Rare cancer incidence trends in North Carolina

Statistical Brief No. 44 July 2016 1908 Mail Service Center ♦ Raleigh, NC 27699-1900 919.733.4728 ♦ www.schs.state.nc.us Rare Cancer Incidence Trends in North Carolina Gary Y. Leung, Ph.D. Introduction The purpose of this report is to examine the most recent incidence trends of rare cancers in North Carolina. Rare cancers, as defined by World Trade Center Health Program, include: adrenal/endocrine glands, anus/anal canal, bone/articular cartilage, breast among men, gallbladder/biliary tract, brain/other parts of central nervous system, pancreas, penis/testis, placenta, small intestine, thymus, female genital system, etc.1 These cancers were listed as rare because the age-adjusted incidence rates were lower than 1 5 cases per 100,000 per year.2 Even though they are called rare cancers, they collectively accounted for 25 percent of all tumors among adults aged 20 and older.2 However, rare cancers in this report only include the following sites: pancreas, male breast, adrenal/other endocrine glands, and malignant neuroendocrine neoplasms. These sites were selected due to increasing incident cases during the last 10 years. Data and Definitions The most current incidence data from the North Carolina Central Cancer Registry was used. Except for yearly incidence trend (data from diagnosis years 2004 to 2013), data from the latest five years of diagnosis, between 2009 and 2013, were employed in the analysis. Pancreatic cancer was defined by 1CD-0 site codes C250-C259. Male breast cancer was defined by ICD-0 site codes C500-C509. Adrenal/other endocrine cancers were defined by ICD-0 site codes C739, C740-C749 or C750-C759. Malignant neuroendocrine neoplasms were defined by histology codes 8246,8013,8247,8041 or 8574. Age groups were based on age at diagnosis and divided into three groups: 1) 0-49, 2) 50-64 and 3) 65 and older. Type of insurance coverage was categorized into four groups based on the variable, primary payer at diagnosis: 1 ) private insurance, 2) government (Medicare, Medicaid, and Military), 3) uninsured and 4) unknown. Public Health HEALTH AND HUMAN SERVICES Results Overall Trend Figure 1 shows the the age-adjusted rates for rare cancers between 2004 and 2013. Only adrenal/other endocrine cancers have been steadily increasing, from 8.4 per 100,000 in 2004 to 13.3 per 100,000 in 2013 while the rates for other rare cancers remained stable during the period. Table 1 shows that the incidence rates were highest among those over 65 years old between 2009 and 2013 (see Table 1). Figure 1. 2004-2013 Rare Cancer Incidence Trends in North Carolina Year of Diagnosis Pancreas Male Breast Adrenal/ Malignant Neuroendocrine Other Endocrine Glands Neoplasms Incidence Trend by Site Pancreas: Table 2 shows that the age-adjusted rates for non- Hispanic African Americans were higher (14.8 per 100,000) than both non-Hispanic whites (10.9 per 100,000) and Hispanics (8.9 per 100,000). Within each race/ethnicity, the incidence was higher among white males ( 12.9 per 100,000) than white females (9.3 per 100,000). Similar trend was observed among non-Hispanic African Americans (males: 16.3 per 100,000; females: 13.5 per 100,000). Higher proportions of African Americans were diagnosed with pancreatic cancer at distant stage (48.4%) than whites (46.6%) between 2009 and 2013 (see Figure 2).