CANCER of the KIDNEY and RENAL PELVIS

CANCER of the KIDNEY and RENAL PELVIS Data Highlights There were 1,695 cases of cancer of the kidney and renal pelvis diagnosed in 1997 among residents of Pennsylvania, the highest annual number since statewide reporting began in 1985. Males had an average annual (1993-97) age-adjusted incidence rate about twice that of females (14.1 and 7.1 per 1,, respectively). Annual numbers of cases and age-adjusted incidence rates by sex and race for 1988 through 1997 have all been on the increase. There are few understood causes of kidney cancer; however, cigarette smoking is an important risk factor. Approximately a quarter of all cases are caused by this behavior. As with age-adjusted rates, age-specific incidence rates were much higher among males for almost all age groups. Fifty-eight percent of all the cases for 1997 were diagnosed during the local stage of the disease. During the five-year period of 1993-97, over 7 percent of the cases of kidney and renal pelvis cancers were diagnosed among residents 6 years of age or older. In 1997, there were 631 resident deaths due to cancer of the kidney and renal pelvis, the highest annual number recorded between 1988 and 1997. The average annual (1993-97) age-adjusted death rate (3.5 per 1,) was over 65 percent lower than the average annual incidence rate (1.1 per 1,). The death rates were also much higher for males, as occurred with the incidence rates. There were no apparent trends for the mortality rates among the four sex/race groups. FIGURE 18 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 2.3 2.3 2.1 3.5 5.1 5. 5.6 7.1 7. 7.4 1.1 14.1 13.8 17.1 4 8 12 16 2 Age-Adjusted Rate Risk Factors Cigarette smoking. Etiological factors are obscure. *per 1, 197 U.S. standard million population. Early Detection None proven to be effective or currently being evaluated. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 156

Cancer of the Kidney and Renal Pelvis: INCIDENCE TABLE 18-A Number of Cancer Cases, Age-Adjusted Incidence Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1988-1997 All Cases* All Races* White Black All Races* White Black Year No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- 1997 1,695 1.8.5 1,16 14.8.9 925 14.5.9 84 18.5 4. 679 7.6.6 618 7.5.6 57 8.7 2.3 1996 1,637 1.4.5 1,7 14.7.9 917 14.4.9 8 17.5 3.8 63 7..5 568 6.8.6 55 8.1 2.1 1995 1,61 1.1.5 971 14.1.9 868 13.5.9 95 21.1 4.2 639 7..5 59 7..6 47 6.9 2. 1994 1,522 9.7.5 96 13.3.9 834 13.3.9 68 15.4 3.7 616 6.9.5 57 6.9.6 42 6.6 2. 1993 1,495 9.7.5 93 13.4.9 838 13.4.9 58 12.9 3.3 592 6.8.5 547 6.8.6 43 6.6 2. 1992 1,423 9.2.5 835 12.5.8 754 12.1.9 75 17. 3.8 588 6.7.5 539 6.7.6 46 7.3 2.1 1991 1,336 8.7.5 776 11.7.8 717 11.8.9 54 12.1 3.2 56 6.4.5 515 6.4.6 39 5.7 1.8 199 1,316 8.6.5 787 11.9.8 717 11.7.9 68 15.9 3.8 529 6.1.5 49 6.1.5 37 5.9 1.9 1989 1,33 8.9.5 794 12.5.9 732 12.4.9 57 13.1 3.4 536 6.2.5 486 6.1.5 49 7.6 2.1 1988 1,237 8.4.5 754 11.9.8 7 11.9.9 5 11.7 3.2 483 5.7.5 449 5.8.5 26 4.2 1.6 * Includes any unknowns. NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). 25 FIGURE 18-A Age-Adjusted Incidence Rates by Sex and Race Pennsylvania Residents, 1988-1997 2 Rate per 1, 15 1 5 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 157

Cancer of the Kidney and Renal Pelvis: INCIDENCE TABLE 18-B Average Annual Age-Specific Incidence Rates by Sex and Race Age Group All Cases All Races White Black All Races White Black Total 13.2 16.6 17. 14. 1.1 1.4 8. Under 5 2.1 1.7 1.8.7 2.4 2.2 4.1 5-9.6.5.5 1.2.6.7.4 1-14.1..1 -.2.2-15-19.2.1.1 -.2.2.4 2-24. - - -.1.1-25-29.6.6.6.9.5.5.4 3-34 1.4 1.6 1.5 2.2 1.2 1.1 1.7 35-39 2.7 3.5 3.5 2.9 1.9 1.8 3.4 4-44 5.8 8. 7.6 12.7 3.7 3.6 4.2 45-49 1.2 13.6 12.9 23.9 7. 6.9 8.3 5-54 18.8 24.8 24.4 31.3 13.2 13.2 14.1 55-59 26. 35.8 34.8 47.7 17.2 16.9 2.8 6-64 33.8 46.6 45.6 61.4 22.7 22.7 23.4 65-69 47.7 69.9 68.4 92.8 3.1 3.1 28.8 7-74 55. 78.7 78.2 8.2 37.8 37.9 36. 75-79 54.1 8.4 81. 73.9 37.3 38.2 25. 8-84 48.4 69.4 69.9 58.1 37. 36.5 45.8 85+ 32.6 45.7 45.7 45.7 27.3 27.2 28.5 NOTE: Rates are per 1, population (1993-1997) for each specified group. FIGURE 18-B Average Annual Age-Specific Incidence Rates by Sex and Race 1 8 RATE PER 1, 6 4 2 Under 5 5-9 1-14 2-24 3-34 4-44 5-54 6-64 7-74 8-84 15-19 25-29 35-39 45-49 55-59 65-69 75-79 AGE GROUP 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 158

Cancer of the Kidney and Renal Pelvis: INCIDENCE TABLE 18-C Total Number of Cancer Cases by Age, Sex and Race Age Group All Cases* All Races* White Black All Races* White Black Total 7,959 4,83 4,382 385 3,156 2,893 244 Under 5 81 34 31 2 47 36 11 5-9 23 11 8 3 12 11 1 1-14 5 1 1 4 4 15-19 7 2 2 5 4 1 2-24 2 2 2 25-29 23 13 11 2 1 8 1 3-34 62 35 3 5 27 22 4 35-39 126 81 72 6 45 37 8 4-44 258 175 151 23 83 73 9 45-49 41 261 224 35 14 124 15 5-54 619 394 354 36 225 22 21 55-59 743 485 432 46 258 228 27 6-64 915 584 527 52 331 31 28 65-69 1,295 839 765 71 456 422 31 7-74 1,353 812 756 49 541 55 33 75-79 1,61 613 581 32 448 429 18 8-84 63 319 32 15 311 288 23 85+ 355 144 135 8 211 197 13 * Includes any unknowns. FIGURE 18-C Stage of Disease at Diagnosis, Percent by Sex and Race Pennsylvania Residents, 1997 8 71.4 68.5 In Situ Local 6 54.7 59.8 Regional Distant Percent 4 2 23.1 2.6 19.5 18.4 2.5 22.2 9.1 9.3 1.6 1.4 Number and Percent of Cases Microscopically Confirmed: 1,544-91.1% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 159

Cancer of the Kidney and Renal Pelvis: MORTALITY TABLE 18-D Number of Deaths, Age-Adjusted Death Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1988-1997 All Deaths* All Races* White Black All Races* White Black Year No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- 1997 631 3.7.3 388 5.4.5 358 5.4.6 3 6.4 2.3 243 2.4.3 226 2.4.3 16 2.5 1.2 1996 614 3.6.3 386 5.5.5 355 5.4.6 31 7. 2.5 228 2.1.3 215 2.2.3 13 1.8 1. 1995 596 3.4.3 337 4.7.5 315 4.7.5 21 4.9 2.1 259 2.4.3 241 2.4.3 18 2.6 1.2 1994 59 3.6.3 349 5.1.5 324 5.1.6 24 5.4 2.2 241 2.4.3 227 2.4.3 14 1.9 1. 1993 532 3.3.3 311 4.6.5 291 4.7.5 2 4.5 2. 221 2.3.3 28 2.3.3 11 1.7 1. 1992 66 3.6.3 359 5.3.5 323 5.1.6 36 8.2 2.7 247 2.4.3 23 2.4.3 16 2.2 1.1 1991 588 3.5.3 352 5.2.5 318 5..5 32 7.3 2.5 236 2.4.3 217 2.4.3 19 2.8 1.3 199 572 3.5.3 347 5.2.5 321 5.2.6 26 6.2 2.4 225 2.3.3 27 2.3.3 18 2.9 1.3 1989 55 3.5.3 338 5.3.6 316 5.3.6 22 5.2 2.2 212 2.2.3 196 2.1.3 15 2.3 1.2 1988 52 3.2.3 267 4.2.5 249 4.2.5 18 4.2 1.9 235 2.5.3 224 2.5.3 11 1.6.9 * Includes any unknowns. NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). 1 FIGURE 18-D Age-Adjusted Death Rates by Sex and Race Pennsylvania Residents, 1988-1997 8 Rate per 1, 6 4 2 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 16

Cancer of the Kidney and Renal Pelvis: MORTALITY TABLE 18-E Number of Deaths and Average Annual Age-Specific Death Rates by Sex and Race All Deaths* All Races* White Black All Races* White Black Age Group No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate Total* 2,963 4.9 1,771 6.1 1,643 6.4 126 4.6 1,192 3.8 1,117 4. 72 2.3 Under 5 4.1 1. 1.1-3.2 3.2-5-9 5.1 5.2 4.2 1.4 - - - 1-14 2.1 2.1 2.1 - - - - 15-19 - - - - - - - 2-24 1. 1. 1.1 - - - - 25-29 2. 1. - 1.4 1. 1.1-3-34 11.2 9.4 4.2 5 2.2 2.1 2.1-35-39 17.4 12.5 12.6-5.2 4.2 1.4 4-44 56 1.3 33 1.5 29 1.5 4 2.2 23 1. 23 1.1-45-49 94 2.4 71 3.7 62 3.6 9 6.2 23 1.1 21 1.2 2 1.1 5-54 194 5.9 141 8.9 125 8.6 15 13. 53 3.1 46 3. 7 4.7 55-59 22 7.7 145 1.7 127 1.2 18 18.7 75 5. 65 4.8 9 6.9 6-64 291 1.7 188 15. 175 15.1 12 14.2 13 7.1 1 7.5 3 2.5 65-69 447 16.5 292 24.3 277 24.8 15 19.6 155 1.2 145 1.3 1 9.3 7-74 59 2.7 3 29.1 28 28.9 2 32.7 29 14.6 196 14.7 13 14.2 75-79 468 23.9 279 36.6 265 37. 14 32.3 189 15.8 18 16. 9 12.5 8-84 335 25.8 165 35.9 163 37.7 2 7.7 17 2.2 157 19.9 12 23.9 85+ 37 28.2 126 4. 116 39.2 1 57.2 181 23.4 174 24. 6 13.2 * Includes any unknowns. NOTE: Rates are per 1, population (1993-1997) for each specified group. FIGURE 18-E Average Annual Age-Specific Death Rates by Sex and Race 8 6 Rate per 1, 4 2 Under 5 5-9 1-14 15-19 2-24 25-29 3-34 35-39 4-44 45-49 Age Group 5-54 55-59 6-64 65-69 7-74 75-79 8-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 161

Cancer of the Kidney and Renal Pelvis: INCIDENCE TABLE 18-F Number of Cases, Average Annual Age-Adjusted Incidence Rates and Range for 95% Confidence Intervals by County and Sex, Total Total County Cases No. Rate CI+/- No. Rate CI+/- County Cases No. Rate CI+/- No. Rate CI+/- All Counties 7,959 4,83 14.1.4 3,156 7.1.2 Adams 52 34 14.4 4.8 18 6. 2.8 Juniata 7 5 7.7 6.7 2 2.6 3.6 Allegheny 944 561 13.9 1.2 383 7..7 Lackawanna 145 76 11.2 2.5 69 6.8 1.6 Armstrong 52 29 13.2 4.8 23 7.8 3.2 Lancaster 26 142 12.1 2. 118 8.1 1.5 Beaver 144 9 14.9 3.1 54 7.1 1.9 Lawrence 64 38 12.3 3.9 26 6.1 2.3 Bedford 38 21 13.3 5.7 17 1. 4.8 Lebanon 65 48 13.8 3.9 17 4.5 2.1 Berks 241 146 14.4 2.3 95 7.4 1.5 Lehigh 198 15 12. 2.3 93 8. 1.6 Blair 79 46 12.5 3.6 33 5.8 2. Luzerne 267 168 16.1 2.4 99 6.2 1.2 Bradford 3 16 8.5 4.2 14 6.1 3.2 Lycoming 7 4 11.9 3.7 3 6.7 2.4 Bucks 369 233 15.9 2. 136 7.5 1.3 McKean 27 13 9.3 5.1 14 7.4 3.9 Butler 87 49 11.1 3.1 38 7.9 2.5 Mercer 88 53 13.5 3.6 35 7.4 2.5 Cambria 121 7 14.5 3.4 51 7.5 2.1 Mifflin 26 15 11. 5.6 11 6.7 4. Cameron 7 5 26.3 23.1 2 1.1 14. Monroe 59 37 11.9 3.8 22 6.4 2.7 Carbon 42 26 13.9 5.3 16 6. 2.9 Montgomery 58 39 15.1 1.7 199 7.3 1. Centre 58 41 15.3 4.7 17 5. 2.4 Montour 8 6 11.9 9.5 2 2. 2.8 Chester 219 139 13.6 2.3 8 6.4 1.4 Northampton 169 18 15. 2.8 61 6.3 1.6 Clarion 24 15 13.6 6.9 9 5.5 3.6 Northumberland 7 44 14.5 4.3 26 6.2 2.4 Clearfield 46 33 14. 4.8 13 3.7 2. Perry 29 16 13.3 6.5 13 9.5 5.2 Clinton 2 1 8.9 5.5 1 7.4 4.6 Philadelphia 1,47 657 17.9 1.4 39 7.5.7 Columbia 43 29 15.5 5.6 14 6. 3.1 Pike 12 1 9.3 5.8 2 1.5 2.1 Crawford 49 31 12. 4.2 18 6.2 2.9 Potter 8 5 9.4 8.2 3 4.3 4.9 Cumberland 121 75 13.5 3.1 46 6.4 1.8 Schuylkill 128 81 16.6 3.6 47 7.5 2.1 Dauphin 149 75 11.5 2.6 74 8.7 2. Snyder 17 1 9.8 6.1 7 5.9 4.4 Delaware 377 212 13.8 1.9 165 7.9 1.2 Somerset 6 32 12.4 4.3 28 9.4 3.5 Elk 12 7 6.3 4.7 5 4.1 3.6 Sullivan 6 4 17. 16.7 2 12. 16.6 Erie 172 98 13.2 2.6 74 7.9 1.8 Susquehanna 22 12 9.5 5.4 1 7.4 4.6 Fayette 97 61 13.8 3.5 36 6. 2. Tioga 34 2 16.2 7.1 14 9. 4.7 Forest 5 3 17.5 19.8 2 11. 15.2 Union 24 11 1.5 6.2 13 1.5 5.7 Franklin 82 55 15.1 4. 27 5. 1.9 Venango 29 18 11. 5.1 11 5. 3. Fulton 9 6 15. 12. 3 6.2 7. Warren 17 1 6.8 4.2 7 4.8 3.6 Greene 18 8 7.1 4.9 1 7.1 4.4 Washington 153 89 13.6 2.8 64 7.2 1.8 Huntingdon 37 22 17.5 7.3 15 1.7 5.4 Wayne 32 17 11.8 5.6 15 8.9 4.5 Indiana 45 29 12.2 4.4 16 5.6 2.7 Westmoreland 265 17 14.2 2.1 95 6. 1.2 Jefferson 27 18 12.9 6. 9 4.9 3.2 Wyoming 11 8 1. 6.9 3 2.7 3.1 York 218 133 13.7 2.3 85 7.6 1.6 NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 162

Cancer of the Kidney and Renal Pelvis: MORTALITY TABLE 18-G Number of Deaths, Average Annual Age-Adjusted Death Rates and Range for 95% Confidence Intervals By County and Sex, Total Total County Deaths No. Rate CI+/- No. Rate CI+/- County Deaths No. Rate CI+/- No. Rate CI+/- All Counties 2,963 1,771 5.1.2 1,192 2.3.1 Adams 16 1 4.1 2.5 6 1.6 1.3 Juniata 3 2 3.2 4.4 1 1.4 2.7 Allegheny 364 223 5.5.7 141 2.2.4 Lackawanna 61 35 4.9 1.6 26 1.9.7 Armstrong 26 12 4.7 2.7 14 4. 2.1 Lancaster 19 68 5.7 1.4 41 2.7.8 Beaver 52 32 5.1 1.8 2 2.5 1.1 Lawrence 33 22 7.3 3.1 11 2.4 1.4 Bedford 14 9 5.5 3.6 5 2.5 2.2 Lebanon 27 2 5.4 2.4 7 1.6 1.2 Berks 87 56 5.5 1.4 31 2..7 Lehigh 79 43 4.7 1.4 36 2.7.9 Blair 28 12 3.1 1.8 16 2.6 1.3 Luzerne 13 6 5.6 1.4 43 2.2.7 Bradford 15 6 3.1 2.5 9 3.6 2.4 Lycoming 32 21 6.1 2.6 11 2.4 1.4 Bucks 16 6 4.2 1.1 46 2.4.7 McKean 12 7 4.8 3.6 5 1.9 1.7 Butler 46 24 5.4 2.2 22 3.9 1.6 Mercer 28 2 4.8 2.1 8 1.5 1. Cambria 4 25 5.2 2. 15 2. 1. Mifflin 11 6 4.4 3.5 5 3. 2.6 Cameron 4 3 16.1 18.2 1 3.9 7.6 Monroe 24 18 5.5 2.5 6 1.4 1.1 Carbon 22 13 6. 3.3 9 3.4 2.2 Montgomery 155 94 4.5.9 61 1.8.5 Centre 25 17 6.5 3.1 8 2.4 1.7 Montour 3 2 3.3 4.6 1 1.2 2.4 Chester 82 56 5.5 1.4 26 1.9.7 Northampton 52 25 3.3 1.3 27 2.6 1. Clarion 1 6 5.7 4.6 4 2.8 2.7 Northumberland 35 21 6.2 2.7 14 2.5 1.3 Clearfield 23 12 4.8 2.7 11 3.1 1.8 Perry 13 5 4.4 3.9 8 5.7 3.9 Clinton 9 6 5.6 4.5 3 1.8 2. Philadelphia 346 27 5.3.7 139 2.3.4 Columbia 19 12 6.4 3.6 7 2.2 1.6 Pike 11 9 7.8 5.1 2 1.7 2.4 Crawford 21 15 6. 3. 6 1.2 1. Potter 3 1 1.9 3.7 2 2.8 3.9 Cumberland 34 26 4.8 1.8 8.7.5 Schuylkill 53 34 6.5 2.2 19 2.7 1.2 Dauphin 61 31 4.7 1.7 3 3.2 1.1 Snyder 6 2 2.1 2.9 4 2.8 2.7 Delaware 128 66 4.3 1. 62 2.7.7 Somerset 23 12 4.7 2.7 11 3.7 2.2 Elk 6 4 3.4 3.3 2 1.6 2.2 Sullivan 4 3 9.2 1.4 1 3.3 6.5 Erie 55 35 4.4 1.5 2 1.8.8 Susquehanna 14 11 8.7 5.1 3 2.1 2.4 Fayette 39 21 4.5 1.9 18 2.5 1.2 Tioga 1 9 7.2 4.7 1.6 1.2 Forest 2 2 7.4 1.3 - - Union 1 2 1.9 2.6 8 5.6 3.9 Franklin 48 28 7.4 2.7 2 3.6 1.6 Venango 8 6 3.5 2.8 2.9 1.2 Fulton 4 1 2.5 4.9 3 5.5 6.2 Warren 4 2 1.3 1.8 2 1.3 1.8 Greene 1 5 4.4 3.9 5 4.3 3.8 Washington 61 38 5.5 1.7 23 2.7 1.1 Huntingdon 12 9 7. 4.6 3 1.2 1.4 Wayne 13 9 6.4 4.2 4 2.2 2.2 Indiana 14 9 3.6 2.4 5 1.4 1.2 Westmoreland 99 59 4.7 1.2 4 2.4.7 Jefferson 11 6 4.2 3.4 5 2.4 2.1 Wyoming 5 4 5.2 5.1 1.8 1.6 York 8 42 4.3 1.3 38 2.9.9 NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1993-1997 - Page 163