Progress in Chronic Disease Prevention The Prevalence of Cancer -- Connecticut, January 1, 1982

Incidence and follow-up data from the Connecticut Tumor Registry were analyzed in order to estimate the prevalence of cancer (1). A case was included in this analysis if the patient was alive on January 1, 1982, and had been diagnosed with cancer at any time during the study period, 1935 through 1981. Cases of basal- and squamous-cell cancer of the skin were not included. During the study period, 288,221 residents of Connecticut were diagnosed with invasive cancer. Of these, 53,628 (18.6%) were known to be living on January 1, 1982; 19,881 (6.9%) were lost to follow-up (i.e., reported alive with a date of last contact prior to January 1, 1982). The life-table method was used to estimate the number of patients among those lost to follow-up who were alive on January 1, 1982 (2).

On January 1, 1982, the age-adjusted* prevalence rate among males for all sites of cancer combined was 1,789/100,000 compared with 2,222/100,000 among females. In contrast, the age-adjusted cancer incidence rate for all sites among males diagnosed during the period 1978-1981 was almost one-third higher than among females (463/100,000 compared with 342/100,000). The mortality rate among males was about 50% higher than among females (246/100,000 compared with 154/100,000) (3). The relatively favorable survival rate for women with cancer affecting many of the common sites (e.g., breast and gynecological malignancies) and the poor survival rate for patients with lung cancer (the most common cancer in males) resulted in an age-adjusted prevalence rate among females that was about 25% higher than that among males.

The five most prevalent malignant diseases among males were prostate cancer (372/100,000), colon cancer (249/100,000), bladder cancer (233/100,000), rectal cancer (145/100,000), and lung cancer (135/100,000). The most prevalent cancer site in females was the breast (848/100,000), followed by corpus uteri (273/100,000), colon (224/100,000), cervix (138/100,000), and rectum (98/100,000).

The age-specific prevalence rates for all sites of cancer combined among females 20 to 59 years of age were about twice the rates for males (Figure 4). The rates for all sites combined for males 70 years of age were higher than those for females, partly because of the high prevalence of prostate cancer in elderly males. For females, prevalence rates for all sites combined ranged from 1,170/100,000 for those 30 to 49 years of age to 10,635/100,000 for those 70. For males, the rates for all sites combined increased from 598/100,000 for those 30 to 49 years old to 11,810/100,000 for those 70.

Editorial Note

Editorial Note: The magnitude of the cancer problem has been measured traditionally by incidence and mortality statistics. The knowledge of cancer prevalence rates adds a new dimension to the assessment of this problem. While incidence reflects only the rate of occurrence of newly diagnosed cancer cases in one particular year, prevalence estimates include patients diagnosed during previous years who survived to the point in time of interest. Because most patients with cancer survive more than one year, prevalence is a useful indicator of the cancer burden on the health care system.

"Cured" and "uncured" cases were included in this study because, in many cases, the determination of cure is ambiguous. It has been suggested that even for so-called cancer survivors, the experience of cancer leaves a long-lasting impression (4). Problems of employment, insurance, second malignancies, and reproduction linger long after the patient's treatment is completed and probably justify including all patients with a history of cancer in the prevalence calculations.

Approximately 2% of the population of the state of Connecticut had a history of cancer on January 1, 1982. Perhaps even more surprising is the fact that 11% of females and 12% of males greater than or equal to 70 years of age had a history of cancer. Applying the age-specific prevalence rates to the estimated 1986 U.S. population (5) results in an estimate of approximately 5 million persons with a history of cancer in the United States. With the anticipated aging of the U.S. population, the number of individuals with a history of cancer can be expected to increase. Calculations using projected populations (5) and assuming constant prevalence rates yield prevalence estimates of 6.2 million for the year 2000 and 9.6 million for 2030. These projections should be viewed cautiously since the racial and ethnic composition of Connecticut is different from that of the United States as a whole and since incidence and survival patterns among blacks, whites, and other races are known to differ.

Advances in cancer treatment that improve patient survival will almost certainly increase the prevalence rates of cancer over time. With more and more patients living with a history of cancer, an increase in resources will be required to help patients with their medical problems, physical limitations, and social adjustments. However, the successful application of cancer prevention strategies, including smoking cessation and diet modification programs, should decrease the incidence of cancer and thereby lower cancer prevalence. Reported by: AR Feldman, MD, L Kessler, ScD, MH Myers, PhD, MD Naughton, Surveillance and Operations Research Br and Biometry Br, Div of Cancer Prevention and Control, National Cancer Institute.

References

1. Feldman AR, Kessler L, Myers MH, Naughton MD. The prevalence of cancer: estimates based on the Connecticut Tumor Registry. N Engl J Med 1986;315:1394-7.

2. Cutler SJ, Ederer F. Maximum utilization of the life table method in analyzing survival. J Chron Dis 1958;8:699-712.

3. National Cancer Institute. SEER program: cancer incidence and mortality in the United States, 1973-1981. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1984; DHHS publication no. (NIH)85-1837.

4. Mullan F. Seasons of survival: reflections of a physician with cancer. New Engl J Med 1985;313:270-3.

5. Bureau of the Census. Projections of the population of the United States, by age, sex, and race: 1983 to 2080. Washington, DC: US Department of Commerce, 1984;(current population reports; series P-25; no. 952). *Adjusted to the 1980 U.S. population, U.S. Bureau of the Census.

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