Late-Stage Cancer Diagnoses Are Common, Says CDC Report

Nick Mulcahy

November 29, 2010

November 29, 2010 — Approximately half of colon/rectum and cervix cancers and one third of breast cancers are diagnosed at a late stage of disease, according to a new report from the Centers for Disease Control and Prevention (CDC).

The report appears in the November 26 issue of Morbidity and Mortality Weekly Report Surveillance Summaries, and uses data from 2004 to 2006 to examine the incidence of late-stage diagnoses of 3 cancers.

Incidence rates of late-stage colorectal cancer were highest in black men and women. Incidence rates of late-stage breast cancer were highest in women 60 to 79 years of age and in black women. Incidence rates of late-stage cervical cancer were highest in women 50 to 79 years of age and in Hispanic women.

The report was limited to these 3 cancers, which are all the target of population-based screening programs, as recommended by the US Preventive Services Task Force.

"This report causes concern because so many preventable cancers are not being diagnosed when treatment is most effective," said report coauthor Marcus Plescia, MD, MPH, director, Division of Cancer Prevention and Control, CDC, in a press statement. "More work is needed to widely implement evidence-based cancer screening tests, which may lead to early detection and, ultimately, an increase in the number of lives saved."

The consequences of a late-stage diagnosis are considerable.

In the introduction to the report, the authors enumerate these consequences, citing previously published Surveillance, Epidemiology, and End Results (SEER) data from 1975 to 2006.

The 5-year survival rate for people who received a diagnosis of localized colorectal cancer was 91%, compared with 70% for regional-stage disease and 11% for distant-stage disease.

The 5-year survival rate for women who received a diagnosis of localized breast cancer was 98%, compared with 84% for regional-stage disease and 23% for distant-stage disease.

The 5-year survival rate for women who received a diagnosis of localized cervical cancer was 92%, compared with 58% for regional-stage disease and 17% for distant-stage disease.

The authors believe that increased screening rates could reduce the incidence of late-stage diagnoses. They also suggest that the new Patient Protection and Affordable Care Act in the United States could lead to increased screening.

Incidence of Late-Stage Cancers

Data were obtained from population-based cancer registries affiliated with CDC's National Program of Cancer Registries and the National Cancer Institute's SEER program.

"Combined, these programs cover all of the US population and provide the best source of information on population-based cancer incidence for the nation," say the authors.

During the 2004 to 2006 study period, 97,588 late-stage colon and rectum cancer cases were diagnosed in women 50 years and older in the United States (rate, 70.4 per 100,000 women). Incidence rates increased with increasing age, from 30.4 in women 50 to 59 years of age to 150.6 in women 80 years and older. Incidence rates were highest in black women (85.6), followed by white (68.6), Hispanic (60.2), Asian (57.2), and Native American (48.9) women.

During the same period, 99,205 late-stage colon and rectum cancer cases were diagnosed in men 50 years and older (rate, 94.2 per 100,000 men). Incidence rates increased with increasing age, from 40.9 in men 50 to 59 years of age to 182.9 in men 80 years and older. Incidence rates were highest in black men (114.0), followed by white (92.6) and Hispanic (85.1) men. Native American men had the lowest rate (59.9).

In both men and women, approximately half of all colon and rectum cancers were late-stage disease.

From 2004 to 2006, 147,430 late-stage breast cancer cases were diagnosed in women 50 years and older (rate, 108.5 cases per 100,000 women). Incidence rates were lowest in women 50 to 59 years (93.0), highest in women 60 to 69 years (119.2) and 70 to 79 years (123.9), and intermediate in women 80 years and older (109.7). Incidence rates were highest in black women (124.3), followed by white (107.6), Hispanic (87.8), Asian (67.1), and Native American (61.4) women.

Among all women, approximately one third of breast cancers were late-stage disease.

During the study period, 16,947 cases of late-stage cervical cancer were diagnosed in women 20 years and older (5.2 per 100,000 women). Incidence rates were lowest in women 20 to 29 years (0.8), highest in women 50 to 79 years (range, 7.2 to 7.9), and intermediate in women 30 to 49 years and 80 years and older (range, 4.1 to 6.3). Incidence rates were highest in Hispanic women (8.4), followed by black (7.8), Asian (5.2), white (4.9), and Native American (4.4) women.

State Incidence Rates

Geography plays a role in late-stage cancer diagnoses in the United States, according to the authors.

Late-stage colon and rectum cancer incidence rates by state ranged from 51.0 to 86.5, and were highest in Connecticut, Delaware, Illinois, Iowa, Kentucky, Louisiana, Maine, Nebraska, New Jersey, and Pennsylvania.

Late-stage breast cancer incidence rates by state ranged from 92.2 to 132.1, and were highest in Alabama, the District of Columbia, Kansas, Louisiana, Mississippi, New Jersey, Oklahoma, Pennsylvania, Tennessee, and Washington.

Late-stage cervical cancer incidence rates ranged from 3.0 to 8.3, and were highest in Arkansas, the District of Columbia, Illinois, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, and Oklahoma.

Screening Prevalence

The authors also examined cancer screening prevalence using state survey data. Overall, 61.9% of men 50 to 75 years of age reported undergoing recommended colorectal cancer screening in 2008.

Breast cancer screening prevalence was much higher; 81.2% of women 50 to 74 years of age reported undergoing recommended screening in 2008.

Cervical cancer screening was highest; 87.6% of women 21 to 64 years of age were screened in 2008.

The researchers have disclosed no relevant financial relationships.

MMWR Surveill Summ. 2010;59:1-26. Abstract

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