New Cancer Atlas Charts Variations in US Cancer Mortality

BETHESDA, Md—The National Cancer Institute has compressed 45 years of cancer mortality data into a single atlas. The new publication contains 254 color-coded maps showing variations in cancer deaths over two time periods, across various sections of the nation, and between men and women and blacks and whites.

The 367-page Atlas of Cancer Mortality in the United States, 1950-94 is a follow up to an earlier atlas published in 1975 that examined cancer mortality from 1950 to 1969. It compares data from that period with cancer deaths from 1970 to 1994, and, in the latter time frame, it includes separate data on variations in cancer deaths among black Americans.

The atlas presents mortality data for each of the 3,053 counties in the contiguous United States during both time periods. In the 1979-1994 time period, data are presented for the nation’s 506 contiguous state economic areas (SEAs). These are areas that are relatively homogeneous in demographic, economic, and cultural factors.

“The SEAs are useful in highlighting regional variations, compared to more localized variations,” lead author Susan S. Devesa, PhD, told the National Cancer Advisory Board (NCAB). The new atlas was released during the most recent NCAB meeting.

The national mortality rate for all cancers from 1970 to 1994 was 54% higher among white males than white females and 84% higher among black males than black females. Not surprisingly, the greatest change in mortality occurred among white men with lung cancer, rising from an annual rate of 39 per 100,000 in the 1950-1969 period to 69 per 100,000 during 1970-1994.

The atlas was written by Dr. Devesa, Dan J. Grauman, MA, Robert N. Hoover, MD, and Joseph F. Fraumeni, Jr., MD, of NCI’s Division of Cancer Epidemiology and Genetics; William J. Blot, PhD, of the International Epidemiology Institute, Rockville, Md; and Gene A. Pennello, PhD, of the FDA.

The findings do not explain why cancer deaths, overall or for specific sites, are higher in one area than others. However, the data can indicate areas for investigation and may provide clues to explain an increased death rate for a specific cancer.

The first atlas, for example, spotlighted a previously unrecognized high death rate from mouth and throat cancers among women living in the rural Southeast. Follow-up research attributed this finding to the use of smokeless tobacco.

Follow-up studies based on findings from the current atlas will include an investigation of the high rates of bladder cancer in northern New England, to determine the role of environmental pollutants, dietary factors, or other exposures, and a study to address the increased incidence and mortality rates over several years for non-Hodgkin’s lymphoma.

The greatest changes in geographic patterns in the current atlas are seen with lung cancer, with recent elevated mortality rates among white men across the South, among white women in the far West, and among blacks in southern urban areas.

Among whites, patterns changed substantially over time. Among white men in the 1950s and 1960s, high rates were seen in urban areas of the Northeast and North Central states and along the Southeast and Gulf coasts. By the 1980s to the mid-1990s, clustering of elevated rates was seen across the Southeast and South Central areas, with relatively low rates throughout much of the Northeast.

For white women, little geographic variation was evident in the 1950s, but by the 1980s and 1990s, high rates began to appear in clusters along the Atlantic and Pacific coasts. For both sexes, consistently low rates were seen in the mountain and plains states. Among blacks, rates were consistently low across the South. The changing patterns for lung cancer generally follow the regional and time trends in cigarette smoking.

Accessing the Atlas

Single copies of the print version of the atlas can be ordered free of charge by calling NCI’s Cancer Information Service at 1-800-422-6237 or on-line at http://publications.nci.nih.gov.

Internet access to the atlas is available at http://www.nci.nih.gov/atlas. A “static” website contains the atlas’ entire text and maps for both time periods, as well as the tabulated data used to generate the atlas maps. An “interactive” website enables users to create customized maps to compare rates in different time periods and to zoom and pan different areas of the country. The sample map below, created on the interactive site, shows breast cancer mortality among white females from 1970 to 1994 by state. ONI