CANCER IN TENNESSEE

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CANCER IN TENNESSEE2011-2015March 2019Division of Population Health AssessmentTennessee Cancer RegistryThis document presents cancer incidence and mortality information for the entire state of Tennessee focusing on the five-year periodbetween 2011 and 2015, with comparisons to national rates. The report is made possible through data collected by the TennesseeCancer Registry (TCR) as well as cancer registries nationwide. The TCR is dedicated to the collection and use of quality data for thepurpose of decreasing the incidence and mortality of cancer in Tennessee.

PREPARED BY Jake Richards, MBAMartin Whiteside, DC, PhD, MSPHSUGGESTED CITATIONRichards J.E., Whiteside M.A. Cancer in Tennessee. 2011-2015. Tennessee Department ofHealth: Division of Public Health Assessment โ€“ Tennessee Cancer Registry, Nashville,Tennessee. March 2019.COPYRIGHT INFORMATIONThis publication was supported by cooperative agreement grant number 5 NU58DP006307 fromthe Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibilityof the authors and do not necessarily represent the views or opinions of the CDC. All materialsin this report are in the public domain and may be reproduced or copied without permission.Citation as to source, however, is appreciated.CONFIDENTIALITY STATEMENTAll information obtained on patients shall be considered confidential. Absolutely no personal oridentifying information, such as name or social security number, can be released to researchersunless Institutional Review Board (IRB) approval is obtained. All information shall be usedsolely for statistical, scientific and medical research purposes and shall be held strictlyconfidential.CANCER IN TENNESSEE REPORTThis report contains cancer incidence and mortality data for the entire state of Tennessee from2011 through 2015, with some comparisons to national rates. Data collected by the TennesseeCancer Registry (TCR) as well as cancer registries nationwide made the creation of this reportpossible. This report published by the TCR is meant to serve as a reference for researchers andthe general public. For additional information and publications, we encourage you to visit ourwebsite at tistics.htmlIt is important to note that cancer data in this report is dynamic and it is possible that even afterthe standard reporting delay, cases may still be reported to the TCR, which may have a minorstatistical impact on the most recent year of diagnosis.I

ACKNOWLEDGEMENTSThe Tennessee Cancer Registry (TCR) acknowledges the contributions of the followingorganizations and individuals in making the publication of this report possible: The staff of the Tennessee Cancer RegistryCancer registrars from healthcare facilities throughout the State of Tennessee whocompleted the large majority of cancer abstracts available in the TCR database The staff of the Healthcare Patient Statistics group, Division of Population HealthAssessment, Tennessee Department of Health, for providing mortality dataThese dedicated individuals labored tirelessly to ensure the quality and completeness of TDHand TCR data.PARTNERSHIPSThe staff of the TCR wishes to give special thanks to the Centers for Disease Control andPrevention for their financial and programmatic support.The TCR also seeks to thank the following members of the TDH Executive Leadership Team fortheir professional support:Lisa Piercey, MD, MBA, FAAP, CommissionerJohn J. Dreyzehner, MD, MPH, FACOEM, CommissionerDavid Reagan, MD, PhD, Chief Medical OfficerMichael Warren, MD, MPH, FAAP, Deputy Commissioner for Population HealthMorgan McDonald, MD, Assistant Commissioner, Division of Family Health and WellnessShalini Parekh, MPH, Assistant Commissioner, Division of Population Health AssessmentThe mission of the Tennessee Department of Health is to protect, promoteand improve the health and prosperity of people in Tennessee.State of TennesseeDepartment of HealthDivision of Population Health AssessmentTennessee Cancer Registry710 James Robertson ParkwayNashville, Tennessee 37243Phone: (615)741-5548 or 800-547-3558The Tennessee Cancer Registry is dedicated to the collection and use of quality datafor the purpose of decreasing the incidence and mortality of cancer in Tennessee.II

TABLE OF CONTENTSTENNESSEE CANCER REGISTRY . 1WHO WE ARE .1WHAT WE DO .1OUR PURPOSE .1WHAT IS CANCER? . 2WHAT IS CANCER INCIDENCE? .2WHAT IS CANCER MORTALITY? .2EXECUTIVE SUMMARY . 3CANCER AND CANCER RISK FACTORS . 5IMPACT OF CANCER IN THE UNITED STATES .5IMPACT OF CANCER IN TENNESSEE .6Demographics of Cancer Patients in Tennessee, 2011-2015 .7Common Cancers in Tennessee By Gender, 2011-2015 .9CANCER SCREENING AND RISK FACTOR PREVALENCE, 2014.10Cigarette Smoking Prevalence In Tennessee.12Smoking and Cancer .13CANCER SURVIVAL IN TENNESSEE .15LEADING CAUSES OF DEATH IN TENNESSEE, 2015 .18YEARS OF POTENTIAL LIFE LOST TO CANCER, TENNESSEE, 2011-2015 .20TENNESSEE IN COMPARISON TO THE UNITED STATES . 24CANCER MORTALITY HISTORICAL TREND, 1975-2015 .24CANCER INCIDENCE AND MORTALITY RANKINGS IN TENNESSEE, 2011-2015 .25CANCER INCIDENCE AND MORTALITY IN TENNESSEE, 2011-2015. 27CANCER INCIDENCE AND MORTALITY, ALL SITES COMBINED.27MOST COMMON CANCERS IN TENNESSEE, 2011-2015 . 31LUNG CANCER.31PROSTATE CANCER .36FEMALE BREAST CANCER .41COLON AND RECTUM (COLORECTAL) CANCER .46MELANOMA (SKIN) CANCER .51PANCREATIC CANCER .56CHILDHOOD CANCER .61APPENDICES. 67APPENDIX I. CANCER INCIDENCE AND MORTALITY, BY SITE, TENNESSEE, 2011-2015 .67APPENDIX II. CANCER INCIDENCE AND MORTALITY, ALL SITES COMBINED, BY GENDER, RACE AND RESIDENT REGION, TENNESSEE, 20112015 .69APPENDIX III. CANCER INCIDENCE AND MORTALITY, ALL SITES COMBINED, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .70APPENDIX IV. LUNG CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .72APPENDIX V. PROSTATE CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .74APPENDIX VI. FEMALE BREAST CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .76APPENDIX VII. COLORECTAL CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .78APPENDIX VIII. MELANOMA OF THE SKIN INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .80APPENDIX IX. PANCREATIC CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015 .82APPENDIX X. CHILDHOOD CANCER INCIDENCE AND MORTALITY, BY RESIDENT COUNTY, TENNESSEE, 2011-2015.84APPENDIX XI. CANCER INCIDENCE AND MORTALITY OF COMMON CANCERS, THREE-YEAR MOVING AVERAGE, TENNESSEE, 2011-2015 86III

APPENDIX XII. NUMBER OF DEATHS AND YEARS OF POTENTIAL LIFE LOST, BY GENDER AND RACE, TENNESSEE, 2011-2015 .87APPENDIX XIII. NUMBER OF DEATHS AND YEARS OF POTENTIAL LIFE LOST, BY CANCER SITE, TENNESSEE, 2011-2015 .87APPENDIX XIV. COUNTY MAPS OF INCIDENCE AND MORTALITY RATES OF ALL CANCER SITES COMBINED AND COMMON CANCERS .891. Tennessee Counties and Regional Groupings . 892. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, All Sites Combined, Tennessee, 20112015 903. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Lung, Tennessee, 2011-2015 . 914. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Prostate, Tennessee, 2011-2015 . 925. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Female Breast, Tennessee, 2011-2015 . 936. Age-Adjusted Cancer Incidence and Mortality Rates By Resident County, Colon and Rectum, Tennessee, 20112015 947. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Melanoma of the Skin, Tennessee, 20112015 958. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Pancreas, Tennessee, 2011-2015 . 969. Age-Adjusted Cancer Incidence and Mortality Rates by Resident County, Childhood Cancer (0-19 Years of Age),Tennessee, 2011-2015 . 97TECHNICAL NOTES . 98STATISTICAL METHODS .98SOFTWARE USED FOR CALCULATION .98EXPLANATION OF TERMS .99DATA SOURCES .103ADDITIONAL RESOURCES . 104REFERENCES. 105IV

TENNESSEE CANCER REGISTRYWHO WE AREThe Tennessee Cancer Registry (TCR) was established in 1983 by the Tennessee GeneralAssembly with the passage of Tennessee Code Annotated (T.C.A.) ยง 68-1-1001 and isresponsible for collecting information on all reportable cancer diagnoses in Tennessee, includingnon-residents diagnosed and/or treated in TN. The TCR has continuously achieved โ€œGoldCertification,โ€ the highest level of certification by the North American Association of CentralCancer Registries (NAACCR), since the 2005 diagnosis year. More information on NAACCRcertification criteria and certification levels can be found HAT WE DOIn collaboration with local health care facilities and cancer registrars, TCR staff identify newcases of cancer through routine, systematic review of medical records, hospital discharge lists,state vital records and other sources. Information regarding patient characteristics, cancerdiagnosis, and first-course treatment is ascertained primarily from specific statements in themedical record and other sources such as death certificates and physician reports.OUR PURPOSEThe purpose of the TCR is: To collect accurate information on cancer cases diagnosed and/or treated in TN annually. To increase awareness of cancer in TN. To promote and assist hospital cancer registries in each facility to accurately code cancerabstracts. To provide information to the public regarding cancer incidence and mortality in TN. To serve as a data repository for those requesting information on cancer, its effects,treatment, risk factors, and prevention. To support epidemiological research into the causes, distribution, prevention, andtreatment of cancer.1

WHAT IS CANCER?Cancer is a group of more than 100 diseases characterized by uncontrolled growth and spread ofabnormal cells. An individual can be diagnosed with cancer at any time in their life, but persons 55years of age and older are at a higher risk of developing cancer. About 40-50% of all cancer casesmight be potentially preventable with better lifestyle choices, such as increasing physical activity,incorporating better nutrition, and abstaining from tobacco products (Islami et al., 2018).WHAT IS CANCER INCIDENCE?Cancer incidence is defined as the number of new cancers diagnosed in the population at risk. Thecancer incidence rate is the number of new cases of cancer diagnosed in a specified populationduring a specified time period, usually expressed as the number of new cases per 100,000 persons atrisk. That is,๐๐ฎ๐ฆ๐›๐ž๐ซ ๐จ๐Ÿ ๐๐ž๐ฐ ๐‚๐š๐ฌ๐ž๐ฌ ๐จ๐Ÿ ๐‚๐š๐ง๐œ๐ž๐ซ๐‚๐š๐ง๐œ๐ž๐ซ ๐ˆ๐ง๐œ๐ข๐๐ž๐ง๐œ๐ž ๐‘๐š๐ญ๐ž () ๐Ÿ๐ŸŽ๐ŸŽ, ๏ฟฝ๏ฟฝ ๐š๐ญ ๐‘๐ข๐ฌ๐คThe numerator of the incidence rate is the number of newly diagnosed cancer cases and thedenominator is the size of the population at risk. The number of new cancers may include multipleprimary cancers occurring in one patient, and the primary site reported is the site of origin not themetastatic site, which is the distant site to which the cancer has spread. The incidence rate does notinclude cancer recurrences and can be computed for a given cancer primary site, group of cancers orfor all cancers combined.WHAT IS CANCER MORTALITY?Cancer mortality is defined as the number of deaths from cancer in the population at risk. Thecancer mortality rate is defined as the number of deaths with cancer as the underlying cause ofdeath in a specified at-risk population during a given time period, usually expressed as the numberof deaths due to cancer per 100,000 persons at risk. That is,๐๐ฎ๐ฆ๐›๐ž๐ซ ๐จ๐Ÿ ๐‚๐š๐ง๐œ๐ž๐ซ ๐ƒ๐ž๐š๐ญ๐ก๐ฌ๐‚๐š๐ง๐œ๐ž๐ซ ๐Œ๐จ๐ซ๐ญ๐š๐ฅ๐ข๐ญ๐ฒ ๐‘๐š๐ญ๐ž () ๐Ÿ๐ŸŽ๐ŸŽ, ๏ฟฝ๏ฟฝ ๐š๐ญ ๐‘๐ข๐ฌ๐คThe numerator of the mortality rate is the number of cancer deaths and the denominator is the sizeof the population at risk. The mortality rate can be computed for a given cancer site or for allcancers combined.2

EXECUTIVE SUMMARYThis report contains cancer incidence (i.e., newly diagnosed cancer cases) and mortality (i.e., deathsdue to cancer) data for the entire state TN from 2011 through 2015, with some comparisons tonational rates. Data collected by the TCR as well as cancer registries nationwide made the creationof this report possible. The report published by the TCR is meant to serve as a reference forresearchers and the general public. For additional information and publications from the TCR,please visit m-areas/tcr/tennessee-cancerregistry-data.html. It is important to note that cancer data in this report is dynamic and it is possiblethat even after the standard 2 year reporting delay, cases may be reported that may have a minorimpact on the most recent years of diagnosis. From 2011-2015, 175,571 Tennesseans were diagnosed with cancer and 69,358 Tennesseansdied from cancer. Cancer was the second leading cause of death and resulted in nearly 580,000 years of potentiallife lost in Tennesseans during the 5-year period covered by this report. From 2011-2015, TN experienced the 19th highest cancer incidence rate and the 7th highestcancer mortality rate in the United States (US). Much of TNโ€™s observed cancer incidence andmortality disparities relative to other states is due to a greater cancer burden among TNโ€™s malepopulation, who experience respectively the 11th and 7th highest cancer incidence and mortalityburden compared to males in all other US states, whereas TN females experience, respectively,the 29th highest cancer incidence burden and the 7th highest cancer mortality burden in the US.Lung cancer was the most common type of cancer diagnosis and the most common cause ofcancer deaths among Tennesseans, whereas nationally, breast cancer is the most common causeof cancer diagnosis and lung cancer is the most common cause of death. The fact that lungcancer is the leading type of newly diagnosed cancer in Tennesseans could be largely due to thegreater prevalence of smoking in Tennesseans compared to the national average. According tothe TN Behavioral Risk Factor Surveillance Survey, in 2015, 21.9% of TN adults 18 years ofage and older were current smokers compared to only 17.5 % nationally. Smoking is the majorcause of at least 80% of all lung cancers in the US, but is also a known cause for many othertypes of cancer including: oropharyngeal, laryngeal, colorectal, esophageal, stomach, urinarybladder, kidney, pancreatic, liver and uterine cervix cancers. Note that some cancers caused bysmoking are in the top 10 of all cancers affecting Tennesseans as newly diagnosed cases and/or3

cancer deaths. Through substantially reducing the prevalence of smoking, TN could potentiallyprevent considerable numbers of both new cancer cases and cancer deaths. The 10 most common types of cancers newly diagnosed in TN residents during the 2011-2015period in descending number order (counts in parentheses): lung (29253), female breast(24547), prostate (21329), colorectal (15133), melanoma of the skin (7476), urinary bladder(7274), kidney and renal pelvis (6690), non-Hodgkin lymphoma (NHL; 6603), leukemias(5057), and oropharyngeal cancer (4860). The 10 most common types of cancers principally leading to death in Tennesseans from 2011 to2015 in descending number order (counts in parentheses): lung (21688), colorectal (5977),female breast (4532), pancreas (4213), prostate (2826), liver and intrahepatic bile duct (2647),leukemias (2517), NHL (2260), brain and other nervous system (1731), and esophagus (1606). Cancer also demonstrates geographic disparities in TN, see Maps and Appendices. For all newcases of cancer (incidence) combined, the following are the top 5 Tennessee counties indescending order by age-adjusted rate (rate in parentheses): Hancock County (553.8), ClaiborneCounty (538.4), Benton County (533.8), Trousdale County (530.9), and Marion County (529.9).The following are the top 5 Tennessee counties in descending order for overall cancer mortalityby age-adjusted rate (rate in parentheses): Trousdale County (264.0), Cheatham County (240.4),Scott County (238.6), Claiborne County (236.6), and Hancock County (236.2). Regionally inTN, the East region displays the highest overall cancer incidence rate (477.2) of all regions inTN, whereas the Northwest region displays the highest overall cancer mortality rate (200.8).4

CANCER AND CANCER RISK FACTORSIMPACT OF CANCER IN THE UNITED STATESOn average, two out of every five individuals in the US will contract some type of invasive cancerin their lifetime (about a 38.5% lifetime risk). In the US, men have a 39.7% probability and womenhave a 37.7% probability of developing invasive cancer in their lifetime (Howlader et. al., 2017). Inthe US, one in four men (22.0%) and one out of five women (18.8%) are at risk of dying fromcancer in their lifetime. The following tables lists lifetime risks of developing and dying fromcertain cancers for males and females in the US from 2012 to 2014 in decreasing order (Tables 1Aand 1B):Table 1A: Lifetime Risk of Developing and Dying from SelectCancers, Males, U.S., 2012 - 2014Male SiteRisk of Developing%One inRisk of Dying%One inProstate14.072.639Lung and bronchus7.2146.316Colon and rectum4.7212.050Bladder (includes in situ)3.8260.9109Melanoma of the skin2.6380.4233Note. Adapted from the SEER Cancer Statistics Review โ€“ Lifetime Risk, by the National Cancer Institute, 2017.Table 1B: Lifetime Risk of Developing and Dying from SelectCancers, Females, U.S., 2012 - 2014Female SiteRisk of developing%One inRisk of dying from%One inBreast12.382.737Lung and bronchus6.0174.920Colon and rectum4.4231.855Uterine corpus2.8360.6172Non-Hodgkin lymphoma1.9530.7147Note. Adapted from the SEER Cancer Statistics Review โ€“ Lifetime Risk, by the National Cancer Institute, 2017.The direct medical cost, which is the total health care expenditure for cancer in the US in 2010, was 124.6 billion or about 80,136 per cancer diagnosis. By 2020, overall cancer costs could reach 157.8 billion (in 2010 dollars) based only on increases in population; however, if costs of cancercare also increase annually by 2%, the total cost for cancer care in 2020 could reach as high as 186.7 billion (NCI, 2013). The cancer sites with the highest costs in 2010 dollars were: breastcancer ( 16.5 billion), followed by colorectal cancer ( 14.1 billion), lung cancer ( 12.1 billion),lymphoma ( 12.1 billion), and prostate cancer ( 11.9 billion) (Mariotto, 2011).5

IMPACT OF CANCER IN TENNESSEEOn average, one out of every two individuals in TN will contract some type of invasive cancer intheir lifetime, and approximately 579,613 years of potential life were lost by TN residents due topremature cancer deaths from 2011-2015. In TN, men have a 65.6% probability of developing aninvasive cancer in their lifetime, whereas women in TN have a 54.7% probability of developing aninvasive cancer in their lifetime. In TN, one in four men (27.2%) and one in five women (18.5%)are at risk of dying from cancer in their lifetime. The following table lists lifetime risks ofdeveloping and dying from certain cancer for males in Tennessee (TN) from 2011-2015 indecreasing order (Tables 2A and 2B):Table 2A: Lifetime Risk of Developing and Dying from SelectCancers, Males, Tennessee, 2012 - 2015Male SiteRisk of Developing%One inRisk of Dying From%One inProstate15.9%62.6%38Lung and Bronchus13.0%810.3%10Colon and Rectum6.2%162.6%38Melanoma of the Skin5.6%180.7%143Bladder (includes in situ)4.9%201.0100Table 2B: Lifetime Risk of Developing and Dying from SelectCancers, Females, Tennessee, 2012 - 2015Female SiteRisk of Developing%One inRisk of DyingFrom%One inBreast17.4%62.7%37Lung and Bronchus8.5%126.0%17Colon and Rectum4.7%211.8%57Melanoma of the Skin2.8%360.7%154Uterine Corpus2.8%360.6%174EVERY DAY IN TENNESSEE 96 people are diagnosed with cancer16 people are diagnosed with lung cancer14 women are diagnosed with breast cancer12 men are diagnosed with prostate cancer8 people are diagnosed with colorectal cancer38 people die from cancer6Data Source

DEMOGRAPHICS OF CANCER PATIENTS IN TENNESSEE, 2011-2015Figure 1. Cancer Incidence, By Age at Diagnosis,Tennessee, 2011-201530% of cancers30,000Number of New Cancers25,00020,00015,00010,0005,0000 Aging is the most important risk factor for cancer overall, as well as for many individualcancer primary sites. The median age of cancer diagnosis in TN is 65 years, which means that half of all cancercases occur in Tennesseans below this age and half in Tennesseans above this age. Approximately 30% of new cancer cases are diagnosed in Tennesseans aged 60 to 69 years(Figure 1). Although the risk of most cancers increases as an individual becomes older, there are somecancer types more common in younger people, e.g. leukemia and lymphoma.7Data Source

DEMOGRAPHICS OF CANCER PATIENTS IN TENNESSEE, 2011-2015, CONTINUEDFigure 2. Cancer Incidence, By Race and Sex,Tennessee, 2011-2015Other Female0.7%Black Male6.6%White Female41.1%Black Female6.4%White Male44.5%Other Male0.7%From 2011 to 2015 (Figure 2): 150,207 white individuals and 22,772 black individuals were diagnosed with cancer in TN.White Tennesseans accounted for 86% of all new cancer diagnoses, while blacks accountedfor 13% of all new cancer diagnoses.Figure 3. Insurance Coverage Among Cancer Patients,Tennessee, 2011-2015Medicaid5%Medicare48%Military Insurance2%Private Insurance27%Insurance, NOS6% Not insured4%Insurance statusunknown8%Among those individuals with known insurance status, 88% of Tennesseans had insurancecoverage at the time of their initial cancer diagnosis. For 6% of the insured, there was noadditional information on type of insurance, hence these are labeled Insurance, NotOtherwise Specified (Insurance, NOS) (Figure 3). .Data Source8

COMMON CANCERS IN TENNESSEE BY GENDER, 2011-2015New Cancers in WomenCancer Deaths in WomenBreast24,550 (29.0%)Lung and Bronchus12,987 (15.3%)Colon and Rectum7,264 (8.6%)Corpus and Uterus4,846 (5.7%)Thyroid3,268 (3.9%)Melanoma of the Skin3,130 (3.7%)Non-Hodgkin Lymphoma2,977 (3.5%)Kidney and Renal Pelvis2,526 (3.0%)Pancreas2,263 (2.7%)Ovary2,197 (2.6%)All Sites84,672 (100%)Lung and Bronchus9,088 (28.6%)Breast4,532 (14.3%)Colon and Rectum2,816 (8.9%)Pancreas2,063 (6.5%)Ovary1,575 (5.0%)Leukemia1,046 (3.3%)Non-Hodgkin Lymphoma997 (3.1%)Corpus and Uterus881 (2.8%)Liver and Intrahepatic Bile Duct809 (2.5%)Brain and Other Nervous System763 (2.4%)All Sites31,730 (100%)New Cancers in MenCancer Deaths in MenProstate21,329 (23.5%)Lung and Bronchus16,266 (17.9%)Colon and Rectum7,869 (8.7%)Urinary Bladder5,571 (6.1%)Melanoma of the Skin4,346 (4.8%)Kidney and Renal Pelvis4,164 (4.6%)Non-Hodgkin Lymphoma3,626 (4.0%)Oral Cavity and Pharynx3,553 (3.9%)Leukemia2,948 (3.2%)Pancreas2,376 (2.6%)All Sites90,899 (100%)Lung and Bronchus12,600 (33.5%)Colon and Rectum3,161 (8.4%)Prostate2,826 (7.5%)Pancreas2,150 (5.7%)Liver and Intrahepatic Bile Duct1,838 (4.9%)Leukemia1,471 (3.9%)Esophagus1,326 (3.5%)Non-Hodgkin Lymphoma1,263 (3.4%)Urinary Bladder1,130 (3.0%)Kidney and Renal Pelvis1,048 (2.8%)All Sites37,628 (100%)9Data Source

CANCER SCREENING AND RISK FACTOR PREVALENCE, 2014Figure 4. Prevalence of Screening, Adults 18 Years of Age,Tennessee and the United States, 2014Percent (%)100%80%78.8% 78.1%68.7% 69.1%80.3% 75.2%85.5% 82.6%60%41.4% 42.8%40%20%14.1% 12.8%26th0%17th1st21st10th29thEver had aBlood Stool Test Mammogram in Pap Test in Past 3 Pap Test in Past 3 PSA test in Past 2Sigmoidoscopy or within the Past 2Past 2 Years,Years, WomenYears, Women Years, Men AgesColonoscopy,Years, Ages 50 Women Ages 50Ages 18 Ages 21-6540 Ages 50 74TennesseeUnited StatesSource: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S.Department of Health and Human Services, CDC, 2018.In 2014 (Figure 4): Nearly 70% (68.7%) of the TN population, 50 years of age and older, received asigmoidoscopy or colonoscopy, which is the 26th highest rate in the US. 14.1% of Tennesseans 50 years of age and older received a blood stool test within thepast two years, which is the 17th highest rate in the US. Nearly 80% (78.8%) of TN w

1 TENNESSEE CANCER REGISTRY WHO WE ARE The Tennessee Cancer Registry (TCR) was established in 1983 by the Tennessee General Assembly with the passage of Tennessee Code Annotated (T.C.A.) ยง 68-1-1001 and is

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