Cancer in Texas

2020

AcknowledgmentsThe Texas Cancer Registry thanks all cancer reporters for their dedication, hard work, and collaboration. Their efforts help us meet national high quality and timeliness standards. They play a significant role in contributing towards TCR’s mission and the fight against cancer.

About the Texas Cancer RegistryTCR is a statewide, population-based registry. It is the primary source for cancer data in Texas.

TCR serves as the foundation for measuring the cancer burden in Texas; comprehensive cancer control efforts; health disparities; and the progress in cancer prevention, diagnosis, treatment, and survivorship. It also supports a wide variety of cancer-related research. Public health, academic institutions, and the private sector cannot address these priorities without timely, complete, and accurate cancer data.

TCR is one of the largest cancer registries in the United States. The Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries recognizes it as a “Registry of Distinction”. It is also Gold Certified by the North American Association of Central Cancer Registries.

TCR’s goal is to collect, maintain, and disseminate the highest quality cancer data that will contribute towards improving diagnoses, treatments, survival, and quality of life for all cancer patients.

TCR FundingTCR is funded by the Cancer Prevention and Research Institute of Texas and the Texas Department of State Health Services.

TCR acknowledges the CDC for its financial support under Cooperative Agreement #1NU58DP006308. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or US Department of Health and Human Services.

Suggested CitationTexas Cancer Registry, Cancer Epidemiology and Surveillance Branch. Cancer in Texas 2020. Austin, TX. Texas Department of State Health Services, 2020.

Cancer in Texas 2020 | 3

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Estimates for New Cancers

In 2020, an estimated 127,131 new cancer cases are expected to be diagnosed in Texas (61,821 in females, and 65,310 in males).

The most common cancers are breast, lung & bronchus, prostate, and colon & rectum, which make up about 47 percent of all cancer diagnoses.

An estimated 1,324 new cancer cases will be diagnosed in children (ages 0 to 14 years). An additional 556 new cases are expected in adolescents (ages 15 to 19 years).

New Cancer Cases by Sex for Leading Sites, Texas, 2020

Female

Cancer Site Expected New Cases

% of Total

Breast 18,277 29.6

Lung & Bronchus 7,006 11.3

Colon & Rectum 5,170 8.4

Uterus Corpus 3,838 6.2

Thyroid 2,725 4.4

Non-Hodgkin Lymphoma 2,365 3.8

Kidney & Renal Pelvis 2,269 3.7

Pancreas 1,836 3.0

Ovary 1,761 2.8

Leukemia 1,757 2.8

Male

Cancer Site Expected New Cases

% of Total

Prostate 14,468 22.2

Lung & Bronchus 8,527 13.1

Colon & Rectum 6,461 9.9

Kidney & Renal Pelvis 3,679 5.6

Urinary Bladder 3,528 5.4

Non-Hodgkin Lymphoma 2,947 4.5

Liver & Intrahepatic Bile Duct 2,827 4.3

Melanoma of the Skin 2,549 3.9

Oral Cavity & Pharynx 2,527 3.9

Leukemia 2,483 3.8

New Cancer Cases by Public Health Region, 2020

PHR 1 4,071

PHR 2 3,104

PHR 3 35,415

PHR 4 6,962

PHR 5 4,324

PHR 6 29,664

PHR 7 15,413

PHR 8 13,467

PHR 9 2,785

PHR 10 3,679

PHR 11 8,389

For more information, visit dshs.texas.gov/tcr/data/estimates.aspx.

4 | Cancer in Texas 2020

Trends in New Cancer Cases and Cancer Incidence Rates

The age-adjusted cancer incidence rate in Texas has declined in recent years, but the number of new cancer cases continues to increase. The age-adjusted incidence rate is the number of new cancer cases out of 100,000 people. This rise in new cancer cases is mostly because of an aging and growing Texas population.

In 1995, 74,466 Texans were diagnosed with cancer, and the age-adjusted cancer incidence rate was 474.8 per 100,000. In 2017, 114,402 Texans had a cancer diagnosis, an increase of 53.6 percent. Yet, the age-adjusted cancer incidence rate had fallen to 400.1 per 100,000.

Some cancers associated with excess body weight and infections are expected to increase.1 Overweight and obesity raise risk for colon &

rectum, esophagus, uterus, pancreas, kidney, and female breast cancers. Except for breast and colon & rectum cancers, the number of overweight and obesity-related cancers is expected to increase 30–40 percent by 2020.1 The CDC estimates that 35 percent of Texas adults are obese. Another 35 percent are overweight.2

Cancers associated with infections, including hepatitis and human papillomavirus (HPV), are also expected to increase. New liver cancer cases are expected to increase more than 50 percent in the US. This is likely due to the increase in hepatitis infection, especially among those born between 1945 and 1965. Oral cancers in white men are expected to increase by about 30 percent, likely the result of more HPV infections.1

Age

-Adj

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nce

Rate

per

100

,000

Num

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of N

ew C

ance

r Cas

es

350

400

450

500

550

600

650Incidence Rate

20152010200520001995

0

22,000

44,000

66,000

88,000

110,000

132,000New Cancer Cases

74,466

114,402

474.8

400.1

Trends in Total Number of Cancer Cases and Incidence Rates, Texas, 1995–2017

For more information, visit dshs.texas.gov/tcr/data/rates.aspx.

Cancer in Texas 2020 | 5

Living with Cancer

The number of Texas cancer survivors is increasing for many reasons. More people are being diagnosed with cancer, treatment is improving, and cancers are being caught earlier. Also, the number of people living with cancer increases as the population grows.

An estimated 824,631 Texans are cancer survivors (431,157 females and 393,474 males). These are Texans diagnosed with cancer between 1995–2016 who were alive as of January 1, 2017. Some of these people were cancer free, while others were receiving treatment.

Prostate and female breast cancer survivors make up about 42 percent of survivors.

Cancer Survivors by Sex for Select Sites, Texas

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FemaleCancer Site Number

Breast 187,166

Colon & Rectum 37,664

Thyroid 32,686

Uterus Corpus 32,658

Non-Hodgkin Lymphoma 19,048

Lung & Bronchus 17,926

Melanoma of the Skin 17,346

Kidney & Renal Pelvis 16,497

Cervix 15,088

Leukemia 11,644

Ovary 11,244

MaleCancer Site Number

Prostate 162,527

Colon & Rectum 41,880

Urinary Bladder 24,364

Kidney & Renal Pelvis 24,196

Melanoma of the Skin 21,479

Non-Hodgkin Lymphoma 20,854

Lung & Bronchus 16,388

Oral Cavity & Pharynx 15,437

Leukemia 15,114

Testis 11,419

Thyroid 9,468

Cancer Survivors by Public Health Region

PHR 1 28,413

PHR 2 19,885

PHR 3 223,839

PHR 4 43,840

PHR 5 29,801

PHR 6 194,632

PHR 7 96,977

PHR 8 87,862

PHR 9 18,857

PHR 10 25,160

PHR 11 55,303

For more information, visit dshs.texas.gov/tcr/data/prevalence.aspx.

6 | Cancer in Texas 2020

Estimates for Cancer Deaths

In 2020, an estimated 45,858 Texans are expected to die of cancer (21,041 females and 24,818 males). Some of these people were diagnosed with cancer in previous years.

Lung & bronchus cancer is the most common cause of cancer death in Texas, followed by colon & rectum, breast, and pancreas cancers. These four cancers account for about 47 percent of all cancer deaths.

An estimated 161 Texas children will die of cancer in 2020. An additional 72 adolescents are expected to die of the disease. Cancer remains the leading cause of death from disease for children and adolescents in both Texas and the US.

Cancer Deaths by Sex for Leading Sites, Texas, 2020

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Female

Cancer Site Expected Deaths

% of Total

Lung & Bronchus 4,653 22.1

Breast 3,254 15.5

Colon & Rectum 1,854 8.8

Pancreas 1,508 7.2

Ovary 1,018 4.8

Liver & Intrahepatic Bile Duct 844 4.0

Leukemia 739 3.5

Uterus Corpus 735 3.5

Non-Hodgkin Lymphoma 674 3.2

Brain & Other Nervous System 577 2.7

Male

Cancer Site Expected Deaths

% of Total

Lung & Bronchus 6,139 24.7

Colon & Rectum 2,424 9.8

Prostate 2,165 8.7

Liver & Intrahepatic Bile Duct 1,834 7.4

Pancreas 1,611 6.5

Leukemia 1,098 4.4

Non-Hodgkin Lymphoma 896 3.6

Kidney & Renal Pelvis 854 3.4

Esophagus 795 3.2

Urinary Bladder 791 3.2

Cancer Deaths by Public Health Region, 2020

PHR 1 1,626

PHR 2 1,354

PHR 3 11,950

PHR 4 2,595

PHR 5 1,796

PHR 6 10,714

PHR 7 5,176

PHR 8 5,052

PHR 9 1,113

PHR 10 1,265

PHR 11 3,074

For more information, visit dshs.texas.gov/tcr/data/estimates.aspx.

Cancer in Texas 2020 | 7

Trends in Cancer Deaths and Cancer Mortality Rates

The age-adjusted mortality rate in Texas has declined in recent years, but the number of cancer deaths is increasing each year. The age-adjusted mortality rate is the number of deaths attributed to cancer each year out of 100,000 people. This increase is mostly because of an aging and growing Texas population.

In 1995, 31,573 Texans died of cancer, and the age-adjusted cancer mortality rate was 207.5 per 100,000. In 2017, 40,461 Texans died of cancer, an increase of 28.2 percent. Yet, the age-adjusted cancer incidence rate declined to 146.6 per 100,000.

The decline in mortality rates is attributed to the decrease in smoking and advances in cancer screening and treatment. According to the CDC, cancer mortality rates will continue to decline most for the following cancers: prostate, colon & rectum, lung, female breast, oral cavity & pharynx, cervical and melanoma of the skin.1

Age

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s

100

140

180

220

260

300Mortality Rate

20152010200520001995

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9,000

18,000

27,000

36,000

45,000Cancer Deaths

31,573

40,461

207.5

146.6

Trends in Total Number of Cancer Deaths and Mortality Rates, Texas, 1995-2017

For more information, visit dshs.texas.gov/tcr/data/rates.aspx.

8 | Cancer in Texas 2020

Cancer Mortality Rate Trends for Leading Sites

Changes in mortality rates over time are described using the annual average percent change. A negative AAPC shows a decline in rates, while a positive AAPC reveals an increase in rates. In these graphs and charts, the AAPC for mortality rates are presented by sex for leading causes of cancer death in Texas compared to the nation as a whole between 2013 and 2017.

In Texas, the rate for most leading causes of cancer death decreased. The largest decrease was for lung & bronchus cancer, with a greater decline in males than females. Similar decreases for this cancer were seen

nationally. Colon & rectum, ovary, and female breast cancers showed larger decreases nationally compared to Texas. Prostate cancer tended to show a larger decrease in Texas than nationally, although declines were not statistically significant.

The mortality rate for some leading causes of cancer death increased. Uterus cancer rates increased in both Texas and the US. In both sexes, pancreas and liver & intrahepatic bile duct cancers increased in Texas and the US, although these trends were not statistically significant for Texas.

Mortality Rate AAPC for Leading Cancer Sites in Texas, 2013-2017

Cancer Site, Female Texas US

Non-Hodgkin Lymphoma -3.6 -2.6Lung & Bronchus -3.5 -3.7Leukemia -3.0 -2.1Colon & Rectum -1.2 -1.6Breast -0.6 -1.1Brain & Other Nervous System -0.2 0.1Ovary -0.1 -2.1Pancreas 0.4 0.5Liver & Intrahepatic Bile Duct 2.2 1.4Corpus Uterus 2.3 2.1

Cancer Site, Male Texas US

Lung & Bronchus -5.1 -4.8Non-Hodgkin Lymphoma -3.4 -1.6Leukemia -2.2 -2.6Kidney & Renal Pelvis -1.9 -2.3Esophagus -1.7 -1.3Colon & Rectum -1.4 -2.0Prostate -1.2 -0.3Urinary Bladder -0.5 -1.1Pancreas 0.2 0.8Liver & Intrahepatic Bile Duct 0.3 0.5

Female Male

-6 -5 -4 -3 -2 -1 0 1 2 3

USTXNon-Hodgkin Lymphoma

Lung & Bronchus

Leukemia

Colon & Rectum

Breast

Brain & Other Nervous System

Ovary

Pancreas

Liver & Intrahepatic Bile Duct

Corpus Uterus

Average Annual Percent Change-6 -5 -4 -3 -2 -1 0 1 2 3

US

TXLung & Bronchus

Non-Hodgkin Lymphoma

Leukemia

Kidney & Renal Pelvis

Esophagus

Colon & Rectum

Prostate

Urinary Bladder

Pancreas

Liver & Intrahepatic Bile Duct

Average Annual Percent Change

Cancer in Texas 2020 | 9

Leading Causes of Death

For more than a century, heart disease has been the leading cause of death in the US. Cancer has consistently been the second leading cause since 1938. The age-adjusted mortality rate for cancer has been decreasing in Texas since 1993, but the rate for heart disease has been decreasing more steeply. This means the gap between the mortality rates of heart disease and cancer has decreased.

Cancer is expected to surpass heart disease as the leading cause of death in the US by 2020.3 In 2017, cancer was the leading cause of death in 26 Texas counties.

Cancer

Heart Disease

Data are suppressed for counties that had less than 21 deaths reported from cancer or heart disease.

Leading Cause of Death by County, 2017

Age-Adjusted Mortality Rates for Cancer and Heart Disease, Texas, 1990–2017

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Source: Texas Department of State Health Services, Center for Health Statistics; 1990–2017; Texas Mortality Data.

10 | Cancer in Texas 2020

Potential Years of Life Lost

Potential years of life lost estimates the number of years a person could have lived had they not died prematurely of cancer. It helps measure the cancer burden in a population. It also gives more weight to cancers that occur in young people.

Some cancer sites have a large overall number of years of life lost due to the relatively large number of people who die from that cancer.

For example, lung cancer led to a total of 686,235 years of life lost, averaging 15.2 years of life lost for each case.

Cancers with a relatively high average number of potential years of life lost per cancer death are likely those that are diagnosed at younger ages. For example, cervical cancer led to an average of 29.7 years of life lost for each case, with a total of 57,786.4 years of life lost.

Potential Years of Life Lost Due to Cancer, Texas, 2013–2017

Cancer Site DeathsTotal Person-Years of Life

Lost

Average years of life lost per cancer death

All Sites 190,242 3,207,668.5 16.9

Brain & Other Nervous System 5,479 127,649.2 23.3

Female Breast 13,729 279,061.4 20.3

Cervix 1,944 57,786.4 29.7

Colon & Rectum 17,857 310,181.9 17.4

Corpus Uterus 3,003 57,597.4 19.2

Esophagus 4,162 69,051.2 16.6

Hodgkin Lymphoma 434 9,242.1 21.3

Kidney and Renal Pelvis 5,442 92,175.5 16.9

Leukemia 7,610 134,477.3 17.7

Liver & Intrahepatic Bile Duct 10,727 197,981.7 18.5

Lung & Bronchus 45,017 686,235.4 15.2

Melanoma of the Skin 2,521 44,378.7 17.6

Myeloma 3,931 55,676.6 14.2

Non-Hodgkin Lymphoma 6,418 96,586.1 15.0

Oral Cavity & Pharynx 3,303 59,411.5 18.0

Ovary 4,270 80,479.3 18.8

Pancreas 12,823 204,669.0 16.0

Prostate 8,805 94,362.8 10.7

Stomach 4,306 79,182.9 18.4

Urinary Bladder 4,470 52,819.9 11.8

For more information, visit dshs.texas.gov/tcr/data/years-life-lost.aspx.

Cancer in Texas 2020 | 11

Cancer in the Oldest Old2020 Special Section

“Oldest old” is a term used to describe people ages 85 years and older. In 2018, an estimated 400,643 Texans were at least 85 years old. These adults account for 1.4 percent of the Texas population, and about two-thirds of the oldest old are female.4

The total population of Texas is growing. It’s expected to increase by 88 percent from 2010 to 2050. During this time, the population of the oldest old in Texas is expected to increase by 390 percent. Consistent with population growth in the US, this makes it the fastest growing age group in Texas. By 2050 there will be an estimated 1,495,289 Texans ages 85 years and older.4

Cancer can present unique challenges to the oldest old. First, most cancer screening recommendations do not include routine screenings for all persons ages 85 years and older.5 This means cancers might be found at a later stage. Also, this population is more likely to have other health conditions that can lead to more complicated treatment and case management.5

Understanding the cancer burden on the oldest old is crucial for determining health care requirements as the population of older adults grows in Texas over the next thirty years.

Leading Cancer SitesThe most commonly diagnosed cancers in the oldest old men in Texas are prostate, lung & bronchus, and urinary bladder. For the oldest old female Texans, the most common cancers are breast, lung & bronchus, and colon & rectum. The 10 most common cancers in the oldest old men and women (Figure 1) are similar to those in the Texas population as a whole. However, there are two differences. Pancreas cancer is a leading cancer site for the oldest old men but not males of all ages, replacing oral cavity & pharynx cancer. Urinary bladder is a leading site for the oldest old women but not females of all ages, replacing thyroid cancer.

Also, the top 10 cancer sites in ages 85 and older in the US are similar to Texas. However, stomach cancer is a top 10 site in US males, while liver & intrahepatic bile duct cancer is

MaleFemale

Figure 1: Leading Cancer Sites for Ages 85 Years and Older by Sex, Texas, 2013–2017

418.9

411.8

281.6

266.2

136.8

136.3

132.6

105.4

99.7

65.5

Kidney & Renal Pelvis Ovary

Corpus Uterus

Urinary BladderLeukemia

Non-Hodgkin LymphomaPancreas

Colon & RectumLung & Bronchus

Breast 304.8 Prostate Lung & Bronchus

Urinary BladderColon & Rectum

Non-Hodgkin Lymphoma MelanomaLeukemiaPancreas

Kidney & Renal PelvisLiver & Intrahepatic Bile Duct

226.4

206.8

92.6

83.0

72.1

57.8

50.3

40.9

38.4

Age-adjusted incidence rate per 100,000

12 | Cancer in Texas 2020

a leading site in Texas men. Melanoma is a top site for US females, and kidney & renal pelvis is a leading site for Texas women.6

Cancer Incidence RatesThe overall cancer incidence rate increases with age. In females, the rate peaks in ages 80–84 years. In males, it peaks in ages 85 years and older. Similar to the overall US population, the incidence rate for ages 85 years and older in Texas was higher in men (2681.7 per 100,000 males during 2013–2017) than women (1642.8 per 100,000 females). Even though men had a higher incidence rate, more new cancer cases were diagnosed in the oldest old women each year because more women are alive in this age group due to a slightly longer life expectancy. From 2013 to 2018 in Texas, an average of 3,940 cancers were diagnosed in women ages 85 years and older annually, and 3,480 cases per year were diagnosed in the oldest old men.

In addition to differences by sex, incidence rates also vary by race/ethnicity (Figure 2). In the oldest old women, rates were highest

in non-Hispanic whites and NH blacks, whose rates were similar. For Texas women ages 65–84 years, rates were also highest for NH whites and NH blacks. In the overall US population, rates are highest in NH American Indian/Alaska Natives, closely followed by NH whites.6

In the oldest old men, the overall cancer incidence rate was highest in NH whites in both Texas and the US. In comparison, for male Texans ages 65–84 years, the rate was highest in NH blacks.

Age

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HispanicNHAI/AN

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NHBlack

NHWhite

2857.32518.0

1847.31601.0

2243.9

HispanicNHAI/AN

NHA/PI

NHBlack

NHWhite

1708.3 1713.5

1095.8 1067.91443.7

Figure 2: Age-Adjusted Cancer Incidence Rates for Ages 85 Years and Older by Sex and Race/Ethnicity, Texas, 2013–2017

Female Male

Cancer in Texas 2020 | 13

Incidence Rate TrendsBetween 2008 and 2017, the overall cancer incidence rate decreased by 2.4 percent each year for Texans ages 85 and older. The decrease was similar in both women and men. Rates declined significantly in four race/ethnicity groups: NH whites decreased by 1.7 percent each year, NH blacks by 3.7 percent, NH Asian/Pacific Islanders by 4.1 percent, and Hispanics by 3.4 percent.

In women, rates significantly declined in six of the leading cancer sites: urinary bladder (2.1 percent each year), lung & brochures (2.1 percent), breast (2.2 percent), non-Hodgkin lymphoma (2.3 percent), colon & rectum (3.5 percent), and ovary (4.2 percent). In men, there were significant declines in the incidence rate of three cancers: lung & bronchus (3.1 percent each year), colon & rectum (4.1 percent), and prostate (6.1 percent). The incidence rates of leading cancer sites in the oldest old in the US population have also generally declined, although melanoma incidence rates have increased.6

Stage at diagnosisIn Texas, cancers in the oldest old are less often diagnosed at local and regional stages, and more often at a distant stage, when compared to adults ages 65–84 years (Figure 3). Also, a larger proportion of cases are reported with an unknown stage for the oldest old. This might be because some patients are unable or unwilling to undergo additional diagnostic tests due to other health conditions.5 Also some cases are diagnosed only by death certificate or during autopsy.5

Similarly, a smaller proportion of cases in the oldest old are diagnosed at the local and regional stages in the US, with a higher proportion unstaged.6

Figure 3: Proportion of Cancer Cases by Age at Diagnosis and Stage, Texas, 2013–2017

65-8

4 Ye

ars

UnknownDistantRegionalLocalized

85 Y

ears

and

Old

er

41% 18% 26% 14%

28% 14% 28% 30%

Percentages may not total to 100% due to rounding.

Five-Year Relative SurvivalFive-year relative survival represents the percentage of cancer patients who have survived for five years after diagnosis compared to people without cancer. Cancer survival varies considerably with the cancer site and stage at diagnosis (Figure 4). Additionally, when compared to ages 65–84 years, the average five-year relative survival rates for all stages are lower for ages 85 years and older. However, for certain tumors diagnosed at the localized stage, including

Figure 4: Five-Year Relative Survival for Ages 85 Years and Older, All Cancer Sites, Texas, 2013–2017

DistantRegionalLocalized

75.7%

43.4%

21.3%

14 | Cancer in Texas 2020

prostate and female breast cancer, survival rates for ages 85 years and older are similar to that for ages 65–84 years. Similar survival patterns are seen in the overall US population.6

Leading Causes of Cancer DeathThe most common causes of cancer death in the oldest old men in Texas are lung & bronchus, prostate, and colon & rectum. For the oldest old female Texans, the most common causes of cancer death are lung & bronchus, breast, and colon & rectum.

The 10 most common causes of cancer death in the oldest old men and women (Figure 5) are similar to those in the Texas population as a whole. There are a few differences. Urinary bladder is a leading cause of cancer death for the oldest old men but not males of all ages, replacing esophagus cancer. Myeloma and urinary bladder cancer are leading causes for the oldest old women but not females of all ages, replacing uterus corpus and brain and other nervous system.

The top 10 leading causes of cancer death

in the oldest old in the US overall is similar. However, myeloma is a leading cause in Texas males and females ages 85 and older, while in the US esophagus cancer is a leading cause in for the oldest old men and corpus uterus for the oldest old females.

Cancer Mortality RatesFor Texans ages 85 years and older, the overall cancer mortality rate was 1,517 per 100,000 in 2013–2017. An average of 5,605 cancer deaths occurred each year. The mortality rate was higher in men (2070.7 per 100,000) than women (1217.1 per 100,000). Even though men have a higher mortality rate, more oldest old women die of cancer each year because females have a slightly longer life expectancy. During this period, approximately 2,920 women and 2,690 males ages 85 years and older died of cancer each year in Texas. In the overall US population, males ages 85 years and older also have a higher mortality rates than females of the same age.

Similar to incidence rates, mortality rates vary by race/ethnicity (Figure 6). In the oldest old women in Texas, the rate is similar in NH

MaleFemale

Figure 5: Leading Causes of Cancer Death for Ages 85 Years and Older by Sex, Texas, 2013–2017

MyelomaKidney & Renal Pelvis

Liver & Intrahepatic Bile DuctNon-Hodgkin Lymphoma

PancreasLeukemia

Urinary BladderColon & Rectum

ProstateLung & Bronchus 396.5

396.2

189.5

141.4

120.8

101.1

89.5

68.9

59.0

47.4MyelomaUrinary Bladder

Liver & Intrahepatic Bile DuctOvary

Non-Hodgkin LymphomaLeukemiaPancreas

Colon & RectumBreast

Lung & Bronchus 217.1

169.8

140.6

95.6

61.3

58.8

47.0

42.9

36.0

31.6

Age-adjusted mortality rate per 100,000

Cancer in Texas 2020 | 15

whites and NH blacks, the two groups with the highest rates. In the oldest old men, the overall cancer mortality rate was highest in NH blacks despite incidence rates being highest for NH whites.

In the US overall, the cancer mortality rate is highest for NH whites in the oldest old women and NH blacks in the oldest old men.6

Mortality trendsBetween 2008 and 2017 in Texas, cancer mortality rates in ages 85 years and older decreased by 1.2 percent per year. Similarly, mortality rates for ages 85 and older have decreased in the US population.6 In Texas, rates declined significantly for three race/ethnicity groups: NH whites decreased by 0.6 percent each year, NH blacks by 3.0 percent, and Hispanics by 1.8 percent. Rates were stable in NH Asian/Pacific Islanders.

Also, mortality rates for several leading causes of cancer deaths significantly declined in Texas. In women, mortality rates significantly declined in four cancers: non-

Hodgkin lymphoma (1.7 percent each year), lung & bronchus (2.0 percent), ovarian (3.3 percent), and colon & rectum (3.4 percent). In men, rates significantly declined for three cancers: colon & rectum (2.7 percent), prostate (3.5 percent), and lung & bronchus (3.5 percent).

Figure 6: Age-Adjusted Cancer Mortality Rates for Ages 85 Years and Older by Sex and Race/Ethnicity, Texas, 2013–2017

Female Male

Age

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0,00

0

HispanicNHA/PI

NHBlack

NHWhite

2194.52360.5

1273.6

1637.0

HispanicNHA/PI

NHBlack

NHWhite

1267.6 1282.6

833.61036.9

Rates for non-Hispanic American Indian/Alaska Native are suppressed because less than 16 cases were reported by sex.

16 | Cancer in Texas 2020

Online Statistics and Data Visualization Tools

TCR strives to make data available and accessible to anyone with an interest in Texas cancer data. The following online resources use TCR data to provide information on cancer in Texas and the US.

TCR Websitedshs.texas.gov/tcr/

The TCR website offers a wide variety of statistical products, including data tables, topical reports, and fact sheets. It also includes information for researchers interested in obtaining limited-use and confidential data sets.

TCR Web Query Toolcancer-rates.info/tx

The TCR web query tool allows users to customize cancer incidence and mortality rate tables and maps by cancer site, sex, time frame and race/ethnicity.

CDC/NCI State Cancer Profilesstatecancerprofiles.cancer.gov

State Cancer Profiles characterizes the cancer burden in a standardized manner to motivate action, integrate surveillance into cancer control planning, characterize areas and demographic groups, and expose health disparities.

Cancer Control P.L.A.N.E.T.cancercontrolplanet.cancer.gov/planet/

Cancer Control P.L.A.N.E.T. portal provides access to data and resources that can help planners, program staff, and researchers design, implement and evaluate evidence-based cancer control programs.

US Cancer Statistics: Data Visualizationsgis.cdc.gov/Cancer/USCS/DataViz.html

The Data Visualizations tool provides information on the numbers and rates of new cancer cases and deaths at the national, state, and county levels. You can see the numbers by sex, age, race and ethnicity, trends over time, survival, and prevalence.

Cancer Statistics Websitecancerstatisticscenter.cancer.org

The Cancer Statistics Center website is primarily based on the data and analysis provided in the American Cancer Society’s annual Cancer Statistics paper, published in CA: A Cancer Journal for Clinicians, and its consumer-friendly companion report, Cancer Facts & Figures.

NAACCR Fast Statsfaststats.naaccr.org

NAACCR Fast Stats is an interactive tool for quick access to key NAACCR and US cancer statistics for major cancer sites by age, sex, race/ethnicity, registry, stage, and population standard. Statistics are presented as graphs and tables.

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Research Using TCR Data

The Texas Cancer Registry provides data to support research on the impact of cancer in Texas and across the nation. The TCR Epidemiology Group averages over 370 requests for cancer data from researchers, medical professionals, students, and the public each year. In 2019, the group received 442 requests.

In the past five years, 388 published research journal articles used TCR data.

Approximately 70 current studies use TCR data. These studies are approved by the Texas Department of State Health Services Institutional Review Board and Research Executive Steering Committee. TCR data support $117 million in grant funding.

Here are brief descriptions of select studies.

TCR-Medicarehealthcaredelivery.cancer.gov/seermedicare/

TCR cancer incidence data are linked to Medicare claims data every 2 years. It uses the same methodology as the linkage between the Surveillance, Epidemiology, and End Results Program and Medicare data. This

linkage is a collaborative effort between the National Cancer Institute, cancer registries, and the Centers for Medicare and Medicaid Services. The TCR-Medicare linked data provide detailed information about Medicare beneficiaries with cancer in Texas.

Approximately 95% of Texans ages 65 and older in TCR are matched with Medicare files. The TCR data provide information on participant demographics, cancer incidence, stage of disease, first course of therapy, and survival, while the Medicare claims data include information on hospital stays, physician services, and hospital outpatient visits. These data are used for epidemiologic and health services research related to the diagnosis and treatment procedures, costs, and survival of cancer patients.

TCR has provided data for this linkage since 2009.

Virtual Pooled Registry – Cancer Linkage Systemnaaccr.org/about-vpr-cls/

The North American Association of Central Cancer Registries Virtual Pooled Registry

Cancer Linkage System is a national system designed to facilitate data linkages between existing study cohorts and central cancer registries such as TCR. This is a secure, web-based system designed for minimal risk linkages, with the goal of providing timely access to cancer outcome data and a secure and standardized linkage process. TCR has participated in pilot work with the VPR-CLS and has supported several IRB-approved studies that are using this system.

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Transplant Cancer Match Studytransplantmatch.cancer.gov

Solid organ transplantation is a life-saving procedure for individuals with end-stage organ disease, but the need for long-term immunosuppressive medications following the procedure substantially increases cancer risk. Investigators at the NCI and the Health Resources and Services Administration are examining cancer risk, treatment, and outcomes among transplant recipients. For this study, US transplant registry data are linked with data from multiple US cancer registries, including TCR, to determine which individuals in the US transplant registry develop cancer.

TCR has participated in data linkages for this study since 2008.

World Trade Center Health Registrywww1.nyc.gov/site/911health/index.page

The World Trade Center Health Registry was established to evaluate long-term health consequences, including cancer, of the 9/11 disaster among rescue and recovery workers and those who lived, worked or went to school in the World Trade Center area. The WTCHR registrants are linked with multiple US

cancer registries, including TCR, to verify any self-reported cancer and identify unreported incident cancer.

TCR has conducted data linkages for this study since 2008.

NIH-AARP Diet and Health Studydietandhealth.cancer.gov

The NCI developed the NIH-AARP Diet and Health Study to examine the relationship between diet, lifestyle, and cancer among adults who were AARP members when the study began in 1995–1996. Questionnaires that asked information about diet, lifestyle, and other health-related behaviors were returned by over 500,000 people, making this one of the largest, long-term studies of

diet and health ever conducted. NIH-AARP cohort data are linked to multiple US cancer registries, including TCR, to provide the NCI researchers with information on cancer outcomes for participants in their cohort.

TCR has conducted data linkages for this study since 2006.

Black Women’s Health Studybu.edu/bwhs/

The Black Women’s Health Study is the largest long-term study of African-American women to date. This NCI-funded study aims to identify risk factors of cancer and other disease in African-

American women. To achieve these aims, the BWHS cohort data are linked to multiple US cancer registries, including TCR, to provide important cancer diagnostic, prognostic, and treatment information. About every two years, the study’s cohort data are linked to TCR.

TCR has conducted data linkages for this study since 2008.

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American Cancer Society’s Cancer Prevention Study-3 cancer.org/research/we-conduct-cancer-research/behavioral-and-epidemiology-research-group/cancer-prevention-study-3.html

The American Cancer Society’s Cancer Prevention Study-3 is a long-term study of more than 300,000 participants. The study aims to examine the relationship between lifestyle, nutritional, medical, environmental, genetic and other factors that may cause or prevent cancer. Since 2013, TCR links the CPS-3 cohort data every 3 years to identify new cancer cases and obtain important information about the cancer.

HIV/AIDS Cancer Registry Match Studyhivmatch.cancer.gov

People who are living with the human immunodeficiency virus (HIV) or who have acquired immunodeficiency syndrome (AIDS) are at increased risk for certain cancers. The HIV/AIDS Cancer Match Study, led by the NCI, aims to better understand the patterns of cancer risk among people living with HIV in the US. The study involves data linkages between multiple US state HIV and cancer registries, including those in Texas.

TCR has participated in data linkages for this study since 2011.

Mexican American (Mano a Mano) Cohort Studymdanderson.org/research/departments-labs-institutes/departments-divisions/epidemiology/research/mano-a-mano.html

The Mexican American (Mano a Mano) Cohort Study led by investigators at the MD Anderson Cancer Center is investigating behavioral and genetic risk factors for cancer among people of Mexican descent.

TCR has conducted a data linkage each year for the researchers since 2011.

Parkland-UT Southwestern PROSPR Center: Colon Cancer Screening in a Safety Nethealthcaredelivery.cancer.gov/prospr/

Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) is a NCI-funded network of centers conducting research to improve cancer screening. At the Parkland-UT Southwestern PROSPR Center, investigators focus on improving screening on people in Dallas County who lack insurance or are underinsured. Initially focused on colorectal cancer, the PROSPR Center expanded its mission to include cervical cancer screening. Since 2013, TCR links with the Parkland-UT PROSPR’s data to help investigators determine whether cancer patients receive recommended tests and treatment.

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Data Sources and References

Data SourcesAll data are from TCR unless otherwise noted.

Incidence Data: Texas Cancer Registry SEER*Stat Database, 1995–2017 Incidence, Texas statewide, created December 2019, based on NPCR-CSS Submission, cut-off 11/07/2019.

Mortality Data: Texas Cancer Registry SEER*Stat Database, 1990–2017 Mortality, Texas statewide, created December 2019.

References1. Centers for Disease Control and Prevention. Expected New Cancer

Cases and Deaths in 2020. Accessed Aug 11, 2020. cdc.gov/cancer/dcpc/research/articles/cancer_2020.htm.

2. Centers for Disease Control and Prevention. Nutrition, Physical Activity,and Obesity: Data, Trend and Maps. Accessed Aug 11, 2020. cdc.gov/nccdphp/dnpao/data-trends-maps/index.html.

3. Weir HK, Anderson RN, Coleman King SM, et al. Heart Diseaseand Cancer Deaths — Trends and Projections in the United States,1969–2020. Prev Chronic Dis. 2016; 13:160211.

4. Texas Demographic Center. Texas Population Projections 2010 to2050. Accessed Aug 24, 2020. demographics.texas.gov/Resources/publications/2019/20190925_PopProjectionsBrief.pdf.

5. American Cancer Society. 2019 Special Section: Cancer in the OldestOld. Accessed Aug 24, 2020. cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html.

6. DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, et al. (2019)Cancer Statistics for adults aged 85 years and older, 2019. CA: ACancer Journal for Clinicians 69(6): 454-467. doi.org/10.3322/caac.21577

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Additional Resources for Cancer Information

The following organizations provide additional information on cancer that might be helpful to the general public, patients, caregivers, and survivors. The TCR’s referral to these organizations is informational and does not imply endorsement by TCR or the Texas Department of State Health Services.

American Cancer Society800-227-2345, cancer.orgThe American Cancer Society can answer questions to empower you with accurate, up-to-date information to help you make educated health decisions.

CancerCare800-813-4673, cancercare.orgCancerCare provides professional support services and information to help people manage the emotional, practical, and financial challenges of cancer.

HealthCare.gov800-318-2596, healthcare.govHealthCare.gov provides information on health insurance options, including insurance exchanges, Medicaid and Medicare.

LIVESTRONG855-220-7777, livestrong.org

LIVESTRONG provides direct services to anyone affected by cancer and connects people and communities with the services they need.

National Cancer Institute800-422-6237, cancer.govThe National Cancer Institute leads, conducts, and supports cancer research to advance scientific knowledge and help all people live longer, healthier lives.

Texas County Indigent Health Care Programs800-222-3986, Ext 6467The County Indigent Health Care Program helps low-income Texans who don’t qualify for other state or federal health care programs have access to health care services.

2-1-1 Texas211 or 877-541-7905, 211texas.org2-1-1 Texas provides accurate, well-organizedand easy-to-find information from state andlocal health and human services programs,including Medicaid, Children’s Health InsuranceProgram (CHIP), Breast and Cervical CancerServices, and Temporary Assistance for NeedyFamilies (TANF).

CanCer in Texas 2020

Texas Cancer Registry, Cancer Epidemiology and Surveillance BranchTexas Department of State Health ServicesWebsite: dshs.texas.gov/tcrEmail: CancerData@dshs.texas.govPhone: 800-252-8059

Publication #10-12820October 2020