Cancer Mortality -- Tennessee, 1960-1980

Analysis of the leading causes of death among Tennessee residents from 1968 to 1980 revealed that malignant neoplasms and suicide were the only two causes with increasing death rates (1). Age-specific and site-specific death rates for malignant neoplasms were examined for 1968-1980. During this period, mortality per 100,000 population for malignant neoplasms at all sites rose from 143.7 to 180.9 (1).

To determine the groups with increasing rates, changes in age-specific and site-specific malignant neoplasm death rates in Tennessee were tabulated from 1968 to 1980. Age-specific rates were also analyzed for respiratory and intrathoracic malignant neoplasms to determine whether there was any change over time.

For all age groups, the sites of malignant neoplasms with the highest death rates in 1968 were digestive organs and peritoneum (38.5/100,000); respiratory and intrathoracic organs (30.0/100,000); genital (21.7/100,000); and breast (11.1/100,000) (Table 1). By 1980, respiratory and intrathoracic cancer had become the leading site-specific cause of cancer death, with a mortality rate of 51.5/100,000. Digestive organs and peritoneum were second, with a rate of 44.5/100,000. The respiratory cancer death rate rose 71.7% from 1968 to 1980. During this period, death rates for genital cancer remained relatively stable, as did those for breast cancer.

Analyzing the "all other sites" category revealed that the increase from 1968 to 1980 was due to small changes at many sites rather than a large increase at any one site. Most deaths in the respiratory and intrathoracic category were due to lung cancer (Table 2).

For Tennessee residents whose ages at death were under 25 years, mortality for all sites was relatively stable around a mean of 5.9/100,000 during this period. The rate for leukemia, the leading site-specific cause for this age group, declined from 2.6/100,000 in 1968 to 1.9/100,000 in 1980. The rates for all other specific sites remained low and relatively unchanged.

For ages 25-34 years, overall rates declined from 21.3/100,000 population in 1968 to a low of 14.2/100,000 population in 1978. Lymphatic, leukemic, and digestive cancers were leading causes of site-specific deaths for persons aged 25-34 years during this period.

For residents aged 35-44 years, mortality for all sites fell irregularly from 63.7/100,000 in 1968 to 50.0/100,000 in 1980. Rates of genital cancer among females declined from 19.1/100,000 to 10.2/100,000. Respiratory, digestive, and breast cancers were the three other leading causes of malignant neoplasm deaths in this age group.

For residents aged 45-64 years, the overall death rate for malignant neoplasms rose from 285.4/100,000 in 1968 to 321.3/100,000 in 1980. This increase was due mainly to the increase in rates for respiratory and intrathoracic cancer, from 79.8/100,000 in 1968 to 120.9/100,000 in 1980, an increase of 51.5%.

In the 65- to 74-year-old age group, the death rate for all sites rose from 677.1/100,000 to 794.4/100,000; respiratory cancer rates rose from 147.4/100,000 to 245.5/100,000 from 1968 to 1980, an increase of 66.6%.

For residents aged 75 years and older, the cancer mortality rates for all sites increased from 1,004.1/100,000 to 1,216.6/100,000. Increasing rates occurred in this age group for digestive cancer (350.2/100,000 to 378.3/100,000), male genital cancer (306.0/100,000 to 367.5/100,000), and respiratory and intrathoracic cancer (112.8/100,000 to 217.4/100,000). The mortality for respiratory malignant neoplasms in this age group increased 92.7% from 1968 to 1980.

Digestive cancer rates increased sharply with age. Conversely, mortality from respiratory and intrathoracic cancer has increased for all age groups, with a steeper rate of increase for men than for women and with minimal race differences (Figure 1). Nationally, the rate of increase is steeper for women and for blacks and other racial minorities (2). The mortality from male genital cancer increased from 1968 to 1980. This increase was greater with advancing age, especially after age 54 years.

Editorial Note

Editorial Note: In Tennessee, the crude death rates for digestive and male genital cancer have increased, partly because of the aging of the population. The major cause of the increase in cancer death rates in Tennessee, however, is respiratory and intrathoracic malignant neoplasms, which increased with age in all races and both sexes. In a special study commissioned by the National Cancer Institute (3), an estimated 85%-95% of respiratory cancer deaths were caused by tobacco smoking. Increased efforts in patient counseling and public education regarding the health risks of tobacco use may be needed to reverse this trend. Reported by J Harris, MD, Northern Telecom, Nashville, A Hogan, T Spillman, Health Promotion Section, Tennessee Dept of Health and Environment in the Journal of the Tennessee Medical Association, 1984;77:156-61.

References

1. Tennessee Department of Health and Environment. Unpublished data.

2. Office on Smoking and Health. Smoking and health: a report of the Surgeon General. Washington, D.C.: Public Health Service, Department of Health, Education, and Welfare, 1979.

3. Doll R, Peto R. The causes of cancer. New York: Oxford University Press, 1982.

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