporting -- that is, a loss of cases diagnosed or treated in neighboring states that are not reported to the MCR. Presently the MCR has reciprocal reporting agreements with fifteen states -- Alaska, Arkansas, Connecticut, Florida, Maine, Mississippi, New Hampshire, New York, North Carolina, Rhode Island, South Carolina, Texas, Vermont, Wisconsin and Wyoming. Cases Diagnosed in Non-Hospital Settings During the time period covered by this report (1999-2003) hospitals provided most of the information about cancer cases to the MCR. Dermatologists? offices began reporting in 2001, and urologists? offices in 2002. Some types of cancer in this report are undoubtedly under-reported because they may be diagnosed by private physicians, private laboratories, health maintenance organizations or radiotherapy centers that escape hospital case identification systems. Examples may include melanoma of skin, prostate cancer, and certain hematologic malignancies such as leukemia and multiple myeloma. The extent of this under-reporting has not been determined exactly. However, the North American Association of Central Cancer Registries has estimated that the MCR?s records are more than 95% complete for the period 1999-2002. Estimates for the year 2003 have not yet been released. 6 City/Town Misassignment In accordance with standard central cancer registry procedures, each case reported to the MCR ideally should be assigned to the city/town in which the patient lived at the time of diagnosis, based on the address provided by the reporting hospital. In practice, however, a patient may provide the hospital with his/her mailing address (e.g., a post office box located outside the patient?s city/town of residence); a business address; a temporary address (e.g., the patient is staying with a relative while receiving treatment and reports the relative?s address as his/her own); or a locality or post office name (e.g., “Chestnut Hill” rather than “Boston”, “Brookline” or “Newton”). In addition, if a patient has moved since being diagnosed, the hospital may report the patient's current address. Because of the large number of cases reported to the MCR, and because data are reported to the MCR via electronic media, most city/town case assignments are performed by an automated computer process. This simplified matching process may misassign some cases based on the reported locality name. When MCR staff become aware of such misassignments, the errors are corrected manually by staff at the MCR. Furthermore, in order to minimize such errors, cases from fifty geographic localities prone to city/town misassignment are reviewed manually by the MCR. Small Numbers of Cases Standardized incidence ratios based on small numbers of cases result in estimates that are very unstable. This situation is common when the population of a city or town is small or if the particular cancer type is rare. SIRs and statistical significance were not calculated when the number of observed cases for a specific category was less than five. In these instances, the observed and expected cases are presented in the tables for qualitative comparison only. 7 T A B L E S 8 A P P E N D I C E S 361 362 APPENDIX I: INTERNATIONAL CLASSIFICATION OF DISEASES FOR ONCOLOGY (THIRD EDITION) 1CODES USED FOR THIS REPORT 2Cancer Site / Type Primary Site CodesHistologic Type Codes Bladder, Urinary C67.0 - C67.9 all except 9590 - 9989 Brain and Other C70.0 - C72.9 all except 9590 - 9989 Central Nervous System Breast C50.0 - C50.9 all except 9590 - 9989 Cervix Uteri C53.0 - C53.9 all except 9590 - 9989 Colon / Rectum C18.0 - C18.9, C19.9, C20.9, C26.0 all except 9590 - 9989 Esophagus C15.0 - C15.9 all except 9590 - 9989 Hodgkin Lymphoma C00.0 - C80.9 9650 - 9667 3Kidney and Renal Pelvis C64.9, C65.9 all except 9590 - 9989 Larynx C32.0 - C32.9 all except 9590 - 9989 Leukemia C00.0 - C80.9 9733, 9742, 9800 - 9820, 9826 9831 - 9948, 9963, 9964 C42.0, C42.1, C42.4 9823, 9827 Liver and Intrahepatic Bile Ducts C22.0, C22.1 all except 9590 - 9989 Lung and Bronchus C34.0 - C34.9 all except 9590 - 9989 Melanoma of Skin C44.0 - C44.9 8720 - 8790 Multiple Myeloma C00.0 - C80.9 9731, 9732, 9734 Non-Hodgkin Lymphoma C00.0 - C80.9 9590 - 9595, 9670 - 9729 All except C42.0, C42.1, C42.4 9823, 9827 Oral Cavity and Pharynx C00.0 - C14.8 all except 9590 - 9989 Ovary C56.9 all except 9590 - 9989 Pancreas C25.0 - C25.9 all except 9590 - 9989 Prostate C61.9 all except 9590 - 9989 Stomach C16.0 - C16.9 all except 9590 - 9989 Testis C62.0 - C62.9 all except 9590 - 9989 Thyroid C73.9 all except 9590 - 9989 Uteri, Corpus and Uterus, NOS C54.0 - C54.9, C55.9 all except 9590 - 9989 All Sites / Types C00.0 - C80.9 8000 - 9989 1 includes codes added to the International Classification of Diseases for Oncology, Third Edition since its publication. 2 Only invasive cancers (those with invasive behaviors) are included in this publication except Bladder, Urinary, which includes invasive and in situ behaviors.. Non-invasive (in situ) cancers are not included. 3 Massachusetts hospital coding conventions may have assigned some cases to a "not otherwise specified" site category that is not included in this cancer type. 363 364 II: RISK FACTORS FOR SELECTED CANCER TYPES AND APPENDIX REVIEWERS OF RISK FACTORS This Appendix contains a list of risk factors for thirteen types of cancer. The list briefly summarizes available information from the scientific literature. The list was last revised in 2000. Cancers are complex diseases, many of which have multiple factors that may contribute to their development. It should be noted that there is no single agreed-upon list of risk factors -- even the experts may disagree. This list should be viewed only as a starting point for the interested reader, and should not be viewed as constituting a definitive or comprehensive summary of cancer risk factors. Future risk factor lists may change as new research findings emerge. The list separates those characteristics for which research clearly indicates a strong association in the development of the cancer ("Risk Factors") from those characteristics for which weaker associations exist ("Possible Risk Factors") or which are now coming under investigation ("Under Investigation"). For additional information on cancer risk factors or prevention, you may wish to contact the following: Cancer Information Service (National Cancer Institute): 1-800-4-CANCER Cancer Response Line (American Cancer Society): 1-800-ACS-2345 In addition, the following selected Internet websites provide information on cancer. Many of these also provide links to other sites (not listed) which may be of interest. Massachusetts Department of Public Health: American Cancer Society: Centers for Disease Control and Prevention Home Page: Cancer Prevention and Control Program: National Cancer Institute Information: ? CANCERLIT (literature): SEER data: 5-A-Day Program (nutrition): Harvard Center for Cancer Prevention Home Page: Your Cancer Risk: OncoLink (University of Pennsylvania Cancer Center): ?Cancer News on the Net(information on diagnosis and treatment for cancer patients and their families): National Coalition for Cancer Survivorship: 365 BLADDER, URINARY Risk Factors: , Age (In Massachusetts, incidence rates increase markedly in the 65 to 74 year age group, and are highest in the 75 years and older age groups.) , Cigarette smoking , Excessive use of certain pain medications such as those containing phenacetin , Treatment with alkylating agent chemotherapy drugs such as Cytoxan (cyclophosphamide) , Having had radiation therapy to the bladder Possible Risk Factors: , Occupations in which workers are suspected of having an elevated bladder cancer risk due to certain chemical exposures include working in the rubber and/or leather industries, dye manufacturing, painters, professional drivers of trucks and other motor vehicles, aluminum workers, machinists, chemical workers, printers, metal workers, hairdressers and textile workers , Urologic conditions such as urinary tract infections and urinary stasis , Dietary factors 366 BREAST Risk Factors: , Age (In Massachusetts, incidence rates increase markedly in the 45 to 64 year age group, and are highest in the 75 years and older age groups.) , Family (mother, sister or daughter) history of breast cancer, especially if it was detected pre- menopausally (before the change of life) , High-dose radiation therapy to the chest, especially from age 11 until age 30 , Never giving birth , First childbirth after age 30 , Menstruating since age 12 or younger , Late age (older than 55) at menopause (change of life) , Having inherited a mutation in breast cancer susceptibility genes such as BRCA1 or BRCA2 , Increasing body fat in post-menopausal women , Estrogen taken post-menopausally (after the change of life) , More than three alcoholic drinks per day Possible Risk Factors: , Diet low in fruits and vegetables Under Investigation: , Pesticide exposure , Other environmental exposures 367 CERVIX UTERI (cervical cancer) Risk Factors: , Age (In Massachusetts, incidence rates are highest in the 45 years and older age groups.) , Certain types of human papilloma virus (HPV, the virus that causes genital warts) , Sexual intercourse before age 19 , Multiple sexual partners , Unprotected intercourse (having sex without a condom) , Smoking , Infection with HIV (human immunodeficiency virus, the virus that causes AIDS) Possible Risk Factors: , Too little vitamin A, vitamin C and/or folic acid in the diet , Exposure to secondhand smoke (other people's smoke) Use of the medication diethylstilbestrol (DES) during pregnancy is associated with later vaginal clear cell adenocarcinoma (a form of cervical and vaginal cancer) in the female children of those pregnancies. 368 COLON / RECTUM Risk Factors: , Age (In Massachusetts, incidence rates increase markedly in the 45 to 64 year age group, and continue to increase markedly in the 65 to 74 year and 75 to 84 year age groups.) , A personal history of colorectal polyps or colorectal cancer , Family history of colorectal cancer or polyps, including the various polyposis syndromes such as familial adenomatous polyposis, Gardner's Syndrome or Peutz-Jeghers Syndrome , Personal history of inflammatory bowel disease such as ulcerative colitis or Crohn's Disease , Personal history of ovarian, breast or endometrial cancer , Diet high in red meat, and low in fruits, vegetables and folic acid , Physical inactivity Possible Risk Factors: , Alcohol, especially beer , Smoking , Increasing body fat 369 LEUKEMIA Risk Factors: , Exposure to ionizing radiation , Exposure to benzene , Treatment with chemotherapy drugs (especially alkylating agents) , Certain genetic conditions such as Down?s syndrome , Exposure to ethylene oxide Possible Risk Factors: , Exposure to low level solvent and metal mixtures , Smoking Under Investigation: , Exposure to electromagnetic fields (e.g., from power lines) LUNG AND BRONCHUS Risk Factors: , Smoking Note: 85% of all lung cancers are caused by smoking. The risk of lung cancer is 10 times greater for persons who smoke up to one pack of cigarettes a day and 20 times greater for persons who smoke more than one pack of cigarettes a day than for persons who do not smoke. , Occupational, and in some cases environmental, exposures (e.g., asbestos, metals) , Exposure to secondhand smoke (other people?s smoke) 370 OF SKIN MELANOMA Note: changing or changed moles, or new moles which appear after age 30 that itch and are tender are early, potentially malignant lesions, and should be examined by a health care professional. Risk Factors: , Age (In Massachusetts, incidence rates begin to increase markedly in the 45 to 65 year age group, and are highest in the 75 to 84 year age group.) , One or more large or unevenly colored lesions such as: , Dysplastic mole(s), with or without a family history of melanoma , Lentigo maligna , Familial atypical mole and melanoma syndrome , Giant congenital melanocytic nevi (pigmented patches of skin) , Nevus (birthmark) since birth , Caucasian , Previous melanoma , Family history of melanoma , Immunosuppression (when the body's defenses are weakened, such as after transplant surgery) , Sun sensitivity , Repeated sunburns, especially as a child , Easily sunburned , Freckling , Unable to tan easily 371 NON-HODGKIN’S LYMPHOMA (now known as non-Hodgkin lymphoma) Risk Factors: , Age (In Massachusetts, incidence rates begin to increase in the 45 to 65 year age group, and are highest in the 75 to 84 year age group.) , Abnormalities of the immune system, either congenital or resulting from suppression due to organ transplantation or disease , Infection with HIV (human immunodeficiency virus, the virus that causes AIDS) , Exposure to radiation or chemotherapy , Exposure to certain herbicides Possible Risk Factors: , Smoking , Other chemical exposures ORAL CAVITY AND PHARYNX Risk Factors: , Tobacco use (including cigarettes, pipes, cigars, chewing tobacco and snuff) , Heavy alcohol use , Age (In Massachusetts, incidence rates begin to increase in the 45 to 64 year age group, and are highest in the 75 to 84 year age group.) , Poor nutrition, especially chronic iron deficiency Possible Risk Factors: , Chronic irritation of the mouth due to ill-fitting dentures or broken teeth , Poor oral hygiene 372 OVARY Risk Factors: , Age (In Massachusetts, incidence rates increase markedly in the 45 to 64 year age group, and are highest in the 65 to 74 year age group.) , Never giving birth , Personal history of endometrial (lining of the uterus), colon or breast cancer , Family history of ovarian cancer (mother, sister or daughter) , Having one of three inherited ovarian cancer conditions: , breast-ovarian cancer syndrome , site-specific ovarian cancer syndrome , hereditary nonpolyposis colorectal cancer or Lynch II syndrome (includes early-onset colorectal cancer, endometrial cancer, breast cancer and ovarian cancer) , Never having used oral contraceptives, or having used oral contraceptives for fewer than five years , Caucasian Possible Risk Factors: , Fertility drugs , Use of talc powder containing asbestos fibers in the perineal or external genitalia area , High fat diet 373 PROSTATE Risk Factors: , Age (In Massachusetts, incidence rates begin to increase markedly in the 45 to 64 year age group, and are highest in the 65 to 74 year age group.) , Family history of prostate cancer , Hormonal factors , African-American Possible Risk Factors: , Alcohol consumption , Having a history of benign prostate disease , Smoking , Physical inactivity , Diet high in fat TESTIS Risk Factors: , Age (In Massachusetts, incidence rates are highest in the 20 to 44 year age group.) , Undescended testicle Possible Risk Factors: , Inguinal hernia , Testicular trauma , Familial factors , Occupations related to leather processing 374 AND UTERUS, NOS (uterine cancer) UTERI, CORPUS Risk Factors: , Age (In Massachusetts, incidence rates are highest in the 45 years and older age groups.) , Personal history of colon and/or breast cancer , Family history of uterine cancer , Being more than 20 pounds overweight , Never giving birth , Presence of estrogen-producing ovarian tumors , Postmenopausal (change of life) use of estrogen without progesterone , Tamoxifen (a drug given to women who have had breast cancer to lower the risk of recurrence) , Late age (older than 55) at menopause (change of life) Possible Risk Factors: , Diet high in fatty foods , Hypertension (high blood pressure) , Diabetes (high blood sugar) , Chronic anovulation (ovaries do not produce eggs) , Menstrual problems , Radiation therapy to the pelvis , Malignant tumors on the ovaries , Never having used oral contraceptives, or having used oral contraceptives for fewer than five years 375 Reviewers of Risk Factors This Appendix was assembled under the auspices of the American Cancer Society (New England Division) through seeking the advice of leading cancer experts. The following clinicians, researchers and public health professionals reviewed the risk factors for the type(s) of cancers indicated: Ross Berkowitz, MD (ovarian, uterine) Frederick Li, MD (all types) Cynthia Boddie-Willis, MD, MPH (prostate) John Lisco, MPH (colorectal) Risa Burns, MD (breast, cervical) Robert Mayer, MD (colorectal) Richard Clapp, ScD (all types) Kenneth Miller, MD (leukemia) Graham Colditz, DrPH (colorectal) Michael Monopoli, DMD (oral) Suzanne Condon, MS (all types) Nancy Mueller, ScD (non-Hodgkin's lymphoma) Greg Connolly, DMD (lung) J. David Naparstek, ScM, CHO (all types) Daniel Cramer, MD (ovarian) Robert Osteen, MD (breast) Letitia Davis, ScD (all types) James Petros, MD (colorectal) Catherine DuBeau, MD (prostate) Marianne Prout, MD, MPH (all types) Kathleen Egan, PhD (breast) Lowell Schnipper, MD Richard Fabian, MD (oral) (non-Hodgkin's lymphoma) Marc Garnick, MD (prostate, testicular) Paul Schroy, MD, MPH (colorectal) Alan Geller, RN, MPH (melanoma) Ellen Sheets, MD (cervical) Annekathryn Goodman, MD (uterine) William Shipley, MD (bladder) Lauren Holm, RN, MSN (all types) Art Skarin, MD (lung) David Hunter, MD, BS, ScD (all types) Arthur Sober, MD (melanoma) Joe Jacobson, MD (prostate) Bonnie Tavares, MEd (breast, cervical) Phil Kantoff, MD (bladder, prostate) Howard Weinstein, MD (leukemia) Howard Koh, MD, MPH (melanoma) Martha Crosier Wood, MBA (all types) Robert Krane, MD (testicular) and staff members of the Massachusetts Department of Public Health?s Center of Environmental Health (all types), Colorectal Cancer Working Group (colorectal), Skin Cancer Prevention Program (melanoma), and Massachusetts Women?s Health Network (breast, cervical). We would also particularly like to thank Lauren Holm, former Vice President for Planning and Evaluation, American Cancer Society (New England Division) and Martha Crosier Wood, former Director, Comprehensive Cancer Prevention and Control, Massachusetts Department of Public Health for their assistance in the development of this Appendix. 376 APPENDIX III: MDPH CANCER CONTROL INITIATIVES AND PUBLICATIONS This Appendix was developed by Comprehensive Cancer Control, Women?s Health Network, Men?s Health Partnership and Tobacco Control Program of the Bureau of Family and Community Health, Massachusetts Department of Public Health (MDPH). The MDPH is working to reduce the incidence and mortality of cancer throughout the Commonwealth. The following is a description of some of the current efforts to reduce the risk of specific cancers. For further information about specific cancers or cancer-related programs and issues, please contact the Comprehensive Control at 617-624-5480. BREAST CANCER Breast cancer is the most common cancer in women in Massachusetts and throughout the United States. In 1992, MDPH launched a breast and cervical cancer screening program for uninsured and underinsured eligible women in order to detect these diseases when they are most treatable. In addition, in 1992 the state legislature allocated funding for a breast cancer research program. Funding for research increased in subsequent years however, the research program was eliminated in 2002 due to state budget cuts. MDPH is currently involved in numerous activities to address breast cancer in Massachusetts, including: , providing free mammograms and clinical breast examinations for uninsured and underinsured eligible women via the Massachusetts Women's Health Network; , developing and disseminating materials on the Massachusetts Women's Health Network, especially for low-literacy, culturally diverse, and non-English speaking women; , training community health outreach workers on communicating risk factors and screening options with culturally and ethnically diverse populations; , enhancing clinical and diagnostic skills of clinicians throughout Massachusetts by providing continuing education training; , providing a clearinghouse of publications concerning breast cancer; , developing and disseminating statistical publications, including information on breast cancer; , collecting, analyzing and disseminating information about licensed mammography facilities in Massachusetts. CERVICAL CANCER Cancer of the cervix uteri is highly curable when detected at an early, pre-invasive stage. MDPH is currently involved in the following cervical cancer prevention and control activities: , providing free Pap tests for uninsured and underinsured eligible women through Massachusetts Women's Health Network and teens through Family Planning programs; , training community health outreach workers on communicating risk factors and screening options with culturally and ethnically diverse populations; , educating medical professionals on counseling patients about cervical cancer and performing cervical cancer screenings; , working to reduce the risk of cervical cancer associated with exposure to tobacco smoke and sexually transmitted diseases; , developing statistical publications, which include information on cervical cancer; 377 , providing a clearinghouse of publications concerning cervical cancer; , implementing prevention programs to address viral sexually transmitted diseases, such as HPV, herpes virus and HIV infection. COLORECTAL CANCER Colorectal cancer is one of the most preventable types of cancer and, when detected early, is almost always treatable. MDPH is working to increase the rate of colorectal cancer screening and thus reduce the incidence of colorectal cancer through many activities including: , the development of the Massachusetts Colorectal Cancer Coalition and its Colorectal Cancer Working Group; , MDPH and the Coalition, in collaboration with the American Cancer Society, CDC, and Cancer Research & Prevention Foundation will be presenting an evidence-based (proven effective) summit for physicians and other health providers in May 2006--Dialogue for Action: Increasing Access to Colorectal Cancer in Massachusetts; , providing information on colorectal cancer and screening on its website: a variety of languages through the Massachusetts Health Promotion Clearinghouse: Telephone: 1-800-952-6637, 617-536-0501 x210 materials in alternative formats, and TTY at 617-536-5872 , recommending resources such as: CDC?s Screen for Life program (featuring Katie Couric and Morgan Freeman): Telephone: 1-800-232-4636, TTY: 1 (888) 232-6348 US Preventive Task Force Community Guide Evidence Based Recommendations: Telephone: 1-800-358-9295 (Agency for Healthcare Research and Quality (AHRQ) Clearinghouse) LUNG CANCER Lung cancer is the leading cause of cancer death for both men and women. Despite high incidence and mortality rates and the lack of screening tests, lung cancer is a largely preventable disease. Since 85% of lung cancers can be attributed to cigarette smoke, the most effective strategy for preventing lung cancer is through tobacco control. Several prospective studies show that a former smoker's risk of developing lung cancer can be reduced by half within five years. The risk of lung cancer from smoking may be augmented by other factors including exposure to carcinogens. MDPH, mainly through the Massachusetts Tobacco Control Program, is working to reduce the risk of lung cancer through the following activities: 378 , implementing the Massachusetts Smoke-free Workplace Law (effective July 5, 2004) including a complaint and information line 1-800-992-1895 and providing training to local boards of health on enforcement issues; , helping smokers quit smoking through statewide services including the Try to Stop Tobacco Resource Center's telephone helpline (1-800-trytostop), website (www.trytostop.org), and educational print materials; , utilizing QuitWorks program (www.QuitWorks.org) to provide health care clinicians with a simple approach to treating their patients who smoke by linking them to proactive telephone counseling and the state's range of effective tobacco treatment services; , providing funding and training to local boards of health to promote and enforce local regulations that reduce youth access to tobacco products; , raising public awareness about the health issues related to tobacco use and the need for tobacco control public policy initiatives through community-based Tobacco Free Community Mobilization Networks; , measuring changes in adult and youth attitudes toward tobacco use; , developing statistical publications, such as Selected Cancers in Massachusetts Men 1982- 1996 and Cancer in Massachusetts Women 1989-1998, which include information on lung cancer; , analyzing previously collected data in order to better understand tobacco-related disparities in the state. OVARIAN CANCER Ovarian cancer is the fifth most frequent cause of cancer death in women in the United States and the leading cause of death for gynecologic cancers. While there is no accurate detection test currently available for ovarian cancer, recent studies suggests that together the three symptoms of swollen abdomen, a bloated feeling and urinary urgency may be associated with ovarian cancer. When detected at its earliest stage, the five-year survival rate is more than 90%. MDPH, in partnership with the Massachusetts Division of the National Ovarian Cancer Coalition, the Ovarian Cancer Education and Awareness Network (OCEAN), the Rendon Group, Massachusetts General Hospital Cancer Center, M. Patricia Cronin Foundation to Fight Ovarian Cancer, Harvard Medical School, Dana-Farber Cancer Institute, and Brigham and Women's Hospital, has formed the Massachusetts Ovarian Cancer Awareness Partnership and is currently involved in raising awareness of ovarian cancer through the following activities: , promoting public and professional awareness of issues related to ovarian cancer; , promoting public awareness of how to decrease the risk of ovarian cancer through the Massachusetts Women's Health Network, Women, Infants and Children (WIC) and Family Planning; , developing statistical publications, which include information on ovarian cancer. PROSTATE CANCER MDPH, in partnership with the Massachusetts Comprehensive Cancer Control Coalition, Massachusetts Prostate Cancer Coalition, and community based partnership organizations works to reduce prostate cancer incidence and mortality and to address issues of quality of life for prostate cancer survivors and their families. The following MDPH activities are currently underway to address prostate cancer: , increasing knowledge and awareness among men and their families about prostate cancer through a variety of community-based programs and media strategies; 379 , developing and distributing educational materials about prostate cancer that are culturally sensitive and available in several (six) languages and at varying literacy levels; , linking uninsured and underinsured men with medical care, including prostate cancer screening through twelve Men's Health Partnership sites statewide with a focus on high risk populations; , developing statistical publications, such as Selected Cancers in Massachusetts Men 1982- 1996, which include information on prostate cancer; , co-sponsoring an annual prostate cancer symposium; , providing publications concerning prostate cancer through the Massachusetts Health Promotion Clearinghouse; , co-sponsoring trainings for health care outreach workers and health care professionals; , participating in various organizations with a focus on men's health including the Men's Health Committee of the Massachusetts Medical Society, the Massachusetts Prostate Cancer Coalition, the Men's Health Summit; , formulating the Massachusetts Prostate Cancer Working Group, developing a first course of treatment analysis of prostate cancer with Black non-Hispanic and White non-Hispanic men, conducting small educational forums with a prostate survivor group, and developing the Prostate Cancer Peer Messenger Initiative with Black non-Hispanic men, under the auspices of the Massachusetts Comprehensive Cancer Control Coalition. SKIN CANCER In the United States, skin cancer accounts for 2 percent of cancer deaths. There are three major types of skin cancer. Basal cell and squamous cell carcinomas are known as non-melanoma forms of skin cancer and are not life threatening. Melanoma is the most serious type of skin cancer 1because it has the ability to spread throughout the body and can lead to death. While melanoma accounts for only 4 percent of skin cancer cases, it contributes to a majority of skin cancer deaths. The American Cancer Society estimates that melanoma will account for roughly 60,000 cases and 27,770 deaths due to skin cancer in 2005. In the United States, the percentage of people who 3develop melanoma has doubled in the past 30 years. The Massachusetts Melanoma Foundation, in partnership with the American Cancer Society, MDPH, Boston University School of Medicine, the Dana-Farber Cancer Institute, the Harvard School of Public Health, and other organizations and individuals, have formed the Massachusetts Skin Cancer Prevention Collaborative (Collaborative) to address skin cancer in Massachusetts. The Collaborative is currently involved in the following activities to prevent skin cancer: , assisting communities develop local skin cancer prevention programs; , helping recreational/tourism sites and primary schools develop programs and policies to prevent skin cancer; , developing and distributing skin cancer prevention materials including tip cards and posters; , increasing awareness among health professionals; , developing statistical publications, such as Selected Cancers in Massachusetts Men 1982- 1996 and Cancer in Massachusetts Women 1989-1998, which include information on melanoma, , exploring other venues of recreational exposure, including Little Leagues. For more information about the Collaborative please contact the Melanoma Foundation at 617-232-1424. 380 TESTICULAR CANCER Testicular cancer accounts for 1% of all cancers in Massachusetts males. In Massachusetts, testicular cancer is the most common cancer in men ages 20 to 44. Massachusetts is currently working to reduce the risk of testicular cancer through the following efforts: , developing and distributing testicular cancer public and professional information materials; , developing statistical publications, such as Selected Cancers in Massachusetts Men 1982- 1996, which include information on testicular cancer. UTERINE CANCER There is currently no screening test for uterine cancer. The Pap smear, which is used to detect cervical cancer, finds fewer than half of endometrial (uterine) cancers. MDPH is currently working to address uterine cancer through the following activities: , providing information concerning uterine cancer through the Massachusetts Women's Health Network and Family Planning programs; , developing statistical publications, which include information on uterine cancer. 381 Cancer-Related Publications from the Massachusetts Department of Public Health (MDPH) General Cancer The following materials are available through the Massachusetts Health Promotion Clearinghouse, www.maclearinghouse.com: telephone 1-800-952-6637, website Cancer Screening Can Save Your Life (tip sheet, available in English) Breast and Cervical Cancer The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: Bilingual Mammography Patient?s “Bill of Rights” (information card, available in English/Spanish) Bilingual Mammography Patient's "Bill of Rights" (poster, available in English/Spanish) What You Should Know about Breast Cancer (brochure, available in English, Spanish, Portuguese, Haitian Creole, Vietnamese, and Chinese) What You Should Know about Cervical Cancer (brochure, available in English, Spanish, Portuguese, Haitian Creole, Vietnamese, and Chinese) The following materials are available through Massachusetts Department of Public Health Women's Health Network, telephone 1-877-414-4447: Women?s Health Network Bilingual Information Card (eligibility criteria and contact information for free health screening, available in Chinese, English, Haitian Creole, Khmer, Lao, Portuguese, Russian, Spanish, Vietnamese) Women's Health Network Passport Health Guide (booklet, available in Portuguese) You are the difference (video, 12:55 min, in English, promotes the importance of regular screenings and includes personal accounts from women who have participated in WHN, #BC083). Colorectal Cancer The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: Take Control: Get Tested for Colorectal Cancer (public brochure, available in Chinese, English, French, Portuguese, Russian, Spanish, and Vietnamese) You Can Prevent Colorectal Cancer (public brochure, available in Chinese, English, French, Khmer, Portuguese, Russian, Spanish, and Vietnamese) Oral Cancer The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: Don?t Be Afraid to Say Ahh… (public brochure, available in English, Chinese, Portuguese, Russian, and Spanish) Ovarian Cancer To order any of these pamphlets, send requests via mail or fax to: National Ovarian Cancer Coalition, Inc. 500 NE Spanish River Blvd, Ste 14 Boca Raton, FL 33431-4516 main telephone: 561-393-0005, fax 561-393-7275 information line: 1-888-682-7426 (1-888-OVARIAN) website: www.ovarian.org Myths & Facts about Ovarian Cancer. What You Need to Know (2nd ed.) by M. Steven Piver, MD and Gamal Eltabbakh, MD 382 National Ovarian Cancer Coalition. Working to Raise Awareness About Ovarian Cancer Risks and Symptoms Ovarian Cancer…It Whispers…So Listen Patient to Patient (patient resource for women with ovarian cancer) What Every Woman Should Know About Ovarian Cancer Ovarian Cancer Reference Card (a wallet- sized card that provides facts, symptoms and resources) Men’s Health Partnership The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: What Every Man Should Know About Prostate Cancer (public brochure, available in Chinese, English, Haitian Creole, Portuguese, Russian, and Spanish) Prostate Cancer Fact Sheet (fact sheet available in English, Spanish, and Portuguese) What You Learn about Prostate Cancer May Save Your Life (poster, available in English and Spanish) Skin Cancer You can download brochures through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: Nutrition The following materials are available through the Massachusetts Health Promotion Clearinghouse, www.maclearinghouse.com: telephone 1-800-952-6637, website Food Guide Pyramid 2005 Take the 5 A Day Challenge 5 A Day Resource Directory Smart Snacking Tastes Great (brochure) Best and Worst Fast Food (set of 3 fact sheets) Eat 5 Fruits and Vegetables A Day for Health and Energy (poster for youth) 5 A Day Easily Fits Your Schedule (poster) Physical Activity The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: Physical Activity Fact Sheets (reproducible facts sheets from the American Council on Exercise) A Small Investment with a Big Payoff! (tip card) Activity Pyramid (brochure) Tobacco The following materials are available through the Massachusetts Health Promotion Clearinghouse, telephone 1-800-952-6637, website www.maclearinghouse.com: No smoking signs for buildings and vehicles Retailer education kits Palm cards (brochures) promoting the Massachusetts Quitline – 1-800-Try-to-Stop Booklets for those considering quitting smoking Tobacco Facts cards in Spanish/English and Portuguese/English Miscellaneous 383 Take Charge: Medicare Part B Benefits and You (video, 15 min, in English, provides an overview of the screening benefits covered under Medicare Part B.Video is designed to increase awareness about the prevention benefits under Medicare Part B, and to increase screening rates for Medicare beneficiaries, # BC089). Other Massachusetts Cancer Registry Publications The following materials are available through the Massachusetts Cancer Registry, telephone 617-624-5658: Cancer Incidence and Mortality in Massachusetts – Statewide Report 1998-2002 Cancer in Massachusetts Women 1989-1998 Data Report Childhood Cancer in Massachusetts 1990-1999 Selected Cancers in Massachusetts Men 1982-1996 Data Report on Colorectal Cancer in Massachusetts Data Report on In situ Breast Cancer in Massachusetts Massachusetts Cancer Registry Public Information Brochure (available in English, Portuguese, Spanish) References from Appendix III 1National Cancer Institute, Skin Cancer (PDQ): Prevention (2005); available from , What Are the Key Statistics About Melanoma? available from , Surveillance, Epidemiology and End Results (SEER), “Search Cancer Statistics Review, 1975-2002”;. available from bin/csr/1975_2002/search.pl#results. 384 REFERENCES 1. Percy C, VanHolten V, Muir C (eds). International Classification of Diseases for Oncology, 2nd Ed. Geneva: World Health Organization, 1990. 2. Fritz A, Percy C, Jack A, et al. (eds). International Classification of Diseases for Oncology, 3rd Ed. Geneva: World Health Organization, 2000. 3. Fritz A, Percy C. Implementing ICD-O-3: impact of the new edition. National Cancer Institute Web site. Available at: article%20NEW%20PDF.pdf. Accessed April 24, 2006. 385