Cancer Incidence and Mortality in Delaware

November 2006

DELAWARE HEALTH AND SOCIAL SERVICES
DIVISION OF PUBLIC HEALTH
HEALTH PROMOTION AND DISEASE PREVENTION SECTION

This report is made possible with funding from the Delaware Health Fund, with 
strategic leadership and guidance provided by the Delaware Cancer Consortium.


CONTENTS
1.	INTRODUCTION	1
1.1.	Delaware Cancer Registry	1
1.1.1.	Reporting Facilities	1
1.1.2.	Data Confidentiality	1
1.1.3.	Data Quality	1
1.1.4.	NAACCR Certification	2
1.1.5.	Data Uses	2
1.2.	Organization of This Report	2
2.	GUIDELINES FOR THE INTERPRETATION OF INCIDENCE AND MORTALITY RATES	3
2.1.	Incidence and Mortality Rates	3
3.  ALL CANCER SITES	5
Data Highlights	5
All Cancer Incidence	7
All Cancer Mortality 	11
4.  FEMALE BREAST CANCER	15
Risk Factors and Early Detection	15
Data Highlights	16
Female Breast Cancer Incidence	18
Female Breast Cancer by Stage at Diagnosis	21
Female Breast Cancer Mortality	22
5.  CERVICAL CANCER	27
Risk Factors and Early Detection	27
Data Highlights	28
Cervical Cancer Incidence	30
Cervical Cancer by Stage at Diagnosis	33
Cervical Cancer Mortality	34
6.  COLORECTAL CANCER	39
Risk Factors and Early Detection	39
Data Highlights	40
Colorectal Cancer Incidence	42
Colorectal Cancer by Stage at Diagnosis	45
Colorectal Cancer Mortality	47
7. ESOPHAGUS CANCER	51
Risk Factors and Early Detection	51
Chronic Alcohol Use	51
Data Highlights	52
Esophagus Cancer Incidence	54
Esophagus Cancer by Stage at Diagnosis	57
Esophagus Cancer Mortality	59
8.LEUKEMIA	63
Risk Factors and Early Detection	63
Data Highlights	63
Leukemia Incidence	65
Leukemia Mortality	68
9. LUNG AND BRONCHUS CANCER	71
Risk Factors	71
Data Highlights	72
Lung Cancer Incidence	74
Lung Cancer by Stage at Diagnosis	77
Lung Cancer Mortality	79
10. MALIGNANT MELANOMA	83
Risk Factors and Early Detection	83
Data Highlights	83
Malignant Melanoma Incidence	85
Malignant Melanoma by Stage at Diagnosis	89
Malignant Melanoma Mortality	91
11. OVARIAN CANCER	95
Risk Factors	95
Data Highlights	95
Ovarian Cancer Incidence	97
Ovarian Cancer by Stage at Diagnosis	100
Ovarian Cancer Mortality	102
12.PANCREATIC CANCER	105
Risk Factors	105
Data Highlights	105
Pancreatic Cancer Incidence	107
Pancreatic Cancer by Stage at Diagnosis	110
Pancreatic Cancer Mortality	112
13. PROSTATE CANCER	115
Risk Factors and Early Detection	115
Data Highlights	116
Prostate Cancer Incidence	118
Prostate Cancer by Stage at Diagnosis	121
Prostate Cancer Mortality	123
14. URINARY BLADDER CANCER	127
Risk Factors and Early Detection	127
Data Highlights	127
Urinary Bladder Cancer Incidence	129
Urinary Bladder Cancer by Stage at Diagnosis	132
Urinary Bladder Cancer Mortality	134

APPENDICES

A:	Hispanic Cancer Rates
B:	Methodology
C:	Five-Year Average Age-Adjusted Incidence and Mortality Rates for All Cancers, Excluding 
Specific Sites: 1999–2003
D:	Primary Site Definitions for Cancer Incidence and Mortality
E:	Delaware Population Estimates (Five-Year Totals), by Sex, Race, Years, and Age Group: 
1980–2003
F:	Behavioral Risk Factors


LIST OF TABLES
3. ALL CANCER SITES
Table 3.1.	Number of All Cancer Cases in Delaware and Counties, by Race and Sex:  
1999–2003	7
Table 3.2.	Five-Year Average Age-Adjusted All Cancer Incidence Rates in the United  
States (Estimates), Delaware and Counties, by Race and Sex: 1999–2003	7
Table 3.3.	Age-Specific All Cancer Incidence Rates in Delaware, by Race and Sex:  
1999–2003	10
Table 3.4.	Number of All Cancer Deaths in Delaware and Counties, by Race and Sex: 
1999–2003	11
Table 3.5.	Five-Year Average Age-Adjusted All Cancer Mortality Rates in the United  
States, Delaware and Counties, by Race and Sex: 1999–2003	11
Table 3.6.	Age-Specific All Cancer Mortality Rates in Delaware, by Race and Sex:  
1999–2003	14
4. FEMALE BREAST CANCER
Table 4.1.	Number of Female Breast Cancer Cases in Delaware and Counties,  
by Race: 1999–2003	18
Table 4.2.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates  
in the United States (Estimates), Delaware and Counties, by Race:  
1999–2003	18
Table 4.3.	Age-Specific Female Breast Cancer Incidence Rates in Delaware,  
by Race: 1999–2003	20
Table 4.4.	Number of Female Breast Cancer Cases in Delaware, by Stage at  
Diagnosis and Race: 1999–2003	21
Table 4.5.	Percentage of Female Breast Cancer Cases in Delaware, by Stage at  
Diagnosis and Race: 1999–2003	21
Table 4.6.	Number of Female Breast Cancer Deaths in Delaware and Counties, 
by Race: 1999–2003	22
Table 4.7.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates  
in the United States, Delaware and Counties, by Race: 1999–2003	23
Table 4.8.	Age-Specific Female Breast Cancer Mortality Rates in Delaware,  
by Race: 1999–2003	25
5. CERVICAL CANCER
Table 5.1.	Number of Cervical Cancer Cases in Delaware and Counties, by Race:  
1999–2003	30
Table 5.2.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates in the  
United States (Estimates), Delaware and Counties, by Race: 1999–2003	30
Table 5.3.	Age-Specific Cervical Cancer Incidence Rates in Delaware, by Race: 
1999–2003	32
Table 5.4.	Number of Cervical Cancer Cases in Delaware, by Stage at Diagnosis  
and Race: 1999–2003	33
Table 5.5.	Percentage of Cervical Cancer Cases in Delaware, by Stage at Diagnosis 
and Race: 1999–2003	33
Table 5.6.	Number of Cervical Cancer Deaths in Delaware and Counties, by Race:  
1999–2003	34
Table 5.7.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race: 1999–2003	35
Table 5.8.	Age-Specific Cervical Cancer Mortality Rates in Delaware, by Race: 
1999–2003	37
6. COLORECTAL CANCER
Table 6.1.	Number of Colorectal Cancer Cases in Delaware and Counties, by Race  
and Sex: 1999–2003	42
Table 6.2.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates in the 
United States (Estimates), Delaware and Counties, by Race and Sex: 
1999–2003	42
Table 6.3.	Age-Specific Colorectal Cancer Incidence Rates in Delaware, by Race  
and Sex: 1999–2003	44
Table 6.4.	Number of Colorectal Cancer Cases in Delaware, by Stage at Diagnosis,  
Race, and Sex: 1999–2003	45
Table 6.5.	Percentage of Colorectal Cancer Cases in Delaware, by Stage at Diagnosis, 
Race, and Sex: 1999–2003	45
Table 6.6.	Number of Colorectal Cancer Deaths in Delaware and Counties, by Race  
and Sex: 1999–2003	47
Table 6.7.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race and Sex: 1999–2003	47
Table 6.8.	Age-Specific Colorectal Cancer Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	50
7. ESOPHAGUS CANCER
Table 7.1.	Number of Esophagus Cancer Cases in Delaware and Counties, by Race 
and Sex: 1999–2003	54
Table 7.2.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates in  
the United States (Estimates), Delaware and Counties, by Race and Sex:  
1999–2003	54
Table 7.3.	Age-Specific Esophagus Cancer Incidence Rates in Delaware, by Race  
and Sex: 1999–2003	56
Table 7.4.	Number of Esophagus Cancer Cases in Delaware, by Stage at Diagnosis,  
Race, and Sex: 1999–2003	57
Table 7.5.	Percentage of Esophagus Cancer Cases in Delaware, by Stage at  
Diagnosis, Race, and Sex: 1999–2003	57
Table 7.6.	Number of Esophagus Cancer Deaths in Delaware and Counties, by Race  
and Sex: 1999–2003	59
Table 7.7.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates in the 
United States, Delaware and Counties, by Race and Sex: 1999–2003	59
Table 7.8.	Age-Specific Esophagus Cancer Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	61
8. LEUKEMIA
Table 8.1.	Number of Leukemia Cases in Delaware and Counties, by Race and Sex:  
1999–2003	65
Table 8.2.	Five-Year Average Age-Adjusted Leukemia Incidence Rates in the United 
States (Estimates), Delaware and Counties, by Race and Sex: 1999–2003	65
Table 8.3.	Age-Specific Leukemia Incidence Rates in Delaware, by Race and Sex:  
1999–2003	67
Table 8.4.	Number of Leukemia Deaths in Delaware and Counties, by Race and Sex:  
1999–2003	68
Table 8.5.	Five-Year Average Age-Adjusted Leukemia Mortality Rates in the United  
States, Delaware and Counties, by Race and Sex: 1999–2003	68
Table 8.6.	Age-Specific Leukemia Mortality Rates in Delaware, by Race and Sex:  
1999–2003	70
9. LUNG AND BRONCHUS CANCER
Table 9.1.	Number of Lung Cancer Cases in Delaware and Counties, by Race and  
Sex: 1999–2003	74
Table 9.2.	Five-Year Average Age-Adjusted Lung Cancer Incidence Rates in the  
United States (Estimates), Delaware and Counties, by Race and Sex:  
1999–2003	74
Table 9.3.	Age-Specific Lung Cancer Incidence Rates in Delaware, by Race and  
Sex: 1999–2003	76
Table 9.4.	Number of Lung Cancer Cases in Delaware, by Stage at Diagnosis, Race,  
and Sex: 1999–2003	77
Table 9.5.	Percentage of Lung Cancer Cases in Delaware, by Stage at Diagnosis,  
Race, and Sex: 1999–2003	77
Table 9.6.	Number of Lung Cancer Deaths in Delaware and Counties, by Race and  
Sex: 1999–2003	79
Table 9.7.	Five-Year Average Age-Adjusted Lung Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race and Sex: 1999–2003	79
Table 9.8.	Age-Specific Lung Cancer Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	81
10. MALIGNANT MELANOMA
Table 10.1.	Number of Malignant Melanoma Cases in Delaware and Counties, by  
Race and Sex: 1999–2003	85
Table 10.2.	Five-Year Average Age-Adjusted Malignant Melanoma Incidence Rates  
in the United States (Estimates), Delaware and Counties, by Race and  
Sex: 1999–2003	85
Table 10.3.	Age-Specific Malignant Melanoma Incidence Rates in Delaware, by Race  
and Sex: 1999–2003	88
Table 10.4.	Number of Malignant Melanoma Cases in Delaware, by Stage at  
Diagnosis, Race, and Sex: 1999–2003	89
Table 10.5.	Percentage of Malignant Melanoma Cases in Delaware, by Stage at  
Diagnosis, Race, and Sex: 1999–2003	89
Table 10.6.	Number of Malignant Melanoma Deaths in Delaware and Counties,  
by Race and Sex: 1999–2003	91
Table 10.7.	Five-Year Average Age-Adjusted Malignant Melanoma Mortality Rates in  
the United States, Delaware and Counties, by Race and Sex: 1999–2003	91
Table 10.8.	Age-Specific Malignant Melanoma Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	93
11. OVARIAN CANCER
Table 11.1.	Number of Ovarian Cancer Cases in Delaware and Counties, by Race:  
1999–2003	97
Table 11.2.	Five-Year Average Age-Adjusted Ovarian Cancer Incidence Rates in the  
United States (Estimates), Delaware and Counties, by Race: 1999–2003	97
Table 11.3.	Age-Specific Ovarian Cancer Incidence Rates in Delaware, by Race:  
1999–2003	99
Table 11.4.	Number of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis  
and Race: 1999–2003	100
Table 11.5.	Percentage of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis  
and Race: 1999–2003	100
Table 11.6.	Number of Ovarian Cancer Deaths in Delaware and Counties, by Race:  
1999–2003	102
Table 11.7.	Five-Year Average Age-Adjusted Ovarian Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race: 1999–2003	102
Table 11.8.	Age-Specific Ovarian Cancer Mortality Rates in Delaware, by Race:  
1999–2003	104
12. PANCREATIC CANCER
Table 12.1.	Number of Pancreatic Cancer Cases in Delaware and Counties, by Race  
and Sex: 1999–2003	107
Table 12.2.	Five-Year Average Age-Adjusted Pancreatic Cancer Incidence Rates in the 
United States (Estimates), Delaware and Counties, by Race and Sex:  
1999–2003	107
Table 12.3.	Age-Specific Pancreatic Cancer Incidence Rates in Delaware, by Race  
and Sex: 1999–2003	109
Table 12.4.	Number of Pancreatic Cancer Cases in Delaware, by Stage at Diagnosis,  
Race, and Sex: 1999–2003	110
Table 12.5.	Percentage of Pancreatic Cancer Cases in Delaware, by Stage at  
Diagnosis, Race, and Sex: 1999–2003	110
Table 12.6.	Number of Pancreatic Cancer Deaths in Delaware and Counties, by Race  
and Sex: 1999–2003	112
Table 12.7.	Five-Year Average Age-Adjusted Pancreatic Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race and Sex: 1999–2003	112
Table 12.8.	Age-Specific Pancreatic Cancer Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	114
13. PROSTATE CANCER
Table 13.1.	Number of Prostate Cancer Cases in Delaware and Counties, by Race:  
1999–2003	118
Table 13.2.	Five-Year Average Age-Adjusted Prostate Cancer Incidence Rates in the  
United States (Estimates), Delaware and Counties, by Race: 1999–2003	118
Table 13.3.	Age-Specific Prostate Cancer Incidence Rates in Delaware, by Race:  
1999–2003	120
Table 13.4.	Number of Prostate Cancer Cases in Delaware, by Stage at Diagnosis  
and Race: 1999–2003	121
Table 13.5.	Percentage of Prostate Cancer Cases in Delaware, by Stage at Diagnosis  
and Race: 1999–2003	121
Table 13.6.	Number of Prostate Cancer Deaths in Delaware and Counties, by Race:  
1999–2003	123
Table 13.7.	Five-Year Average Age-Adjusted Prostate Cancer Mortality Rates in the  
United States, Delaware and Counties, by Race: 1999–2003	123
Table 13.8.	Age-Specific Prostate Cancer Mortality Rates in Delaware, by Race:  
1999–2003	125
14. URINARY BLADDER CANCER
Table 14.1.	Number of Urinary Bladder Cancer Cases in Delaware and Counties,  
by Race and Sex: 1999–2003	129
Table 14.2.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Incidence Rates  
in the United States (Estimates), Delaware and Counties, by Race and  
Sex: 1999–2003	129
Table 14.3.	Age-Specific Urinary Bladder Cancer Incidence Rates in Delaware,  
by Race and Sex: 1999–2003	131
Table 14.4.	Number of Urinary Bladder Cancer Cases in Delaware, by Stage at  
Diagnosis, Race, and Sex: 1999–2003	132
Table 14.5.	Percentage of Urinary Bladder Cancer Cases in Delaware, by Stage at 
Diagnosis, Race, and Sex: 1999–2003	132
Table 14.6.	Number of Urinary Bladder Cancer Deaths in Delaware and Counties,  
by Race and Sex: 1999–2003	134
Table 14.7.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Mortality Rates in 
the United States, Delaware and Counties, by Race and Sex: 1999–2003	134
Table 14.8.	Age-Specific Urinary Bladder Cancer Mortality Rates in Delaware, by Race  
and Sex: 1999–2003	136


LIST OF FIGURES
3. ALL CANCER SITES
Figure 3.1.	Five-Year Average Age-Adjusted All Cancer Incidence Rates in the  
United States (Estimates) and Delaware, by Sex: 1980–2003	8
Figure 3.2.	Five-Year Average Age-Adjusted All Cancer Incidence Rates in Delaware,  
by Race and Sex: 1980–2003	9
Figure 3.3.	Age-Specific All Cancer Incidence Rates in Delaware, by Race: 1999–2003	10
Figure 3.4.	Five-Year Average Age-Adjusted All Cancer Mortality Rates in the  
United States and Delaware, by Sex: 1980–2003	12
Figure 3.5.	Five-Year Average Age-Adjusted All Cancer Mortality Rates in Delaware,  
by Race and Sex: 1980–2003	13
Figure 3.6.	Age-Specific All Cancer Mortality Rates in Delaware, by Race: 1999–2003	14
4. FEMALE BREAST CANCER
Figure 4.1.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates in  
the United States (Estimates) and Delaware: 1980–2003	19
Figure 4.2.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates in 
Delaware, by Race: 1980–2003	19
Figure 4.3.	Age-Specific Female Breast Cancer Incidence Rates in Delaware, by Race: 
1999–2003	20
Figure 4.4.	Percentage of Female Breast Cancer Cases in Delaware and the  
United States (Estimates), by Stage at Diagnosis: 1999–2003	21
Figure 4.4a.	Delaware: 1999–2003	21
Figure 4.4b.	U.S. Estimates: 1999–2003	21
Figure 4.5. 	Percentage of Female Breast Cancer Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	22
Figure 4.6.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates  
in the United States and Delaware: 1980–2003	23
Figure 4.7.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates  
in Delaware, by Race: 1980–2003	24
Figure 4.8.	Age-Specific Female Breast Cancer Mortality Rates in Delaware, by Race:  
1999–2003	25
5. CERVICAL CANCER
Figure 5.1.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates in the  
United States (Estimates) and Delaware: 1980–2003	31
Figure 5.2.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates in  
Delaware, by Race: 1980–2003	31
Figure 5.3.	Age-Specific Cervical Cancer Incidence Rates in Delaware, by Race: 
1999–2003	32
Figure 5.4.	Percentage of Cervical Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003	33
Figure 5.4a.	Delaware: 1999–2003	33
Figure 5.4b.	U.S. Estimates: 1999–2003	33
Figure 5.5.	Percentage of Cervical Cancer Cases in Delaware, by Stage at Diagnosis:  
1980–2003	34
Figure 5.6.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates in the  
United States and Delaware: 1980–2003	35
Figure 5.7.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates in  
Delaware, by Race: 1980–2003	36
Figure 5.8.	Age-Specific Cervical Cancer Mortality Rates in Delaware, by Race: 
1999–2003	37
6. COLORECTAL CANCER
Figure 6.1.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates in the 
United States (Estimates) and Delaware, by Sex: 1980–2003	43
Figure 6.2.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates in 
Delaware, by Race and Sex: 1980–2003	43
Figure 6.3.	Age-Specific Colorectal Cancer Incidence Rates in Delaware, by Race:  
1999–2003	44
Figure 6.4.	Percentage of Colorectal Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003	45
Figure 6.4a.	Delaware: 1999–2003	45
Figure 6.4b.	U.S. Estimates: 1999–2003	45
Figure 6.5.	Percentage of Colorectal Cancer Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	46
Figure 6.6.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates in the  
United States and Delaware, by Sex: 1980–2003	48
Figure 6.7.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates in  
Delaware, by Race and Sex: 1980–2003	49
Figure 6.8.	Age-Specific Colorectal Cancer Mortality Rates in Delaware, by Race:  
1999–2003	50
7. ESOPHAGUS CANCER
Figure 7.1.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates in  
the United States (Estimates) and Delaware, by Sex: 1980–2003	55
Figure 7.2.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates in 
Delaware, by Race and Sex: 1980–2003	55
Figure 7.3.	Age-Specific Esophagus Cancer Incidence Rates in Delaware, by Race:  
1999–2003	56
Figure 7.4.	Percentage of Esophagus Cancer Cases in Delaware and the  
United States (Estimates), by Stage at Diagnosis: 1999–2003	57
Figure 7.4a.	Delaware: 1999–2003	57
Figure 7.4b.	U.S. Estimates: 1999–2003	57
Figure 7.5.	Percentage of Esophagus Cancer Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	58
Figure 7.6.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates in  
the United States and Delaware, by Sex: 1980–2003	60
Figure 7.7.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates in 
Delaware, by Race and Sex: 1980–2003	60
Figure 7.8.	Age-Specific Esophagus Cancer Mortality Rates in Delaware, by Race:  
1999–2003	61
8. LEUKEMIA
Figure 8.1.	Five-Year Average Age-Adjusted Leukemia Incidence Rates in the  
United States (Estimates) and Delaware, by Sex: 1980–2003	66
Figure 8.2.	Five-Year Average Age-Adjusted Leukemia Incidence Rates in Delaware,  
by Race and Sex: 1980–2003	66
Figure 8.3.	Age-Specific Leukemia Incidence Rates in Delaware, by Race: 1999–2003	67
Figure 8.4.	Five-Year Average Age-Adjusted Leukemia Mortality Rates in the United  
States and Delaware, by Sex: 1980–2003	69
Figure 8.5.	Five-Year Average Age-Adjusted Leukemia Mortality Rates in Delaware, 
by Race and Sex: 1980–2003	69
Figure 8.6.	Age-Specific Leukemia Mortality Rates in Delaware, by Race: 1999–2003	70
9. LUNG AND BRONCHUS CANCER
Figure 9.1.	Five-Year Average Age-Adjusted Lung Cancer Incidence Rates in the  
United States (Estimates) and Delaware, by Sex: 1980–2003	75
Figure 9.2.	Five-Year Average Age-Adjusted Lung Cancer Incidence Rates in  
Delaware, by Race and Sex: 1980–2003	75
Figure 9.3.	Age-Specific Lung Cancer Incidence Rates in Delaware, by Race:  
1999–2003	76
Figure 9.4.	Percentage of Lung Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003	77
Figure 9.4a.	Delaware: 1999–2003	77
Figure 9.4b.	U.S. Estimates: 1999–2003	77
Figure 9.5.	Percentage of Lung Cancer Cases in Delaware, by Stage at Diagnosis:  
1980–2003	78
Figure 9.6.	Five-Year Average Age-Adjusted Lung Cancer Mortality Rates in the  
United States and Delaware, by Sex: 1980–2003	80
Figure 9.7.	Five-Year Average Age-Adjusted Lung Cancer Mortality Rates in  
Delaware, by Race and Sex: 1980–2003	80
Figure 9.8.	Age-Specific Lung Cancer Mortality Rates in Delaware, by Race:  
1999–2003	81
10. MALIGNANT MELANOMA
Figure 10.1.	Five-Year Average Age-Adjusted Malignant Melanoma Incidence Rates  
in the United States (Estimates) and Delaware, by Sex: 1980–2003	86
Figure 10.2.	Five-Year Average Age-Adjusted Malignant Melanoma Incidence Rates in 
Delaware, by Sex: 1980–2003	87
Figure 10.3.	Age-Specific Malignant Melanoma Incidence Rates in Delaware, by Race:  
1999–2003	88
Figure 10.4.	Percentage of Malignant Melanoma Cases in Delaware and the United  
States (Estimates), by Stage at Diagnosis: 1999–2003	89
Figure 10.4a.	Delaware: 1999–2003	89
Figure 10.4b.	U.S. Estimates: 1999–2003	89
Figure 10.5.	Percentage of Malignant Melanoma Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	90
Figure 10.6.	Five-Year Average Age-Adjusted Malignant Melanoma Mortality Rates in  
the United States and Delaware, by Sex: 1980–2003	92
Figure 10.7.	Five-Year Average Age-Adjusted Malignant Melanoma Mortality Rates in 
Delaware, by Sex: 1980–2003	92
Figure 10.8.	Age-Specific Malignant Melanoma Mortality Rates in Delaware, by Race:  
1999–2003	93
11. OVARIAN CANCER
Figure 11.1.	Five-Year Average Age-Adjusted Ovarian Cancer Incidence Rates in the  
United States (Estimates) and Delaware: 1980–2003	98
Figure 11.2.	Five-Year Average Age-Adjusted Ovarian Cancer Incidence Rates in  
Delaware, by Race: 1980–2003	98
Figure 11.3.	Age-Specific Ovarian Cancer Incidence Rates in Delaware, by Race:  
1999–2003	99
Figure 11.4.	Percentage of Ovarian Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003	100
Figure 11.4a.	Delaware: 1999–2003	100
Figure 11.4b.	U.S. Estimates: 1999–2003	100
Figure 11.5.	Percentage of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis:  
1980–2003	101
Figure 11.6.	Five-Year Average Age-Adjusted Ovarian Cancer Mortality Rates in the  
United States and Delaware: 1980–2003	103
Figure 11.7.	Five-Year Average Age-Adjusted Ovarian Cancer Mortality Rates in  
Delaware, by Race: 1980–2003	103
Figure 11.8.	Age-Specific Ovarian Cancer Mortality Rates in Delaware, by Race:  
1999–2003	104
12. PANCREATIC CANCER
Figure 12.1.	Five-Year Average Age-Adjusted Pancreatic Cancer Incidence Rates in  
the United States (Estimates) and Delaware, by Sex: 1980–2003	108
Figure 12.2.	Five-Year Average Age-Adjusted Pancreatic Cancer Incidence Rates in 
Delaware, by Race and Sex: 1980–2003	108
Figure 12.3.	Age-Specific Pancreatic Cancer Incidence Rates in Delaware, by Race:  
1999–2003	109
Figure 12.4.	Percentage of Pancreatic Cancer Cases in Delaware and the United  
States, by Stage at Diagnosis: 1999–2003	110
Figure 12.4a.	Delaware: 1999–2003	110
Figure 12.4b.	U.S. Estimates: 1999–2003	110
Figure 12.5.	Percentage of Pancreatic Cancer Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	111
Figure 12.6.	Five-Year Average Age-Adjusted Pancreatic Cancer Mortality Rates in  
the United States and Delaware, by Sex: 1980–2003	113
Figure 12.7.	Five-Year Average Age-Adjusted Pancreatic Cancer Mortality Rates in  
Delaware, by Race and Sex: 1980–2003	113
Figure 12.8.	Age-Specific Pancreatic Cancer Mortality Rates in Delaware, by Race:  
1999–2003	114
13. PROSTATE CANCER
Figure 13.1.	Five-Year Average Age-Adjusted Prostate Cancer Incidence Rates in the  
United States (Estimates) and Delaware: 1980–2003	119
Figure 13.2.	Five-Year Average Age-Adjusted Prostate Cancer Incidence Rates in  
Delaware, by Race: 1980–2003	119
Figure 13.3.	Age-Specific Prostate Cancer Incidence Rates in Delaware, by Race: 
1999–2003	120
Figure 13.4.	Percentage of Prostate Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003	121
Figure 13.4a.	Delaware: 1999–2003	121
Figure 13.4b.	U.S. Estimates: 1999–2003	121
Figure 13.5.	Percentage of Prostate Cancer Cases in Delaware, by Stage at  
Diagnosis: 1980–2003	122
Figure 13.6.	Five-Year Average Age-Adjusted Prostate Cancer Mortality Rates in the  
United States and Delaware: 1980–2003	124
Figure 13.7.	Five-Year Average Age-Adjusted Prostate Cancer Mortality Rates in  
Delaware, by Race: 1980–2003	124
Figure 13.8.	Age-Specific Prostate Cancer Mortality Rates in Delaware, by Race:  
1999–2003	125
14. URINARY BLADDER CANCER
Figure 14.1.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Incidence Rates  
in the United States (Estimates) and Delaware, by Sex: 1980–2003	130
Figure 14.2.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Incidence Rates  
in Delaware, by Race and Sex: 1980–2003	130
Figure 14.3.	Age-Specific Urinary Bladder Cancer Incidence Rates in Delaware,  
by Race: 1999–2003	131
Figure 14.4.	Percentage of Urinary Bladder Cancer Cases in Delaware and the  
United States (Estimates), by Stage at Diagnosis: 1999–2003	132
Figure 14.4a.	Delaware: 1999–2003	132
Figure 14.4b.	U.S. Estimates: 1999–2003	132
Figure 14.5.	Percentage of Urinary Bladder Cancer Cases in Delaware, by Stage at 
Diagnosis: 1980–2003	133
Figure 14.6.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Mortality Rates  
in the United States and Delaware, by Sex: 1980–2003	135
Figure 14.7.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Mortality Rates  
in Delaware, by Race and Sex: 1980–2003	135
Figure 14.8.	Age-Specific Urinary Bladder Cancer Mortality Rates in Delaware, by Race: 
1999–2003	136


1.	INTRODUCTION
1.1.	DELAWARE CANCER REGISTRY
The Delaware Cancer Registry (DCR) is the state’s central cancer information center. It is part 
of the Health Information and Science section in Delaware’s Division of Public Health. Delaware 
is one of 45 states supported by the National Program of Cancer Registries of the Centers for 
Disease Control and Prevention. 

The DCR was founded in 1972 and was legally established in 1980 under the Delaware Cancer 
Control Act. The registry was established to ensure accurate, timely, and routine surveillance of 
cancer and certain benign tumors. The Act stipulated that all hospitals, clinical laboratories, and 
cancer treatment centers within the state should report all new cancer cases to the DCR. In 
1996, the Cancer Control Act was amended to oblige “any physician, surgeon, dentist, 
podiatrist, or other health care practitioner who diagnoses or provides treatment” to report 
cancer cases to the DCR. Further enhancements of the Cancer Control Act took effect in 2002 
when Senate Bill 372 was passed. The new law required physicians to provide additional 
information on their cancer patients, including their place and duration of residence in Delaware, 
and occupational history. The bill also extended the reporting deadline to 180 days from initial 
diagnosis or treatment.
1.1.1.	Reporting Facilities
There are 29 facilities that submit reports to the DCR. Data were collected from eight hospitals, 
eight in-state and out-of-state diagnostic laboratories, nine state central registries and hundreds 
of physician offices. Demographic and medical information is collected on all newly diagnosed 
patients. Incidence data are reported by facilities to the DCR electronically or using the 
Delaware Cancer Registry’s reporting form. The DCR has established reciprocal agreements for 
data exchange with state central registries in Pennsylvania, Maryland, New Jersey, South 
Carolina, Washington, Florida, Texas, Alaska, and Wyoming to identify new cases of cancer in 
Delaware residents that were diagnosed or treated in other states.
1.1.2.	Data Confidentiality
The DCR maintains the confidentiality of incidence data using a combination of techniques. 
Data are submitted from reporting facilities using computerized data encryption techniques. 
Published reports or data requests are limited to the presentation of aggregated data. The 
release of data sets is only permitted after the removal of all personal identifiers. Researchers 
using data from the registry, or conducting research that involves patient contact, must comply 
with the regulations stated in the formal data use agreement or obtain clearance from 
Delaware’s Human Subjects Review Board. 
1.1.3.	Data Quality
Quality control procedures have been implemented internally at the DCR to check for 
consistency of coded demographic and medical information according to standards set by the 
North American Association of Central Cancer Registries (NAACCR). Visual reviews of coded 
data items and electronic text submissions are also checked for consistency. Record 
consolidation using a computerized matching program is conducted to identify multiple reports 
on the same individual received from facilities which are required to submit cases. An example 
of this is when a patient is diagnosed and treated in separate hospitals, and each hospital 
submits a cancer case abstract to the DCR. Plans are being implemented to conduct routine 
offsite audits at reporting facilities in Delaware. Criteria are being established to identify and 
select reporting facilities at which onsite quality assessments or audits will be conducted. 
Auditors will assess completeness and timeliness of reporting at those facilities, and data quality 
will be evaluated through re-abstracting.
1.1.4.	NAACCR Certification and NPCR Standard Status
The North American Association of Central Cancer Registries (NAACCR) certifies registry data 
on an annual basis. Gold or silver certifications are awarded after evaluating the quality and 
completeness of data and the timeliness of reporting. The DCR’s incidence data was certified by 
NAACCR as meeting standards for high quality data in 1997, 1998, 1999, 2002, and 2003.

Additionally, the National Program of Cancer Registries (NPCR) provides an annual Standard 
Status Report to central registries supported by this program.  Delaware’s 2006 submission of 
data from diagnosis years 1999-2004 met the standard levels for all indices measuring quality, 
completeness and timeliness.
1.1.5.	Data Uses
DCR data are used to support various programs and initiatives in Delaware’s Division of Public 
Health, including the Breast and Cervical Cancer Control Program, the Delaware Cancer 
Consortium and other advisory committees involved in the state’s cancer control program. Other 
uses of DCR data include responding to citizen inquiries, routine reporting of cancer statistics, 
and research programs at universities, federal agencies and research institutes within the state. 
1.2.	ORGANIZATION OF THIS REPORT
This report describes cancer incidence and mortality in Delaware by sex, race, and county. 
Race-specific data were limited to Caucasians and African Americans due to the small sample 
size and the need to protect the confidentiality of individuals. Incidence and mortality rates were 
age-adjusted to the year 2000 standard population. The body of this report discusses the results 
for all cancers and site-specific cancers. The methodological challenges in analyzing Hispanic 
cancer rates in Delaware and the results of such analyses are presented in appendix A. In 
appendix B, the methodological approach and data sources used to produce incidence and 
mortality statistics are discussed. Incidence and mortality counts and rates for 1) all cancer sites 
combined and 2) site-specific cancers are presented in the results section (chapters 3–14). Site-
specific cancer statistics were limited to the following cancers and are presented in this order: 
breast (female), cervical, colorectal, esophagus, leukemia, lung and bronchus, malignant 
melanoma, ovarian, pancreatic, prostate, and urinary bladder. The data for all cancer sites 
excluding the site-specific cancers are presented in appendix C.  Behavioral risk factor data and 
stage at diagnosis are also presented in the relevant chapters. 


2.	GUIDELINES FOR THE INTERPRETATION OF INCIDENCE AND MORTALITY 
RATES

2.1.	INCIDENCE AND MORTALITY RATES
Rates are expressed per 100,000 of the population in Delaware or the United States. Ninety-five 
percent confidence intervals were computed to facilitate comparison of rates in the different sub-
populations in Delaware. The results of these comparisons were deemed significant only if the 
confidence intervals for the rates compared did not overlap. Differences in rates are also 
expressed using percentages. For example, to compare the rate of cancer for males with that 
for females, the rate is expressed as a ratio, and the extent of the difference is expressed as a 
percentage.


3. All Cancer Sites


Data Highlights

New Cancer Cases and Deaths (Tables 3.1 and 3.4)
>	A total of 20,793 cancer cases were diagnosed among Delaware residents during 1999–2003, 10,850 
cases (52.2 percent) in males and 9,943 cases (47.8 percent) in females. 
>	The 12,538 cases diagnosed among New Castle County residents made up the majority 
(60.3 percent) of Delaware’s total 1999–2003 incident cancer case count; 5,223 cancer cases 
(25.1 percent) were Sussex County residents, and 2,995 (14.4 percent) were Kent County residents.
>	Eighty-two percent (17,095) of cancer cases in 1999–2003 were diagnosed among Caucasians and 
14.8 percent (3,072) among African Americans. Cancer cases among Hispanics accounted for 
1.0 percent (211) of the total incident cases in Delaware in 1999–2003.
>	The proportion of cancer cases diagnosed among other race groups was 1.1 percent (219). Less than 
1 percent (196 cases) of people of unknown racial origin were diagnosed with cancer in 1999–2003. 
>	During 1999–2003, 8,466 Delaware residents died from cancer; 51.8 percent (4,388) were male, and 
48.2 percent (4,078) were female.
>	Of the 8,466 cancer deaths, 82.8 percent (7,010) of decedents were Caucasian, and 15.5 percent 
(1,312) were African-American. Sixty-three decedents belonged to other race groups, and 1.0 percent 
(81) of the decedents were of Hispanic ethnicity.
>	A total of 4,929 (58.2 percent) deaths occurred among residents of New Castle County, followed by 
2,223 (26.3 percent) among Sussex County residents and 1,314 (15.5 percent) among Kent County 
residents.

Incidence and Mortality Rates (Tables 3.2 and 3.5)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	Delaware’s 1999–2003 overall cancer incidence rate was 5.3 percent higher than the U.S. estimate. 
>	Overall, Delaware’s African-American residents had a higher all cancer incidence rate (539.8 per 
100,000 in 1999–2003) than Caucasian residents (493.4 per 100,000). 
>	Incidence rates among African-American males and females were 20.3 percent higher and 
1.0 percent lower, respectively, than their Caucasian counterparts.
>	The five-year average age-adjusted all cancer incidence rate among males (594.4 per 100,000) was 
higher than that among females (439.7 per 100,000) in 1999–2003.
>	Similarly, the overall incidence rates among Caucasian (574.4 per 100,000) and African-American 
(691.1 per 100,000) males in Delaware were higher than overall rates among Caucasian (437.8 per 
100,000) and African-American (434.0 per 100,000) females in 1999–2003.
>	African-American males in New Castle County had a higher incidence rate (752.2 per 100,000) than 
Caucasian males in Sussex County (544.7 per 100,000) in 1999–2003.
>	Caucasian males in New Castle and Sussex Counties had higher rates of cancer diagnoses than 
Caucasian females diagnosed with cancer in the same counties in 1999–2003. 
>	By comparison, only African-American males in New Castle County had a higher incidence rate 
(752.2 per 100,000) than African-American females in New Castle County (461.8 per 100,000) in 
1999–2003.
>	African-American females (434.0 per 100,000) in Delaware had higher cancer incidence rates, 
compared with African-American females in the United States (403.6 per 100,000) in 1999–2003. 
>	The all cancer gender-specific incidence rates were higher in Delaware in 1999–2003, compared with 
the United States.
>	In Delaware in 1999-2003, the overall cancer mortality rate was 5.7 percent higher than the U.S. 
estimate.
>	Caucasians in Delaware had higher all cancer mortality rates (200.3 per 100,000) compared to 
Caucasians in the U. S. (193.5 per 100,000).
>	Overall cancer mortality in 1999–2003 was about 46 percent higher among Delaware males (256.1 
per 100,000) than among females (174.9 per 100,000).
>	The overall cancer mortality rate in Delaware was 25 percent higher among African-American 
residents (250.6 per 100,000) than among Caucasian residents (200.3 per 100,000) during 1999–
2003. Similarly, African-American males and females in Delaware died from cancer at rates higher 
than their Caucasian counterparts.
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	African-American males in New Castle County had the highest incidence rate (752.2 per 100,000) of 
any sex-race-county category in Delaware during 1999–2003. 
>	The overall cancer mortality rate was highest in Kent County during 1999–2003 (211.5 per 100,000), 
and African-American males in Sussex County had the highest age-adjusted all cancer mortality rate 
(353.81 per 100,000).

Trends in Cancer Incidence and Mortality Rates (Figures 3.1–3.5)
>	The all cancer incidence rate declined within the population of Delaware. The rate among males 
declined 10.1 percent since 1990–94, whereas the rate among females remained relatively stable 
during the same time period. 
>	The rate of decline in cancer among Caucasians (3.5 percent) since 1990–94 was less than half of 
that for African Americans (11.7 percent) over the same time period. 
>	All cancer mortality in Delaware declined by 15 percent between intervals 1990–94 and 1999–2003.

Age-Specific Incidence and Mortality (Tables 3.3 and 3.6, Figures 3.3 and 3.6)
>	Cancer risk generally increased with age. Exceptions were among females overall and Caucasian 
females, where people ages 75–84 and older had the highest age-specific incidence rates.
>	Mortality rates rose with increasing age and peaked at ages 85 and older in both men and women.


All Cancer Incidence

Table 3.1.	Number of All Cancer Cases in Delaware and Counties, by Race and Sex: 
1999–2003

REGION
All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
20,793
10,850
9,943
17,095
8,883
8,212
3,072
1,637
1,435
Kent
2,995
1,561
1,434
2,400
1,232
1,168
483
266
217
New Castle
12,538
6,478
6,060
10,031
5,163
4,868
2,108
1,105
1,003
Sussex
5,223
2,788
2,435
4,633
2,470
2,163
480
265
215
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 3.2.	Five-Year Average Age-Adjusted All Cancer Incidence Rates* in the United 
States (Estimates), Delaware and Counties, by Race and Sex: 1999–2003 

RACE AND REGION
SEX

All
Male 
Female
ALL RACES



United States
478.1 (476.9–479.3)
565.2 (563.2–567.2)
418.4 (416.9–420.0)
Delaware
503.5 (496.7–510.3)
594.4 (583.2–605.7)
439.7 (431.1–448.3)
Kent
474.3 (434.5–514.1)
556.3 (481.5–631.2)
415.8 (369.4–462.2)
New Castle
518.8 (497.2–540.4)
622.1 (580.7–663.4)
449.1 (424.3–474.0)
Sussex
483.1 (452.0–514.2)
553.5 (497.9–609.1)
429.6 (392.3–467.0)
CAUCASIAN



United States
487.1 (485.8–488.5)
568.1 (566.0–570.3)
432.4 (430.7–434.2)
Delaware
493.4 (486.0–500.8)
574.4 (562.4–586.4)
437.8 (428.3–447.3)
Kent
469.2 (426.1–512.2)
542.0 (459.7–624.4)
421.7 (371.3–472.0)
New Castle
505.3 (482.3–528.3)
597.2 (553.8–640.6)
444.3 (417.5–471.0)
Sussex
479.6 (447.0–512.2)
544.7 (486.6–602.9)
430.2 (390.8–469.6)
AFRICAN-AMERICAN



United States
516.4 (512.1–520.8)
684.4 (676.3–692.5)
403.6 (398.7–408.6)
Delaware
539.8 (520.4–559.3)
691.1 (655.7–726.4)
434.0 (411.3–456.7)
Kent
466.7 (360.0–573.4)
548.2 (381.7–714.6)
387.7 (253.5–521.9)
New Castle
573.8 (507.4–640.3)
752.2 (605.4–899.0)
461.8 (389.8–533.8)
Sussex
489.7 (381.1–598.3)
652.4 (439.7–865.1)
378.7 (260.2–497.2)
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 3.1.	Five-Year Average Age-Adjusted All Cancer Incidence Rates* in the United 
States (Estimates) and Delaware, by Sex: 1980–2003 

 


	
	
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.

Figure 3.2.	Five-Year Average Age-Adjusted All Cancer Incidence Rates* in Delaware, 
by Race and Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.
       
       


       
Table 3.3.	Age-Specific All Cancer Incidence Rates* in Delaware, by Race and Sex: 
1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
51.8
41.4
62.3
53.1
43.5
62.8
46.0
33.2
58.4
40–64
639.4
665.6
614.8
630.9
639.6
622.6
679.3
803.8
574.0
65–74
2,101.1
2,709.7
1,579.1
2,070.4
2,624.2
1,587.7
2,182.3
3,084.9
1,487.7
75–84
2,487.1
3,203.0
2,005.3
2,468.8
3,157.0
2,001.5
2,445.4
3,316.9
1,913.1
85+
2,221.8
3,230.4
1,821.8
2,161.3
3,164.4
1,760.5
2,498.7
3,583.5
2,119.3
* = Rates are per 100,000 population. 

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
       
Figure 3.3.	Age-Specific All Cancer Incidence Rates in Delaware, by Race: 1999–2003

 
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.





All Cancer Mortality

Table 3.4.	Number of All Cancer Deaths in Delaware and Counties, by Race and Sex: 
1999–2003

REGION
All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
8,466
4,388
4,078
7,010
3,642
3,368
1,312
673
639
Kent
1,314
717
597
1,051
572
479
231
127
104
New Castle
4,929
2,498
2,431
4,016
2,042
1,974
823
410
413
Sussex
2,223
1,173
1,050
1,943
1,028
915
258
136
122
SOURCE: Delaware Health Statistics Center, 2005.


Table 3.5.	Five-Year Average Age-Adjusted All Cancer Mortality Rates* in the United 
States, Delaware and Counties, by Race and Sex: 1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES



United States
195.7 (195.5-196.0)
243.7 (243.3-244.1)
164.3 (164.0-164.5)
Delaware
206.9 (202.5–211.3)
256.1 (248.3–263.8)
174.9 (169.5–180.3)
Kent
211.5 (180.0–243.0)
273.2 (209.8–336.6)
169.7 (134.7–204.6)
New Castle
207.7 (191.5–223.9)
257.9 (225.4–290.3)
176.9 (158.5–195.2)
Sussex
203.8 (179.8–227.7)
244.1 (199.1–289.0)
174.7 (146.7–202.7)
CAUCASIAN



United States
193.5 (193.2-193.7)
239.2 (238.7-239.6)
163.4 (163.1-163.7)
Delaware
200.3 (195.7–205.0)
246.9 (238.8–255.1)
169.6 (163.8–175.3)
Kent
205.0 (171.5–238.6)
264.8 (196.7–332.8)
165.2 (127.9–202.5)
New Castle
201.1 (183.9–218.3)
248.8 (214.8–282.8)
171.1 (151.5–190.8)
Sussex
197.6 (172.8–222.5)
236.0 (189.3–282.7)
170.0 (140.9–199.1)
AFRICAN-AMERICAN



United States
244.0 (243.1-244.9)
331.0 (329.4-332.7)
192.4 (191.4-193.3)
Delaware
250.6 (236.7–264.4)
326.8 (300.4–353.1)
204.8 (188.8–220.9)
Kent
241.2 (148.4–334.1)
294.4 (130.0–458.9)
197.4 (87.8–307.0)
New Castle
246.0 (195.7–296.3)
330.5 (210.9–450.1)
202.8 (150.1–255.6)
Sussex
259.8 (190.2–329.5)
353.8 (176.6–531.0)
217.7 (112.3–323.1)
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 3.4.	Five-Year Average Age-Adjusted All Cancer Mortality Rates* in the United 
States and Delaware, by Sex: 1980–2003

 
     
     * = Rates are age-adjusted to the 2000 U.S. standard population.
     
SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 3.5.	Five-Year Average Age-Adjusted All Cancer Mortality Rates* in Delaware, 
by Race and Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Health Statistics Center, 2005.




Table 3.6.	Age-Specific All Cancer Mortality Rates* in Delaware, by Race and Sex: 
1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
8.4
7.1
9.7
8.1
6.5
9.7
9.5
9.7
9.3
40–64
183.8
195.5
172.9
178.2
190.8
166.2
219.8
230.2
211.0
65–74
837.1
1,024.1
676.7
810.8
994.4
650.8
1,053.7
1,317.4
850.8
75–84
1,447.3
1,880.9
1,155.5
1,427.6
1,818.1
1,162.4
1,623.1
2,452.3
1,116.7
85+
1,790.0
2,668.8
1,441.4
1,752.1
2,596.8
1,414.7
2,009.1
3,127.4
1,618.0
* = Rates are per 100,000 population.

SOURCE: Delaware Health Statistics Center, 2005.


Figure 3.6.	Age-Specific All Cancer Mortality Rates in Delaware, by Race: 1999–2003

 
SOURCE: Delaware Health Statistics Center, 2005.






4. Female Breast Cancer 


Risk Factors and Early Detection

Risk Factors for Female Breast Cancer
>	Female sex
>	Increasing age
>	Mother, daughter, and/or sister with breast cancer
>	Inherited mutation in BRCA1 or BRCA2 genes
>	Personal history of breast cancer
>	Previous abnormal breast biopsy
>	Race; Caucasian women are slightly more likely to develop breast cancer than African-American 
women.
>	High-dose radiation therapy to chest
>	Early age at menarche and/or late age at menopause
>	Obesity
>	First childbirth after age 30 
>	Never giving birth
>	Estrogen replacement therapy
>	More than three alcoholic drinks per day


Possible Risk Factors for Female Breast Cancer
>	Having taken diethylstilbestrol (DES) during pregnancy 
>	High-fat diet

Under Consideration as Risk Factors for Female Breast Cancer
>	Use of oral contraceptives
>	Pesticide and other exposures



Early Detection of Female Breast Cancer
Women at increased risk should talk with their doctors about the benefits and limitations of starting 
mammograms when they are younger, having additional tests, or having more frequent exams.

Regular clinical breast exams and mammography can detect female breast cancer at an earlier stage, 
resulting in improved chances for survival. The American Cancer Society recommendations for 
appropriate breast cancer screening are age-specific as follows:

Type of Exam
Ages 20–39
Ages 40 and Older
Breast self-exam
Monthly
Monthly
Clinical breast exam
Every three years
Annual
Mammogram
Baseline by age 40
Annual

The Behavioral Risk Factor Surveillance System (BRFSS) survey included several questions related to 
breast cancer screening practices:
>	Have you ever had a mammogram?
>	How long has it been since your last mammogram?
>	Was your last mammogram done as part of a routine checkup, because of a breast problem other 
than cancer, or because you’ve already had breast cancer?

Delaware Women Ages 40 and Older With Mammogram Within the Past Two Years
>	In 2004, 82.4 percent of Delaware women age 40 and older reported having a mammography exam 
within the previous two years, compared with 74.7 percent in the United States.
>	Delaware women age 50 and older were most likely to have received a mammogram within the past 
two years, with about 84 percent reporting they had done so; 78.8 percent of Delaware women in 
their 40s said they had received a mammogram within the past two years.  Of U.S. females, 77 
percent of those in their 40s reported having a mammogram in the past two years.
>	African-American women in Delaware were more likely to have had a mammogram in the previous 
two years than were their Caucasian counterparts - 86 percent among African Americans, compared 
to  82.4 percent among Caucasians.  The difference, however, is not statistically significant. 
>	Females with higher education levels were more likely to have received a mammogram in the past 
two years – 86.6 percent among college graduates compared to 77.3 percent among high school 
graduates.  


Data Highlights

New Cancer Cases and Deaths (Tables 4.1 and 4.6)
>	Breast cancer was the most frequently diagnosed cancer among females. There were 2,884 new 
cases in Delaware during 1999–2003, accounting for 29.0 percent of all cancer cases diagnosed 
during that time period among females. 
>	Eighty-three percent (2,396) of female breast cancer cases in Delaware diagnosed from 1999–2003 
were Caucasian residents, and 14.3 percent (412) were African-American residents; 44 cases were 
other race groups, and 23 were residents of Hispanic ethnicity. 
>	The majority of female breast cancer cases during 1999–2003 were New Castle County residents 
(1,798 or 62.3 percent), followed by Sussex County (668 or 23.2 percent) and Kent County (416 or 
14.4 percent) residents. 
>	Breast cancer was the second leading cause of cancer death among women in Delaware, surpassed 
only by lung cancer. Breast cancer accounted for 7.2 percent of all cancer deaths among females in 
1999–2003.
>	During 1999–2003, 612 female Delaware residents died from breast cancer; 481 (78.6 percent) 
decedents were Caucasian, and 119 (19.4 percent) were African-American; six decedents were of 
other race groups.
>	A total of 377 (61.6 percent) decedents were from New Castle County, 149 (24.4 percent) were from 
Sussex County, and 86 (14.1 percent) were from Kent County.

Incidence and Mortality Rates (Tables 4.2 and 4.7)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	In 1999–2003, the breast cancer mortality rate was 41.9 percent higher among African-American 
females (35.2 per 100,000) than among Caucasian females (24.8 per 100,000) in Delaware. 
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	Caucasian women (130.2 per 100,000) in Delaware had a higher overall breast cancer incidence, 
compared with African-American women (117.8 per 100,000). 
>	In 1999–2003, the breast cancer incidence rate was highest in New Castle County among both 
Caucasian females (134.4 per 100,000) and African-American females (131.5 per 100,000). 
>	African-American females in Sussex County had the highest breast cancer mortality rate (50.1 per 
100,000) in any race/county category. 

Trends in Cancer Incidence and Mortality Rates (Figures 4.1–4.2 and 4.6–4.7)
>	Delaware’s female breast cancer incidence rate decreased 6.5 percent from 1990–94 to 1999–2003. 
>	From 1980–84 to 1984–88, Delaware’s female breast cancer incidence rates were similar to U.S. 
estimates. In 1987–91, Delaware’s rate surpassed the U.S. rate; the rate leveled off but remained 
above the U.S. rate. Since 1996–2000, Delaware’s rate has fallen below that of the United States.
>	The breast cancer mortality rate decreased from 1988–92 to 1999–2003 among Delaware’s 
Caucasian women. The mortality rate among African-American women, which declined in 1987–91, 
increased in 1992–96 and has remained stable since that time.

Age-Specific Incidence and Mortality Rates (Tables 4.3 and 4.8, Figures 4.3 and 4.8)
>	The incidence of female breast cancer increased with age and peaked at ages 75–84. 
>	Mortality from female breast cancer increased with age and reached 185.2 per 100,000 among 
women ages 85 and older.

Stage at Diagnosis of Female Breast Cancer (Tables 4.4–4.5, Figures 4.4–4.5)
>	A total of 904 cases (31.4 percent of all female breast cancers) were late stage at the time of 
diagnosis (i.e., either regional or distant). The proportion of late stage breast cancers was higher 
among African-American women (36.9 percent) than among Caucasian women (30.1 percent).
>	There was an increase in the proportion of female breast cancer cases diagnosed in the local stage 
from 46.2 percent in 1983–87 to 63.2 percent in 1992–96. The increase in the proportion of breast 
cancer cases diagnosed at local stage among females in Delaware increased until 1999–2003, but at 
a lower rate. This trend in local stage disease was complemented by a decrease in the proportion of 
cases diagnosed in the regional stage (from 40.4 percent in 1983–87 to 27.7 percent in 1992–96). 
Both proportions in local and regional stage of disease, however, remained constant from 1991–95 to 
1999–2003.
>	The proportion of breast cancer cases diagnosed in the distant stage decreased from 1980–84 to 
1999–2003. Over this time period, the proportion of breast cancer cases diagnosed in the distant 
stage decreased by approximately 50 percent.
>	In the United States during 1999–2003, 63.1 percent, 30.2 percent, and 4.4 percent of female breast 
cancers were diagnosed in the local, regional, and distant stage, respectively. 



Female Breast Cancer Incidence

Table 4.1.	Number of Female Breast Cancer Cases in Delaware and Counties, by 
Race: 1999–2003


All  
Female
Caucasian 
Female
African-American 
Female
Delaware
2,884
2,396
412
Kent
416
350
57
New Castle
1,798
1,449
301
Sussex
668
595
54
SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; 
U.S.: Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Table 4.2.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates* in 
the United States (Estimates), Delaware and Counties, by Race: 1999–2003 


All  
Female
Caucasian 
Female
African-American  
Female
U.S. Estimates
134.1 (133.3–135.0)
139.9 (138.9–140.9)
118.8 (116.2–121.5)
Delaware
129.2 (124.5–133.9)
130.2 (125.0–135.5)
117.8 (106.3–129.3)
Kent
121.9 (99.0–144.7)
127.8 (102.0–153.7)
94.6 (47.9–141.3)
New Castle
134.0 (121.4–146.5)
134.4 (120.7–148.1)
131.5 (96.4–166.5)
Sussex
120.3 (102.4–138.2)
119.4 (100.5–138.3)
92.9 (47.7–138.1)
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 4.1.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates* in 
the United States (Estimates) and Delaware: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.

Figure 4.2.	Five-Year Average Age-Adjusted Female Breast Cancer Incidence Rates* in 
Delaware, by Race: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 4.3.	Age-Specific Female Breast Cancer Incidence Rates* in Delaware, by Race: 
1999–2003

Age Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
14.2
13.4
16.7
40–64
227.1
230.8
216.1
65–74
415.1
433.4
305.7
75–84
467.4
478.1
337.6
85+
332.8
323.2
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 4.3.	Age-Specific Female Breast Cancer Incidence Rates in Delaware, by Race: 
1999–2003

 
NOTE: Rate for African American females ages 85+ is not displayed because of patient confidentiality rules.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Female Breast Cancer by Stage at Diagnosis

Table 4.4.	Number of Female Breast Cancer Cases in Delaware, by Stage at Diagnosis 
and Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
1,892
1,607
244
Regional
804
639
136
Distant
100
82
16
Unknown
88
68
16
Total
2,884
2,396
412 
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 4.5.	Percentage of Female Breast Cancer Cases in Delaware, by Stage at 
Diagnosis and Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
65.6
67.1
59.2
Regional
27.9
26.7
33.0
Distant
3.5
3.4
3.9
Unknown
3.1
2.8
3.9
Total
100.0
100.0
100.0
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 4.4.	Percentage of Female Breast Cancer Cases in Delaware and the United 
States (Estimates), by Stage at Diagnosis: 1999–2003


Figure 4.4a. Delaware: 1999–2003

Figure 4.4b. U.S. Estimates: 1999–2003
 

 

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 4.5. 	Percentage of Female Breast Cancer Cases in Delaware, by Stage at 
Diagnosis: 1980–2003

 

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Female Breast Cancer Mortality

Table 4.6.	Number of Female Breast Cancer Deaths in Delaware and Counties, by 
Race: 1999–2003

Region
All  
Female
Caucasian 
Female
African-American  
Female
Delaware
612
481
119
Kent
86
67
17
New Castle
377
294
75
Sussex
149
120
27
SOURCE: Delaware Health Statistics Center, 2005.


Table 4.7.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates* in 
the United States, Delaware and Counties, by Race: 1999–2003

Region
All  
Female
Caucasian 
Female
African-American  
Female
United States
26.0 (25.9–26.1)
25.4 (25.3–25.5)
34.4 (34.0–34.9)
Delaware
26.7 (24.6–28.8)
24.8 (22.5–27.0)
35.2 (28.7–41.6)
Kent
24.8 (12.7–36.9)
23.6 (10.7–36.6)
---
New Castle
27.5 (20.6–34.4)
25.7 (18.3–33.2)
33.7 (15.1–52.2)
Sussex
26.5 (16.6–36.3)
23.4 (13.2–33.5)
50.1 (14.9–85.3)
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 deaths.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 4.6.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates* in 
the United States and Delaware: 1980–2003

 
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.
	

Figure 4.7.	Five-Year Average Age-Adjusted Female Breast Cancer Mortality Rates* in 
Delaware, by Race: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Health Statistics Center, 2005.




Table 4.8.	Age-Specific Female Breast Cancer Mortality Rates* in Delaware, by Race: 
1999–2003 

Age 
Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
2.3
---
---
40–64
34.8
30.0
57.2
65–74
84.6
77.8
127.4
75–84
148.7
158.0
---
85+
185.2
178.6
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 4.8.	Age-Specific Female Breast Cancer Mortality Rates in Delaware, by Race: 
1999–2003

 
NOTE: Rates for Caucasian and African-American females ages 0–39 and for African-American females ages 75 and 
older are not displayed because of patient confidentiality rules.

SOURCE: Delaware Health Statistics Center, 2005.







5. Cervical Cancer 


Risk Factors and Early Detection

Risk Factors for Cervical Cancer
>	Infection by the human papillomavirus (HPV)
>	Sexual intercourse at a young age
>	Multiple sexual partners
>	Long-term use of oral contraceptives

>	Mother who took diethylstilbestrol (DES) during pregnancy (associated with vaginal clear cell 
adenocarcinoma, a form of cervical and vaginal cancer)
>	Cigarette smoking
>	Low socioeconomic status
>	Multiple pregnancies
>	Family history of cervical cancer

Possible Risk Factors for Cervical Cancer
>	Having a weakened immune system (e.g., through HIV, AIDS, or receiving drugs to suppress the 
immune system)
>	History of sexually transmitted disease(s), such as chlamydia
>	Diet low in fruits and vegetables

Early Detection of Cervical Cancer
Routine Pap smear tests can detect cervical cancer at an earlier stage, generally the in situ stage, 
resulting in greatly improved chances for survival. 

The American Cancer Society recommends that all females who are or have been sexually active and all 
females ages 18 and older have an annual Pap test. After three or more consecutive normal tests, the 
Pap test can be performed less frequently. 

Current recommendations for cervical cancer screening are:
>	All females should begin having the Pap test about three years after they start having sex, but no 
later than age 21.
>	Beginning at age 30, women who have had three normal test results in a row may get the test every 
two to three years.
>	Women should follow the same guidelines in regard to having pelvic exams.

The BRFSS survey asked several questions related to cervical cancer screening:
>	Have you ever had a Pap smear?
>	How long has it been since your last Pap smear?
>	Was your last Pap smear done as part of a routine exam, or to check a current or previous problem?
>	Have you ever had a hysterectomy?

In Delaware
>	In 2004, 87.7 percent of Delaware women ages 18 and older reported that they had a Pap smear 
within the previous three years, compared with 86.0 percent in the United States.
>	More African-American females (94.8 percent) than Caucasian females (87.4 percent) reported that 
they had had a Pap smear within the last three years. 
>	The percentage of females who had not had a Pap smear in the last three years was highest in the 
18–24 and 65 and older age groups (23.1 and 23.2 percent, respectively). 
>	Women in the 35–44 age group had the highest prevalence of having had a Pap smear within the 
past three years (94.9 percent).  
>	College graduates were the most likely to have had a Pap smear within the past three years. In 2004, 
89.7 percent of college graduates reported having had a Pap smear, compared with 77.1 percent of 
women with less than a high school education. 
>	Among income strata, women with incomes between $15,000 and $24,999 were the least likely to 
have had a Pap smear within the past three years (81.8 percent). 

Data Highlights

New Cancer Cases and Deaths (Tables 5.1 and 5.6)
>	Cervical cancer accounted for 1.9 percent of all cancer cases among females. There were 184 newly 
diagnosed cases during 1999–2003 in Delaware. 
>	Caucasian females made up 70.7 percent (130) of cervical cancer cases in 1999–2003, and African- 
American females made up 23.4 percent (43); 8 cases diagnosed were Hispanic females.
>	The majority of cervical cancer cases diagnosed in 1999–2003 were among New Castle County 
residents (95 or 51.6 percent), followed by Sussex County (52 or 28.3 percent) and Kent County (37 
or 20.1 percent) residents. 
>	Deaths from cervical cancer accounted for 0.9 percent of all cancer deaths among Delaware women 
during 1999–2003.
>	During 1999–2003, 76 Delaware women died from cervical cancer; 54 (71.1 percent) decedents were 
Caucasian, and 18 (23.7 percent) were African-American.
>	A total of 39 (51.3 percent) cervical cancer deaths were New Castle County residents, 26 
(34.2 percent) were Sussex County residents, and 11 (14.5 percent) were Kent County residents.

Incidence and Mortality Rates (Tables 5.2 and 5.7)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	There are no significant findings to report for cervical cancer in Delaware in 1999–2003.
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	Cervical cancer incidence in African-American females in Delaware (11.4 per 100,000) was 
44 percent higher than in Caucasian females (7.9 per 100,000). 
>	During 1999–2003, cervical cancer mortality was twice as high among African-American women (5.1 
per 100,000) than among Caucasian women (2.4 per 100,000) in the United States.

Trends in Cancer Incidence and Mortality (Figures 5.1–5.2 and 5.6–5.7)
>	Although Delaware’s cervical cancer incidence rate was 13.2 percent higher than the U.S. estimate in 
1999–2003, the difference between the two rates has decreased since the 1990s. 
>	Delaware’s cervical cancer incidence rate decreased from 1988–92 through 1999–2003. 
>	Delaware’s cervical cancer mortality rate was higher than the U.S. rate, but recently the disparity has 
decreased. In 1999–2003, Delaware’s mortality rate was 29.6 percent higher than the U.S. rate.
>	The cervical cancer mortality rate for Delaware’s African-American women decreased 34.3 percent 
from 1994–98 through 1999–2003.

Age-Specific Incidence and Mortality Rates (Tables 5.3 and 5.8, Figures 5.3 and 5.8)
>	The overall age-specific incidence rate of cervical cancer was higher among women ages 40–64, 
compared with those younger than age 40. 

Stage at Diagnosis of Cervical Cancer (Tables 5.4–5.5, Figures 5.4–5.5)
>	A total of 69 cases (37.5 percent of all cervical cancers) were diagnosed in the late stages (i.e., 
regional or distant) during 1999–2003. The proportion of late stage diagnoses was higher among 
Caucasian females (40.0 percent) than African-American females (32.6 percent). This was due to a 
higher percentage of regional stage diagnoses among Caucasian females (35.4 percent) than among 
African- American females (18.6 percent) in 1999–2003. 
>	The proportion of local stage cervical cancer cases was higher among African-American females 
(62.8 percent) than among Caucasian females (50.0 percent).
>	In Delaware during 1999–2003, a higher proportion of cases was diagnosed in the local stage 
(53.8 percent), compared with the U.S. estimates for 1999–2003 (51.9 percent). 
>	A smaller proportion of cervical cancer cases were diagnosed in the regional and distant stages in 
Delaware (31.0 percent and 6.5 percent, respectively), compared with U.S. estimates of 32.4 percent 
and 10.7 percent, respectively. 
>	In Delaware, the percentage of cervical cancer cases diagnosed in the local stage increased from 
32.4 percent in 1980–84 to 53.8 percent in 1999–2003.
>	There was a decline in the percentage of regional stage cases from 48.9 percent in 1980–84 to 
31.0 percent in 1999–2003. 
>	The overall percentage of distant stage cervical cancer cases did not change appreciably during 
1980–2003.




Cervical Cancer Incidence

Table 5.1.	Number of Cervical Cancer Cases in Delaware and Counties, by Race: 
1999–2003


All  
Female
Caucasian 
Female
African-American  
Female
Delaware
184
130
43
Kent
37
29
8
New Castle
95
57
28
Sussex
52
44
7
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 5.2.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates* in the 
United States (Estimates), Delaware and Counties, by Race: 1999–2003 


All  
Female
Caucasian 
Female
African-American  
Female
U.S. Estimates
7.6 (7.4–7.8)
7.2 (7.0–7.4)
11.1 (10.3–11.9)
Delaware
8.6 (7.4–9.9)
7.9 (6.5–9.2)
11.4 (8.0–14.9)
Kent
11.0 (5.4–16.7)
11.3 (5.3–17.4)
---
New Castle
7.1 (4.8–9.4)
5.6 (3.5–7.8)
11.1 (1.4–20.8)
Sussex
11.3 (7.2–15.4)
11.5 (7.3–15.8)
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 cases.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.
     
     
Figure 5.1.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates* in the 
United States (Estimates) and Delaware: 1980–2003 

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.

Figure 5.2.	Five-Year Average Age-Adjusted Cervical Cancer Incidence Rates* in 
Delaware, by Race: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 5.3.	Age-Specific Cervical Cancer Incidence Rates* in Delaware, by Race: 
1999–2003

Age 
Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
4.5
4.1
---
40–64
15.0
13.8
---
65–74
14.3
---
---
75–84
---
---
---
85+
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 5.3.	Age-Specific Cervical Cancer Incidence Rates in Delaware, by Race: 
1999–2003







NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Cervical Cancer by Stage at Diagnosis

Table 5.4.	Number of Cervical Cancer Cases in Delaware, by Stage at Diagnosis and 
Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
99
65
27
Regional
57
46
8
Distant
12
6
6
Unknown
16
13
< 6
Total
184
130
43
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 5.5.	Percentage of Cervical Cancer Cases in Delaware, by Stage at Diagnosis 
and Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
53.8
50.0
62.8
Regional
31.0
35.4
18.6
Distant
6.5
4.6
14.0
Unknown
8.7
10.0
---
Total
100.0
100.0
100.0
--- = Percentage based on fewer than six cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 5.4.	Percentage of Cervical Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 5.4a. Delaware: 1999–2003

Figure 5.4b. U.S. Estimates: 1999–2003
 

 
SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.
Figure 5.5.	Percentage of Cervical Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003

 

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Cervical Cancer Mortality

Table 5.6.	Number of Cervical Cancer Deaths in Delaware and Counties, by Race: 
1999–2003


All  
Female
Caucasian 
Female
African-American  
Female
Delaware
76
54
18
Kent
11
8
< 6
New Castle
39
24
13
Sussex
26
22
< 6
SOURCE: Delaware Health Statistics Center, 2005.


Table 5.7.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates* in the 
United States, Delaware and Counties, by Race: 1999–2003


All  
Female
Caucasian 
Female
African-American  
Female
U.S. Estimates
2.7 (2.6–2.7)
2.4 (2.4–2.4)
5.1 (4.9–5.2)
Delaware
3.5 (2.7–4.2)
3.0 (2.2–3.8)
---
Kent
---
---
---
New Castle
2.9 (1.1–4.7)
---
---
Sussex
4.9 (1.7–8.0)
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 deaths.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 5.6.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates* in the 
United States and Delaware: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 5.7.	Five-Year Average Age-Adjusted Cervical Cancer Mortality Rates* in 
Delaware, by Race: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Health Statistics Center, 2005.




Table 5.8.	Age-Specific Cervical Cancer Mortality Rates* in Delaware, by Race: 
1999–2003

Age 
Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
---
---
---
40–64
6.4
5.2
---
65–74
---
---
---
75–84
---
---
---
85+
---
---
---
* = Rates are per 100,000 population. 
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 5.8.	Age-Specific Cervical Cancer Mortality Rates in Delaware, by Race: 
1999–2003







NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
     SOURCE: Delaware Health Statistics Center, 2005.






6. Colorectal Cancer


Risk Factors and Early Detection

Risk Factors for Colorectal Cancer
>	Increasing age
>	Personal history of colorectal polyps or colorectal cancer 
>	Family history of colorectal cancer or polyps, including familial adenomatous polyposis
>	Personal history of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
>	Personal history of ovarian, breast, or endometrial cancer
>	Diet high in red meat and other high-fat foods
>	Low dietary intake of fruits, vegetables, and folic acid
>	Physical inactivity 

Possible Risk Factors for Colorectal Cancer
>	Consumption of alcohol, especially beer
>	Cigarette smoking

Early Detection of Colorectal Cancer
The American Cancer Society’s (ACS) Colorectal Cancer Screening Guidelines are: 
>	Beginning at age 50, both men and women should follow one of the five screening options below: 
*	Yearly fecal occult blood test. The take-home multiple sample method should be used, and all 
positive tests should be followed up with colonoscopy.
*	Flexible sigmoidoscopy every five years 
*	Yearly fecal occult blood test, plus flexible sigmoidoscopy every five years*
*	Double contrast barium enema every five years 
*	Colonoscopy every 10 years 

Results are shown below for the following questions in the BRFSS survey:
>	A blood stool test is a test that may use a special kit at home to determine whether the stool contains 
blood. Have you ever had this test using a home kit?
>	A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to view the bowel for signs 
of cancer and other health problems. Have you ever had this exam?


In Delaware in 2005
>	A home blood stool test had been used by 40.1 percent of Delaware respondents. Comparable 
percentages of males (38.4 percent) and females (41.4 percent) in Delaware reported that they had 
used a home blood stool test. 
>	Nearly 69 percent of Delawareans reported that they had had a sigmoidoscopy or a colonoscopy; 
males were more likely than females to have had the exam (73.9 percent versus 64.5 percent).  
>	Approximately two-thirds of African Americans and Caucasians in Delaware reported having had a 
sigmoidoscopy or colonoscopy (64.0 percent and 69.3 percent, respectively).
>	The percentage of Delaware residents who had had a sigmoidoscopy or a colonoscopy increased as 
age increased. Among those ages 65 and older, 76.0 percent had a sigmoidoscopy or a colonoscopy, 
compared with 64.1 percent in the 50–64 age group.
>	Residents of each county were equally likely to have had a sigmoidoscopy or colonoscopy:  68.6 
percent of Kent County residents, 68.4 percent of New Castle County residents, and 69.7 percent of 
Sussex County residents reported having had this exam.  


Data Highlights

New Colorectal Cancer Cases and Deaths (Tables 6.1 and 6.6)
>	Colorectal cancer was the fourth most frequently diagnosed cancer among all Delaware residents. It 
was the third most common cancer among males and females. 
>	Colorectal cancer accounted for 11.2 percent of all cases diagnosed during 1999–2003 in Delaware. 
>	A total of 2,327 colorectal cancer cases were diagnosed among Delaware residents during 
1999–2003, 1,190 in males and 1,137 in females. 
>	The majority of colorectal cancer cases during 1999–2003 were New Castle County residents (1,341 
or 57.6 percent), followed by Sussex County (589 or 25.3 percent) and Kent County (392 or 
16.9 percent) residents.
>	A total of 1,916 (82.3 percent) cases were diagnosed among Caucasian residents in 1999–2003 in 
Delaware, and 14.8 percent (345) of cases were diagnosed among African Americans. Less than 
1 percent of colorectal cancer cases occurred among Hispanics, and 26 cases were diagnosed in 
other races.
>	Colorectal cancer was the second most common cancer-related cause of death among all Delaware 
residents. It was the third most common cancer-related cause of death in males and females. 
>	Deaths from colorectal cancer accounted for about 10 percent of all cancer deaths during 1999–2003 
in Delaware.
>	During 1999–2003, 851 Delaware residents died from colorectal cancer, and the majority of deaths 
(51.5 percent) were among males.
>	Most of the colorectal cancer deaths occurred among Caucasian residents (81.6 percent or 694), and 
17.4 percent (148) of decedents were African-American. 
>	A total of 505 (59.3 percent) decedents were from New Castle County, 234 (27.5 percent) were from 
Sussex County, and 112 (13.2 percent) were from Kent County.

Incidence and Mortality Rates (Tables 6.2 and 6.7)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	Colorectal cancer incidence in Delaware was higher among males (67.2 per 100,000) than females 
(48.8 per 100,000) in 1999–2003.
>	In 1999–2003, African Americans in Delaware had a higher age-adjusted colorectal cancer incidence 
rate (65.0 per 100,000) than Caucasians (54.8 per 100,000). 
>	Incidence rates among African-American females were higher than among their Caucasian 
counterparts.
>	Delaware’s 1999–2003 colorectal cancer mortality rate was higher among males (26.1 per 100,000) 
than among females (17.4 per 100,000).
>	The colorectal cancer mortality rate was higher among African-American residents (29.3 per 100,000) 
than among Caucasian residents (19.9 per 100,000) during 1999–2003. 
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals did 
overlap. This means that observed differences in rates may simply be due to chance variation.)
>	Incidence rates among African-American males (74.7 per 100,000) were higher than among 
Caucasian males (65.7 per 100,000).
>	Colorectal cancer incidence was highest in New Castle County among African-American males (81.9 
per 100,000) and in Kent County among African-American females (65.7 per 100,000). 
>	The colorectal cancer mortality rate was lowest in Kent County (18.2 per 100,000) during 1999–2003; 
New Castle and Sussex Counties had comparable rates of colorectal cancer mortality. 

Trends in Incidence and Mortality Rates (Figures 6.1–6.2 and 6.6–6.7)
>	Although Delaware’s colorectal cancer incidence during 1980–84 to 1999–2003 was higher than the 
U.S. estimates, recently the gap has narrowed. In 1999–2003, Delaware’s colorectal cancer 
incidence was 7.4 percent higher than the U.S. estimate (8.6 percent higher in males and 6.8 percent 
higher in females).
>	Colorectal cancer incidence has decreased overall since the mid-1980s among Caucasian Delaware 
residents. Since 1997–2001, the rates among African-American females and Caucasian males have 
remained steady. 
>	Although Delaware’s colorectal cancer mortality rate was higher than the U.S. rate since 1980–84, 
the gap between the two rates has narrowed since the early 1990s.
>	Colorectal cancer mortality declined among Caucasian and African-American females. Mortality, 
however, has increased among African-American males since 1994–98 and stabilized among 
Caucasian males since 1997–2001.

Age-Specific Incidence and Mortality Rates (Tables 6.3 and 6.8, Figures 6.3 and 6.8) 
>	The incidence of colorectal cancer increased with age.
>	Mortality from colorectal cancer peaked at ages 85 and older in both men and women.

Stage at Diagnosis of Colorectal Cancer (Tables 6.4–6.5, Figures 6.4–6.5)
>	A total of 1,467 cases (63.0 percent of all colorectal cancers) were diagnosed in the late stages (i.e., 
regional or distant), compared with the U.S. estimate of 55.1 percent in 1999–2003.
>	In Delaware, fewer colorectal cancers were diagnosed in the local stage in 1999–2003 (30.0 percent), 
compared with the U.S. estimate for 1999–2003 (39.8 percent). Delaware, however, had a greater 
proportion of cases diagnosed in the regional stage (46.2 percent) than the U.S. estimate 
(37.4 percent).
>	In 1985–89, the proportions of local and regional stage diagnoses of colorectal cancer were almost 
the same. Since that time, the proportion of local stage cancers has decreased (from 37.9 percent to 
30.0 percent in 1999–2003), while the proportion of regional stage cancers has increased 
(38.8 percent to 46.2 percent).
>	The percentage of distant stage colorectal cancer cases has decreased approximately 2–3 percent 
since 1988–92. 
>	Fewer African-American Delaware residents, on average, were diagnosed in the local stage 
(28.7 percent), compared with Caucasian residents (30.4 percent), and more African Americans were 
diagnosed in the distant stage (21.2 percent) than Caucasians (16.1 percent).


Colorectal Cancer Incidence

Table 6.1.	Number of Colorectal Cancer Cases in Delaware and Counties, by Race and 
Sex: 1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
2,327
1,190
1,137
1,916
992
924
345
165
180
Kent
392
216
176
315
177
138
66
32
34
New Castle
1,341
671
670
1,066
541
525
231
108
123
Sussex
589
299
290
531
271
260
47
24
23
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 6.2.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates* in the 
United States (Estimates), Delaware and Counties, by Race and Sex: 
1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
52.8 (52.4–53.2)
61.9 (61.2–62.6)
45.7 (45.3–46.2)
Delaware
56.7 (54.4–59.0)
67.2 (63.3–71.1)
48.8 (45.9–51.6)
Kent
63.0 (46.3–79.7)
80.2 (48.5–111.9)
50.1 (31.0–69.3)
New Castle
56.2 (48.1–64.2)
66.1 (51.2–80.9)
48.7 (39.1–58.4)
Sussex
54.5 (42.4–66.6)
62.2 (40.1–84.2)
48.7 (34.0–63.5)
CAUCASIAN


United States
52.3 (51.9–52.8)
61.3 (60.5–62.0)
45.2 (44.7–45.8)
Delaware
54.8 (52.4–57.3)
65.7 (61.5–69.8)
46.5 (43.4–49.5)
Kent
61.7 (43.7–79.8)
81.1 (45.3–116.9)
47.8 (27.5–68.1)
New Castle
53.4 (44.9–61.8)
63.5 (48.1–78.8)
45.4 (35.3–55.5)
Sussex
54.4 (41.6–67.2)
62.1 (38.9–85.3)
48.4 (32.9–64.0)
AFRICAN-AMERICAN



United States
62.4 (60.8–63.9)
72.8 (70.1–75.7)
55.7 (53.8–57.6)
Delaware
65.0 (57.9–72.0)
74.7 (62.4–87.1)
58.4 (49.8–67.0)
Kent
68.5 (21.3–115.8)
69.6 (3.3–136.0)
65.7 (2.4–129.0)
New Castle
69.2 (42.0–96.5)
81.9 (23.7–140.2)
62.4 (30.9–94.0)
Sussex
48.8 (10.0–87.5)
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 cases.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 6.1.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates* in the 
United States (Estimates) and Delaware, by Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute.

Figure 6.2.	Five-Year Average Age-Adjusted Colorectal Cancer Incidence Rates* in 
Delaware, by Race and Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       

Table 6.3.	Age-Specific Colorectal Cancer Incidence Rates* in Delaware, by Race and 
Sex: 1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
2.2
2.4
---
2.1
---
---
---
---
---
40–64
57.4
68.7
46.8
55.9
67.8
44.6
63.4
74.7
53.8
65–74
234.0
279.2
195.2
223.4
271.4
181.6
279.3
317.8
249.7
75–84
366.1
409.1
337.2
363.3
406.8
333.8
370.8
382.7
363.6
85+
426.4
548.9
377.9
417.3
539.2
368.6
489.6
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 6.3.	Age-Specific Colorectal Cancer Incidence Rates in Delaware, by Race: 
1999–2003

 
NOTE: Rates for African Americans ages 0–39 are not displayed due to patient confidentiality rules.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005. 


Colorectal Cancer by Stage at Diagnosis

Table 6.4.	Number of Colorectal Cancer Cases in Delaware, by Stage at Diagnosis, 
Race, and Sex: 1999–2003

Stage at 
Diagnosis
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
Local
697
378
319
582
316
266
99
56
43
Regional
1,076
522
554
893
442
451
159
68
91
Distant
391
210
181
309
167
142
73
36
37
Unknown
163
80
83
132
67
65
14
< 6
9
Total
2,327
1,190
1,137
1,916
992
924
345
165
180
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 6.5.	Percentage of Colorectal Cancer Cases in Delaware, by Stage at Diagnosis, 
Race, and Sex: 1999–2003

Stage at 
Diagnosis
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
Local
30.0
31.8
28.1
30.4
31.9
28.8
28.7
33.9
23.9
Regional
46.2
43.9
48.7
46.6
44.6
48.8
46.1
41.2
50.6
Distant
16.8
17.7
15.9
16.1
16.8
15.4
21.2
21.8
20.6
Unknown
7.0
6.7
7.3
6.9
6.8
7.0
4.1
---
5.0
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
--- = Percentage based on fewer than six cases. 

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 6.4.	Percentage of Colorectal Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 6.4a. Delaware: 1999–2003

Figure 6.4b. U.S. Estimates: 1999–2003
 

 

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.

Figure 6.5.	Percentage of Colorectal Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003
 
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Colorectal Cancer Mortality


Table 6.6.	Number of Colorectal Cancer Deaths in Delaware and Counties, by Race 
and Sex: 1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
851
439
412
694
365
329
148
69
79
Kent
112
57
55
84
46
38
26
9
17
New Castle
505
248
257
409
203
206
89
42
47
Sussex
234
134
100
201
116
85
33
18
15
SOURCE: Delaware Health Statistics Center, 2005.



Table 6.7.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates* in the 
United States, Delaware and Counties, by Race and Sex: 1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
20.0 (20.0–20.1)
24.3 (24.2–24.2)
17.0 (16.9–17.1)
Delaware
21.0 (19.6–22.4)
26.1 (23.6–28.7)
17.4 (15.7–19.1)
Kent
18.2 (8.4–28.0)
22.2 (3.5–40.8)
15.5 (4.4–26.6)
New Castle
21.5 (15.8–27.1)
26.1 (15.2–37.0)
18.3 (11.8–24.9)
Sussex
21.6 (13.4–29.8)
28.4 (12.0–44.8)
16.6 (7.5–25.8)
CAUCASIAN


United States
19.5 (19.4–19.6)
23.7 (23.6–23.9)
16.4 (16.3–16.5)
Delaware
19.9 (18.4–21.4)
25.3 (22.7–28.0)
16.1 (14.4–17.9)
Kent
16.5 (6.5–26.5)
21.5 (1.7–41.3)
13.1 (2.2–24.1)
New Castle
20.5 (14.5–26.5)
25.4 (13.6–37.1)
17.2 (10.3–24.1)
Sussex
20.5 (12.0–29.0)
27.2 (10.0–44.3)
15.6 (6.2–25.0)
AFRICAN-AMERICAN


United States
27.5 (27.2–27.8)
33.6 (33.1–34.1)
23.7 (23.3–24.0)
Delaware
29.3 (24.5–34.2)
33.9 (25.4–42.4)
26.0 (20.2–31.8)
Kent
28.2 (-5.3–61.8)
---
---
New Castle
28.0 (9.8–46.2)
33.7 (0.4–67.0)
23.9 (3.4–44.4)
Sussex
34.8 (0.9–68.8)
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 deaths.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.

 
Figure 6.6.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates* in the 
United States and Delaware, by Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.

Figure 6.7.	Five-Year Average Age-Adjusted Colorectal Cancer Mortality Rates* in 
Delaware, by Race and Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Health Statistics Center, 2005.




Table 6.8.	Age-Specific Colorectal Cancer Mortality Rates* in Delaware, by Race and 
Sex: 1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
---
---
---
---
---
---
---
---
---
40–64
15.9
18.3
13.8
14.5
17.2
12.0
24.1
---
23.9
65–74
82.0
104.7
62.5
78.7
104.2
56.5
112.3
---
---
75–84
149.6
186.7
124.7
142.7
172.6
122.4
204.2
---
---
85+
258.0
340.7
225.2
257.3
361.8
215.5
287.0
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 6.8.	Age-Specific Colorectal Cancer Mortality Rates* in Delaware, by Race: 
1999–2003

 
NOTE: Rates for African Americans and Caucasians ages 0–39 years are not shown due to patient confidentiality rules.
  
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.




7. Esophagus Cancer


Risk Factors and Early Detection

Risk Factors for Esophagus Cancer
>	Alcohol abuse 
>	Cigarette smoking
>	Smokeless tobacco use
>	African-American race
>	Increasing age
>	Male sex
>	Obesity
>	Chronic gastroesophageal reflux disease and/or Barrett’s esophagus

Possible Risk Factors for Esophagus Cancer
>	Diet low in fruits and/or vegetables
>	Occupational exposure to dry cleaning and other chemicals


Early Detection of Esophagus Cancer
No early detection tests are used to screen for esophagus cancer, but those with high risk factors should 
talk to their doctors about regular endoscopies and biopsies.


Chronic Alcohol Use

Chronic alcohol use is associated with increased risk of developing cancers of the breast, esophagus, 
larynx, oral cavity, and pharynx and suspected in the development of colorectal and prostate cancers. In 
addition, chronic alcohol use is strongly associated with deaths from cirrhosis of the liver and deaths from 
motor vehicle accidents.

In the BRFSS survey, “chronic alcohol use” was defined as an average of two or more drinks per day (i.e., 
60 or more alcoholic drinks a month) based on combined responses to the following questions:
>	During the past month, have you had at least one drink of any alcoholic beverage such as beer, wine, 
wine coolers, or liquor?
>	During the past month, how many days per week or per month did you drink any alcoholic beverages, 
on the average?
>	On the days when you drank, about how many drinks did you drink on average?

In Delaware in 2004
>	In 2004, 6.8 percent of Delaware residents were chronic users of alcohol, compared with 4.8 percent 
in the United States.
>	More males (8.5 percent) than females (5.2 percent) in Delaware were chronic users of alcohol.
>	People ages 18–24 (17.3 percent) had the highest proportion of chronic drinkers, compared with less 
than 10 percent for all other age groups.
>	African Americans in Delaware (3.0 percent) were less likely to be chronic drinkers, compared with 
Caucasians (7.5 percent).
>	The highest proportion of individuals who were chronic drinkers were those with less than a high 
school education (12.2 percent), compared with 5.1 percent of college graduates.

Data Highlights

New Cancer Cases and Deaths (Tables 7.1 and 7.6)
>	Esophagus cancer accounted for 1.2 percent of all cancer cases diagnosed among Delaware 
residents during 1999–2003.
>	A total of 242 esophagus cancer cases were diagnosed among Delaware residents during 
1999–2003 (187 cases (77.3 percent) in males and 55 cases in females). 
>	The majority of esophagus cancer cases in 1999–2003 were diagnosed among New Castle County 
residents (141 or 58.3 percent), followed by Sussex County (66 or 27.3 percent) and Kent County (35 
or 14.5 percent) residents. 
>	Caucasian residents made up 83.1 percent (201) of esophagus cancer cases in 1999–2003; African 
Americans made up 14.9 percent (36). 
>	Deaths from esophagus cancer accounted for 2.2 percent of all cancer deaths in Delaware during 
1999–2003.
>	During 1999–2003, 188 Delaware residents died from esophagus cancer, and the majority of deaths 
(78.7 percent) occurred among males.
>	Caucasians made up 84.0 percent (158) of decedents, and African Americans made up 15.4 percent 
(29). 
>	A total of 110 (58.5 percent) decedents resided in New Castle County, 48 (25.5 percent) resided in 
Sussex County, and 30 (16.0 percent) resided in Kent County.

Incidence and Mortality Rates (Tables 7.2 and 7.7)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	Delaware’s 1999–2003 esophagus cancer incidence rate was higher than the U.S. estimate in males 
and overall. 
>	Delaware’s esophagus cancer incidence rate was nearly five times higher in males (10.3 per 
100,000) than females (2.3 per 100,000) in 1999–2003.
>	Delaware’s 1999–2003 esophagus cancer mortality rate was more than four times higher among 
males (8.3 per 100,000) than females (1.7 per 100,000).
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	African Americans in Delaware had a higher esophagus cancer incidence rate (6.6 per 100,000) in 
1999–2003 than Caucasians (5.7 per 100,000). 
>	Incidence rates among African-American males were 12 percent higher than their Caucasian 
counterparts.

Trends in Cancer Incidence and Mortality (Figures 7.1–7.2 and 7.6–7.7)
>	The gap between Delaware and U.S. rates has decreased since 1996–2002.
>	In Delaware, the incidence rate of esophagus cancer was steady among Caucasian males and 
females and declined among African-American males and females. 
>	Although Delaware’s esophagus cancer mortality rates were higher than those for the United States 
in both males and females, the gap has narrowed in recent years.
Age-Specific Incidence and Mortality Rates (Tables 7.3 and 7.8, Figures 7.3 and 7.8)
>	The incidence of esophagus cancer in Delaware increased with age.
>	Mortality from esophagus cancer increased with age.

Stage at Diagnosis of Esophagus Cancer (Tables 7.4–7.5, Figures 7.4–7.5)
>	A total of 132 cases (54.5 percent of all esophagus cancers) were diagnosed in the late stages 
(regional or distant).
>	In Delaware, the proportion of esophagus cancer cases diagnosed in the local stage in 1999–2003 
(27.7 percent) was higher than the U.S. estimate for 1999–2003 (25.3 percent). 
>	Delaware had a smaller proportion of cases diagnosed in the distant stage (26.0 percent), compared 
with the U.S. estimate (29.6 percent), and a smaller proportion of cases diagnosed in the regional 
stage (28.5 percent) than in the United States (30.6 percent).
>	The proportion of esophagus cancers diagnosed in the local stage was approximately the same in 
1999–2003 as it was in 1980–84, although the proportion had declined in the interim.
>	The percentage of esophagus cancer cases diagnosed in the regional stage increased from 
26.0 percent in 1980–84 to 37.1 percent in 1992–96, whereas the percentage of distant stage cases 
decreased from 41.8 percent in 1980–84 to 19.4 percent in 1995–99. The proportion of regional and 
distant stage cancers increased after these time periods.
>	A smaller proportion of Caucasians than African Americans were diagnosed with esophagus cancer 
in the regional stage (27.9 percent for Caucasians versus 33.3 percent for African Americans), while 
a greater proportion of Caucasians than African Americans were diagnosed in the distant stage (27.4 
percent for Caucasians versus 22.2 percent for African Americans).


Esophagus Cancer Incidence

Table 7.1.	Number of Esophagus Cancer Cases in Delaware and Counties, by Race 
and Sex: 1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
242
187
55
201
156
45
36
27
9
Kent
35
26
9
29
23
6
6
< 6
< 6
New Castle
141
113
28
116
93
23
22
17
< 6
Sussex
66
48
18
56
40
16
9
7
< 6
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 7.2.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates* in 
the United States (Estimates), Delaware and Counties, by Race and Sex: 
1999–2003 

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
4.7 (4.6–4.8)
8.1 (7.9–8.4)
2.0 (1.9–2.1)
Delaware
5.8 (5.1–6.6)
10.3 (8.8–11.8)
2.3 (1.7–3.0)
Kent
5.5 (1.4–9.6)
9.0 (1.4–16.6)
---
New Castle
5.9 (3.4–8.4)
11.0 (5.3–16.7)
2.1 (0.1–4.1)
Sussex
6.1 (2.3–10.0)
9.9 (2.0–17.9)
---
CAUCASIAN


United States
4.7 (4.6–4.9)
8.2 (7.9–8.4)
1.9 (1.8–2.1)
Delaware
5.7 (4.9–6.5)
10.0 (8.4–11.6)
2.2 (1.6–2.9)
Kent
5.6 (1.1–10.2)
---
---
New Castle
5.8 (3.2–8.4)
10.7 (4.9–16.5)
2.0 (-0.1–4.1)
Sussex
5.7 (1.7–9.8)
9.2 (0.7–17.7)
---
AFRICAN-AMERICAN


United States
6.6 (10.7–3.7)
10.7 (9.8–11.8)
3.7 (3.2–4.2)
Delaware
6.6 (4.4–8.8)
11.2 (6.7–15.7)
---
Kent
---
---
---
New Castle
---
---
---
Sussex
---
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 cases.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 7.1.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates* in 
the United States (Estimates) and Delaware, by Sex: 1980–2003 

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute.

Figure 7.2.	Five-Year Average Age-Adjusted Esophagus Cancer Incidence Rates* in 
Delaware, by Race and Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 7.3.	Age-Specific Esophagus Cancer Incidence Rates* in Delaware, by Race and 
Sex: 1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
---
---
0.0
---
---
0.0
0.0
0.0
0.0
40–64
6.3
10.1
---
6.4
9.9
---
---
---
---
65–74
28.4
52.3
---
27.3
49.9
---
---
---
---
75–84
35.9
64.5
---
35.5
66.3
---
---
---
---
85+
---
---
---
---
---
---
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 7.3.	Age-Specific Esophagus Cancer Incidence Rates in Delaware, by Race: 
1999–2003




NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
     SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Esophagus Cancer by Stage at Diagnosis

Table 7.4.	Number of Esophagus Cancer Cases in Delaware, by Stage at Diagnosis, 
Race, and Sex: 1999–2003

Stage at 
Diagnosis
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
Local
67
53
14
60
48
12
7
< 6
< 6
Regional
69
56
13
56
45
11
12
10
< 6
Distant
63
53
10
55
46
9
8
7
< 6
Unknown
43
25
18
30
17
13
9
< 6
< 6
Total
242
187
55
201
156
45
36
27
9
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 7.5.	Percentage of Esophagus Cancer Cases in Delaware, by Stage at 
Diagnosis, Race, and Sex: 1999–2003

Stage at 
Diagnosis
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
Local
27.7
28.3
25.5
29.9
30.8
26.7
19.4
---
---
Regional
28.5
30.0
23.6
27.9
28.9
24.4
33.3
37.0
---
Distant
26.0
28.3
18.2
27.4
29.5
20.0
22.2
25.9
---
Unknown
17.8
13.4
32.7
14.9
10.9
28.9
25.0
---
---
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
--- = Percentage based on fewer than six cases. 

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 7.4.	Percentage of Esophagus Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 7.4a. Delaware: 1999–2003

Figure 7.4b. U.S. Estimates: 1999–2003
 

 

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.
Figure 7.5.	Percentage of Esophagus Cancer Cases in Delaware, by Stage at 
Diagnosis: 1980–2003

 
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.



Esophagus Cancer Mortality

Table 7.6.	Number of Esophagus Cancer Deaths in Delaware and Counties, by Race 
and Sex: 1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
188
148
40
158
127
31
29
20
9
Kent
30
23
7
24
20
< 6
6
< 6
< 6
New Castle
110
89
21
94
77
17
15
11
< 6
Sussex
48
36
12
40
30
10
8
6
< 6
SOURCE: Delaware Health Statistics Center, 2005.


Table 7.7.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates* in the 
United States, Delaware and Counties, by Race and Sex: 1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
4.4 (4.4–4.4)
7.8 (7.7–7.8)
1.8 (1.7–7.8)
Delaware
4.5 (3.9–5.2)
8.3 (6.9–9.7)
1.7 (1.2–2.2)
Kent
4.8 (0.5–9.0)
---
---
New Castle
4.6 (2.3–6.9)
8.9 (3.3–14.4)
---
Sussex
4.5 (0.9–8.1)
7.6 (-0.3–15.6)
---
CAUCASIAN


United States
4.3 (4.3–4.3)
7.6 (7.6–7.7)
1.7 (1.6–1.7)
Delaware
4.5 (3.8–5.2)
8.3 (6.8–9.7)
1.5 (1.0–2.1)
Kent
---
---
---
New Castle
4.6 (2.3–6.9)
9.0 (3.3–14.6)
---
Sussex
4.5 (0.9–8.1)
7.1 (-1.4–15.7)
---
AFRICAN-AMERICAN


United States
6.2 (6.1–6.3)
10.7 (10.4–11.0)
3.0 (2.9–3.2)
Delaware
5.4 (3.4–7.4)
---
---
Kent
---
---
---
New Castle
---
---
---
Sussex
---
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 deaths.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 7.6.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates* in the United 
States and Delaware, by Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.
SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.

Figure 7.7.	Five-Year Average Age-Adjusted Esophagus Cancer Mortality Rates* in Delaware, 
by Race and Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.  SOURCE: Delaware Health Statistics Center, 2005

Table 7.8.	Age-Specific Esophagus Cancer Mortality Rates* in Delaware, by Race and 
Sex: 1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
---
---
0.0
---
0.0
---
0.0
0.0
0.0
40–64
4.7
7.7
---
4.7
7.8
---
---
---
---
65–74
21.7
41.0
---
21.2
40.3
---
---
---
---
75–84
27.6
50.8
---
28.7
50.9
---
---
---
---
85+
---
---
---
---
---
---
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 7.8.	Age-Specific Esophagus Cancer Mortality Rates in Delaware, by Race: 
1999–2003



NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
SOURCE: Delaware Health Statistics Center, 2005.
    

8. Leukemia


Risk Factors and Early Detection

Risk Factors for Leukemia
>	Exposure to ionizing radiation
>	Exposure to benzene
>	Chemotherapy
>	Certain genetic conditions, such as Down syndrome

Possible Risk Factors for Leukemia
>	Cigarette smoking

Under Investigation as Risk Factors for Leukemia
>	Exposure to electromagnetic fields (e.g., from power lines)

Early Detection of Leukemia
There is currently no recommended screening test for leukemia. The best method of early detection is for 
individuals to report any symptoms to their doctors.


Data Highlights

New Cancer Cases and Deaths (Tables 8.1 and 8.4)
>	Leukemia accounted for 1.9 percent of all cancer cases diagnosed during 1999–2003 in Delaware. 
>	A total of 398 leukemia cases were diagnosed among Delaware residents during 1999–2003, 223 
cases (56.0 percent) in males and 175 cases in females. 
>	The majority of leukemia cases (1999–2003) were diagnosed among New Castle County residents 
(230 or 57.8 percent), followed by Sussex County (110 or 27.6 percent) and Kent County (58 or 
14.6 percent) residents. 
>	Caucasian residents made up 83.4 percent (332) of all leukemia cases during 1999–2003, and 
African Americans made up 13.8 percent (55). 
>	Deaths from leukemia accounted for 4 percent of all cancer deaths in Delaware during 1999–2003.
>	During 1999–2003, 336 Delaware residents died from leukemia, and 55.7 percent (187) of deaths 
occurred among males.
>	Caucasians made up 86.9 percent (292) of decedents, and African Americans made up 11.3 percent.
>	A total of 194 (57.7 percent) decedents were from New Castle County, 86 (25.6 percent) were from 
Sussex County, and 56 (16.7 percent) were from Kent County.

Incidence and Mortality Rates (Tables 8.2 and 8.5)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	The leukemia incidence rate in the United States was 60 percent higher among males (12.5 per 
100,000) than females (7.8 per 100,000) in 1999–2003.
>	Delaware’s 1999–2003 leukemia mortality rate was 73 percent higher among males (11.1 per 
100,000) than among females (6.4 per 100,000).
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	The 1999–2003 leukemia incidence rate among Delaware males was 23.8 percent lower than the 
U.S. rate; among females, Delaware’s rate was 18.8 percent lower than the U.S. rate. 
>	The overall leukemia incidence rate was highest in Sussex County, compared with other counties in 
Delaware.
>	Delaware’s 1999–2003 leukemia mortality rate (8.3 per 100,000) was comparable with that of the 
United States (7.6 per 100,000). 
>	The leukemia mortality rate was 18.3 percent higher among Caucasian residents (8.4 per 100,000), 
compared with African-American residents (7.1 per 100,000) during 1999–2003. 
>	The overall, county-specific leukemia mortality rate was highest in Kent County during 1999–2003 
(9.1 per 100,000). 

Trends in Cancer Incidence and Mortality (Figures 8.1–8.2 and 8.4–8.5)
>	The incidence rate of leukemia was stable from 1980–84 to 1999–2003 in Delaware and the United 
States.
>	Mortality rates from leukemia were stable among males and females in Delaware and the United 
States. 

Age-Specific Incidence and Mortality Rates (Tables 8.3 and 8.6, Figures 8.3 and 8.6)
>	The age-specific rates for Delaware showed that the incidence of leukemia increased as age 
increased.
>	Mortality from leukemia peaked at ages 85 and older in both men and women.

Stage at Diagnosis of Leukemia 
>	Leukemia was not staged as local, regional, or distant.


Leukemia Incidence

Table 8.1.	Number of Leukemia Cases in Delaware and Counties, by Race and Sex: 
1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
398
223
175
332
190
142
55
26
29
Kent
58
32
26
46
27
19
11
4
7
New Castle
230
130
100
193
111
82
31
15
16
Sussex
110
61
49
93
52
41
13
7
6
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 8.2.	Five-Year Average Age-Adjusted Leukemia Incidence Rates* in the United 
States (Estimates), Delaware and Counties, by Race and Sex: 1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
12.5 (12.4–12.7)
16.4 (16.1–16.8)
9.6 (9.4–9.8)
Delaware
9.8 (8.8–10.7)
12.5 (10.8–14.1)
7.8 (6.6–8.9)
Kent
9.3 (3.2–15.4)
11.9 (-1.1–24.9)
7.6 (1.1–14.1)
New Castle
9.5 (3.4–15.6)
12.4 (-0.6–25.5)
7.4 (0.9–13.9)
Sussex
10.6 (4.5–16.8)
12.7 (-0.3–25.8)
8.8 (2.3–15.3)
CAUCASIAN


United States
13.2 (13.0–13.4)
17.3 (16.9–17.7)
10.1 (9.9–10.4)
Delaware
9.9 (8.8–11.0)
12.7 (10.9–14.5)
7.7 (6.4–9.0)
Kent
9.2 (2.8–15.6)
---
7.1 (0.6–13.7)
New Castle
9.9 (3.5–16.3)
13.0 (-0.9–26.8)
7.5 (1.0–14.1)
Sussex
10.4 (4.0–16.7)
12.5 (-1.3–26.4)
8.4 (1.8–14.9)
AFRICAN-AMERICAN


United States
9.8 (9.2–10.5)
12.4 (11.4–13.6)
8.0 (7.3–8.7)
Delaware
9.5 (6.9–12.1)
11.9 (6.7–17.0)
8.6 (5.4–11.8)
Kent
---
---
---
New Castle
7.8 (-13.1–28.6)
---
---
Sussex
---
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 cases.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.
       
       
Figure 8.1.	Five-Year Average Age-Adjusted Leukemia Incidence Rates* in the United 
States (Estimates) and Delaware, by Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 8.2.	Five-Year Average Age-Adjusted Leukemia Incidence Rates* in Delaware, 
by Race and Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
Table 8.3.	Age-Specific Leukemia Incidence Rates* in Delaware, by Race and Sex: 
1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
3.0
3.4
2.6
3.3
3.9
---
---
---
---
40–64
9.6
11.4
8.0
9.6
11.3
8.0
---
---
---
65–74
31.9
42.5
22.8
32.6
44.6
22.1
---
---
---
75–84
46.4
63.2
35.1
46.1
64.7
33.5
---
---
---
85+
66.3
---
---
66.8
---
---
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 8.3.	Age-Specific Leukemia Incidence Rates in Delaware, by Race: 1999–2003




NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
     SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
Leukemia Mortality

Table 8.4.	Number of Leukemia Deaths in Delaware and Counties, by Race and Sex: 
1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
336
187
149
292
160
132
38
21
17
Kent
56
32
24
44
24
20
11
7
< 6
New Castle
194
111
83
171
96
75
19
11
8
Sussex
86
44
42
77
40
37
8
< 6
< 6
SOURCE: Delaware Health Statistics Center, 2005.


Table 8.5.	Five-Year Average Age-Adjusted Leukemia Mortality Rates* in the United 
States, Delaware and Counties, by Race and Sex: 1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
7.6 (7.5–7.6)
10.1 (10.0–10.2)
5.8 (5.7–5.9)
Delaware
8.3 (7.4–9.1)
11.1 (9.5–12.8)
6.4 (5.4–7.4)
Kent
9.1 (2.2–15.9)
12.2 (-1.6–26.1)
7.1 (-0.5–14.7)
New Castle
8.2 (4.9–11.5)
12.0 (4.3–19.7)
6.1 (2.9–9.3)
Sussex
7.8 (2.8–12.9)
8.5 (1.2–15.9)
6.7 (0.4–13.0)
CAUCASIAN


United States
7.8 (7.7–7.8)
10.4 (10.3–10.5)
5.9 (5.9–6.0)
Delaware
8.4 (7.4–9.4)
10.9 (9.2–12.7)
6.8 (5.6–7.9)
Kent
8.6 (1.6–15.6)
11.0 (-2.9–24.9)
6.8 (-1.2–14.9)
New Castle
8.6 (5.0–12.2)
12.1 (3.9–20.2)
6.7 (3.1–10.4)
Sussex
7.7 (2.3–13.1)
8.4 (0.5–16.3)
6.6 (0.0–13.3)
AFRICAN-AMERICAN


United States
6.7 (6.5–6.8)
8.8 (8.5–9.0)
5.3 (5.2–5.5)
Delaware
7.1 (4.8–9.5)
---
---
Kent
---
---
---
New Castle
---
---
---
Sussex
---
---
---
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.
--- = Rate based on fewer than 25 deaths.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 8.4.	Five-Year Average Age-Adjusted Leukemia Mortality Rates* in the United 
States and Delaware, by Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Health Statistics Center, 2005; U.S.: National Center for Health Statistics, 2006.


Figure 8.5.Five-Year Average Age-Adjusted Leukemia Mortality Rates* in Delaware, 
by Race and Sex: 1980–2003

 

* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Health Statistics Center, 2005.
Table 8.6.	Age-Specific Leukemia Mortality Rates* in Delaware, by Race and Sex: 
1999–2003

Age 
Group
All Races
Caucasian
African-American

All
Male
Female
All
Male
Female
All
Male
Female
0–39
---
---
---
---
---
---
---
---
---
40–64
5.4
5.7
5.2
5.5
6.0
5.2
---
---
---
65–74
33.6
43.2
25.4
35.5
45.5
26.7
---
---
---
75–84
56.9
87.9
36.0
59.2
92.4
36.6
---
---
---
85+
86.0
---
67.6
87.1
---
73.7
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.


Figure 8.6.	Age-Specific Leukemia Mortality Rates in Delaware, by Race: 1999–2003




NOTE: Figure is not displayed because of patient confidentiality rules; 
small number of cases precludes display of data.
SOURCE: Delaware Health Statistics Center, 2005.


9. Lung and Bronchus Cancer


Risk Factors

Risk Factors for Lung Cancer
>	Tobacco use: cigarette, cigar, and pipe smoking (87 percent of lung cancers are estimated to be 
caused by smoking cigarettes, cigars, or pipes) 
>	Occupational or environmental exposures to asbestos, chromium, mustard gas, nickel, or other 
metals
>	Exposure to secondhand smoke 
>	Exposure to radon gas
>	Marijuana use
>	Radiation therapy to the lungs
>	Personal history of lung cancer 

Possible Risk Factors for Lung Cancer
>	Low intake of fruits and vegetables

Early Detection of Lung Cancer
There is currently no effective screening test for lung cancer. The American Cancer Society recommends 
that people at higher risk for lung cancer be aware of their risk.

Cigarette smoking is recognized as a risk factor in the development of numerous other cancers, including 
cervical, esophagus, kidney, larynx, oral cavity and pharynx, pancreas and urinary bladder. Although this 
document is about cancer in Delaware, it is important to note that cigarette smoking is the single most 
preventable cause of both morbidity and mortality from chronic diseases in the United States.

In the BRFSS survey, a “current cigarette smoker” was defined as a respondent who answered “every 
day” or “some days” to the question: “Do you now smoke cigarettes every day, some days, or not at all?”

Current Trends in Smoking in Delaware and the United States

Note:  Current trends in smoking may be predictive of cancer rates in the 2030s.  In the 1980s (i.e., the 
time period relevant to current lung and bronchus cancer rates), Delaware had smoking prevalence rates 
among the highest in the country; about one-third of Delaware adults smoked in the period 1979-1982.  
This rate declined to about 25 to 26 percent in the 1990s, and is now approaching 20 percent.  

Smoking Trends in Delaware in 2005
>	The prevalence of cigarette smoking in Delaware (20.7 percent) was comparable to prevalence in the 
U.S. (20.5 percent).  
>	More males in Delaware (22.5 percent) than females (19.0 percent) were cigarette smokers, and the 
same was true for the United States (22.1 percent and 19.2 percent, respectively).
>	In Delaware, the prevalence of smoking is comparable between African Americans and Caucasians:  
20.7 and 20.9 percent, respectively.  For the United States, 20.7 percent of African Americans and 
20.4 percent of Caucasians were current smokers.
>	The prevalence of cigarette smoking was similar across all age groups between the ages of 18 and 
54 in Delaware, with rates ranging from 23.6 to 26.1 percent.  Prevalence was somewhat lower in the 
55-64 age group (17.3 percent) and lowest in the 65 and older age group (7.9 percent).
>	Smoking was highest in prevalence among those Delawareans with less than a high school education 
(35.8 percent), followed by those with a high school education (27.0 percent), and was lowest among 
college graduates (11.6 percent). U.S. data similarly showed that the prevalence of cigarette smoking 
decreased as level of education increased. 
>	In Delaware, smoking prevalence was comparable across all income groups under $50,000, ranging 
from 24.1 to 26.7 percent.  Prevalence declined somewhat in the $50,000-$74,999 and equal to or 
greater than $75,000 income groups, which had rates of 18.2 and 16.6 percent, respectively. 


Data Highlights

New Cancer Cases and Deaths (Tables 9.1 and 9.6)
>	Lung cancer was the most commonly diagnosed cancer overall in Delaware and the second most 
commonly diagnosed cancer in males and in females. 
>	The 3,238 lung cancer cases during 1999–2003 in Delaware accounted for 15.6 percent of all cancer 
cases.
>	The majority of lung cancer cases diagnosed during 1999–2003 were New Castle County residents 
(1,796 or 55.5 percent), followed by Sussex County (919 or 28.4 percent) and Kent County (519 or 
16.0 percent) residents. 
>	Fifty-five percent (1,780) of lung cancer cases were males, and 45.0 percent (1,458) were females 
during 1999–2003. 
>	Caucasian residents made up 84.1 percent (2,723) of lung cancer cases in 1999–2003, and African 
Americans  made up 14.3 percent (466); 21 cases were Hispanic residents, and 26 were from other 
race groups.
>	Lung cancer was the primary cause of cancer deaths among Delaware males and females and 
accounted for about 30 percent of all cancer deaths during 1999–2003.
>	During 1999–2003, 2,545 Delaware residents died from lung cancer, 1,447 males (56.9 percent) and 
1,098 females (43.1 percent).
>	Caucasian residents made up 2,143 (84.2 percent) of decedents, and African Americans made up 
369 (14.5 percent); Hispanic residents made up 18 decedents, and 15 were from other race groups.
>	Most decedents (1,387 or 54.5 percent) were residents of New Castle County, followed by Sussex 
County (716 or 28.1 percent) and Kent County (442 or 17.4 percent).

Incidence and Mortality Rates (Tables 9.2 and 9.5)
Significant Findings (The results reported in this section reflect rates in which the confidence intervals did 
not overlap. This means that differences in observed rates were unlikely to be due to chance variation.)
>	Lung cancer incidence in Delaware was 55 percent higher among males (97.9 per 100,000) than 
females (63.2 per 100,000) in 1999–2003.
>	Delaware’s overall lung cancer incidence rate was 21.7 percent higher than the U.S. estimate in 
1999–2003.
>	There was a greater racial disparity in Delaware among males than among females. African-
American males (119.3 per 100,000) had a 25 percent higher rate, compared with Caucasian males 
(95.3 per 100,000). 
>	The 1999–2003 lung cancer mortality rate was 73 percent higher among males (81.1 per 100,000) 
than females (47.0 per 100,000) in Delaware.
>	Lung cancer mortality was 16 percent higher among African Americans (70.4 per 100,000) than 
among Caucasians (60.5 per 100,000) in Delaware during 1999–2003. 
Suggestive Findings (The results reported in this section reflect rates in which the confidence intervals 
overlap. This means that observed differences may be due simply to chance variation.)
>	Kent and Sussex Counties had similar overall lung cancer incidence rates (82.1 and 81.0 per 
100,000, respectively), compared with New Castle County (75.0 per 100,000).
>	Among males overall, incidence was highest in Kent County (107.0 per 100,000), while incidence 
among females was highest in Sussex County (65.2 per 100,000).
>	African Americans in Delaware had a higher lung cancer incidence rate (86.0 per 100,000 in  
1999–2003) than Caucasian residents (76.9 per 100,000). 
>	African-American and Caucasian females had comparable lung cancer incidence rates (63.4 and 
63.6 per 100,000, respectively).
>	Overall lung cancer mortality was highest in Kent County during 1999–2003 (70.5 per 100,000). 
African-American males living in Sussex County, however, had a higher lung cancer mortality rate 
(136.0 per 100,000) than any other race/sex group in any county.

Trends in Cancer Incidence and Mortality (Figures 9.1–9.2 and 9.6–9.7)
>	Lung cancer incidence has decreased in Delaware in recent years in males, particularly among 
African Americans.
>	Lung cancer incidence rates in Delaware among females, however, increased or remained the same.
>	Lung cancer mortality rates have decreased among Caucasian and African-American males in 
Delaware and the United States since 1990–94. 
>	Delaware’s mortality rates were higher than those for the United States for both males and females. 
In 1999–2003, the rates were 11.6 percent higher than the overall U.S. rates.

Age-Specific Incidence and Mortality Rates (Tables 9.3 and 9.8, Figures 9.3 and 9.8)
>	The incidence of lung cancer increased as age increased, with a peak incidence at ages 75–84.
>	The age-specific mortality rates from lung cancer peaked at ages 75–84 in men and women in 
Delaware. 

Stage at Diagnosis of Lung Cancer (Tables 9.4–9.5, Figures 9.4–9.5)
>	A total of 2,309 cases (71.3 percent of all lung cancers) were diagnosed in the late stages (i.e., 
regional or distant).
>	In Delaware, a greater proportion of lung cancers were diagnosed in the local stage (18.9 percent), 
compared with the U.S. estimate (16.9 percent). Also, fewer lung cancers were diagnosed in the 
distant stage in Delaware (43.8 percent) than in the U.S. estimate (52.5 percent).
>	Caucasian females were the most likely (21.7 percent) and African-American males the least likely 
(14.9 percent) to be diagnosed with lung cancer in the local stage.
>	Caucasians were less likely than African Americans  to be diagnosed with lung cancer in the late 
stages (70.3 percent and 76.6 percent, respectively).


Lung Cancer Incidence

Table 9.1.	Number of Lung Cancer Cases in Delaware and Counties, by Race and Sex: 1999–2003


All Races
Caucasian
African-American

All
Male 
Female
All
Male 
Female
All
Male 
Female
Delaware
3,238
1,780
1,458
2,723
1,483
1,240
466
268
198
Kent
519
299
220
435
249
186
75
44
31
New Castle
1,796
957
839
1,461
772
689
308
166
142
Sussex
919
522
397
824
462
364
83
58
25
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 9.2.	Five-Year Average Age-Adjusted Lung Cancer Incidence Rates* in the 
United States (Estimates), Delaware and Counties, by Race and Sex:  
1999–2003

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
63.9 (63.4–64.3)
81.0 (80.3–81.8)
51.6 (51.1–52.1)
Delaware
77.8 (75.1–80.5)
97.9 (93.3–102.5)
63.2 (60.0–66.5)
Kent
82.1 (65.2–98.9)
107.0 (73.9–140.1)
63.2 (44.6–81.8)
New Castle
75.0 (66.5–83.6)
93.3 (76.7–110.0)
62.3 (52.4–72.1)
Sussex
81.0 (68.2–93.9)
101.6 (76.9–126.2)
65.2 (50.7–79.7)
CAUCASIAN


United States
64.6 (64.1–65.1)
80.0 (79.2–80.9)
53.6 (53.0–54.2)
Delaware
76.9 (74.0–79.8)
95.3 (90.4–100.2)
63.6 (60.0–67.1)
Kent
83.9 (65.6–102.3)
108.6 (72.0–145.2)
65.4 (44.9–85.9)
New Castle
73.3 (64.1–82.4)
90.0 (72.5–107.5)
61.6 (50.9–72.2)
Sussex
80.6 (67.2–94.0)
98.5 (72.9–124.1)
67.0 (51.5–82.5)
AFRICAN-AMERICAN


United States
80.5 (78.8–82.3)
115.0 (111.7–118.5)
57.2 (55.3–59.2)
Delaware
86.0 (78.0–94.0)
119.3 (104.1–134.5)
63.4 (54.5–72.3)
Kent
78.2 (31.6–124.8)
102.1 (17.7–186.5)
58.3 (8.1–108.4)
New Castle
87.5 (61.2–113.8)
116.0 (55.4–176.6)
69.9 (41.3–98.4)
Sussex
86.7 (39.1–134.2)
145.7 (41.7–249.7)
45.2 (3.0–87.4)
* = Rates are per 100,000 population and age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 9.1.	Five-Year Average Age-Adjusted Lung Cancer Incidence Rates* in the 
United States (Estimates) and Delaware, by Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCES: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005; U.S.: Surveillance, 
Epidemiology, and End Results (SEER) Program, National Cancer Institute, 2006.


Figure 9.2.Five-Year Average Age-Adjusted Lung Cancer Incidence Rates* in Delaware, 
by Race and Sex: 1980–2003

 
* = Rates are age-adjusted to the 2000 U.S. standard population.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health,