Cancer

Giving the immunotherapy Opdivo to lung cancer patients before surgery can help prevent the disease from coming back, a new study says. The FDA approved Opdivo for this use on March 4, and yesterday the data behind that decision were presented at the annual meeting of the American Association for Cancer Research and published in the New England Journal of Medicine.

Patients in the study who received three courses of Opdivo in combination with chemotherapy were 37% less likely to have progression of disease that prevented surgery, any progression of disease after surgery, or death. In patients receiving Opdivo and chemotherapy, the median time to one of these negative events was 31.6 months, compared to 20.8 months for patients treated with chemotherapy alone.

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DOVER, DEL. (Oct. 11, 2021) – According to the latest cancer data from the Division of Public Health (DPH), Delaware’s mortality rate for all cancer sites combined (all-site cancer) improved in most categories during the last decade; however, the state remains 15^th-highest in the U.S. for the timeframe of 2013-2017, which is unchanged from 2012-2016. Delaware also remains second-highest nationally for all-site cancer incidence during the same period, which may be partly due to the state’s continued increases in early detection and screening.

DPH presented its data report, Cancer Incidence and Mortality in Delaware, 2013-2017, to the Delaware Cancer Consortium (DCC) on Monday. The annual report seeks to compare Delaware’s cancer incidence and mortality trends for 2013-2017 to those of the U.S. over the same period. DPH also summarizes how Delaware and U.S. cancer rates have changed from the five-year periods of 2003-2007 to 2013-2017. This year’s report analyzes all-site cancer and eight site-specific cancer types: breast, colorectal, lung, cervical, kidney, leukemia, oral and prostate.

DPH also issued a new compendium report, Census Tract-Level Cancer Incidence in Delaware, 2013-2017, which replaces previous secondary analysis reports. This report presents modified calculations and detailed maps with all-site cancer incidence rates by census tract. 

From 2003-2007 to 2013-2017 in Delaware, all-site cancer mortality rates decreased 26% among non-Hispanic African American males and 15% among non-Hispanic Caucasian males, yet increased 18% among Hispanic males. Among Delaware females during the same period, all-site cancer mortality rates decreased 12% among non-Hispanic African Americans, 15% among non-Hispanic Caucasians, and 12% among Hispanics. DPH attributes these decreases to screening and early detection.

“After decades of dedicated early detection and screening efforts by a wide array of partners, it’s reassuring to see improvement in certain areas,” Governor John Carney said. “I commend the Delaware Cancer Consortium and the Division of Public Health for expertly coordinating our state’s cancer prevention advocacy and education. I also thank those Delawareans who get their recommended cancer screenings, and encourage everyone to do the same.”

For 2013-2017, the state’s all-site cancer mortality rate (171.0 deaths per 100,000 people) was higher than the U.S. rate (158.3 deaths per 100,000). Also, for 2013-2017:

• Delaware males (204.1 per 100,000) ranked 17^th for all-site cancer mortality (18^th in 2012-2016) and had higher rates compared to U.S. males (189.5 per 100,000). 

• Delaware females (146.3.1 per 100,000) had a higher all-site cancer mortality rate compared to U.S. females (135.7 per 100,000) and ranked 17^th for all-site cancer mortality, an improvement from 14^th in 2012-2016.   

“The data show us clearly that early screening and prevention are critical for bringing down cancer mortality rates. Unfortunately, the COVID-19 pandemic has caused many people to delay cancer screenings and other preventive chronic disease care, and economically disadvantaged communities are typically impacted the most,” said Molly Magarik, Secretary of the Delaware Department of Health and Social Services. “Free cancer screenings are available to eligible Delawareans and we know they can lead to earlier diagnosis and to saving lives.”

Regarding incidence or diagnosis of new cancer cases, in 2013-2017, there were nearly 29,000 new cancer cases diagnosed in Delaware, a slight increase from the 28,581 cases in 2012-2016 . Of those cases, 51% of those diagnosed were male, and 78% were non-Hispanic Caucasians. Delaware saw statistically higher rates (484.3 per 100,000) for all-site cancer incidence than the U.S. (435.0 per 100,000). Also, for 2013-2017:

• Delaware males (531.5 per 100,000) had a higher all-site cancer incidence rate compared to U.S. males (472.9 per 100,000), ranking fourth nationally, an improvement from third in 2012-2016.
• Delaware females (450.8 per 100,000) had a higher rate of all-site cancer incidence in 2013-2017 compared to U.S. females (410.5 per 100,000); their ranking improved to ninth from fifth in 2012-2016. 

Noticeable improvements exist among many racial and ethnic groups, likely due to Delaware’s health equity initiatives. While there was no significant statistical difference in all-site cancer incidence rates between non-Hispanic Caucasians (496.9 per 100,00) and non-Hispanic African Americans (485.5 per 100,000) in the 2013-2017 period, Hispanics (389.1 per 100,000) had a lower all-site cancer incidence rate compared to both non-Hispanic Caucasians and non-Hispanic African Americans.

In Delaware, from 2003-2007 to 2013-2017, all-site cancer incidence rates decreased 12% among non-Hispanic Caucasian males, 22% among non-Hispanic African-American males, and12% in Hispanic males. For females during the same 10-year period, the all-site cancer incidence rate decreased 9% among Hispanic females, but increased 3% among non-Hispanic Caucasians and less than 1% among non-Hispanic African Americans. 

“In order to address the disparities that persist in cancer incidence and mortality, we must address the circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness,” said DPH Director Dr. Karyl Rattay. “These social determinants of health include housing and neighborhood conditions, educational and economic factors, transportation systems, social connections, and other social factors. We must look at the racial disparities across the cancer continuum from prevention to end-of-life care that result from differences in the social determinants of health as no longer endurable.”

BREAST CANCER

Breast cancer is the most common type of cancer among women in Delaware. In 2013-2017:

• From 2003-2007 to 2013-2017, female breast cancer mortality in Delaware decreased 2%, compared to the U.S. decline of 15%.

• Female breast cancer incidence rate for Delaware (135.4 per 100,000) was higher than the U.S. female rate (126.8 per 100,000). 
• Delaware’s percent of female breast cancer cases diagnosed at the local stage increased from 42% in 1980-1984 to 68% in 2013-2017. 
• Delaware females 40 years of age and older who reported having a mammogram within the previous two years ranked third-highest nationally (79%) in the 2018 Behavioral Risk Factor Survey.

COLORECTAL CANCER

Colorectal cancer is the fourth most diagnosed cancer in the U.S. and Delaware. Delaware ranked 11^th-highest in prevalence in the U.S. for meeting the U.S. Preventive Services Task Force colorectal screening recommendations. In addition:

• Between 2003-2007 and 2013-2017, incidence rates for colorectal cancer decreased by 26% in Delaware and 21% in the U.S.
• During the same 10-year time period, mortality rates for colorectal cancer decreased by 21% both in Delaware and in the U.S.
• Nearly 73% of Delawareans age 50-74 years reported meeting the recommendations, more than the national median of 70%. 

• For 2013-2017 in Delaware, non-Hispanic African Americans (44.6 per 100,000) had a statistically higher colorectal cancer incidence rate compared to non-Hispanic Caucasians (37.6 per 100,000).
• Non-Hispanic Caucasians accounted for 78% of colorectal cancer deaths in Delaware in 2013-2017.

LUNG CANCER

Lung cancer remains the most frequently diagnosed cancer and the most common cause of cancer deaths in the U.S. and Delaware. In addition:

• Delaware males (75.7 per 100,000) had a higher lung cancer incidence rate compared to Delaware females (61.3 per 100,000). 
• Delaware’s 2013-2017 lung cancer incidence rate improved to 17^th, compared to 10^th in 2012-2016. 
• Delaware’s 2013-2017 lung cancer mortality rank improved to 16^th from 14^th in 2012-2016.
• Non-Hispanic Caucasians accounted for 82% of lung cancer cases in 2013-2017. 
• Hispanics (29.1 per 100,000) had a lower lung cancer incidence rate compared to both non-Hispanic Caucasians (70.7 per 100,000) and non-Hispanic African Americans (65.5 per 100,000). 
• Over the past decade, cancer incidence rates decreased among all sex, race, and ethnic groups. From 2003-2007 to 2013-2017 in Delaware, lung cancer incidence rates decreased:

• 21% in non-Hispanic Caucasian males

• 11% in non-Hispanic Caucasian females

• 31% in non-Hispanic African-American males

• 13% in non-Hispanic African-American females

• 45% in Hispanic males

• 55% in Hispanic females

PROSTATE CANCER

Prostate cancer is the most diagnosed cancer among males in the U.S. and Delaware. According to the 2020 Behavioral Risk Factor Survey (BRFS), 33% of Delaware males 40 and older reported having a Prostate Specific Antigen (PSA) test in the past two years, compared to the national median prevalence of 32%. In addition:

• Between 2003-2007 and 2013-2017, prostate cancer incidence rates decreased by 30% in Delaware and 33% in the U.S.
• Between 2003-2007 and 2013-2017, mortality rates for prostate cancer decreased by 31% in Delaware and 24% in the U.S.
• In 2013-2017, Delaware’s non-Hispanic African Americans (205.8 per 100,000) had a much higher prostate cancer incidence rate compared to non-Hispanic Caucasians (110.3 per 100,000) and Hispanics (114.3 per 100,000). 
• Non-Hispanic African Americans (34.1 per 100,000) in Delaware had a higher prostate cancer mortality rate in 2013-2017 compared to Delaware’s non-Hispanic Caucasians (14.2 per 100,000). 

CERVICAL CANCER

Cervical cancer accounted for 1% of all female cancer cases in Delaware in 2013-2017. According to the BRFS, 83% of Delaware women 21-65 years of age reported that they had had a Pap test within the previous three years, compared to the national median of 80% among U.S. women of the same ages. In addition:

• Delaware ranked 20^th in the U.S. for cervical cancer incidence, a six-place improvement from 14^th in 2012-2016.
• Non-Hispanic Caucasians accounted for 70% of Delaware’s cervical cancer cases in 2013-2017.
• Non-Hispanic Caucasian females (48%) had a higher proportion of cervical cancer diagnosed at the local stage compared to non-Hispanic African American females (35%).
• In 2013-2017, Delaware’s cervical cancer mortality rate (2.6 per 100,000) was not statistically significantly different from the U.S. cervical cancer mortality rate (2.3 per 100,000).

 RESOURCES

• In addition to cancer data, the Cancer Incidence and Mortality in Delaware, 2013-2017 report alsoincludes information about risk factors, screening, state of diagnosis, data trends, and cancer survivorship. The Census Tract-Level Cancer Incidence in Delaware, 2013-2017 compendium report presentsanalyses of all-site cancer incidence rates by census tract.

• For more information about DPH’s cancer prevention and treatment work, visit https://www.dhss.delaware.gov/dhss/dph/dpc/cancer.html or call the Delaware Comprehensive Cancer Control Program at 302-744-1020. For more information about the DCC, visit https://www.healthydelaware.org/Consortium. To learn how to prevent, detect, and treat chronic diseases and obtain assistance with a cancer screening, visit the Healthy Delaware website at HealthyDelaware.org.

• The Screening for Life (SFL) program provides payment for cancer screening tests to qualified Delaware adults. Eligible individuals can receive office visits, mammograms and clinical breast exams, Pap tests and screening tests for prostate, colorectal, and lung cancer when recommended by a doctor. SFL also provides lung cancer screenings for eligible men and women. Contact SFL at https://www.dhss.delaware.gov/dph/dpc/sfl.html or call 302-401-4212 to speak with a screening nurse navigator.

• Delaware residents 18 and older who want help quitting smoking should contact the Delaware Quitline at 1-866-409-1858 or QuitSupport.com. 

• For population health, environmental and social determinant of health data at the smallest geographical area available, visit the My Healthy Community data portal at de.gov/healthycommunity.