The National Cancer Institute (NCI) "Atlas of Cancer Mortality in the United States, 1950-94"

Some Changes for Prostate Cancer

Black Men's Prostate Cancer Deaths by State Economic Area 1970-1994 Click for full screen

White Men's Prostate Cancer Deaths by State Economic Area 1970-1994 Click for full screen

The National Cancer Institute (NCI) "Atlas of Cancer Mortality in the United States, 1950-94," shows geographic patterns of cancer death rates in more than 3,000 counties across the country over more than four decades. Except for the United States, few countries have mapped cancer mortality data over such an extensive time period and in such geographic detail, making it a unique resource.
      The 254 color-coded maps in the atlas makes it easy to identify places where high or low rates occur and to uncover patterns of cancer that would escape notice if larger areas, such as states, were mapped.
       The atlas cannot tell researchers why death rates are higher in certain localities than in others, but it will provide important clues for further in-depth studies into the causes and control of cancer.
      For the first time, maps are presented for both white and black populations. Earlier mortality statistics lacked data that would permit a separation of blacks from the nonwhite category.
    "It's not easy to sort out why cancer mortality rates vary among geographic areas and why they might be changing," said Joseph F. Fraumeni Jr., M.D., director of NCI's Division of Cancer Epidemiology and Genetics, and the senior author of the current and earlier atlases. "It's natural to want to know why cancer rates are elevated in a particular area, but it's important not to jump to conclusions before careful studies can be conducted in these areas."

Patterns for Prostate - Northern Exposure, Rural and Agricultural, African Americans At Risk

The patterns of prostate cancer deaths have changed. High rates among white men are much more prominent now in the north central areas. In contrast, among black men, rates are excessive in the southeastern United States, particularly in rural areas.
      "We don't know right now why the patterns for prostate cancer are changing," said Robert N. Hoover, M.D., also at the Division of Cancer Epidemiology and Genetics and an author of both current and past atlases. "But the atlas provides clues that will stimulate efforts to find out what characteristics of these populations and their exposures are responsible for the higher rates."
      Geographic variation for prostate cancer shows "a concentration of elevated rates in the Northwest, Rocky Mountain, and north-central areas of the United States and low mortality in the south-central areas."Prostate cancer looks to be commoner in rural areas than in cities, "with high rates in less populated areas of New England, the midwestern, northern Plains, and Rocky Mountain states, and the West."
      The recent patterns for white males show more clustering in the northwest sector of the country than in earlier years. Black males have especially high mortality from prostate cancer at the national level, with pockets of elevated rates in the southeastern part of the country.
      It is unclear whether the patterns are partly related to screening and treatment practices, the NCI analysts say. "But there is some evidence that agricultural exposures may contribute to the geographic variation, including the high rates among whites in farming communities in the north-central and western states (108) and among blacks in the southeastern states."

Colon Rates May Reflect Diet; Bladder, Auto Pollution

      Even greater changes are seen with lung cancer. Among white men, the rate of lung cancer rose from 39 per 100,000 during 1950-69 to 69 per 100,000 during 1970-94. In earlier atlases, elevated rates were seen in men in the Northeast and Southern Coastal areas of the United States. The highest rates now occur among white men in broad stretches across the South, among white women in the far West, and among the black population in northern urban areas. These changes generally coincide with regional and time trends in cigarette smoking.
      Many of the patterns displayed in the current atlas are similar to previous ones. Rates of breast cancer and colon cancer are high in urban centers in the Northeast, and have been for at least four decades.
      Regional variations in colon colon cancer are though to involve dietary and nutritional factors, although the specific causative elements are not clear. Breast cancer rates are partly, but not entirely, due to known risk factors, including late age at first birth, early menarche and late menopause, education and mammography history.
      Earlier atlases have been successful in generating leads that prompted further studies of high-risk areas of the country. The results of these studies are reported in the new atlas. Some of the findings include:
      -- High lung cancer death rates were seen not only among smelter workers but also among people who live close to arsenic-emitting smelters.
      -- High rates of lung cancer among men in Southern Coastal areas were related to asbestos exposure resulting from work in shipyards, particularly during World War II
      -- Elevated death rates for mouth and throat cancers among women living in the rural South were associated with use of smokeless tobacco.
      -- High death rates of esophageal cancer in Washington, D.C., and the coastal areas of South Carolina were linked to alcohol consumption and tobacco use, along with deficiencies in fruit and vegetable consumption.
      -- High colon cancer death rates in eastern Nebraska occurred mainly among persons of Czechoslovakian background, in whom dietary factors appeared to contribute to the risk.

      One study has already been started in response to the new atlas. Bladder cancer among men has tended to cluster in the urban Northeast since the 1950s, especially in areas with chemical industries. Previous studies in high-risk areas have also shown bladder cancer is high for truck drivers and other workers exposed to motor exhausts. The main risk factor, though, is cigarette smoking, which accounts for one-half of bladder cancer. But the new atlas has shown that Maine, Vermont, New Hampshire and upstate New York have elevated rates in both sexes that have become more pronounced over time.
      "We have been working with the states and with some of the academic departments in these states to develop a pilot study to pursue some of the current hypotheses for why the rates for bladder cancer have become more pronounced," said Hoover.
      The first atlas with color-coded mortality maps at the county level was published in 1975 and covered the years 1950-69. The current atlas adds 25 years of data to the original atlas and compares the patterns for 1950-69 with those for 1970-94. In addition, for the first time, an interactive version of the data will be available on the Internet.
      The Internet makes several new features possible. Not only can the maps, text, tables, and figures from the hard copy be downloaded from the Web site, but national and state mortality rates are also available, as are the tabulated data used to generate the maps. Another feature of the atlas Web site is that the user can create customized maps. For example, the user can compare rates in different time periods, look at rates for any cancer in any county, zoom and pan different areas of the country, and make color selections. Visit the atlas web site at http://www.nci.nih.gov/atlas and check the maps by county.