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, 2005.
Table 9.3.	Age-Specific Lung 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
1.7
---
---
1.80
---
---
---
---
---
40–64
90.1
103.6
77.5
89.7
100.1
79.9
100.4
132.3
73.5
65–74
393.3
484.7
314.9
398.3
486.0
322.0
377.2
476.6
300.6
75–84
439.5
571.1
351.0
434.9
551.6
355.7
478.3
765.5
303.0
85+
302.8
548.9
205.2
291.7
539.2
192.8
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

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

Figure 9.3.Age-Specific Lung Cancer Incidence Rates in Delaware, by Race:  
1999–2003


 
NOTE: Rates for African Americans ages 0–39 and 85+ are not displayed due to patient confidentiality rules.

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



Lung Cancer by Stage at Diagnosis

Table 9.4.	Number of Lung 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
613
302
311
529
260
269
79
40
39
Regional
892
478
414
739
388
351
142
83
59
Distant
1,417
836
581
1,175
691
484
215
129
86
Unknown
316
164
152
280
144
136
30
16
14
Total
3,238
1,780
1,458
2,723
1,483
1,240
466
268
198
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 9.5.	Percentage of Lung 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
18.9
17.0
21.3
19.4
17.5
21.7
17.0
14.9
19.7
Regional
27.6
26.9
28.4
27.1
26.2
28.3
30.5
31.0
29.8
Distant
43.8
47.0
39.9
43.2
46.6
39.0
46.1
48.1
43.4
Unknown
9.8
9.2
10.4
10.2
9.7
11.0
6.4
6.0
7.1
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.

Figure 9.4.	Percentage of Lung Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 9.4a. Delaware: 1999–2003

Figure 9.4b. 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 9.5.	Percentage of Lung Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003

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



Lung Cancer Mortality

Table 9.6.	Number of Lung 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
2,545
1,447
1,098
2,143
1,204
939
369
224
145
Kent
442
272
170
376
226
150
59
41
18
New Castle
1,387
774
613
1,139
632
507
232
130
102
Sussex
716
401
315
628
346
282
78
53
25
SOURCE: Delaware Health Statistics Center, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
55.1 (55.0–55.2)
74.8 (74.5–75.0)
41.0 (40.9–41.2)
Delaware
61.5 (59.1–63.8)
81.1 (76.8–85.3)
47.0 (44.2–49.8)
Kent
70.5 (53.4–87.6)
100.3 (65.0–135.5)
48.5 (30.5–66.4)
New Castle
58.3 (50.3–66.3)
76.8 (60.9–92.6)
45.0 (36.0–54.0)
Sussex
63.5 (51.1–75.8)
79.5 (56.0–102.9)
51.0 (36.7–65.3)
CAUCASIAN


United States
55.3 (55.2–55.4)
73.8 (73.6–74.0)
42.0 (41.8–42.1)
Delaware
60.5 (57.9–63.0)
78.4 (73.9–83.0)
47.1 (44.1–50.1)
Kent
72.7 (54.0–91.5)
101.6 (62.5–140.7)
52.0 (32.2–71.9)
New Castle
56.9 (48.4–65.5)
74.3 (57.7–90.8)
44.2 (34.6–53.9)
Sussex
61.5 (48.7–74.2)
75.2 (51.1–99.3)
50.9 (36.0–65.8)
AFRICAN-AMERICAN


United States
63.0 (62.5–63.4)
98.4 (97.6–99.3)
39.8 (39.4–40.3)
Delaware
70.4 (63.0–77.7)
103.3 (88.9–117.7)
47.7 (39.9–55.6)
Kent
61.3 (17.7–104.9)
90.5 (12.1–169.0)
---
New Castle
69.1 (44.2–94.0)
97.5 (39.6–155.5)
51.6 (25.2–78.0)
Sussex
82.4 (31.6–133.1)
136.0 (28.6–243.4)
45.0 (-4.8–94.7)
* = 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 9.6.	Five-Year Average Age-Adjusted Lung 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 9.7.Five-Year Average Age-Adjusted Lung 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 9.8.	Age-Specific Lung 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
---
40–64
60.0
73.3
47.6
59.6
71.0
49.3
66.6
92.9
44.4
65–74
297.4
390.7
217.3
295.1
384.3
217.4
345.5
483.3
239.5
75–84
417.5
550.5
327.9
416.2
534.6
335.8
430.0
694.6
268.4
85+
331.5
536.3
250.2
318.0
517.9
238.1
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 9.8.	Age-Specific Lung Cancer Mortality Rates in Delaware, by Race: 1999–2003

 
NOTE: Rates for African Americans ages 85+ and Caucasians and African Americans ages 0–39 are not displayed 
due to patient confidentiality rules.

SOURCE: Delaware Health Statistics Center, 2005.


10. Malignant Melanoma


Risk Factors and Early Detection

Risk Factors for Malignant Melanoma
>	Exposure to sunlight or artificial ultra-violet light
>	One or more large or uneven moles
>	Fair skin, light hair, blue eyes and freckling
>	Previous malignant melanoma
>	Family history of malignant melanoma
>	Increasing age
>	Immune suppression


Early Detection of Malignant Melanoma
>	Self-examination of skin
>	Physician examination of skin in high-risk individuals


Data Highlights

New Cancer Cases and Deaths (Tables 10.1 and 10.6)
>	There were 674 cases of malignant melanoma among Delaware residents during 1999–2003, 394 
cases (58.5 percent) in males and 280 (41.5 percent) in females. 
>	The majority of malignant melanoma cases during 1999–2003 were diagnosed among New Castle 
County residents (433 or 64.2 percent), followed by Sussex County (173 or 25.7 percent) and Kent 
County (65 or 9.6 percent) residents. 
>	Almost all malignant melanoma cases in 1999–2003 occurred among Caucasian residents (624 or 
92.6 percent). 
>	During 1999–2003, 130 Delaware residents died from malignant melanoma, and the majority of 
deaths (66.2 percent) occurred among males.
>	Almost all decedents were Caucasian (127 or 97.7 percent). 
>	A total of 83 (63.9 percent) decedents were from New Castle County, 32 (24.6 percent) were from 
Sussex County, and 15 (11.5 percent) were from Kent County.

Incidence and Mortality Rates (Tables 10.2 and 10.7)
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 had a lower incidence rate of melanoma in 1999–2003, compared with the United States.
>	During 1999–2003, the malignant melanoma incidence rate was 69 percent higher among males 
(21.6 per 100,000) than females (12.8 per 100,000).
>	Delaware’s 1999–2003 malignant melanoma mortality rate was higher among males (5.0 per 
100,000) than females (2.0 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.)
>	Malignant melanoma incidence was highest in Caucasian males in New Castle County (26.9 per 
100,000).
Trends in Cancer Incidence and Mortality (Figures 10.1–10.2 and 10.6–10.7)
>	Since 1990–94, Delaware’s malignant melanoma incidence rate was lower than the U.S. estimate in 
both men and women.
>	Malignant melanoma increased at a greater rate among Caucasian males than females in Delaware.
>	Although Delaware’s incidence was lower than that of the United States, Delaware’s mortality rate 
from malignant melanoma was higher than the U.S. rate for both males and females. The gap 
between Delaware and U.S. rates narrowed among females and widened among males.

Age-Specific Incidence and Mortality Rates (Tables 10.3 and 10.8, Figures 10.3 and 10.8)
>	The age-specific incidence rates showed that the incidence of malignant melanoma increased with 
age.

Stage at Diagnosis of Malignant Melanoma (Tables 10.4–10.5, Figures 10.4–10.5)
>	In Delaware, proportionally fewer malignant melanoma cases were diagnosed in the local stage in 
1999–2003 (79.4 percent), compared with the U.S. estimate for 1999–2003 (86.0 percent). 
>	Delaware had larger proportions of cases diagnosed in the regional (8.5 percent) and distant stages 
(3.9 percent) than the United States (7.6 percent and 3.3 percent, respectively). In Delaware, there 
were more unstaged malignant melanoma cases, compared with the United States (8.3 and 
3.2 percent, respectively).
>	From 1980–84 to 1999–2003, the proportions of local, regional, and distant stages of malignant 
melanoma did not change appreciably.


Malignant Melanoma Incidence

Table 10.1.	Number of Malignant Melanoma 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
674
394
280
624
374
250
< 6
< 6
< 6
Kent
65
38
27
59
36
23
0
0
0
New Castle
433
248
185
400
235
165
< 6
< 6
< 6
Sussex
173
106
67
163
102
61
0
0
0
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.

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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
18.7 (18.5–18.9)
23.3 (22.9–23.7)
15.5 (15.2–15.8)
Delaware
16.4 (15.2–17.7)
21.6 (19.4–23.7)
12.8 (11.3–14.4)
Kent
10.3 (4.4–16.3)
14.1 (-0.0–28.2)
8.1 (3.4–12.7)
New Castle
17.7 (14.0–21.3)
23.4 (15.4–31.4)
13.9 (10.1–17.6)
Sussex
17.2 (11.9–22.4)
20.6 (11.4–29.8)
14.4 (8.5–20.4)
CAUCASIAN


United States
22.4 (22.1–22.7)
27.4 (27.0–27.9)
19.0 (18.6–19.3)
Delaware
18.6 (17.1–20.0)
24.4 (21.9–26.9)
14.4 (12.6–16.2)
Kent
11.6 (4.7–18.6)
16.5 (-0.5–33.4)
---
New Castle
20.4 (16.2–24.5)
26.9 (17.9–35.9)
15.9 (11.6–20.2)
Sussex
18.6 (12.9–24.4)
23.1 (13.0–33.2)
15.6 (9.0–22.2)
AFRICAN-AMERICAN


United States
0.9 (0.7–1.1)
1.3 (0.9–1.7)
0.7 (0.5–0.9)
Delaware
---
---
---
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 10.1.	Five-Year Average Age-Adjusted Malignant Melanoma 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 10.2.Five-Year Average Age-Adjusted Malignant Melanoma Incidence Rates* in 
Delaware, by 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 10.3.	Age-Specific Malignant Melanoma 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
3.8
2.5
5.1
4.8
3.2
6.4
0.00
0.00
0.00
40–64
24.1
28.3
20.0
27.8
33.8
22.0
---
0.00
---
65–74
53.6
82.7
28.6
58.3
90.2
30.5
---
---
0.00
75–84
56.9
92.0
33.3
62.9
100.2
37.7
0.00
0.00
0.00
85+
64.5
---
---
68.9
141.9
39.7
0.00
0.0
0.0
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 10.3.	Age-Specific Malignant Melanoma 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.


Malignant Melanoma by Stage at Diagnosis

Table 10.4.	Number of Malignant Melanoma 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
535
307
228
495
290
205
< 6
< 6
< 6
Regional
57
39
18
57
39
18
0
0
0
Distant
26
16
10
26
16
10
0
0
0
Unknown
56
32
24
46
29
17
0
0
0
Total
674
394
280
624
374
250
< 6
< 6
< 6
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 10.5.	Percentage of Malignant Melanoma 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
79.4
77.9
81.4
79.3
77.5
82.0
---
---
---
Regional
8.5
9.9
6.4
9.11
10.4
7.2
0
0
0
Distant
3.9
4.1
3.6
4.2
4.3
4.0
0
0
0
Unknown
8.3
8.1
8.6
7.4
7.8
6.8
0
0
0
Total
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 10.4.	Percentage of Malignant Melanoma Cases in Delaware and the United 
States (Estimates), by Stage at Diagnosis: 1999–2003


Figure 10.4a. Delaware: 1999–2003

Figure 10.4b. 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 10.5.	Percentage of Malignant Melanoma Cases in Delaware, by Stage at 
Diagnosis: 1980–2003

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


Malignant Melanoma Mortality

Table 10.6.	Number of Malignant Melanoma 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
130
86
44
127
84
43
< 6
< 6
< 6
Kent
15
10
< 6
15
10
< 6
0
0
0
New Castle
83
54
29
81
53
28
< 6
< 6
< 6
Sussex
32
22
10
31
21
10
< 6
< 6
0
SOURCE: Delaware Health Statistics Center, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
2.6 (2.6–2.7)
3.8 (3.8–3.9)
1.8 (1.7–1.8)
Delaware
3.2 (2.6–3.7)
5.0 (3.9–6.1)
2.0 (1.4–2.5)
Kent
---
---
---
New Castle
3.5 (1.6–5.4)
5.4 (1.0–9.9)
2.2 (0.5–3.8)
Sussex
3.0 (0.5–5.4)
4.6 (-0.9–10.2)
1.8 (-0.3–4.0)
CAUCASIAN


United States
3.0 (3.0–3.0)
4.3 (4.3–4.4)
2.0 (2.0–2.0)
Delaware
3.7 (3.0–4.3)
5.7 (4.4–6.9)
2.4 (1.6–3.1)
Kent
---
---
---
New Castle
4.1 (1.9–6.2)
6.3 (1.2–11.3)
2.6 (0.6–4.5)
Sussex
3.4 (0.7–6.0)
---
---
AFRICAN-AMERICAN 


United States
0.4 (0.4–0.5)
0.5 (0.4–0.5)
0.4 (0.4–0.5)
Delaware
---
---
---
Kent
0
0
0
New Castle
---
---
---
Sussex
---
---
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 10.6.	Five-Year Average Age-Adjusted Malignant Melanoma 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 10.7.Five-Year Average Age-Adjusted Malignant Melanoma Mortality Rates* in 
Delaware, by Sex: 1980–2003

 

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


Table 10.8.	Age-Specific Malignant Melanoma 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
40–64
3.9
4.4
---
4.8
5.5
---
---
0.0
---
65–74
12.3
22.0
---
13.9
24.5
---
---
---
0.0
75–84
17.7
---
---
19.3
---
---
---
---
0.0
85+
---
---
---
---
---
---
0.0
0.0
0.0
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 10.8.	Age-Specific Malignant Melanoma 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.


11. Ovarian Cancer


Risk Factors

Risk Factors for Ovarian Cancer
>	Increasing age
>	Family history of cancer of the uterus, colon, or breast
>	Mother, sister, or daughter with ovarian cancer 
>	Personal history of breast cancer
>	Inherited mutation in BRCA1 or BRCA2 genes
>	Obesity
>	No history of oral contraceptive use or use for fewer than five years
>	Never giving birth

Possible Risk Factors for Ovarian Cancer
>	Fertility drugs
>	Talc exposure
>	Smoking and alcohol use
>	Hormone replacement therapy in postmenopausal females

Early Detection of Ovarian Cancer
There is currently no reliable way to identify ovarian cancer early. Females are encouraged to have 
regular health examinations.


Data Highlights

New Cancer Cases and Deaths (Tables 11.1 and 11.6)
>	Ovarian cancer accounted for 3.2 percent of all cancers among females in Delaware during  
1999–2003.
>	Caucasian residents made up 86.0 percent (277) of the 322 ovarian cancer cases in 1999–2003, and 
African-American residents made up 11.0 percent (35); six cases were diagnosed among other race 
groups in Delaware.
>	The majority of ovarian cancer cases during 1999–2003 were diagnosed among New Castle County 
residents (199 or 61.8 percent), followed by Sussex County (74 or 23.0 percent) and Kent County (46 
or 14.3 percent) residents. 
>	During 1999–2003, 211 Delaware residents died from ovarian cancer; 188 (89.1 percent) decedents 
were Caucasian, and 16 (7.6 percent) were African-American.
>	A total of 125 (59.2 percent) decedents were from New Castle County, 54 (25.6 percent) were from 
Sussex County, and 32 (15.2 percent) were from Kent County.
>	Differences in ovarian cancer mortality patterns by race were difficult to identify due to the small 
number of deaths among African-American females in Delaware. 

Incidence and Mortality Rates (Tables 11.2 and 11.7)
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.)
>	Caucasian female Delaware residents in 1999–2003 had a 57 percent higher ovarian cancer 
incidence rate (15.1 per 100,000) than African-American females (9.6 per 100,000).
>	Ovarian cancer mortality rates in Delaware are difficult to compare by race due to the small number of 
deaths among African-American females. 
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.)
>	In 1999–2003, the overall ovarian cancer incidence was highest in Caucasian females in New Castle 
County (15.7 per 100,000).
>	Delaware’s 1999–2003 age-adjusted ovarian cancer mortality rate was similar to the U.S. rate (9.1 
per 100,000 and 8.9 per 100,000, respectively).

Trends in Cancer Incidence and Mortality (Figures 11.1–11.2 and 11.6–11.7)
>	Delaware’s overall ovarian cancer incidence rate has been higher than the U.S. estimate since  
1984–88 and was 3.4 percent higher than the U.S. estimate in 1999–2003.
>	Delaware’s ovarian cancer incidence rate increased from 1980–84 to 1992–96, but since then the 
rates in both Delaware and the United States have declined. 

Age-Specific Incidence and Mortality Rates (Tables 11.3 and 11.8, Figures 11.3 and 11.8)
>	In Delaware, age-specific mortality from ovarian cancer increased with age. 

Stage at Diagnosis of Ovarian Cancer (Tables 11.4–11.5, Figures 11.4–11.5)
>	Most ovarian cancer cases in Delaware were diagnosed either in the local (21.7 percent) or distant 
(55.6 percent) stages. 
>	The proportion of distant stage ovarian cancers was higher among African-American (60 percent) 
than Caucasian (54.2 percent) females. 
>	A higher proportion of Caucasian (22.4 percent) than African-American (20.0 percent) females had 
local stage ovarian cancer at the time of diagnosis. 
>	The proportion of ovarian cancer cases diagnosed in the distant stage was stable from 1980–84 to 
1999–2003.
>	In Delaware during 1999–2003, more ovarian cancers were diagnosed in the local stage 
(21.7 percent), compared with the U.S. estimate of 14.3 percent for 1999–2003. 
>	The proportions of cases diagnosed in the regional (15.2 percent) and distant stages (55.6 percent) in 
Delaware were lower than the U.S. estimates (17.4 percent and 61.5 percent, respectively).


Ovarian Cancer Incidence

Table 11.1.	Number of Ovarian Cancer Cases in Delaware and Counties, by Race: 
1999–2003


All  
Female
Caucasian 
Female
African-American 
Female
Delaware
322
277
35
Kent
46
36
8
New Castle
199
168
24
Sussex
74
70
< 6
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 11.2.	Five-Year Average Age-Adjusted Ovarian Cancer Incidence Rates* in the 
United States (Estimates), Delaware and Counties, by Race: 1999–2003 


All  
Female
Caucasian 
Female
African-American 
Female
United States 
13.9 (13.7–14.2)
14.7 (14.4–15.0)
10.5 (9.7–11.3)
Delaware
14.4 (12.8–16.0)
15.1 (13.3–16.8)
9.6 (6.4–12.9)
Kent
13.4 (5.4–21.4)
14.7 (5.6–23.8)
---
New Castle
14.9 (10.7–19.0)
15.7 (10.9–20.4)
---
Sussex
12.7 (6.6–18.8)
14.5 (7.7–21.3)
---
* = 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 11.1.	Five-Year Average Age-Adjusted Ovarian 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 11.2.	Five-Year Average Age-Adjusted Ovarian 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 11.3.	Age-Specific Ovarian Cancer Incidence Rates* in Delaware, by Race: 
1999–2003

Age 
Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
---
---
---
40–64
25.1
26.0
---
65–74
47.5
50.4
---
75–84
48.0
51.3
---
85+
---
---
0.00
* = Rates are per 100,000 population. 
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
Figure 11.3.	Age-Specific Ovarian 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.


Ovarian Cancer by Stage at Diagnosis

Table 11.4.	Number of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis and 
Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
70
62
7
Regional
49
43
< 6
Distant
179
150
21
Unknown
24
22
< 6
Total
322
277
35
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.

Table 11.5.	Percentage of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis 
and Race: 1999–2003

Stage at 
Diagnosis
All  
Female
Caucasian 
Female
African-American  
Female
Local
21.7
22.4
20.0
Regional
15.2
15.5
---
Distant
55.6
54.2
60.0
Unknown
7.5
7.9
---
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 11.4.	Percentage of Ovarian Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 11.4a. Delaware: 1999–2003

Figure 11.4b. 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 11.5.	Percentage of Ovarian Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003

 

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


Ovarian Cancer Mortality

Table 11.6.	Number of Ovarian Cancer Deaths in Delaware and Counties, by Race:  
1999–2003


All  
Female
Caucasian 
Female
African-American  
Female
Delaware
211
188
16
Kent
32
25
6
New Castle
125
12
8
Sussex
54
52
< 6
SOURCE: Delaware Health Statistics Center, 2005.


Table 11.7.	Five-Year Average Age-Adjusted Ovarian Cancer Mortality Rates* in the United 
States, Delaware and Counties, by Race: 1999–2003


All  
Female
Caucasian 
Female
African-American  
Female
United States
8.9 (8.8–9.0)
9.2 (9.2–9.3)
7.4 (7.2–7.6)
Delaware
9.1 (7.9–10.4)
9.7 (8.3–11.0)
---
Kent
9.2 (2.0–16.3)
8.7 (0.9–16.4)
---
New Castle
9.2 (5.3–13.1)
---
---
Sussex
9.2 (3.0–15.3)
10.1 (3.3–16.9)
---
* = 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 11.6.	Five-Year Average Age-Adjusted Ovarian 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 11.7.	Five-Year Average Age-Adjusted Ovarian Cancer Mortality Rates* in 
Delaware, by Race: 1980–2003

 

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

NOTE: Rates for 1980–84 to 1982–86 and 1993–97 to 1999–2003 among African-American females have been omitted 
due to patient confidentiality rules.

SOURCE: Delaware Health Statistics Center, 2005.


Table 11.8.	Age-Specific Ovarian Cancer Mortality Rates* in Delaware, by Race:  
1999–2003 

Age 
Group
All  
Female
Caucasian 
Female
African-American  
Female
0–39
---
---
0.0
40–64
11.3
12.6
---
65–74
39.7
39.7
---
75–84
49.9
52.3
---
85+
---
---
---
* = Rates are per 100,000 population. 

SOURCE: Delaware Health Statistics Center, 2005.


Figure 11.8.	Age-Specific Ovarian 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.


12. Pancreatic Cancer


Risk Factors

Risk Factors for Pancreatic Cancer
>	Increasing age
>	Being male
>	African-American race
>	Family history 
>	Cigarette smoking
>	Diabetes 
>	Occupational exposure to petroleum and certain chemicals

Possible Risk Factors for Pancreatic Cancer
>	Diet high in fat and/or low in fruits and vegetables
>	Chronic pancreatitis
>	Stomach problems
>	Certain hereditary conditions, such as hereditary pancreatitis
>	Obesity


Early Detection of Pancreatic Cancer
There is currently no simple screening test for pancreatic cancer. People with a strong family history of 
pancreatic cancer may want to consider genetic screening or one of the more complicated and expensive 
forms of screening, such as a combined PET and CT scan.


Data Highlights

New Cancer Cases and Deaths (Tables 12.1 and 12.6)
>	Pancreatic cancer accounted for 2.2 percent of all cancer cases diagnosed during 1999–2003 in 
Delaware. 
>	A total of 457 pancreatic cancer cases were diagnosed among Delaware residents during  
1999–2003, 215 (47.1 percent) in males and 242 (52.9 percent) in females. 
>	The majority of pancreatic cancer cases (1999–2003) were New Castle County residents (262 or 
57.3 percent), followed by Sussex County (117 or 25.6 percent) and Kent County (78 or 17.1 percent) 
residents. 
>	Caucasian residents made up 81.0 percent (370) of all pancreatic cancer cases in 1999–2003, and 
African-American residents made up 16.9 percent (77); six cases were from other race groups.
>	Deaths from pancreatic cancer accounted for 5.3 percent of all cancer deaths during 1999–2003 in 
Delaware.
>	During 1999–2003, 445 Delaware residents died from pancreatic cancer; the majority of decedents 
(232 or 52.1 percent) were male, and 213 were female. 
>	Caucasian residents made up 81.8 percent (364) of decedents, and African-American residents made 
up 16.6 percent (74).
>	A total of 260 (58.4 percent) decedents were from New Castle County, followed by 107 (24.0 percent) 
from Sussex County and 78 (17.5 percent) from Kent County.

Incidence and Mortality Rates (Tables 12.2 and 12.7)
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.)
>	None to report
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.)
>	Delaware’s pancreatic cancer incidence was similar to the U.S. estimate (11.1 and 11.3 per 100,000, 
respectively). 
>	Pancreatic cancer incidence was 16 percent higher among males (11.9 per 100,000) than females 
(10.3 per 100,000) in 1999–2003.
>	Pancreatic cancer incidence was highest among males (13.1 per 100,000) and females (11.3 per 
100,000) in Kent County. 
>	African Americans in Delaware had a 42 percent higher overall pancreatic cancer incidence rate (14.9 
per 100,000 in 1999–2003) than Caucasians (10.5 per 100,000).
>	Delaware’s overall pancreatic cancer mortality rate was similar to the U.S. rate (10.9 and 10.5 per 
100,000, respectively). 
>	Delaware’s 1999–2003 pancreatic cancer mortality rate was 47 percent higher among males (13.2 
per 100,000) than females (9.0 per 100,000).
>	The pancreatic cancer mortality rate was 39 percent higher among African-American residents (14.5 
per 100,000) than among Caucasian residents (10.4 per 100,000) during 1999–2003. 
>	Overall, pancreatic cancer mortality was highest in Kent County during 1999–2003 (12.5 per 
100,000). 

Trends in Cancer Incidence and Mortality (Figures 12.1–12.2 and 12.6–12.7)
>	Incidence and mortality rates for pancreatic cancer remained steady from 1980–84 to 1999–2003.

Age-Specific Incidence and Mortality Rates (Tables 12.3 and 12.8, Figures 12.3 and 12.8)
>	The incidence of pancreatic cancer increased with age.
>	Mortality from pancreatic cancer peaked at ages 85 and older in both males and females.

Stage at Diagnosis of Pancreatic Cancer (Tables 12.4–12.5, Figures 12.4–12.5)
>	A total of 332 cases or 72.7 percent of all pancreatic cancers were diagnosed in the late (i.e., regional 
or distant) stages, compared with 77.2 percent in U.S. estimates for 1999–2003. 
>	In Delaware, the percentage of pancreatic cancer cases diagnosed in the regional stage 
(26.5 percent) in 1999–2003 was similar to the U.S. estimate of 26.2 percent for 1999–2003. 
>	The proportion of pancreatic cancer cases diagnosed in the local stage was greater among African- 
American residents (13.0 percent) than Caucasian residents (6.5 percent) in 1999–2003.
>	From 1980–84 to 1999–2003, the percentages of local and regional stages of pancreatic cancer 
cases decreased. During that same time period, the proportions of distant cancers increased. 


Pancreatic Cancer Incidence

Table 12.1.	Number of Pancreatic 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
457
215
242
370
175
195
77
35
42
Kent
78
38
40
63
30
33
13
7
6
New Castle
262
116
146
206
92
114
48
20
28
Sussex
117
61
56
101
53
48
16
8
8
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
11.3 (11.1–11.5)
12.9 (12.6–13.2)
10.0 (9.8–10.3)
Delaware
11.1 (10.1–12.1)
11.9 (10.3–13.6)
10.3 (9.0–11.6)
Kent
12.4 (4.9–20.0)
13.1 (2.1–24.1)
11.2 (1.5–20.9)
New Castle
11.0 (7.3–14.7)
11.4 (5.1–17.7)
10.5 (5.9–15.2)
Sussex
10.5 (5.1–15.8)
12.4 (3.5–21.4)
8.7 (2.1–15.3)
CAUCASIAN


United States
11.0 (10.8–11.2)
12.7 (12.4–13.0)
9.6 (9.4–9.9)
Delaware
10.5 (9.5–11.6)
11.5 (9.7–13.1)
9.7 (8.3–11.1)
Kent
12.3 (4.2–20.3)
12.7 (0.3–25.1)
11.3 (1.2–21.5)
New Castle
10.3 (6.4–14.2)
10.9 (4.2–17.6)
9.8 (4.9–14.6)
Sussex
10.1 (4.5–15.7)
12.0 (2.7–21.4)
8.3 (1.4–15.2)
AFRICAN-AMERICAN


United States
15.5 (14.8–16.3)
16.7 (15.5–18.1)
14.4 (13.4–15.4)
Delaware
14.9 (11.5–18.3)
15.3 (10.0–20.6)
14.1(9.8–18.4)
Kent
---
---
---
New Castle
14.5 (1.4–27.6)
---
14.3 (-2.1–30.7)
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 12.1.	Five-Year Average Age-Adjusted Pancreatic 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 12.2.	Five-Year Average Age-Adjusted Pancreatic 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 12.3.	Age-Specific Pancreatic 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
40–64
10.5
11.7
9.4
9.8
11.1
8.6
13.0
---
---
65–74
48.0
54.6
42.3
45.2
51.6
39.7
66.2
---
---
75–84
76.8
79.6
74.8
72.9
75.5
71.1
112.9
---
---
85+
78.8
---
85.1
81.0
---
85.0
---
0.0
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
       
Figure 12.3.	Age-Specific Pancreatic Cancer Incidence Rates in Delaware, by Race: 
1999–2003


 

NOTE: Rates for Caucasians ages 0–39 years and African Americans ages 0–39 and 85+ years are not displayed 
due to patient confidentiality rules.

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


Pancreatic Cancer by Stage at Diagnosis

Table 12.4.	Number of Pancreatic 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
34
17
17
24
10
14
10
7
< 6
Regional
121
53
68
93
39
54
24
12
12
Distant
211
105
106
170
88
82
35
14
21
Unknown
91
40
51
83
38
45
8
< 6
6
Total
457
215
242
370
175
195
77
35
42
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 12.5.	Percentage of Pancreatic 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
7.4
7.9
7.0
6.5
5.7
7.2
13.0
20.0
---
Regional
26.5
24.7
28.1
25.1
22.3
27.7
31.2
34.3
28.6
Distant
46.2
48.8
43.8
46.0
50.3
42.1
45.5
40.0
50.0
Unknown
19.9
18.6
21.1
22.4
21.7
23.1
10.4
---
14.3
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 12.4.	Percentage of Pancreatic Cancer Cases in Delaware and the United States, 
by Stage at Diagnosis: 1999–2003


Figure 12.4a. Delaware: 1999–2003

Figure 12.4b. 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 12.5.	Percentage of Pancreatic Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003

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




Pancreatic Cancer Mortality

Table 12.6.	Number of Pancreatic 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
445
232
213
364
192
172
74
36
38
Kent
78
48
30
64
39
25
13
8
< 6
New Castle
260
129
131
207
105
102
47
21
26
Sussex
107
55
52
93
48
45
14
7
7
SOURCE: Delaware Health Statistics Center, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
10.5 (10.5–10.6)
12.2 (12.1–12.2)
9.2 (9.2–9.3)
Delaware
10.9 (9.8–11.9)
13.2 (11.4–14.9)
9.0 (7.8–10.2)
Kent
12.5 (4.8–20.2)
16.9 (3.8–30.0)
8.4 (-0.7–17.5)
New Castle
11.0 (7.1–14.8)
13.1 (5.8–20.4)
9.5 (5.0–13.9)
Sussex
9.6 (4.3–15.0)
10.7 (2.6–18.8)
8.2 (1.6–14.8)
CAUCASIAN


United States
10.3 (10.3–10.4)
12.0 (11.9–12.1)
9.0 (8.9–9.1)
Delaware
10.4 (9.3–11.4)
12.7 (10.8–14.5)
8.4 (7.1–9.7)
Kent
12.4 (4.2–20.6)
16.6 (3.2–30.1)
8.4 (-1.1–18.0)
New Castle
10.3 (6.3–14.4)
12.6 (5.1–20.2)
8.6 (3.9–13.4)
Sussex
9.3 (3.7–14.9)
10.4 (2.2–18.7)
8.0 (1.0–14.9)
AFRICAN-AMERICAN


United States
13.9 (13.7–14.1)
15.7 (15.3–16.0)
12.5 (12.2–12.7)
Delaware
14.5 (11.1–17.9)
18.3 (11.9–24.7)
12.6 (8.5–16.6)
Kent
---
---
---
New Castle
14.2 (2.4–26.0)

12.9 (0.5–25.3)
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 12.6.	Five-Year Average Age-Adjusted Pancreatic 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 12.7.	Five-Year Average Age-Adjusted Pancreatic 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 12.8.	Age-Specific Pancreatic 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
40–64
9.3
11.9
6.9
8.8
12.2
5.6
---
---
---
65–74
45.9
51.6
41.0
43.6
50.0
38.2
---
---
---
75–84
80.1
101.6
65.6
77.3
95.5
64.9
---
---
---
85+
87.8
---
87.6
87.1
---
90.7
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 12.8.	Age-Specific Pancreatic 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.


13. Prostate Cancer 


Risk Factors and Early Detection

Risk Factors for Prostate Cancer
>	Increasing age
>	Family history of prostate cancer
>	African-American race
>	Nationality: It is most common in North America and northwestern Europe.

Possible Risk Factors for Prostate Cancer
>	High-fat diet low in fruits and vegetables
>	Physical inactivity

Under Investigation as Risk Factors for Prostate Cancer
>	Vasectomies. Some earlier studies suggested that males who had a vasectomy may have a slightly 
increased risk for prostate cancer, but this link is not consistent.

Early Detection of Prostate Cancer
>	Digital rectal exam (DRE)
>	Prostate-specific antigen (PSA) blood test
>	Transrectal ultrasonography

DRE and the PSA blood test are two methods recommended for prostate cancer screening. 

Results are shown below for the following questions in the BRFSS survey:
>	A prostate-specific antigen test, also called a PSA test, is a blood test used to check men for prostate 
cancer.  Have you ever had a PSA test?
>	A digital rectal exam is an exam in which a doctor, nurse or other health professional places a gloved 
finger into the rectum to feel the size, shape and hardness of the prostate gland.  Have you ever had 
a digital rectal exam?

Delaware Men Ages 40 and Older With PSA Within the Past Two Years

In 2004, 54.4 percent of men in Delaware ages 40 and older had had a PSA blood test within the past two 
years, compared with 51.8 percent of men in the United States.

The number of men in Delaware who had had a PSA blood test increased as age increased. Among 
those ages 40–49, 24.7 percent had had a PSA blood test within the past two years, compared with 60.8 
percent of men ages 50–59 and 81.2 percent of men ages 65 and older.

College graduates (59.5 percent) were most likely to have had a PSA blood test within the past two years, 
compared with men with a high school education (48.7 percent) or with some post-high school education 
(57.1 percent).


Data Highlights

New Cancer Cases and Deaths (Tables 13.1 and 13.6)
>	Prostate cancer was the most frequently diagnosed cancer among men, and during 1999–2003 it 
accounted for 3,275 (30.2 percent) of newly diagnosed cancer cases. 
>	Caucasian Delaware residents made up 77.4 percent (2,534) of prostate cancer cases in 1999–2003, 
and African-American residents made up 19.0 percent (621); Hispanic residents and those of other 
races made up less than 1 percent of prostate cancer cases. 
>	The majority of prostate cancer cases (1999–2003) were New Castle County residents (2,068 or 
63.2 percent), followed by Sussex (750 or 22.9 percent) and Kent (451 or 13.8 percent) County 
residents. 
>	During 1999–2003, 429 Delaware residents died from prostate cancer; 325 (75.8 percent) decedents 
were Caucasian, and 96 (22.4 percent) were African American. 
>	A total of 256 (59.7 percent) decedents were from New Castle County, followed by 114 (26.6 percent) 
from Sussex County and 59 (13.8 percent) from Kent County.

Incidence and Mortality Rates (Tables 13.2 and 13.7)
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.)
>	Prostate cancer incidence was 65 percent higher among African-American men (263.1 per 100,000) 
than Caucasian males (159.5 per 100,000) in 1999–2003.
>	Prostate cancer mortality was more than twice as high among African-American men (57.0 per 
100,000) than among Caucasian men (25.0 per 100,000) 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.)
>	Overall prostate cancer incidence was highest in New Castle County (199.3 per 100,000). African- 
American and Caucasian males in New Castle County also had higher incidence rates than their 
counterparts in Kent and Sussex Counties.

Trends in Cancer Incidence and Mortality (Figures 13.1–13.2 and 13.6–13.7)
>	Delaware’s overall prostate cancer incidence rate has been less than the U.S. estimate since  
1995–99.
>	Mortality from prostate cancer declined among men in Delaware and the United States. The 
difference in the mortality rates between men in Delaware and United States also declined from 
1992–96 to 1999–2003.

Age-Specific Incidence and Mortality Rates (Tables 13.3 and 13.8, Figures 13.3 and 13.8)
>	The incidence of prostate cancer increased with age and peaked at ages 85 and older.
>	Mortality from prostate cancer increased from ages 60–74 to ages 85 and older.

Stage at Diagnosis of Prostate Cancer (Tables 13.4–13.5, Figures 13.4–13.5)
>	A total of 331 cases (10.1 percent of all prostate cancers) were diagnosed in the late (i.e., regional or 
distant) stages. 
>	In Delaware during 1999–2003, a similar proportion of prostate cancers were diagnosed in the local 
and regional stages (92.2 percent), compared with the U.S. estimate (92.9 percent) for 1999–2003. 
Delaware had a lower proportion of cases diagnosed in the distant stage (3.4 percent) than in U.S. 
estimates (4.3 percent).
>	The increase in the proportion of prostate cancers diagnosed in the local stage since 1986–90 (from 
52.4 percent to 85.5 percent in 1999–2003) was mirrored by a decrease in the proportion of distant 
stage (from 21.6 percent in 1986–90 to 3.4 percent in 1999–2003) and regional stage cancers (from 
16.6 percent in 1986–90 to 6.7 percent in 1999–2003).


Prostate Cancer Incidence

Table 13.1.	Number of Prostate Cancer Cases in Delaware and Counties, by Race: 
1999–2003


All  
Male
Caucasian 
Male
African-American  
Male
Delaware
3,275
2,534
621
Kent
451
318
101
New Castle
2,068
1,567
436
Sussex
750
644
84
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 13.2.	Five-Year Average Age-Adjusted Prostate Cancer Incidence Rates* in the 
United States (Estimates), Delaware and Counties, by Race: 1999–2003


All  
Male
Caucasian 
Male
African-American 
Male
United States
177.8 (176.6–178.9)
173.8 (172.6–175.0)
272.6 (267.5–277.8)
Delaware
176.2 (170.1–182.3)
159.5 (153.2–165.8)
263.1 (241.4–284.8)
Kent
155.2 (120.0–190.4)
132.8 (98.7–166.8)
207.6 (109.0–306.3)
New Castle
199.3 (176.1–222.5)
180.9 (157.0–204.8)
300.6 (212.7–388.4)
Sussex
140.3 (113.2–167.4)
132.3 (104.3–160.2)
206.2 (93.8–318.6)
* = 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 13.1.	Five-Year Average Age-Adjusted Prostate 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 13.2.	Five-Year Average Age-Adjusted Prostate 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 13.3.	Age-Specific Prostate Cancer Incidence Rates* in Delaware, by Race: 
1999–2003

Age 
Group
All  
Male
Caucasian 
Male
African-American  
Male
0–39
---
---
---
40–64
206.7
184.5
320.1
65–74
981.6
905.1
1,383.6
75–84
848.5
796.6
1077.3
85+
788.7
730.8
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
       
       
Figure 13.3.	Age-Specific Prostate Cancer Incidence Rates in Delaware, by Race:  
1999–2003



NOTE: Rates for Caucasians ages 0–39 years and African Americans ages 0–39 and 85+ years are not displayed 
due to patient confidentiality rules.

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


Prostate Cancer by Stage at Diagnosis

Table 13.4.	Number of Prostate Cancer Cases in Delaware, by Stage at Diagnosis and 
Race: 1999–2003

Stage at 
Diagnosis
All  
Male
Caucasian 
Male
African-American  
Male
Local
2,800
2,175
533
Regional
220
176
39
Distant
111
80
25
Unknown
144
103
24
Total
3,275
2,534
621
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Table 13.5.	Percentage of Prostate Cancer Cases in Delaware, by Stage at Diagnosis 
and Race: 1999–2003 

Stage at 
Diagnosis
All  
Male
Caucasian 
Male
African-American 
Male
Local
85.5
85.8
85.8
Regional
6.7
7.0
6.3
Distant
3.4
3.2
4.0
Unknown
4.4
4.1
4.0
Total
100.0
100.0
100.0
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


Figure 13.4.	Percentage of Prostate Cancer Cases in Delaware and the United States 
(Estimates), by Stage at Diagnosis: 1999–2003


Figure 13.4a. Delaware: 1999–2003

Figure 13.4b. 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 13.5.	Percentage of Prostate Cancer Cases in Delaware, by Stage at Diagnosis: 
1980–2003

 

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




Prostate Cancer Mortality

Table 13.6.	Number of Prostate Cancer Deaths in Delaware and Counties, by Race: 
1999–2003


All  
Male
Caucasian 
Male
African-American  
Male
Delaware
429
325
96
Kent
59
35
23
New Castle
256
196
56
Sussex
114
94
17
SOURCE: Delaware Health Statistics Center, 2005.


Table 13.7.	Five-Year Average Age-Adjusted Prostate Cancer Mortality Rates* in the 
United States, Delaware, and Counties, by Race: 1999–2003


All  
Male
Caucasian 
Male
African-American  
Male
United States
29.1 (28.9–29.2)
26.7 (26.5–26.8)
65.1 (64.3–66.0)
Delaware
28.5 (25.7–31.3)
25.0 (22.2–27.8)
57.0 (45.0–69.0)
Kent
24.6 (2.0–47.3)
18.0 (-3.8–39.9)
---
New Castle
30.1 (16.1–44.2)
26.7 (12.4–41.0)
58.4 (-3.1–119.9)
Sussex
27.5 (4.2–46.5)
25.3 (4.2–46.5)
---
* = 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 13.6.	Five-Year Average Age-Adjusted Prostate 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 13.7.	Five-Year Average Age-Adjusted Prostate 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 13.8.	Age-Specific Prostate Cancer Mortality Rates* in Delaware, by Race:  
1999–2003

Age 
Group
All  
Male
Caucasian 
Male
African-American  
Male
0–39
---
---
0.0
40–64
6.0
---
---
65–74
71.3
56.0
192.0
75–84
277.3
238.8
595.4
85+
605.7
581.8
---
* = Rates are per 100,000 population.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 13.8.Age-Specific Prostate Cancer Mortality Rates in Delaware, by Race:  
1999–2003


 
NOTE: Rates for Caucasians ages 0–39 and Caucasians and African Americans ages 40–64 are not displayed 
due to data  suppression rules.

SOURCE: Delaware Health Statistics Center, 2005.


14. Urinary Bladder Cancer


Risk Factors and Early Detection

Risk Factors for Urinary Bladder Cancer
>	Cigarette smoking
>	Increasing age
>	Race: Caucasians get bladder cancer twice as often as African Americans and Hispanics.
>	Sex: Males are two to three times more likely to get bladder cancer.
>	Family history of bladder cancer
>	Treatment with alkylating agent chemotherapy drugs such as Cytoxan (cyclophosphamide)
>	Radiation therapy to the bladder

Possible Risk Factors for Urinary Bladder Cancer
>	Employment in certain occupations (e.g., rubber and/or leather industries, dye manufacturing, 
painters, professional drivers of trucks and other motor vehicles)
>	Exposure to arsenic, either in drinking water or in medical treatments
>	Urologic conditions such as urinary tract infections and urinary stasis or being infected with certain 
parasites not common in the United States but found in tropical areas
>	Low fluid consumption

Early Detection of Urinary Bladder Cancer
>	Urine tests for presence of blood
>	Cystoscopy for people with history of bladder cancer
>	Imaging tests (such as CT scans or MRIs) can be used in further diagnosis.


Data Highlights

New Cancer Cases and Deaths (Tables 14.1 and 14.6)
NOTE: In situ cancers of the urinary bladder were included in the overall urinary bladder cancer incidence 
rates. 
>	A total of 919 urinary bladder cancer cases were diagnosed among Delaware residents during  
1999–2003, 682 (74.2 percent) males and 237 (25.8 percent) females. 
>	The majority of urinary bladder cancer cases during 1999–2003 were New Castle County residents 
(527 or 57.3 percent), followed by Sussex County (272 or 29.6 percent) and Kent County (120 or 
13.1 percent) residents. 
>	Caucasian residents made up 90.1 percent (828) of urinary bladder cancer cases in 1999–2003, and 
African-American residents made up 7.6 percent (70). Six cases were Hispanic residents, and 11 
were from other race groups.
>	During 1999–2003, 206 Delaware residents died from urinary bladder cancer, and approximately 
two-thirds were males (140 or 68.0 percent).
>	Most decedents were Caucasian (178 or 86.4 percent), and approximately 13.6 percent (28) were 
African-American. 
>	A total of 107 (51.9 percent) decedents were from New Castle County, followed by 67 (32.5 percent) 
from Sussex County and 32 (15.5 percent) from Kent County.

Incidence and Mortality Rates (Tables 14.2 and 14.7)
NOTE: In situ cancers of the urinary bladder were included in the overall urinary bladder cancer incidence 
rates. 
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 1999–2003 bladder cancer incidence rate was four times higher among males (38.5 per 100,000) 
than females (10.2 per 100,000).
>	Caucasian Delaware residents had a 71 percent higher urinary bladder cancer incidence rate (23.4 
per 100,000 in 1999–2003) than African-American residents (13.7 per 100,000).
>	In Delaware, urinary bladder cancer incidence for 1999–2003 was 80 percent higher among 
Caucasian males than among African-American males (40.6 per 100,000 versus 22.6 per 100,000, 
respectively). The number of cases among African-American females, however, was too small to 
compare with Caucasian females.
>	The 1999–2003 urinary bladder cancer mortality rate was at least three times higher among males 
(8.4 per 100,000) than females (2.7 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.)
>	The overall county-specific urinary bladder cancer incidence rate was highest in Sussex County (24.2 
per 100,000). 
>	Although the urinary bladder cancer mortality rate was higher among African-American residents 
(5.8 per 100,000) than Caucasian residents (5.0 per 100,000) during 1999–2003, it was difficult to 
compare mortality rates by race due to the small number of deaths among African Americans. 
>	The overall urinary bladder cancer mortality rate was highest in Sussex County during 1999–2003 
(6.1 per 100,000). 

Trends in Cancer Incidence and Mortality (Figures 14.1–14.2 and 14.6–14.7)
>	From 1980–84 to 1999–2003, Delaware’s urinary bladder cancer incidence rates increased among 
males, while U.S. estimates among males remained stable. In comparison, rates among females in 
Delaware and the United States were stable.
>	Urinary bladder cancer mortality has decreased among Caucasian males in Delaware since 1995–99 
and  among African-American males since 1997–2001. In comparison, the rate among U.S. males 
remained steady.

Age-Specific Incidence and Mortality Rates (Tables 14.3 and 14.8, Figures 14.3 and 14.8)
>	Age-specific incidence and mortality rates increased as age increased. However, incidence rates 
peaked at ages 75 to 84, compared with ages 85 and older for mortality rates.

Stage at Diagnosis of Urinary Bladder Cancer (Tables 14.4–14.5, Figures 14.4–14.5)
NOTE: In situ cancers of the urinary bladder were included in the overall urinary bladder cancer incidence 
rates. 
>	A total of 85 cases (9.3 percent of all urinary bladder cancers) were diagnosed in the late (i.e., 
regional or distant) stages in 1999–2003.
>	In Delaware, the proportion (85.7 percent) of urinary bladder cancer cases diagnosed in the in situ 
and local stages was similar to the U.S. estimate (85.4 percent) for 1999–2003. 
>	The proportion of urinary bladder cancers diagnosed in the local stage has decreased in Delaware 
since the mid-1980s, but there was an increase in the proportion of in situ cases. 


Urinary Bladder Cancer Incidence

Table 14.1.	Number of Urinary Bladder 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
919
682
237
828
620
208
70
49
21
Kent
120
89
31
106
81
25
9
7
< 6
New Castle
527
393
134
469
354
115
44
29
15
Sussex
272
200
72
253
185
68
17
13
< 6
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
21.3 (21.1–21.6)
37.5 (36.9–38.0)
9.6 (9.4–9.8)
Delaware
22.3 (20.8–23.7)
38.5 (35.5–41.4)
10.2 (8.9–11.5)
Kent
19.0 (10.3–27.6)
32.7 (11.6–53.9)
9.0 (2.6–15.5)
New Castle
22.2 (17.1–27.2)
39.2 (27.8–50.6)
9.7 (5.3–14.2)
Sussex
24.2 (16.0–32.3)
39.9 (22.5–57.4)
11.7 (4.1–19.4)
CAUCASIAN


United States
23.4 (23.1–23.7)
41.0 (40.4–41.6)
10.4 (10.1–10.7)
Delaware
23.4 (21.8–25.0)
40.6 (37.4–43.9)
10.5 (9.1–12.0)
Kent
20.5 (10.8–30.3)
36.7 (11.6–61.8)
9.3 (2.7–15.9)
New Castle
23.5 (17.9–29.0)
41.7 (29.2–54.3)
10.0 (5.3–14.8)
Sussex
24.8 (16.3–33.3)
40.2 (22.3–58.1)
12.4 (4.3–20.5)
AFRICAN-AMERICAN


United States
12.7 (12.0–13.4)
19.6 (18.2–21.2)
8.1 (7.4–8.8)
Delaware
13.7 (10.4–17.0)
22.6 (15.8–29.4)
7.3 (4.2–10.5)
Kent
---
---
---
New Castle
13.4 (2.3–24.6)
20.6 (-1.3–42.6)
---
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 14.1.	Five-Year Average Age-Adjusted Urinary Bladder 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 14.2.	Five-Year Average Age-Adjusted Urinary Bladder Cancer Incidence Rates 
in Delaware, by Race and Sex: 1980–2003

 


SOURCE: Delaware: Delaware Cancer Registry, Delaware Division of Public Health, 2005.
Table 14.3.	Age-Specific Urinary Bladder 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
---
---
---
---
---
---
---
0.00
---
40–64
19.5
30.84
8.9
21.6
33.3
10.4
---
---
---
65–74
110.7
183.6
48.2
118.6
194.3
52.6
---
---
---
75–84
153.0
288.3
61.9
156.4
300.4
58.6
---
---
---
85+
132.6
252.4
85.1
133.7
269.6
79.4
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 cases.

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



Figure 14.3.	Age-Specific Urinary Bladder 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.


Urinary Bladder Cancer by Stage at Diagnosis

Table 14.4.	Number of Urinary Bladder 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
In Situ
440
322
118
403
295
108
25
19
6
Local
347
269
78
309
244
65
34
24
10
Regional
57
38
19
51
36
15
< 6
0
< 6
Distant
28
21
7
24
17
7
< 6
< 6
0
Unknown
47
32
15
41
28
13
< 6
< 6
< 6
Total
919
682
237
828
620
208
70
49
21
SOURCE: Delaware Cancer Registry, Delaware Division of Public Health, 2005.

Table 14.5.	Percentage of Urinary Bladder 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
In Situ
47.9
47.2
49.8
48.7
47.6
51.9
35.7
38.8
28.6
Local
37.8
39.4
32.9
37.3
39.4
31.3
48.6
50.0
47.6
Regional
6.2
5.6
8.0
6.2
5.8
7.2
---
0.0
---
Distant
3.1
3.1
3.0
2.9
2.7
3.4
---
---
0.0
Unknown
5.1
4.7
6.3
5.0
4.5
6.3
---
---
---
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 14.4.	Percentage of Urinary Bladder Cancer Cases in Delaware and the United 
States (Estimates), by Stage at Diagnosis: 1999–2003


Figure 14.4a. Delaware: 1999–2003

Figure 14.4b. 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 14.5.	Percentage of Urinary Bladder Cancer Cases in Delaware, by Stage at 
Diagnosis: 1980–2003

 

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


Urinary Bladder Cancer Mortality

Table 14.6.	Number of Urinary Bladder 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
206
140
66
178
128
50
28
12
16
Kent
32
22
10
26
20
6
6
< 6
< 6
New Castle
107
69
38
93
64
29
14
< 6
9
Sussex
67
49
18
59
44
15
8
< 6
< 6
SOURCE: Delaware Health Statistics Center, 2005.


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

RACE AND REGION
SEX

All
Male 
Female
ALL RACES


United States
4.3 (4.3–4.4)
7.5 (7.5–7.6)
2.3 (2.2–2.3)
Delaware
5.1 (4.4–5.8)
8.4 (7.0–9.9)
2.7 (2.1–3.4)
Kent
5.1 (-0.1–10.3)
7.9 (-2.2–18.0)
2.9 (-2.1–7.8)
New Castle
4.6 (1.8–7.3)
7.0 (1.0–13.0)
6.1 (2.1–10.2)
Sussex
6.1 (1.2–11.1)
10.4 (-0.3–21.0)
3.0 (-1.7–7.6)
CAUCASIAN


United States
4.5 (4.4–4.5)
7.9 (7.8–7.9)
2.3 (2.2–2.3)
Delaware
5.0 (4.3–5.8)
8.8 (7.2–10.4)
2.4 (1.7–3.1)
Kent
---
---
---
New Castle
4.6 (1.7–7.6)
8.1 (1.3–14.9)
2.3 (-0.5–5.2)
Sussex
5.9 (0.9–11.0)
---
---
AFRICAN-AMERICAN


United States
3.8 (3.7–3.9)
5.5 (5.3–5.7)
2.9 (2.7–3.0)
Delaware
5.8 (3.6–8.0)
---
---
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 14.6.	Five-Year Average Age-Adjusted Urinary Bladder 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 14.7.	Five-Year Average Age-Adjusted Urinary Bladder 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 14.8.	Age-Specific Urinary Bladder 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
2.5
---
---
2.6
---
---
---
---
---
65–74
23.1
38.7
---
23.6
41.1
---
---
---
---
75–84
37.6
70.0
---
38.6
75.5
---
---
---
---
85+
71.7
---
---
66.8
---
---
---
---
---
* = Rates are per 100,000 population.
--- = Rate based on fewer than 25 deaths.

SOURCE: Delaware Health Statistics Center, 2005.



Figure 14.8.	Age-Specific Urinary Bladder 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.



* “The ACS recommends more intensive surveillance for individuals at higher risk for colorectal cancer, 
including those with a history of adenomatous polyps; those with a personal history of curative-intent 
resection of colorectal cancer; those with a family history of either colorectal cancer or colorectal 
adenomas diagnosed in a first-degree relative before age 60; those with a history of inflammatory bowel 
disease of significant duration; or those with a family history or genetic testing indicating the presence 
of 1 of 2 hereditary syndromes, such as hereditary nonpolyposis colorectal cancer and familial adenomatous 
polyposis.”


APPENDIX A

HISPANIC CANCER RATES

The Delaware Division of Public Health would like to present cancer rates for racial and ethnic 
groups in addition to Delaware’s Caucasian and African-American populations. To explore this 
possibility, an attempt was made to calculate rates for Delaware residents with Hispanic 
ethnicity. However, this report includes only cancer cases and deaths for the Hispanic 
population in Delaware (tables A1 and A2). Cancer rates were not calculated because of 
several methodological issues that would prevent the rates from being fairly compared with 
similar data for the Caucasian and African-American populations. Because cancer rates are 
calculated by dividing the number of cancer cases (numerator) by a population (denominator), 
the rates can be heavily influenced by changes or uncertainties in either. Specific issues that 
suggest that Hispanic cancer rates would be subject to misinterpretation are presented below:

*	Uncertain estimate of Delaware’s Hispanic population—Estimates of Delaware’s 
population are derived from a census performed every 10 years by the U.S. Census Bureau. 
The Delaware Population Consortium (DPC) uses the census to estimate the Delaware 
population between census years. In 1997, the DPC began releasing studies on special 
topics of interest, including Hispanic population estimates. Because the estimates are 
calculated from mortality, fertility, labor-force, and migration statistics and because these 
statistics are based on a small population of Hispanics, the DPC urged that the Hispanic 
population estimates presented in its studies be used with caution (Delaware Population 
Consortium. Delawareans of Hispanic Origin, 1991–1998. Population Study Series. 
PS-00-01, April 2000). For these reasons, the estimates are not included in the DPC’s 
annual Delaware population projection. In less-populated areas, such as small states, and 
especially in subsets of the population (for example, for one sex or one county), even a 
small inaccuracy can result in a substantial error in the cancer rate. 

*	Inaccurate recording of Hispanic ethnicity on death certificates—Race and Hispanic 
origin are treated as distinct concepts and reported separately on death certificates and to 
the Delaware Cancer Registry, in accordance with guidelines from the federal Office of 
Management and Budget. To assess the completeness of the reporting of Hispanic 
ethnicity, expected numbers of cancer cases and deaths in the Hispanic population were 
calculated and compared with the actual (observed) reports. Because the Hispanic 
population is younger than the Delaware population as a whole, and because cancer rates 
increase with age, the expected values were age-adjusted to ensure comparability. There 
were 81 deaths from cancer actually reported on death certificates between 1999 and 2003, 
but 130 expected. Similarly, 211 cases were actually reported to the registry, but 399 were 
expected. Although this analysis is a cursory attempt to estimate the degree of under-
reporting of Hispanic ethnicity, it demonstrates the possibility of significant inaccurate 
Hispanic cancer rates. 

*	Small number of cases or deaths and small population sizes—An incidence or mortality 
rate is an estimate, and the reliability of the estimate can be measured by calculating a 
confidence interval. A small confidence interval suggests that the rate is a good estimate; a 
wide confidence interval suggests that the rate should be interpreted with caution. If the 
confidence intervals of two rates do not overlap, the rates are considered to be statistically 
different. Both the size of the numerator (number of cases or deaths) and the denominator 
(the population) determine the width of the confidence interval. 

To illustrate the impact of these statistical concepts on the calculation of Hispanic cancer 
rates, five-year average annual age-adjusted cancer rates were compared for three 
racial/ethnic groups, along with their 95-percent confidence intervals. A 95-percent 
confidence interval suggests that there is a 95-percent probability that the actual rate is 
within that interval.

As shown in the tables below, the small numerators and denominators for the Hispanic 
population produced large confidence intervals, compared with those of the Caucasian and 
African-American populations.

Table A1.	Cancer Cases, Population, and Age-Adjusted Cancer Incidence Rates in 
Delaware: 1999–2003

Race/Ethnicity
Average Annual 
Cases
(1999–2003)
Average Annual 
Population
(1999–2003)
Annual Average 
Incidence Rate 
per 100,000
95% Confidence Interval




Lower
Upper
Hispanic
42
40,168
261.4
220.0
302.8
Caucasian
3,419
598,569
493.4
486.0
500.8
African-American
614
160,683
539.8
520.4
559.3


Table A2.	Cancer Deaths, Population, and Age-Adjusted Cancer Mortality Rates in 
Delaware: 1999–2003 

Race/Ethnicity
Average Annual 
Deaths
(1999–2003)
Average Annual 
Population
(1999–2003)
Annual Average 
Mortality Rate per 
100,000
95% Confidence Interval




Lower
Upper
Hispanic
16
40,168
132.6
99.9
165.3
Caucasian
1,402
598,569
200.3
195.7
205.0
African-American
262
160,683
250.6
236.7
264.4
SOURCES: For Hispanics, the population is estimated by the U.S. Census Bureau. For Caucasians and African 
Americans, the population is provided by the Delaware Population Consortium. Incidence data: Delaware Cancer 
Registry, Delaware Division of Public Health, 2005. Mortality data: Delaware Health Statistics Center, 2005.

This analysis assumes that the risk of cancer in the Hispanic population, for any particular age, is the 
same as the Delaware population as a whole. The indirect standardization of age adjustment was used to 
calculate the expected number of cases and deaths in the Hispanic population. The indirect method applies 
the age-specific rates of a standard population (Delaware’s 1998–2002 rates) to the age distribution of the 
study (Hispanic) population in order to estimate the expected deaths or cases in the study population. Indirect 
adjustment is used when the number of deaths or cases in each age group in the study population is too small 
to calculate stable age-specific rates. The rest of this report uses the direct standardization of age 
adjustment, which is explained in appendix B. 


APPENDIX B

METHODOLOGY

The purpose of the methodology section is to document the materials, data sources, and 
statistical methods that were used to generate the counts and age-adjusted and age-specific 
incidence and mortality rates discussed in this report. Coding and classification schemes used 
for both incidence and mortality cases included in the report are described, and a description of 
technical terms and variable definitions used in the report is provided. 
SOURCES OF DATA
Incidence Data
Delaware Cancer Registry

Incident cancer cases that were diagnosed between January 1, 1999, and December 31, 2003, 
and reported to the Delaware Cancer Registry (DCR) by November 2005 were included in this 
report to compute the five-year average age-adjusted incidence rates. Trends in incidence were 
based on cancer diagnoses from January 1, 1980, to December 31, 2003, reported to DCR by 
November 2005. The total number of newly diagnosed reportable cancers between 1999 and 
2003 that occurred among Delaware residents was 20,793. This number includes individuals 
with cancers diagnosed at more than one site, also known as multiple primaries. 

DCR’s reporting procedures are consistent with those adopted by the American Cancer Society 
(ACS) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 
program. Currently, the procedures exclude all cases of benign brain cancers and in situ cancer, 
except for in situ bladder cancer and borderline ovarian cancer. Invasive and in situ bladder 
cancer cases were combined in the analysis because of the difficulty in distinguishing between 
the two types of cancers based on the language used by pathologists. 

The International Classification of Diseases for Oncology, Second Edition (ICD-O-2) was used 
to describe the topography (primary anatomic site) and morphology (histology) for cancers 
reported between 1988 and 2000. Cancers reported between 2001 and 2003 were coded using 
the International Classification of Diseases for Oncology, Third Edition (ICD-O-3). The 
topography code (ICD-O-2 or ICD-O-3) defines both the site of the tumor and the type of 
neoplasm. The codes range from C00.0 to C80.9. Five-digit morphology codes ranging from 
M8000/0 to M9989/3 were used to describe both the histology and the behavior of the tumor. 
The first four digits of the morphology codes define the histology of the cancer, and the fifth digit 
indicates whether the cancer was malignant, benign, in situ, or uncertain (whether benign or 
malignant). ICD-O-2 codes were converted to ICD-O-3 codes for all cases diagnosed between 
1988 and 2000 using conversion programs, primarily to account for the changes in the 
morphology codes. The topography codes for ICD-O-2 and ICD-O-3 were identical. Cancer 
primary site groupings used in this report were based on SEER Program conventions and are 
shown in appendix D. 

SEER Program

Data from the SEER program were used to compare Delaware’s incidence and mortality rates 
and those for the United States. The SEER program was established in 1971 after legislation 
was passed by Congress to collect, analyze, and disseminate data for cancer control, diagnosis, 
and treatment. Several population-based registries that are representative of the different 
regions in the United States routinely collect data to allow SEER to produce cancer incidence 
and mortality statistics. Connecticut, Hawaii, Iowa, New Mexico, Utah, metropolitan areas of 
Detroit in Michigan, and San Francisco and Oakland in California have provided data to SEER 
since January 1, 1973. Other states that participate include parts of Georgia and Washington, 
Kentucky, Louisiana, New Jersey, and the remaining counties in California. Recently, SEER 
expanded data collection activities to 17 population-based registries. This report was based on 
the nine registries that have provided data to SEER since 1974–75. These registries include 
Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget 
Sound, and Utah.
Mortality Data
Delaware Health Statistics Center

Cancer mortality data used in this report were provided by the Delaware Health Statistics 
Center. The data file was compiled from all death certificates filed in Delaware between 1980 
and 2003. Five-year average age-adjusted mortality rates were based on deaths that occurred 
between 1999 and 2003. Trends in cancer mortality were presented for deaths that occurred 
between 1980 and 2003. 

The underlying cause-of-death codes were based on the International Classification of 
Diseases, Ninth Edition (ICD-9) for deaths that occurred between 1980 and 1998. The 
International Classification of Diseases, Tenth Edition (ICD-10) was used to code deaths that 
occurred between 1999 and 2003. The underlying cause of death was the cause of death listed 
on the death certificate that started the sequence of events that eventually led to the death of 
the individual. It was usually selected from a list of causes of death that appears on the death 
certificate. Only cancer deaths that occurred among residents of Delaware were included in the 
analysis. The recodes used to define the overall primary site cancer groups were based on 
those adopted by SEER (see appendix D).

National Center for Health Statistics

U.S. mortality data were obtained from the National Center for Health Statistics to allow for 
comparisons between Delaware’s mortality rates and national data. The data were compiled 
from all death certificates filed in the 50 states and the District of Columbia between 1980 and 
2003. Cancer deaths were coded in accordance with World Health Organization regulations, 
which stipulate that cancer deaths should be coded using the most current revision of the 
International Classification of Diseases (ICD).  Accordingly, deaths that occurred prior to 1999 
were coded using ICD-9. Beginning with 1999, deaths were coded using ICD-10.
Population Data
Standard Population

The year 2000 standard U.S. population was used for age adjustment of incidence and mortality 
rates. The standard population was used for direct standardization of the incidence and 
mortality rates to enable comparisons among populations (United States and Delaware 
counties) that had different age structures.
Population Estimates for Delaware, 2003

The Delaware Population Consortium provided population estimates for Delaware by age, 
race/ethnicity, sex, and county. Between 1980 and 1989, race/ethnicity was defined as 
Caucasian, African-American , and other. Beginning in 1990, detailed race/ethnicity categories 
were collected as follows: Asian/Pacific Islander, African-American, Caucasian, American Indian 
and Alaska Native, and Hispanic. In 2000, the population estimates included a separate 
multiracial category, but these cases are not included in this report. The population data for 
Delaware are presented in appendix E.
RISK FACTORS AND EARLY DETECTION
Cancer risk factors and effective means of preventing cancer are described at the beginning of 
each chapter of this report. Three web sites were used as primary sources to update risk factors 
for cancer: the American Cancer Society (www.cancer.org), the National Cancer Institute   
(www.cancer.gov), and WebMD (www.webmd.com). 
Behavioral Risk Factor Surveillance System 
The Behavioral Risk Factor Surveillance System provided estimates on the prevalence of risk 
factors in Delaware and the United States. Cancer risk factor data for Delaware and the United 
States were obtained from the Centers for Disease Control and Prevention’s interactive data 
system. The most recent updates were from 2003, 2004 or 2005, depending on the risk factor. 
The results are included in the appropriate chapters on the site-specific cancers. However, data 
on obesity, physical inactivity, and diet are presented in appendix F, since the literature to 
support their role in the etiology of cancer is inconsistent. 
STATISTICAL METHODOLOGY AND TECHNICAL TERMS
Age-adjusted and age-, race-, and sex-specific incidence and mortality rates are presented in 
this report to describe the pattern of cancer incidence and mortality in Delaware. All rates and 
the 95-percent confidence intervals were computed using Microsoft Excel and expressed as a 
five-year average per 100,000 population. 
Direct Standardization and Age-Adjusted Incidence and Mortality Rates
The age distribution of a population is an important determinant of the burden of cancer. 
Because cancer incidence and mortality increase with age, crude rates cannot be used for 
comparisons of cancer statistics between sexes, racial or ethnic groups, or geographic entities 
or across different time spans. In order to enable comparisons that were independent of the age 
distribution of the population of Delaware, directly standardized age-adjusted rates were 
calculated (Anderson & Rosenberg, 1998; Klein & Schoenborn, 2001; Goodman & Wilkens, 
1994). Age-adjusted incidence and mortality rates for Delaware were computed using an 
external reference population with a fixed standard age distribution. Age-standardized rates 
represent a theoretical rate of cancer incidence or mortality in a population with an age 
distribution identical to the reference or standard population. 

Incidence and mortality rates were adjusted to the U.S. standard million population using direct 
standardization. This process involved calculating the age-specific incidence or mortality rates 
for the residents of Delaware and then applying or multiplying these rates to the proportion of 
individuals in the same age group in the reference population. The individual age-specific rates 
were then summed to obtain the overall age-adjusted rate.

The formula for an age-adjusted rate can be presented as follows:

Age-Adjusted Rate = sum (wi x ((ci/ni) x 100,000))

Where ci is the number of new cases or deaths in the i age group, ni is the population estimate 
for the i age group, and wi is the proportion of the standard population in the i age group. All 
rates are expressed per 100,000 of the population.
Age-Specific Incidence and Mortality Rates
Age-related differences in the risk of cancer incidence and mortality and variations in the 
patterns of cancer were provided by calculating age-specific rates. The age-specific rates were 
calculated by dividing the number of cases or deaths using the following age groups (0–39, 
40–64, 65–74, 75–84, and 85 and older) in a defined time period by the total population of 
Delaware in that age group and for the same time period. The rates were expressed per 
100,000 of the population.
Race- and Sex-Specific Incidence and Mortality Rates
Subgroup differences in patterns of observed cancer incidence and mortality were 
demonstrated by calculating race- and sex-specific incidence and mortality rates. These rates 
were calculated by dividing the number of cases or deaths that occurred in each race and/or sex 
group by the total population in the corresponding race and/or sex group over the same time 
period. These rates were adjusted to the U.S. standard population and expressed per 100,000 
of the population.
Confidence Intervals
Age-adjusted incidence and mortality rates are subject to chance variation, particularly when 
they are based on an unusually large or small number of new cancer cases or deaths occurring 
over a limited period of time or in a limited geographic area. Aggregating several years of data 
sometimes provides more reliable estimates of incidence and mortality in these situations. The 
level of uncertainty associated with incidence and mortality statistics can be estimated by the 
standard error used to calculate the 95-percent confidence interval. 

Traditional confidence limits are based on the assumption that the study population is large and 
that the population under investigation has a normal distribution. A population is considered to 
be large when the number of deaths or new cancer cases exceeds 100. When cancers are rare, 
it is more appropriate to calculate the confidence limit based on the inverse gamma function. 
This method assumes that the direct standardized rate is a linear combination of random 
Poisson variables (Fay & Feuer, 1997). The advantage of the Poisson model is that it assigns 
more variability to incidence or mortality rates that are based on a small number of cases than is 
assigned to rates based on larger counts of deaths or new cases. The confidence limits for the 
age-adjusted rates for Delaware were calculated by assuming that the population has a normal 
distribution.
Stage at Diagnosis
The stage of diagnosis describes the extent to which newly diagnosed cancer cases had spread 
from the site of origin. SEER summary staging was used to define the stage at diagnosis for all 
incident cancer cases. Cancer cases diagnosed between 1980 and 2000 were coded according 
to the Summary Stage 1977; beginning with 2000, cases were coded using the codes for 
Summary Stage 2000. Four categories were used to code the metastases for any particular 
cancer site: 

*	“In situ” (Stage 0) was used to code in situ cancer cases that had not spread beyond the site 
of origin.
*	“Local” describes tumors that were invasive but confined to the organ of origin.
*	“Regional” tumors had extended beyond the limits of the organ of origin, but there was no 
evidence of distant metastasis.
*	“Distant” stage described cancer cells that had detached from the primary site and begun to 
grow at a new site in the body.
OTHER TECHNICAL INFORMATION
Suppression of Data
Presentation of data was limited to those rates that were based on an adequate number of 
cancer cases or deaths. Rates that were based on a very small number of cases were unstable 
and therefore could not be reliably interpreted.

In addition, suppressing incidence and mortality statistics based on a small number of new 
cancer cases or deaths protected patient privacy and confidentiality (Coughlin, Clutter, & 
Hutton, 1999; McLaughlin, 2002). Counts were suppressed using the recommendations of the 
National Center for Health Statistics. All incidence and mortality counts presented for subgroups 
that were fewer than six per cell were suppressed. Age-adjusted incidence and mortality rates 
based on fewer than 25 cases or deaths were also suppressed. The same criteria were applied 
to age-, race-, and sex-specific incidence and mortality rates.
Interpretation
The cancer incidence rate was interpreted as the rate at which individuals developed cancer in 
the population of Delaware between 1999 and 2003. The mortality rate was the rate at which 
individuals in Delaware died from cancer between 1999 and 2003. 
Definition of Race/Ethnicity
Race groupings in this report were defined using both race and Hispanic ethnicity. For incidence 
and mortality rates, the total population included people of Hispanic ethnicity and those of 
unknown race. Race-specific incidence and mortality rates excluded all people of Hispanic 
ethnicity.


REFERENCE LIST

Anderson, R. N. & Rosenberg, H. M. (1998). Age standardization of death rates: Implementation 
of the year 2000 standard. (Rep. No. 47(3)). Hyattsville, MD: National Center for Health 
Statistics.
Coughlin, S. S., Clutter, G. G., & Hutton, M. (1999). Ethics in cancer registries. Journal of 
Cancer Registry Management, 26, 5–10.
Fay, M. P. & Feuer, E. J. (1997). Confidence intervals for directly standardized rates: A method 
based on the gamma distribution. Stat.Med, 16, 791–801.
Goodman, M. T. & Wilkens, L. R. (1994). Calculation and assessment of incidence rates. In 
H. R. Menck & C. R. Smart (Eds.), Central Cancer Registries: Design, Management, and 
Use. (pp. 193–229). Langhorne, PA: Gordon and Breasch.
Klein, R. J. & Schoenborn, C. A. (2001). Age-adjustment using the 2000 projected U.S. 
population (Rep. No. 20). Hyattsville, MD: National Center for Health Statistics.
McLaughlin, C. C. (2002). Confidentiality protection in publicly released central registry data. 
Journal of Cancer Registry Management, 29, 84–88.
       

APPENDIX C

FIVE-YEAR AVERAGE AGE-ADJUSTED INCIDENCE AND MORTALITY RATES 
FOR ALL CANCERS, EXCLUDING SPECIFIC SITES: 1999–2003

All
Caucasian
African-American
Total
Male
Female
Total
Male
Female
Total
Male
Female
Incidence*
Delaware
Count
5,830
2,861
2,969
4,730
2,325
2,405
900
436
464
Rate
142.2
(138.5–
145.8)
156.1 
(150.3–
161.9)
132.0 
(127.3–
136.8)
139.3 
(135.3–
143.3)
152.5 
(146.2–
158.8)
130.0 
(124.8–
135.2)
152.3 
(142.0–
162.6)
169.1 
(151.9–
186.3)
139.7 
(126.8–
152.6)
Kent
Count
773
367
406
610
287
323
129
67
62
Rate
122.7
(102.4–
142.9)
131.1
(94.3–
167.9)
117.8
(92.9–
142.7)
121.1
(99.2–
142.9)
129.6
(87.6–
171.6)
118.0
(91.6–
144.4)
120.2
(63.9–
176.5)
125.3
(57.1–
193.5)
112.2
(31.2–
193.1)
New Castle
Count
3,626
1,760
1,866
2,864
1,383
1,481
625
306
319
Rate
148.8
(137.6–
160.0)
163.9
(143.7–
184.2)
138.5
(124.9–
152.1)
145.0
133.0–
156.9
158.0
(136.7–
179.4)
136.4
(121.8–
151.0)
161.5
(127.2–
195.8)
190.9
(117.5–
264.4)
144.0
(104.7–
183.4)
Sussex
Count
1,417
725
692
1,244
648
51
146
63
83
Rate
136.5
(120.2–
152.9)
150.6
(123.8–
177.4)
123.9
(103.3–
144.4)
136.1
(118.9–
153.3)
152.3
(123.8–
180.7)
108.3
(86.0–
130.7)
147.4
(86.9–
207.9)
146.6
(56.3–
237.0)
146.5
(68.2–
224.8)
Mortality*
Delaware
Count
2,434
1,277
1,157
2,003
1,054
949
374
193
181
Rate
59.8
(57.4–
62.1)
74.1
(69.9–78.3)
49.4
(46.5–52.2)
57.7
(55.1–
60.2)
71.6
(67.1–
76.0)
48.6
(45.5–
51.7)
70.2
(62.9–
77.5)
87.4
(73.9–
100.8)
58.9
(50.2–
67.6)
Kent
Count
361
190
167
283
152
131
62
34
28
Rate
58.7
(41.1–
76.3)
81.2
(45.9–
116.5)
47.0
(27.2–66.7)
55.7
(36.8–
74.7)
73.3
(34.4–
112.1)
44.1
(22.9–
65.3)
62.7
(16.8–
108.7)
75.5
(6.4–
157.4)
52.6
(3.6–
108.8)
New Castle
Count
1,483
765
718
1,194
613
581
253
133
120
Rate
62.4
(53.5–
71.3)
77.6
(60.2–94.9)
52.0
(41.7–62.2)
59.9
(50.4–
69.3)
74.0
(55.9–
92.1)
50.1
(39.1–
61.0)
74.7
(46.6–
102.7)
99.0
(36.0–
162.0)
60.4
(29.8–
91.0)
Sussex
Count
590
318
272
526
289
237
59
26
33
Rate
54.9
(42.2–
67.6)
66.5
(44.5–88.6)
44.8
(29.4–60.2)
54.7
(41.5–
68.0)
67.3
(44.1–
90.6)
43.9
(27.9–
59.9)
62.7
(15.4–
110.0)
66.3
(12.3–
145.0)
59.3
(0.9–
119.6)
* = Rates are expressed per 100,000.

NOTE: Rates exclude the following sites: female breast, cervical, colorectal, esophagus, leukemia, 
lung and bronchus, malignant melanoma, ovarian, pancreatic, prostate, and urinary bladder.


APPENDIX D

PRIMARY SITE DEFINITIONS FOR CANCER INCIDENCE AND MORTALITY

Primary Site
ICD-O-2
ICD-O-3
ICD-9
ICD-10
Oral cavity and pharynx
C00.0–C14.8
C00.0–C14.8
140.0–149.9
C00.0–C14.8
Esophagus
C15.0–C15.9
C15.0–C15.9
150.0–150.9
C15.0–C15.9
Stomach
C16.0–C16.9
C16.0–C16.9
151.0–151.9
C16.0–C16.9
Colon and rectum
C18.0–C20.9, C26.0
C18.0–C20.9, C26.0
153.0–154.1, 159.0
C18.0–C20.9, C26.0
Liver/intrahepatic bile
C22.0–C22.1
C22.0–C22.1
155.0–155.2
C22.0–C22.9
Pancreatic
C25.0–C25.9
C25.0–C25.9
157.0–157.9
C25.0–C25.9
Larynx
C32.0–C32.9
C32.0–C32.9
161.0–161.9
C32.0–C32.9
Bronchus and lung
C34.0–C34.9
C34.0–C34.9
162.2–162.9
C34.0–C34.9
Melanoma of the skin
C44.0–C44.9 and 
M8720–M8790
C44.0–C44.9 and 
M8720–M8790
172.0–172.9
C43.0–C43.9
Female breast
C50.0–C50.9
C50.0–C50.9
174.0–174.9
C50.0–C50.9
Cervix uteri
C53.0–C53.9
C53.0–C53.9
180.0–180.9
C53.0–C53.9
Corpus/uterus, not otherwise specified
C54.0–C55.9
C54.0–C55.9
182.0–182.9, 179
C54.0–C55.9
Ovary
C56.9
C56.9
183.0
C56.9
Prostate
C61.9
C61.9
185
C61
Testis
C62.0–C62.9
C62.0–C62.9
186.0–186.9
C62.0–C62.9
Urinary bladder
C67.0–C67.9
C67.0–C67.9
188.0–188.9
C67.0–C67.9
Kidney and renal pelvis
C64.9, C65.9
C64.9, C65.9
189.0–189.1
C64, C65
Brain/other nervous system
C70.0–C72.9
C70.0–C72.9
191.0–192.9
C70.0–C72.9
Thyroid
C73.9
C73.9
193
C73
Non-Hodgkins lymphomas
M9590–M9595,
M9670–M9717
M9590–M9596,
M9670–M9729
200.0–200.8,
202.0–202.2,
202.8–202.9
C82.0–C85.9
Hodgkins lymphomas
M9650–M9667
M9650–M9667
201.0–201.9
C81.0–C81.9
Multiple myeloma
M9731–M9732
M9731–M9732
M9734
203.0,
203.2–203.8
C88.7–C88.9,
C90.0–C90.2
Leukemias
M9800–M9941
M9733, M9742,
M9800–M9948,
M9963–M9964
202.4, 203.1, 
204.0–208.9
C90.1,
C91.0–C95.9


APPENDIX E

DELAWARE POPULATION ESTIMATES (FIVE-YEAR TOTALS), 
BY SEX, RACE, YEARS, AND AGE GROUP: 1980–2003

TOTAL POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
214,207
215,224
238,510
284,928
287,504
257,448
240,373
198,978
169,336
160,852
159,719
157,164
137,314
112,545
82,140
56,216
35,859
27,646
3,035,963
1981–85
218,519
217,674
235,624
278,183
285,957
262,204
247,217
205,957
176,370
163,939
158,955
156,135
138,915
115,869
84,762
58,120
36,884
28,312
3,069,596
1982–86
222,918
220,151
232,773
271,597
284,419
267,048
254,255
213,182
183,696
167,085
158,194
155,112
140,534
119,290
87,468
60,088
37,938
28,995
3,104,743
1983–87
227,406
222,657
229,956
265,167
282,889
271,982
261,493
220,660
191,326
170,291
157,437
154,097
142,173
122,813
90,260
62,123
39,023
29,694
3,141,447
1984–88
231,983
225,191
227,174
258,889
281,367
277,007
268,938
228,400
199,273
173,559
156,684
153,088
143,831
126,440
93,141
64,227
40,139
30,410
3,179,741
1985–89
236,653
227,754
224,425
252,761
279,854
282,125
276,595
236,411
207,551
176,889
155,935
152,086
145,508
130,174
96,115
66,402
41,286
31,143
3,219,667
1986–90
241,417
230,346
221,710
246,778
278,349
287,338
284,469
244,704
216,172
180,283
155,189
151,090
147,204
134,018
99,184
68,651
42,467
31,894
3,261,263
1987–91
247,002
233,344
221,422
239,937
277,915
290,859
292,199
253,305
226,107
183,991
155,843
150,234
148,777
137,280
102,762
70,853
43,848
33,044
3,308,722
1988–92
252,939
237,039
222,907
234,247
276,897
292,805
298,751
262,638
234,402
190,346
158,034
149,705
149,883
139,752
106,802
73,121
45,335
34,445
3,360,048
1989–93
258,679
241,198
226,409
230,132
275,530
292,343
303,805
272,267
241,848
198,345
162,375
149,809
150,596
141,613
110,952
75,571
46,885
36,158
3,414,515
1990–94
263,575
245,976
231,812
228,278
273,079
289,734
307,523
281,967
248,810
207,578
168,638
150,931
150,828
142,664
115,253
78,238
48,501
38,109
3,471,495
1991–95
267,276
251,644
238,648
229,237
269,266
285,672
309,672
291,351
255,795
218,395
176,552
152,922
150,922
142,984
119,406
81,230
50,469
40,220
3,531,662
1992–96
268,230
257,884
244,332
234,502
262,602
282,623
309,916
300,043
261,684
230,929
184,172
156,088
150,842
143,580
122,749
84,821
52,337
42,224
3,589,559
1993–97
267,318
264,096
249,956
241,269
256,251
279,379
309,039
307,035
269,684
240,209
193,595
160,553
150,922
144,422
125,162
88,785
54,357
44,091
3,646,121
1994–98
265,318
270,063
255,087
249,306
251,098
276,614
306,836
312,437
278,979
247,970
203,452
166,464
151,575
145,375
127,290
92,731
56,609
45,874
3,703,078
1995–99
263,097
275,155
259,963
257,829
248,402
273,725
303,060
316,753
288,783
254,999
213,433
173,368
153,324
146,388
128,811
96,676
59,072
47,686
3,760,523
1996–2000
260,887
278,384
265,330
265,682
248,998
269,598
298,611
319,891
298,156
261,724
224,182
181,016
155,416
147,743
130,117
100,350
61,687
49,464
3,817,237
1997–2001
260,222
279,236
271,171
270,361
254,617
262,938
294,526
321,205
306,718
267,541
236,586
188,557
158,410
148,605
131,729
103,494
64,856
51,192
3,871,965
1998–2002
261,182
278,111
276,995
273,420
262,695
255,987
290,542
320,747
314,036
275,407
246,059
197,923
162,941
149,202
133,595
106,149
68,385
53,284
3,926,663
1999–2003
263,147
275,728
282,716
276,063
270,531
250,646
286,717
318,458
319,534
284,720
253,936
208,082
168,894
150,079
135,437
108,913
72,185
55,811
3,981,596



TOTAL MALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
109,306
109,805
121,585
141,190
140,621
126,224
117,528
96,927
82,646
78,388
77,061
74,473
65,132
50,443
33,955
21,202
11,611
7,269
1,465,366
1981–85
111,544
111,121
120,157
137,931
140,086
128,782
121,035
100,443
86,114
79,862
76,725
74,084
65,854
51,973
35,246
22,030
11,988
7,332
1,482,307
1982–86
113,828
112,453
118,745
134,748
139,553
131,392
124,646
104,086
89,727
81,364
76,391
73,698
66,584
53,549
36,586
22,890
12,378
7,395
1,500,013
1983–87
116,159
113,801
117,350
131,638
139,021
134,054
128,365
107,861
93,492
82,895
76,058
73,314
67,322
55,173
37,976
23,784
12,780
7,458
1,518,501
1984–88
118,537
115,165
115,971
128,600
138,491
136,771
132,195
111,773
97,415
84,454
75,727
72,931
68,068
56,846
39,420
24,712
13,196
7,522
1,537,794
1985–89
120,964
116,546
114,608
125,632
137,964
139,543
136,139
115,827
101,503
86,043
75,397
72,551
68,823
58,570
40,919
25,677
13,625
7,587
1,557,918
1986–90
123,441
117,943
113,261
122,733
137,438
142,371
140,201
120,028
105,762
87,662
75,069
72,173
69,585
60,346
42,474
26,679
14,068
7,652
1,578,887
1987–91
126,361
119,575
113,147
119,415
137,266
144,393
144,160
124,332
110,654
89,453
75,440
71,791
70,326
61,932
44,245
27,669
14,586
7,935
1,602,682
1988–92
129,420
121,562
113,881
116,683
136,734
145,559
147,517
129,015
114,657
92,613
76,507
71,522
70,884
63,213
46,211
28,723
15,182
8,316
1,628,201
1989–93
132,392
123,724
115,770
114,714
136,060
145,319
150,055
133,884
118,210
96,587
78,550
71,575
71,327
64,282
48,108
29,921
15,851
8,786
1,655,113
1990–94
134,893
126,195
118,659
113,863
134,793
143,882
151,941
138,762
121,554
101,108
81,480
72,141
71,505
65,105
49,980
31,199
16,567
9,376
1,683,004
1991–95
136,777
129,054
122,259
114,510
132,759
141,725
152,970
143,435
124,882
106,389
85,222
73,078
71,636
65,589
51,812
32,650
17,462
10,031
1,712,240
1992–96
137,127
132,227
125,389
117,153
129,509
139,932
153,216
147,705
127,627
112,514
88,790
74,649
71,602
66,183
53,329
34,376
18,327
10,620
1,740,276
1993–97
136,560
135,384
128,537
120,476
126,511
138,066
152,850
151,106
131,610
116,796
93,387
76,842
71,604
66,898
54,471
36,193
19,279
11,215
1,767,785
1994–98
135,513
138,493
131,217
124,569
124,021
136,681
151,765
153,614
136,352
120,327
98,249
79,630
71,829
67,657
55,678
37,857
20,366
11,836
1,795,655
1995–99
134,370
141,136
133,699
128,994
122,710
135,375
149,777
155,661
141,353
123,570
103,159
82,833
72,633
68,311
56,850
39,503
21,522
12,507
1,823,964
1996–2000
133,161
142,939
136,383
132,978
123,174
133,430
147,574
157,118
146,142
126,696
108,399
86,446
73,549
69,158
57,860
41,098
22,776
13,252
1,852,133
1997–2001
132,716
143,337
139,243
135,903
125,672
130,319
145,374
157,968
150,411
129,323
114,470
90,033
74,975
69,650
59,001
42,519
24,294
13,961
1,879,169
1998–2002
133,022
142,634
142,083
138,230
129,134
127,095
143,248
157,865
153,944
133,336
118,785
94,643
77,147
69,924
60,295
43,821
25,892
14,804
1,905,901
1999–2003
133,607
141,297
144,922
139,954
132,619
124,625
141,349
156,805
156,439
138,155
122,341
99,690
79,962
70,284
61,539
45,363
27,474
15,850
1,932,275


TOTAL FEMALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
104,902
105,418
116,924
143,736
146,881
131,220
122,842
102,049
86,690
82,462
82,657
82,688
72,182
62,100
48,170
35,008
24,246
20,361
1,570,536
1981–85
106,976
106,551
115,467
140,250
145,868
133,416
126,178
105,512
90,256
84,074
82,228
82,047
73,061
63,894
49,496
36,082
24,893
20,959
1,587,208
1982–86
109,091
107,697
114,028
136,848
144,862
135,649
129,604
109,093
93,968
85,718
81,802
81,411
73,950
65,739
50,858
37,188
25,557
21,574
1,604,637
1983–87
111,248
108,855
112,607
133,529
143,863
137,919
133,123
112,795
97,833
87,394
81,378
80,780
74,851
67,638
52,258
38,328
26,239
22,208
1,622,846
1984–88
113,447
110,025
111,203
130,290
142,871
140,227
136,738
116,623
101,857
89,102
80,956
80,154
75,763
69,592
53,696
39,503
26,940
22,861
1,641,848
1985–89
115,689
111,208
109,817
127,130
141,885
142,574
140,451
120,581
106,047
90,844
80,536
79,533
76,686
71,602
55,174
40,714
27,659
23,533
1,661,663
1986–90
117,976
112,404
108,448
124,046
140,906
144,961
144,264
124,673
110,409
92,620
80,119
78,917
77,620
73,670
56,692
41,962
28,398
24,224
1,682,310
1987–91
120,640
113,769
108,274
120,523
140,646
146,461
148,036
128,971
115,454
94,537
80,402
78,442
78,453
75,346
58,505
43,178
29,261
25,098
1,705,994
1988–92
123,518
115,476
109,025
117,564
140,161
147,244
151,232
133,623
119,745
97,732
81,525
78,181
79,000
76,537
60,585
44,395
30,153
26,123
1,731,819
1989–93
126,286
117,475
110,640
115,418
139,469
147,023
153,749
138,383
123,639
101,757
83,825
78,235
79,270
77,330
62,842
45,649
31,034
27,370
1,759,392
1990–94
128,683
119,782
113,153
114,415
138,286
145,852
155,582
143,205
127,256
106,470
87,157
78,790
79,324
77,559
65,273
47,039
31,934
28,733
1,788,491
1991–95
130,498
122,590
116,390
114,727
136,507
143,947
156,702
147,916
130,913
112,005
91,330
79,843
79,287
77,395
67,594
48,581
33,007
30,190
1,819,422
1992–96
131,103
125,658
118,943
117,349
133,093
142,691
156,700
152,338
134,056
118,415
95,382
81,439
79,241
77,397
69,420
50,445
34,010
31,604
1,849,283
1993–97
130,758
128,712
121,419
120,793
129,740
141,313
156,188
155,930
138,074
123,412
100,207
83,711
79,318
77,523
70,691
52,591
35,079
32,877
1,878,336
1994–98
129,805
131,570
123,871
124,736
127,077
139,933
155,071
158,823
142,627
127,643
105,203
86,834
79,746
77,718
71,612
54,874
36,243
34,037
1,907,423
1995–99
128,726
134,019
126,264
128,834
125,692
138,350
153,282
161,092
147,431
131,428
110,275
90,535
80,691
78,077
71,961
57,173
37,550
35,178
1,936,559
1996–2000
127,727
135,445
128,948
132,704
125,824
136,169
151,037
162,773
152,014
135,028
115,783
94,570
81,867
78,585
72,257
59,252
38,911
36,212
1,965,104
1997–2001
127,506
135,899
131,928
134,457
128,945
132,619
149,152
163,237
156,307
138,218
122,117
98,525
83,436
78,955
72,728
60,976
40,562
37,231
1,992,796
1998–2002
128,161
135,478
134,912
135,190
133,561
128,892
147,294
162,882
160,092
142,071
127,274
103,281
85,794
79,278
73,300
62,328
42,493
38,481
2,020,762
1999–2003
129,539
134,430
137,794
136,109
137,912
126,022
145,368
161,653
163,095
146,566
131,594
108,392
88,931
79,795
73,898
63,550
44,712
39,962
2,049,321



TOTAL CAUCASIAN POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
161,578
164,018
181,424
224,599
233,283
209,496
197,457
164,950
140,805
135,974
137,745
137,055
121,128
98,211
72,417
49,295
32,140
24,892
2,486,467
1981–85
165,108
165,832
179,045
218,700
231,353
213,038
202,745
170,315
146,500
138,347
136,602
135,821
122,426
101,259
74,803
51,006
33,035
25,460
2,511,395
1982–86
168,715
167,666
176,697
212,956
229,439
216,640
208,175
175,855
152,425
140,762
135,468
134,598
123,738
104,402
77,268
52,776
33,955
26,041
2,537,576
1983–87
172,401
169,520
174,380
207,363
227,541
220,304
213,750
181,575
158,590
143,218
134,344
133,386
125,064
107,642
79,814
54,607
34,901
26,635
2,565,035
1984–88
176,168
171,395
172,093
201,917
225,659
224,029
219,474
187,481
165,005
145,717
133,229
132,185
126,404
110,983
82,444
56,502
35,873
27,244
2,593,802
1985–89
180,017
173,291
169,836
196,614
223,792
227,817
225,351
193,578
171,679
148,260
132,123
130,995
127,758
114,428
85,161
58,463
36,872
27,866
2,623,901
1986–90
183,950
175,207
167,609
191,451
221,941
231,670
231,386
199,873
178,624
150,847
131,026
129,816
129,127
117,980
87,967
60,492
37,899
28,503
2,655,366
1987–91
187,894
177,153
166,863
185,435
220,429
233,668
236,950
206,300
186,376
153,654
131,079
128,661
130,340
120,965
91,201
62,536
39,077
29,527
2,688,106
1988–92
191,482
179,322
167,125
180,133
217,986
233,865
241,209
213,099
192,430
158,654
132,454
127,698
131,049
123,163
94,871
64,638
40,365
30,776
2,720,317
1989–93
194,527
181,518
168,606
175,680
215,064
231,556
243,878
219,891
197,450
164,885
135,647
127,228
131,291
124,781
98,560
66,965
41,688
32,322
2,751,535
1990–94
196,541
183,858
171,241
172,627
211,065
227,003
245,006
226,480
201,837
171,857
140,503
127,525
130,982
125,640
102,304
69,478
43,072
34,075
2,781,094
1991–95
197,412
186,426
174,732
171,429
205,735
220,756
244,418
232,502
205,982
179,838
146,738
128,525
130,397
125,760
105,836
72,293
44,756
35,969
2,809,504
1992–96
196,651
189,133
177,569
173,360
198,474
215,370
242,035
237,686
209,264
188,958
152,691
130,589
129,548
126,041
108,655
75,544
46,418
37,738
2,835,726
1993–97
194,914
191,522
180,524
176,197
191,712
209,970
238,546
241,328
214,237
194,942
160,089
133,824
128,769
126,460
110,586
79,153
48,220
39,380
2,860,373
1994–98
192,142
193,572
183,087
180,113
185,796
205,241
233,844
243,436
220,158
199,443
167,649
138,299
128,457
126,835
112,312
82,600
50,327
40,896
2,884,205
1995–99
188,932
194,765
185,366
184,555
181,700
200,659
227,822
244,375
226,303
203,325
174,928
143,676
129,091
127,140
113,534
85,979
52,617
42,427
2,907,193
1996–2000
184,527
194,549
187,688
188,692
180,124
195,312
221,186
244,155
231,860
206,909
182,487
149,683
130,063
127,584
114,588
89,037
55,043
43,903
2,927,389
1997–2001
181,606
192,937
190,124
190,745
182,626
188,335
215,368
242,431
236,668
209,906
191,266
155,510
131,973
127,505
115,785
91,683
57,891
45,339
2,947,698
1998–2002
180,206
190,281
192,184
191,812
187,218
181,454
210,062
239,373
240,546
214,723
197,260
162,833
135,299
127,174
117,089
93,824
61,061
47,125
2,969,523
1999–2003
180,280
186,740
193,974
192,646
191,680
176,071
205,224
235,036
242,929
220,703
201,862
170,609
139,929
127,053
118,258
96,126
64,358
49,368
2,992,844


CAUCASIAN MALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
82,959
83,837
93,237
111,461
115,453
104,632
98,145
81,339
69,237
66,809
66,667
65,197
57,578
44,196
29,758
18,440
10,352
6,397
1,205,694
1981–85
84,785
84,833
92,019
108,599
114,559
106,506
100,888
84,155
72,123
67,961
66,144
64,724
58,206
45,589
30,962
19,201
10,689
6,443
1,218,386
1982–86
86,651
85,841
90,817
105,811
113,673
108,413
103,707
87,068
75,129
69,132
65,625
642,55
58,841
47,026
32,215
19,993
11,037
6,490
1,23,1724
1983–87
88,558
86,861
89,631
103,095
112,793
110,354
106,606
90,082
78,261
70,324
65,110
63,789
59,484
48,508
33,519
20,818
11,396
6,537
1,245,726
1984–88
90,507
87,893
88,459
100,448
111,919
112,330
109,586
93,200
81,523
71,537
64,600
63,327
60,133
50,037
34,875
21,677
11,766
6,584
1,260,401
1985–89
92,499
88,937
87,303
97,869
111,053
114,341
112,649
96,427
84,921
72,771
64,094
62,868
60,789
51,615
36,286
22,572
12,149
6,632
1,275,775
1986–90
94,536
89,993
86,162
95,356
110,193
116,388
115,797
99,764
88,461
74,025
63,592
62,412
61,453
53,243
37,755
23,503
12,544
6,680
1,291,859
1987–91
96,603
91,084
85,801
92,401
109,365
117,553
118,677
103,103
92,377
75,404
63,670
61,899
62,058
54,702
39,395
24,463
12,993
6,954
1,308,504
1988–92
98,415
92,299
85,916
89,772
108,060
117,753
120,867
106,617
95,377
77,933
64,379
61,412
62,459
55,871
41,201
25,486
13,518
7,317
1,324,653
1989–93
99,976
93,496
86,759
87,553
106,568
116,515
122,185
110,104
97,882
81,089
65,921
61,169
62,693
56,848
42,907
26,655
14,105
7,762
1,340,188
1990–94
100,944
94,755
88,204
86,059
104,476
114,058
122,732
113,431
100,104
84,572
68,261
61,295
62,616
57,611
44,554
27,878
14,727
8,326
1,354,604
1991–95
101,316
96,062
90,063
85,584
101,649
110,756
122,359
116,385
102,202
88,543
71,293
61,697
62,429
58,057
46,110
29,235
15,517
8,943
1,368,200
1992–96
100,728
97,455
91,652
86,573
98,014
107,767
121,224
118,867
103,867
93,072
74,142
62,694
62,034
58,543
47,411
30,791
16,313
9,468
1,380,616
1993–97
99,722
98,630
93,312
87,994
94,667
104,786
119,500
120,558
106,495
95,906
77,803
64,290
61,582
59,097
48,364
32,446
17,187
10,003
1,392,341
1994–98
98,201
99,623
94,637
90,036
91,660
102,343
117,163
121,394
109,608
98,028
81,613
66,398
61,292
59,607
49,390
33,899
18,212
10,551
1,403,657
1995–99
96,518
100,126
95,789
92,340
89,600
100,026
114,113
121,704
112,789
99,912
85,260
68,933
61,495
59,930
50,431
35,331
19,290
11,134
1,414,720
1996–2000
94,269
99,975
96,920
94,357
88,932
97,325
110,832
121,464
115,584
101,719
88,998
71,844
61,777
60,338
51,357
36,685
20,435
11,787
1,424,600
1997–2001
92,809
98,925
98,067
95,791
89,892
93,851
107,793
120,723
117,874
103,230
93,364
74,654
62,618
60,355
52,324
37,907
21,789
12,415
1,434,381
1998–2002
92,038
97,369
99,020
96,917
91,678
90,456
104,973
119,239
119,639
105,824
96,193
78,306
64,200
60,112
53,379
38,978
23,227
13,155
1,444,703
1999–2003
91,842
95,475
99,777
97,689
93,503
87,784
102,418
117,163
120,526
109,002
98,354
82,255
66,392
59,923
54,320
40,294
24,611
14,094
1,455,422



CAUCASIAN FEMALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
78,619
80,179
88,187
113,136
117,829
104,864
99,309
83,606
71,566
69,165
71,077
71,854
63,550
54,015
42,639
30,847
21,787
18,481
1,280,710
1981–85
80,323
80,997
87,026
110,099
116,793
106,532
101,853
86,153
74,375
70,386
70,456
71,092
64,219
55,670
43,813
31,793
22,344
18,998
1,292,922
1982–86
82,064
81,824
85,880
107,144
115,766
108,227
104,463
88,778
77,294
71,629
69,840
70,338
64,895
57,376
45,020
32,769
22,915
19,529
1,305,751
1983–87
83,842
82,659
84,750
104,269
114,748
109,948
107,139
91,483
80,327
72,893
69,230
69,592
65,578
59,134
46,259
33,774
23,501
20,076
1,319,202
1984–88
85,660
83,502
83,634
101,470
113,739
111,697
109,883
94,271
83,479
74,180
68,626
68,854
66,269
60,945
47,533
34,810
24,102
20,637
1,3332,91
1985–89
87,517
84,354
82,533
98,746
112,739
113,474
112,698
97,143
86,755
75,490
68,027
68,124
66,967
62,812
48,842
35,878
24,719
21,214
1,348,032
1986–90
89,414
85,214
81,446
96,096
111,747
115,279
115,585
100,103
90,159
76,823
67,433
67,401
67,673
64,736
50,187
36,979
25,352
21,808
1,363,437
1987–91
91,290
86,069
81,061
93,036
111,064
116,114
118,271
103,194
93,997
78,251
67,409
66,761
68,282
66,261
51,788
38,067
26,082
22,563
1,379,558
1988–92
93,067
87,022
81,208
90,361
109,925
116,111
120,341
106,481
97,052
80,722
68,076
66,286
68,590
67,291
53,660
39,149
26,846
23,453
1,395,640
1989–93
94,551
88,022
81,847
88,126
108,496
115,042
121,693
109,787
99,568
83,796
69,726
66,059
68,598
67,933
55,649
40,309
27,583
24,557
1,411,340
1990–94
95,596
89,103
83,037
86,568
106,589
11,2945
122,275
113,048
101,733
87,285
72,242
66,230
68,366
68,029
57,749
41,600
28,345
25,750
1,426,490
1991–95
96,096
90,364
84,668
85,845
104,086
110,000
122,059
116,117
103,780
91,295
75,446
66,828
67,968
67,703
59,727
43,058
29,238
27,026
1,441,304
1992–96
95,923
91,678
85,917
86,788
100,461
107,603
120,811
118,818
105,397
95,886
78,549
67,895
67,515
67,498
61,244
44,753
30,105
28,269
1,455,110
1993–97
95,192
92,892
87,211
88,204
97,046
105,184
119,046
120,770
107,742
99,036
82,286
69,534
67187
67,363
62,222
46,707
31,033
29,377
1,468,032
1994–98
93,941
93,950
88,449
90,077
94,136
102,898
116,682
122,041
110,550
101,414
86,036
71,901
67,164
67,227
62,921
48,701
32,115
30,345
1,480,548
1995–99
92,414
94,638
89,577
92,216
92,100
100,633
113,708
122,671
113,514
103,413
89,668
74,743
67,596
67,210
63,103
50,648
33,328
31,293
1,492,473
1996–2000
90,257
94,574
90,768
94,336
91,192
97,987
110,354
122,691
116,276
105,190
93,489
77,839
68,286
67,246
63,230
52,351
34,608
32,116
1,502,789
1997–2001
88,797
94,011
92,057
94,954
92,734
94,483
107,575
121,708
118,795
106,677
97,902
80,856
69,354
67,150
63,461
53,776
36,102
32,924
1,513,316
1998–2002
88,168
92,912
93,163
94,895
95,540
90,998
105,089
120,134
120,907
108,899
101,067
84,527
71,099
67,061
63,710
54,846
37,834
33,970
1,524,819
1999–2003
88,438
91,266
94,197
94,957
98,177
88,286
102,806
117,873
122,403
111,701
103,508
88,353
73,537
67,130
63,938
55,832
39,748
35,274
1,537,423


TOTAL AFRICAN-AMERICAN POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
46,897
45,434
51,959
55,157
49,134
42,910
37,844
29,625
24,715
22,107
19,988
18,744
15,266
13,530
9,147
6,527
3,534
2,579
495,097
1981–85
47,798
46,196
51,582
54,338
49,512
44,071
39,300
31,127
25,939
22,701
20,217
18,846
15,518
13,785
9,379
6,711
3,653
2,675
503,348
1982–86
48,717
46,971
51,208
53,532
49,893
45,264
40,812
32,705
27,223
23,311
20,448
18,949
15,774
14,045
9,617
6,900
3,776
2,774
511,919
1983–87
49,653
47,759
50,837
52,737
50,277
46,489
42,383
34,362
28,572
23,938
20,682
19,052
16,035
14,310
9,861
7,095
3,903
2,878
520,823
1984–88
50,607
48,560
50,468
51,954
50,664
47,747
44,014
36,104
29,987
24,581
20,919
19,156
16,300
14,579
10,111
7,295
4,034
2,986
530,066
1985–89
51,579
49,374
50,102
51,183
51,054
49,040
45,708
37934
31,472
25,241
21,159
19,260
16,569
14,853
10,367
7,500
4,170
3,097
539,662
1986–90
52,570
50,202
49,738
50,423
51,446
50,367
47,468
39,856
33,031
25,919
21,402
19,366
16,843
15,132
10,630
7,711
4,310
3,212
549,627
1987–91
54,172
51,175
50,053
49,380
52,258
51,673
49,437
41,844
34,988
26,674
21,825
19,558
17,117
15,379
10,960
7,860
4,499
3,339
562,191
1988–92
56,275
52,448
50,874
48,472
53,098
53,002
51,406
44,030
36,959
27,792
22,436
19,828
17,401
15,598
11,303
8,018
4,680
3,490
577,111
1989–93
58,557
53,977
52,253
48,037
53,735
54,200
53,281
46,384
39,055
29,223
23,336
20,179
17,717
15,768
11,715
8,128
4,887
3,653
594,086
1990–94
60,844
55,778
54,147
48,271
54,031
55,213
55,154
48,880
41,207
31,038
24,457
20,707
18,070
15,855
12,203
8,261
5,096
3,840
613,053
1991–95
62,920
57,989
56,443
49,280
53,969
56,174
56,918
51,458
43,509
33,330
25,785
21,344
18,506
15,917
12,721
8,409
5,361
4,035
634,069
1992–96
63,895
60,622
58,351
51,544
53,045
57,127
58,446
54,115
45,547
36,102
27,134
22,050
19,002
16,076
13,133
8,703
5,540
4,245
654,678
1993–97
64,057
63,449
60,202
54,537
52,021
57,719
59,830
56,586
47,878
38,767
28,753
22,904
19,548
16,313
13,491
8,991
5,742
4,437
675,224
1994–98
64,021
66,258
62,036
57,806
51,513
57,973
61,017
58,851
50,440
41,418
30,550
23,991
20,152
16,671
13,774
9,404
5,871
4,663
696,409
1995–99
63,978
68,919
63,926
61,065
51,864
57,878
61,835
61,040
53,223
43,955
32,627
25,196
20,862
17,138
13,925
9,881
6,005
4,905
718,221
1996–2000
64,374
71,027
66,136
64,067
53,217
57,262
62,534
63,030
56,076
46,437
35,125
26,486
21,569
17,779
14,029
10,386
6,143
5,175
740,853
1997–2001
65,054
72,187
68,668
66,184
55,750
56,044
62,816
64,727
58,871
48,620
38,016
27,870
22,250
18,402
14,284
10,768
6,400
5,421
762,333
1998–2002
66,052
72,427
71,468
67,799
58,888
54,819
62,668
66,024
61,387
50,999
40,812
29,515
23,093
19,006
14,657
11,168
6,678
5,686
783,147
1999–2003
66,965
72,306
74,289
69,286
62,010
54,087
62,215
66,882
63,510
53,597
43,489
31,386
24,127
19,632
15,102
11,524
7,083
5,923
803,414



AFRICAN-AMERICAN MALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
23,413
22,932
25,771
27,047
22,479
19,198
17,162
13,572
11,436
10,281
9,361
8,588
7,120
5,899
3,946
2,611
1,200
808
232,824
1981–85
23,891
23,338
25,628
26,664
22,826
19,852
17,861
14,215
11,990
10,553
9,467
8,635
7,190
6,021
4,026
2,670
1,235
825
236,887
1982–86
24,379
23,752
25,485
26,286
23,179
20,528
18,588
14,888
12,570
10,832
9,574
8,683
7,261
6,146
4,108
2,731
1,271
842
241,103
1983–87
24,876
24,173
25,343
25,914
23,537
21,227
19,345
15,593
13,179
11,118
9,682
8,730
7,333
6,274
4,191
2,793
1,308
859
245,475
1984–88
25,384
24,602
25,202
25,547
23,901
21,949
20,133
16,332
13,817
11,412
9,792
8,778
7,405
6,404
4,276
2,856
1,346
877
250,013
1985–89
25,902
25,038
25,062
25,185
24,270
22,696
20,952
17,106
14,487
11,714
9,903
8,826
7,478
6,536
4,363
2,921
1,386
896
254,721
1986–90
26,431
25,482
24,922
24,828
24,646
23,468
21,805
17,916
15,189
12,024
10,016
8,874
7,552
6,671
4,451
2,988
1,427
914
259,606
1987–91
27,285
25,995
25,079
24,352
25,172
24,218
22,764
18,777
16,088
12,375
10,225
8,954
7,649
6,779
4,574
3,013
1,490
925
265,715
1988–92
28,423
26,651
25,469
23,967
25,637
24,958
23,744
19,765
16,981
12,890
10,507
9,083
7,758
6,867
4,719
3,041
1,549
946
272,956
1989–93
29,636
27,393
26,167
23,794
25,968
25,603
24,686
20,891
17,881
13,544
10,917
9,253
7,899
6,933
4,882
3,067
1,618
969
281,102
1990–94
30,855
28,277
27,146
23,910
26,118
26,116
25,636
22,121
18,792
14,367
11,411
9,519
8,077
6,950
5,074
3,113
1,699
992
290,173
1991–95
31,970
29,365
283,38
24,385
26,063
26,594
26,507
23,431
19,740
15,413
11,998
9,853
8,291
6,933
5,303
3,192
1,792
1,021
300,191
1992–96
32,488
30,680
29,423
25,424
25,618
27,040
27,287
24,768
20,517
16,699
12,595
10,229
8,522
6,981
5,470
3,339
1,848
1,074
310,000
1993–97
32,547
32,134
30,512
26,801
25,168
27,304
27,979
26,010
21,491
17,863
13,334
10,665
8,813
7,062
5,612
3,469
1,919
1,118
319,801
1994–98
32,560
33,663
31,509
28,385
24,975
27,411
28,532
2,7136
22,672
18,977
14,152
11,193
9,144
7,209
5,755
3,633
1,978
1,172
330,057
1995–99
32,552
35,111
32,505
30,077
25,127
27,411
28,852
28,229
24,010
20,038
15,112
11,746
9,515
7,440
5,829
3,802
2,041
1,242
340,637
1996–2000
32,685
36,310
33,646
31,728
25,735
27,143
29,164
29,185
25,459
21,032
16,268
12,317
9,918
7,763
5,853
3,995
2,125
1,313
351,639
1997–2001
32,932
37,013
34,893
33,052
26,898
26,607
29,251
30,042
269,02
21,814
17,623
12,941
10,315
8,083
5,963
4,143
2,259
1,370
362,099
1998–2002
33,346
37,160
36,259
34,125
28,367
26,072
29,153
30,712
28,173
22,838
18,820
13,682
10,760
8,434
6,114
4,330
2,382
1,451
372,179
1999–2003
33,649
37,065
37,728
34,977
29,887
25,801
28,952
31,108
29,249
24,061
19,928
14,541
11,254
8,799
6,307
4,524
2,530
1,535
381,895


AFRICAN-AMERICAN FEMALE POPULATION
Years
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85+
Total
1980–84
23,486
22,500
26,187
28,110
26,638
23,700
20,681
16,052
13,279
11,827
10,628
10,155
8,143
7,631
5,200
3,915
2,336
1,769
262,237
1981–85
23,909
22,856
25,953
27,674
26,662
24,203
21,438
16,910
13,949
12,149
10,751
10,210
8,323
7,764
5,352
4,039
2,419
1,847
266,408
1982–86
24,339
23,217
25,721
27,245
26,686
24,717
22,223
17,814
14,653
12,480
10,875
10,266
8,508
7,899
5,508
4,167
2,505
1,929
270,752
1983–87
24,777
23,584
25,491
26,822
26,709
25,242
23,036
18,766
15,393
12,819
11,001
10,322
8,696
8,036
5,669
4,300
2,594
2,015
275,272
1984–88
25,223
23,957
25,263
26,407
26,733
25,778
23,879
19,769
16,170
13,168
11,128
10,379
8,888
8,176
5,835
4,437
2,687
2,104
279,981
1985–89
25,677
24,336
25,037
25,997
26,757
26,326
24,753
20,826
16,985
13,526
11,256
10,436
9,084
8,318
6,005
4,578
2,783
2,197
284,877
1986–90
26,139
24,720
24,813
25,594
26,781
26,885
25,660
21,939
17,842
13,894
11,386
10,494
9,285
8,462
6,180
4,723
2,883
2,295
289,975
1987–91
26,887
25,179
24,972
25,028
27,073
27,446
26,670
23,068
18,900
14,298
11,601
10,605
9,463
8,600
6,388
4,848
3,009
2,411
296,445
1988–92
27,852
25,797
25,404
24,506
27,453
28040
27,660
24,264
19,978
14,902
11,929
10,746
9,640
8,732
6,585
4,978
3,131
2,544
304,139
1989–93
28,921
26,584
26,086
24,242
27,764
28,595
28,594
25,493
21,174
15,679
12,419
10,926
9,817
8,835
6,834
5,063
3,269
2,684
312,978
1990–94
29,989
27,501
27,002
24,361
27,913
29,097
29,518
26,760
22,415
16,671
13,045
11,188
9,992
8,905
7,129
5,148
3,397
2,848
322,880
1991–95
30,951
28,624
28,105
24,896
27,906
29,580
30,411
28,027
23,768
17,917
13,787
11,492
10,215
8,984
7,418
5,217
3,568
3,014
333,879
1992–96
31,407
29,943
28,928
26,120
27,427
30,087
31,159
29,347
25,031
19,403
14,540
11,821
10,480
9,095
7,663
5,364
3,692
3,171
344,678
1993–97
31,511
31,314
29,690
27,737
26,853
30,415
31,852
30,577
26,387
20,904
15,419
12,239
10,735
9,251
7,878
5,521
3,823
3,319
355,424
1994–98
31,461
32,595
30,528
29,420
26,538
30,562
32,485
31,715
27,768
22,441
16,398
12,798
11,008
9,462
8,019
5,771
3,893
3,490
366,352
1995–99
31,426
33,808
31,421
30,987
26,737
30,467
32,983
32,811
29,213
23,917
17,516
13,449
11,348
9,698
8,096
6,080
3,965
3,663
377,584
1996–2000
31,689
34,717
32,490
32,339
27,482
30,120
33,370
33,845
30,617
25,405
18,857
14,169
11,650
10,016
8,177
6,391
4,018
3,862
306,470
1997–2001
32,122
35,174
33,775
33,132
28,852
29,438
33,564
34,685
31,970
26,806
20,393
14,929
11,936
10,319
8,322
6,625
4,141
4,051
233,242
1998–2002
32,707
35,267
35,209
33,674
30,521
28,747
33,515
35,311
33,214
28,161
21,992
15,833
12,333
10,571
8,544
6,838
4,296
4,235
410,968
1999–2003
33,316
35,241
36,561
34,310
32,123
28,287
33,263
35,775
34,262
29,535
23,562
16,845
12,872
10,833
8,795
7,000
4,552
4,388
421,519

SOURCE: Delaware Health Statistics Center, Department of Health and Social Services.


APPENDIX F


BEHAVIORAL RISK FACTORS

Delaware’s Behavioral Risk Factor Surveillance System (BRFSS), an annual survey of adults ages 18 
and older, is a collaboration between the Delaware Division of Public Health and the Centers for Disease 
Control and Prevention (CDC). The BRFSS includes a core set of questions developed by CDC and 
administered annually as a random-digit dial telephone survey in all 50 states. The BRFSS was 
developed to monitor the statewide prevalence of behavioral risk factors among adults that relate to 
premature morbidity and mortality. Questions in the survey include lifestyle behaviors (including tobacco 
use, fruit and vegetable consumption, exercise, and weight control), cancer screening practices, health 
status, and health care access and use. The data provided here for Delaware are a subset of the 
available information and relate specifically to prevalence estimates of risk factors for the development of 
cancer and of screening practices that affect cancer survival among Delaware residents.

More information about Delaware’s BRFSS is available at http://www.state.de.us/dhss/dph/dpc/ 
brfsurveys.html. General information on the BRFSS is available at http://www.cdc.gov/brfss/.


Overweight / Obesity

Being overweight or obese is a risk factor for several cancers, including female breast (in 
post-menopausal women), colorectal, kidney, and uterus. In addition, being overweight or obese is a 
major risk factor for other chronic diseases, including coronary heart disease, type 2 diabetes, and stroke. 

The term “overweight” is defined by the Centers for Disease Control and Prevention (CDC) as a Body 
Mass Index (BMI) greater than 25 and less than or equal to 30; “obese” is defined as a BMI greater than 
30. (BMI is calculated using a person’s height and weight.)

In Delaware in 2005
>	Almost sixty-three percent (62.5%) of Delaware residents were overweight or obese: 39.4% were 
overweight; 23.5 percent were obese.  The rate of overweight/obesity among U.S. adults, according 
to National Health and Nutrition Examination Survey data published in 2005, was 65%.
>	The prevalence of overweight people in Delaware differed by sex: 70.5 percent of males and 
55.5 percent of females were currently overweight/obese.
>	Among African Americans in Delaware, 74.8 percent were overweight/obese, compared with 61.6 
percent of Caucasians.
>	The prevalence of overweight/obese people in Delaware was highest in the 45-54 and 55-64 age 
groups (69.6 and 69.5 percent, respectively), followed by the 65+ age group (64.7 percent); it was 
lowest in the 18–24 age group (47.5 percent).
>	The prevalence of overweight/obese people in Delaware was highest among those with less than a 
high school education (69.3 percent) and lowest among college graduates (56.9 percent). 
>	In Delaware, the prevalence of overweight/obese people was highest in the $35,000–$49,000 income 
group (72.1 percent) and lowest in the $15,000–$24,999 income group (58.7 percent).


Physical Activity

Lack of physical activity is a risk factor for colorectal cancer and a suspected risk factor in other cancers, 
including prostate cancer. The benefits of regular sustained physical activity, however, also include 
reduction in risk of other chronic diseases, including coronary heart disease, type 2 diabetes, and stroke, 
as well as improved overall well-being.

BRFSS questions examine the intensity, duration and frequency of activity reported by respondents. 
“Physically active” is defined as 30 or more minutes of exercise of moderate activity at least five days per 
week, or 20 or more minutes of vigorous activity at least three days per week. 

In Delaware in 2005
>	The prevalence of physically active people in Delaware was 45.1 percent, compared with 
49.1 percent in the United States.
>	Forty-six percent of females and 44.7 percent of males were physically active, compared with 47.9 
percent and 50.7 percent, respectively, in the United States.
>	The prevalence of physically active people in Delaware was 46.5 percent among Caucasians and 
39.7 percent among African Americans, compared with 51.1 percent of Caucasians and 41.8 percent 
of African Americans in the United States.
>	The prevalence of physical activity in Delaware was lowest among those age 65+ (37.5 percent) and 
highest in the youngest age group (18-24; 60.5 percent).  This same pattern occurred in the U.S., 
where 39.0 percent of people age 65+ and 59.6 percent of people age 18-24 were physically active.  
>	The prevalence of physical activity was highest among college graduates (48.2 percent) and lowest 
among those with less than a high school education (35.8 percent).  U.S. data showed the same 
trend of increased prevalence of physical activity with increasing levels of education. 
>	Delaware data showed a pattern of increased prevalence of physical activity with increasing income 
level for people who earned at least $15,000. Prevalence of physical activity was 31.7 percent in the 
$15,000–$24,999 income group and 50.4 to 50.8 percent in groups within income at/above $50,000.


Dietary Fruits and Vegetables

A diet high in fruit and vegetable intake is known or strongly suspected to be effective in the prevention of 
numerous cancers, including breast, cervical, colorectal, corpus uterus, esophagus, oral cavity and 
pharynx, ovarian, pancreatic, prostate, and stomach cancers. In addition to cancer, dietary factors are 
associated with coronary heart disease, type 2 diabetes, and stroke.

A diet “low in fruit and vegetables” was defined as an average daily frequency of fewer than five servings 
of fruits and vegetables and was summarized based on responses to the following 2003 BRFSS survey 
questions: 

>	How often do you drink fruit juices such as orange, grapefruit, or tomato?
>	Not counting juice, how often do you eat fruit?
>	How often do you eat green salad?
>	How often do you eat potatoes, not including French fries, fried potatoes, or potato chips?
>	How often do you eat carrots?
>	Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?


In Delaware in 2005
>	A similar proportion of Delaware residents (21.3 percent) and U.S. residents (23.2 percent) consumed 
fruit and vegetables five or more times a day.
>	Delaware males were less likely than females to consume five or more fruits and vegetables daily:  
17.2 percent versus 25.1 percent.  Rates of adequate fruit and vegetable consumption were 18.6 
percent among U.S. males, and 28.1 percent among U.S. females.  
>	Fewer African Americans (14.1 percent) than Caucasians (22.3 percent) in Delaware had a diet with 
five or more fruits and vegetables a day, compared with 21.5 percent of African Americans and 23.5 
percent of Caucasians in the United States.
>	The prevalence of adequate fruit and vegetable intake was highest in the 65+ age category 
(26.9 percent); prevalence for all other age groups was comparable – and low - ranging from 17.7 
percent to 22.2 percent.  This pattern was also exhibited in U.S. prevalence, though rates were 
slightly higher.  
>	Prevalence of a diet with five fruits and vegetables a day was highest among college graduates (27.0 
percent) and lowest among those with less than a high school education (14.3 percent). U.S. data 
also showed that the prevalence of a diet with adequate fruits and vegetables decreased as level of 
education decreased. 

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The Delaware Department of Health and Social Services, Division of Public Health acknowledges
Macro International’s analytic contributions to this report, performed under contract to the Division.
QRC DIVISION OF MACRO INTERNATIONAL INC.
7315 WISCONSIN AVENUE • SUITE 400W • BETHESDA, MD 20814


Document Control Number: 35-05-20/06/08/01