Detecting New Cancers as Early as Possible

Cancers of the lung, breast, prostate, and colon account for about 55 percent of all new cancers diagnosed in Vermont between 1997 and 2001. Many cancers can be treated quickly and effectively if they are detected and treated in early stages before cancer cells spread to surrounding organs or tissues.

There are screening tests to detect some types of cancers at an early stage, and some of theses tests can actually remove abnormal tissue before they become cancerous. In this plan, we have emphasized early detection for common cancers that can be easily treated if found early by established screening techniques. These include cancers of the breast, colon, cervix and prostate.

Every Vermonter is encouraged to talk with their health care providers about cancer prevention and appropriate screening strategies based on age, gender, race and family medical history.

For more information on ACS cancer screening recommendations, go to: www.cancer.org

Colon Cancer

In Vermont, cancers of the colon (large intestine) and rectum are the second most common cancer diagnosed in women and the third most common cancer diagnosed in men. Each year, approximately 186 cases of colon cancer are diagnosed in women and 173 cases are diagnosed in men in Vermont. Moreover, approximately 72 women and 62 men die of colon cancer in Vermont each year.

Vermont incidence and mortality rates among women are both higher than the US rates among white women. Incidence and mortality rates among Vermont men are similar to US rates, and about 1.3 times higher than in women.

Colon cancer is one of the few cancers that can be prevented through a screening test. Colonoscopy, a procedure for detecting cancer throughout the colon, can detect and remove small growths (or polyps) in the colon and rectum before they become cancerous. The five-year survival rate of colon cancer is 90 percent when diagnosed at an early stage. Regrettably, only about one-third of colon cancers are diagnosed at an early, localized stage.

Compared to the US, Vermont has a higher rate of colon cancers diagnosed at a later stage, and has a higher mortality rate of cancers of the colon and rectum. Almost half of the eligible population in Vermont has never been screened for colon cancer.

Screening for colon cancer is recommended for all individuals over the age of 50, including one of the following: fecal occult blood test (FOBT) every year, colonoscopy every 10 years, or double-contrast barium enema every five to 10 years.

If you are African-American or have family members diagnosed with cancer of the colon or rectum, screening should begin at 40 years of age.

Goal: Increase the use of appropriate screening methods for cancers of the colon and rectum.

Objectives: Increase the percentage of Vermonters aged 50+ receiving the recommended screening tests from 59% in 2004 to 65% in 2010. Increase the percentage of patients referred for colon cancer screening. Increase screening and follow-up rates among people with high risk indicators for colon cancer such as family or personal medical history.

Breast Cancer

Breast cancer is the most common cancer diagnosed in women. Each year, approximately 465 breast cancer cases are diagnosed among Vermont women. Breast cancer is the second leading cause of cancer death among women. Each year, approximately 97 Vermont women die from breast cancer.

Breast cancer incidence and mortality rates for Vermont women are comparable to US rates among white women. Breast cancer among men accounts for less than one percent of all cases nationally. In the US, breast cancer mortality significantly decreased from 1997 to 2001, but there has been no significant change in breast cancer incidence. In Vermont, there has been no significant change in breast cancer incidence or mortality.

The incidence of breast cancer, as with many cancers, is extremely low in childhood and increases dramatically with age. Breast cancer is most often found in women over the age of 50. Sixty-five percent of breast cancers are diagnosed at the localized stage, and three percent of breast cancers are diagnosed at the distant stage. According to national survival data, 98 percent of women with localized breast cancer survive for at least five years; only 27 percent of women diagnosed with distant breast cancer survive for at least five years.

Regular self-breast exams, clinical breast exams by a healthcare provider and mammograms are effective methods to detect lumps and cancerous tumors in the breast early. In 2004, 87 percent ofVermont women 40 and older had a mammogram in the preceding two years, which surpassed the Healthy Vermonters objective of 70 percent. Increase the use of appropriate screening methods for breast cancer.

Objectives:
Increase the percentage of women age 40 and over getting a mammogram within the past 2 years from 76% in 2004 to 85% in 2010.

For more information on Ladies First, go to: www.healthyvermonters.info

Cervical Cancer

Each year, approximately 31 women are diagnosed with cervical cancer in Vermont, making it the tenth most commonly diagnosed cancer among Vermont women. Cervical cancer ranks twelfth in causes of cancer deaths in women with about 10 women dying each year.

Cervical cancer incidence rates for Vermont women are significantly higher than the US Mortality rates are comparable to US rates. While both the incidence and mortality of cervical cancer have decreased in the US between 1997and 2001, there has been no significant change in cervical cancer incidence or mortality in Vermont.

Women of all ages are at risk for cervical cancer, including those in younger age groups and older women. Ninety-four percent of newly diagnosed cervical cancer cases are in women age 30 and older; 30 percent of these cases are in women 65 and older. Vermont women aged 70 to74 have a significantly higher incidence rate compared to the U.S., while the rates of all other Vermont age groups are comparable to U.S. rates. Women who smoke are twice as likely as non-smokers to develop cervical cancer.

National survival data show that 93 percent of women diagnosed with localized cervical cancer survive for at least five years, while only 18 percent of women diagnosed with distant cervical cancer survive that long. Only 63 percent of cervical cancers are diagnosed at the localized stage, and 9 percent are diagnosed at the distant stage.

Regular gynecological exams including a Pap test is a standard screening method for cervical cancer. While Vermont is approaching our goal for screening, rates vary among different groups of women.

(Please note: With the advent of the HPV vaccine, VTAAC is now reviewing its objectives.)

Goal: Increase the use of appropriate screening for cervical cancer.

Objectives: Increase percentage of women (age 18+) who have had a Pap test in the past 3 years from 87% in 2004 to 90% in 2010.

Prostate Cancer

In the United States and Vermont, prostate cancer is the most commonly diagnosed cancer in men. A man’s risk of developing prostate cancer in his lifetime is one in six.

In Vermont, prostate cancer is the second leading cause of death due to cancer, representing 32 percent of all cancer deaths in men. Each year in Vermont, approximately 445 prostate cancer cases are diagnosed in men, and approximately 205 men die from this cancer. Prostate cancer incidence and mortality rates for Vermont men are not significantly different compared to U.S. white men.

The incidence of prostate cancer increases dramatically with age. In Vermont, approximately 65 percent of all prostate cases are diagnosed in men 65 and older; with men aged 75 to 79 have the highest age-specific incidence of prostate cancer, at a rate of 1,050 per 100,000. Statistically, Vermont men aged 50 to 54 have a higher incidence rate of prostate cancer compared to the U.S. male white rate, and Vermont men aged 80 to 84 have a significantly lower prostate cancer incidence rate compared to the U.S. male white rate. Prostate cancer is more common among African-American men than among white men; and African-American men are twice as likely to die from the disease.

Men with close family members (a brother or father) who have had prostate cancer are more likely to get it themselves, especially if their relatives were young when they got the disease. Screening methods for prostate cancer exist but scientific consensus is lacking as to the benefits and risks of universal screening recommendations, especially for men over 75 years old. The digital rectal exam (DRE) and the prostate-specific antigen (PSA) test may be most appropriate for healthy men aged 50 to 75 years old. Individual men should discuss screening options with their healthcare provider.

Goal: To promote, increase, and optimize the appropriate utilization of high quality prostate cancer screening and follow-up services.

Objectives: Promote informed decision-making about prostate cancer screening among Vermont men age 50 and over.