BETHESDA, MdThe National Cancer Institute has compressed 45
years of cancer mortality data into a single atlas. The new
publication contains 254 color-coded maps showing variations in
cancer deaths over two time periods, across various sections of the
nation, and between men and women and blacks and whites.
The 367-page Atlas of Cancer Mortality in the United States,
1950-94 is a follow up to an earlier atlas published in 1975 that
examined cancer mortality from 1950 to 1969. It compares data from
that period with cancer deaths from 1970 to 1994, and, in the latter
time frame, it includes separate data on variations in cancer deaths
among black Americans.
The atlas presents mortality data for each of the 3,053 counties in
the contiguous United States during both time periods. In the
1979-1994 time period, data are presented for the nations 506
contiguous state economic areas (SEAs). These are areas that are
relatively homogeneous in demographic, economic, and cultural factors.
The SEAs are useful in highlighting regional variations,
compared to more localized variations, lead author Susan S.
Devesa, PhD, told the National Cancer Advisory Board (NCAB). The new
atlas was released during the most recent NCAB meeting.
The national mortality rate for all cancers from 1970 to 1994 was 54%
higher among white males than white females and 84% higher among
black males than black females. Not surprisingly, the greatest change
in mortality occurred among white men with lung cancer, rising from
an annual rate of 39 per 100,000 in the 1950-1969 period to 69 per
100,000 during 1970-1994.
The atlas was written by Dr. Devesa, Dan J. Grauman, MA, Robert N.
Hoover, MD, and Joseph F. Fraumeni, Jr., MD, of NCIs Division
of Cancer Epidemiology and Genetics; William J. Blot, PhD, of the
International Epidemiology Institute, Rockville, Md; and Gene A.
Pennello, PhD, of the FDA.
The findings do not explain why cancer deaths, overall or for
specific sites, are higher in one area than others. However, the data
can indicate areas for investigation and may provide clues to explain
an increased death rate for a specific cancer.
The first atlas, for example, spotlighted a previously unrecognized
high death rate from mouth and throat cancers among women living in
the rural Southeast. Follow-up research attributed this finding to
the use of smokeless tobacco.
Follow-up studies based on findings from the current atlas will
include an investigation of the high rates of bladder cancer in
northern New England, to determine the role of environmental
pollutants, dietary factors, or other exposures, and a study to
address the increased incidence and mortality rates over several
years for non-Hodgkins lymphoma.
The greatest changes in geographic patterns in the current atlas are
seen with lung cancer, with recent elevated mortality rates among
white men across the South, among white women in the far West, and
among blacks in southern urban areas.
Among whites, patterns changed substantially over time. Among white
men in the 1950s and 1960s, high rates were seen in urban areas of
the Northeast and North Central states and along the Southeast and
Gulf coasts. By the 1980s to the mid-1990s, clustering of elevated
rates was seen across the Southeast and South Central areas, with
relatively low rates throughout much of the Northeast.
For white women, little geographic variation was evident in the
1950s, but by the 1980s and 1990s, high rates began to appear in
clusters along the Atlantic and Pacific coasts. For both sexes,
consistently low rates were seen in the mountain and plains states.
Among blacks, rates were consistently low across the South. The
changing patterns for lung cancer generally follow the regional and
time trends in cigarette smoking.
Accessing the Atlas
Single copies of the print version of the atlas can be ordered free
of charge by calling NCIs Cancer Information Service at 1-800-422-6237
or on-line at http://publications.nci.nih.gov.
Internet access to the atlas is available at http://www.nci.nih.gov/atlas.
A static website contains the atlas entire text
and maps for both time periods, as well as the tabulated data used to
generate the atlas maps. An interactive website enables
users to create customized maps to compare rates in different time
periods and to zoom and pan different areas of the country. The sample
map below, created on the interactive site, shows breast cancer
mortality among white females from 1970 to 1994 by state. ONI