CANCER of the PANCREAS

CANCER of the PANCREAS Data Highlights The highest 1992-96 average annual age-adjusted incidence rate for pancreatic cancer occurred in black males (13.9). Black females had the second highest rate (10.5). The rate of 8.9 for white males was 36 percent lower than the rate for black males. The rate for white females (6.6) was over 37 percent lower than the rate for black females. A total of 1,459 cases of pancreatic cancer were diagnosed among residents of Pennsylvania in 1996 the highest annual number of cases recorded since statewide reporting began in 1985. Annual age-adjusted incidence rates by sex and race between 1987 and 1996 suggest a slight increase for both white and black males as well as for white females but no discernible trend among black females. There is very little information about the etiology of this disease except for cigarette smoking. Epidemiological studies have consistently shown an excess risk for smokers relative to nonsmokers. This risk increases with the amount of tobacco use. Smoking is directly responsible for about 25 percent of pancreatic cancer cases. Because nearly all cases are diagnosed at advanced stages, the five-year relative survival rates approach zero. In 1996, almost 85 percent of all the cases were diagnosed at the regional or distant stages of the disease among Pennsylvania residents. While pancreatic cancer represented only 2.1 percent of all new cancer cases in 1996, it accounted for 4.9 percent of the cancer deaths that year. In fact, the 1992-96 average annual age-adjusted death rates for this site were higher than the average annual incidence rates among all four sex/race groups. This was also true for many of the annual numbers as well as for the age-specific and single year age-adjusted rates. This is possibly due to the problems of accurate assigning of the underlying cause of death and/ or underreporting of incidence that are associated with this disease. Over the ten-year period of 1987 to 1996, there were no discernible long term trends in the annual death rates by sex or race. FIGURE 7 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 7.9 8.2 9.3 9.5 8.9 9.1 6.8 7.1 6.6 6.8 10.5 10.9 13.9 1 0 5 10 15 Age-Adjusted Rate Risk Factors Cigarette smoking. Diet high in fat content is suggestive. *per 100,000 1970 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 1992-1996 - Page 68

Cancer of the Pancreas: INCIDENCE TABLE 7-A Number of Cancer Cases, Age-Adjusted Incidence Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1987-1996 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+/- 1996 1,459 8.3 0.4 721 10.1 0.7 656 9.8 0.7 57 12.4 3.2 738 6.9 0.5 661 6.6 0.5 75 10.8 2.4 1995 1,427 8.4 0.4 690 9.8 0.7 613 9.4 0.7 71 15.9 3.7 737 7.1 0.5 658 6.9 0.5 73 10.4 2.4 1994 1,291 7.6 0.4 653 9.4 0.7 584 9.0 0.7 64 14.6 3.6 638 6.2 0.5 585 6.2 0.5 49 7.0 2.0 1993 1,341 7.8 0.4 567 8.1 0.7 511 7.9 0.7 53 12.3 3.3 774 7.5 0.5 681 7.1 0.5 88 12.4 2.6 1992 1,279 7.5 0.4 618 8.9 0.7 549 8.5 0.7 63 14.5 3.6 661 6.5 0.5 576 6.0 0.5 80 11.9 2.6 1991 1,224 7.4 0.4 584 8.6 0.7 523 8.3 0.7 59 13.1 3.3 640 6.5 0.5 561 6.1 0.5 72 10.6 2.4 1990 1,228 7.5 0.4 604 9.0 0.7 556 8.9 0.7 45 10.6 3.1 624 6.4 0.5 538 5.8 0.5 80 12.5 2.7 1989 1,223 7.7 0.4 560 8.7 0.7 503 8.4 0.7 51 11.9 3.3 663 7.0 0.5 593 6.8 0.5 66 10.0 2.4 1988 1,111 7.1 0.4 544 8.4 0.7 495 8.2 0.7 48 11.2 3.2 567 6.1 0.5 510 5.9 0.5 55 8.6 2.3 1987 1,101 7.0 0.4 541 8.4 0.7 492 8.2 0.7 47 11.1 3.2 560 5.9 0.5 501 5.7 0.5 56 8.8 2.3 * Includes any unknowns. NOTES: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. Rates based on less than 20 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). 18 FIGURE 7-A Age-Adjusted Incidence Rates by Sex and Race Pennsylvania Residents, 1987-1996 16 14 Rate per 100,000 12 10 8 6 4 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 69

Cancer of the Pancreas: INCIDENCE TABLE 7-B Average Annual Age-Specific Incidence Rates by Sex and Race Age Group All Cases All Races White Black All Races White Black Total 11.3 11.2 11.3 11.4 11.3 11.4 12.0 Under 5 - - - - - - - 5-9 - - - - - - - 10-14 - - - - - - - 15-19 - - - - - - - 20-24 0.1 0.0 0.1-0.2 0.3-25-29 0.1 0.0 0.1-0.2 0.2-30-34 0.5 0.6 0.6 0.9 0.4 0.4-35-39 0.7 0.7 0.6 1.0 0.8 0.8 0.8 40-44 2.5 3.2 3.0 5.6 1.7 1.7 2.4 45-49 4.3 5.6 5.1 12.1 3.1 3.0 4.6 50-54 8.9 10.3 9.8 18.8 7.7 7.0 13.8 55-59 16.4 19.3 18.3 31.5 13.8 12.8 23.4 60-64 26.6 33.4 31.8 50.1 20.8 20.0 29.9 65-69 37.5 43.6 41.4 72.3 32.7 31.3 51.6 70-74 49.9 59.3 56.5 94.3 43.1 41.7 63.8 75-79 59.0 69.7 69.5 73.0 52.2 50.4 73.7 80-84 67.0 68.7 68.0 77.6 66.1 63.2 106.7 85+ 67.7 76.1 74.5 111.0 64.4 62.2 101.3 NOTE: Rates are per 100,000 population (1992-1996) for each specified group. 120 FIGURE 7-B Average Annual Age-Specific Incidence Rates by Sex and Race 100 80 Rate per 100,000 60 40 20 0 Under 5 5-9 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 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 1992-1996 - Page 70

Cancer of the Pancreas: INCIDENCE TABLE 7-C Total Number of Cancer Cases by Age, Sex and Race Age Group All Cases* All Races* White Black All Races* White Black Total 6,797 3,249 2,913 308 3,548 3,161 365 Under 5 0 0 0 0 0 0 0 5-9 0 0 0 0 0 0 0 10-14 0 0 0 0 0 0 0 15-19 0 0 0 0 0 0 0 20-24 6 1 1 0 5 5 0 25-29 5 1 1 0 4 4 0 30-34 23 14 12 2 9 9 0 35-39 34 16 13 2 18 16 2 40-44 109 70 60 10 39 34 5 45-49 165 104 87 17 61 53 8 50-54 284 158 137 21 126 104 20 55-59 460 256 222 30 204 171 30 60-64 731 423 373 43 308 269 36 65-69 1,041 535 473 57 506 448 57 70-74 1,235 615 550 58 620 559 59 75-79 1,146 525 492 31 621 562 53 80-84 851 305 284 19 546 490 52 85+ 707 226 208 18 481 437 43 * Includes any unknowns. FIGURE 7-C Stage of Disease at Diagnosis, Percent by Sex and Race Pennsylvania Residents, 1996 60 53.6 In Situ Local 44.0 41.9 46.0 45.4 Regional Distant 40 38.0 38.4 33.3 Percent 20 13.9 16.0 16.3 11.6 0 0.2 1.5 Number and Percent of Cases Microscopically Confirmed: 1,112-76.2% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 71

Cancer of the Pancreas: MORTALITY TABLE 7-D Number of Deaths, Age-Adjusted Death Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1987-1996 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+/- 1996 1,498 8.4 0.4 700 9.8 0.7 633 9.5 0.7 64 14.4 3.5 798 7.2 0.5 720 6.9 0.5 76 10.6 2.4 1995 1,452 8.1 0.4 679 9.5 0.7 602 9.1 0.7 75 16.8 3.8 773 7.1 0.5 713 7.0 0.5 58 8.0 2.1 1994 1,409 7.9 0.4 645 9.1 0.7 576 8.7 0.7 68 15.5 3.7 764 7.0 0.5 695 6.8 0.5 64 9.2 2.3 1993 1,391 8.0 0.4 641 9.1 0.7 583 8.9 0.7 57 12.9 3.3 750 7.1 0.5 661 6.7 0.5 86 12.5 2.6 1992 1,467 8.4 0.4 696 10.0 0.7 625 9.6 0.8 69 15.9 3.8 771 7.2 0.5 664 6.7 0.5 100 14.3 2.8 1991 1,404 8.2 0.4 663 9.7 0.7 618 9.7 0.8 43 9.8 2.9 741 7.1 0.5 672 6.9 0.5 65 9.1 2.2 1990 1,377 8.2 0.4 683 10.1 0.8 618 9.8 0.8 65 15.2 3.7 694 6.8 0.5 614 6.4 0.5 78 12.2 2.7 1989 1,428 8.8 0.5 651 10.0 0.8 589 9.7 0.8 59 13.9 3.5 777 7.8 0.5 705 7.7 0.6 67 9.8 2.3 1988 1,233 7.6 0.4 587 9.0 0.7 536 8.8 0.7 49 11.7 3.3 646 6.6 0.5 587 6.5 0.5 59 9.1 2.3 1987 1,314 8.1 0.4 620 9.6 0.8 561 9.3 0.8 58 14.0 3.6 694 7.0 0.5 632 6.8 0.5 61 9.5 2.4 * Includes any unknowns. NOTES: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. Rates based on less than 20 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). FIGURE 7-D Age-Adjusted Death Rates by Sex and Race Pennsylvania Residents, 1987-1996 18 16 14 Rate per 100,000 12 10 8 6 4 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 72

Cancer of the Pancreas: MORTALITY TABLE 7-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* 7,217 12.0 3,361 11.6 3,019 11.7 333 12.3 3,856 12.3 3,453 12.4 384 12.6 Under 5 0-0 - 0-0 - 0-0 - 0-5-9 0-0 - 0-0 - 0-0 - 0-10-14 0-0 - 0-0 - 0-0 - 0-15-19 0-0 - 0-0 - 0-0 - 0-20-24 1 0.0 0-0 - 0-1 0.0 1 0.1 0-25-29 2 0.0 1 0.0 1 0.1 0-1 0.0 1 0.1 0-30-34 17 0.4 9 0.4 9 0.4 0-8 0.3 8 0.4 0-35-39 23 0.5 14 0.6 10 0.5 3 1.5 9 0.4 7 0.3 2 0.8 40-44 78 1.8 53 2.4 43 2.2 10 5.6 25 1.1 21 1.0 4 1.9 45-49 157 4.1 107 5.7 95 5.6 12 8.5 50 2.6 46 2.6 4 2.3 50-54 260 8.2 138 9.0 123 8.8 15 13.4 122 7.4 100 6.8 19 13.1 55-59 444 15.8 249 18.8 209 17.2 38 39.9 195 13.2 166 12.5 29 22.6 60-64 688 25.0 401 31.6 353 30.1 45 52.4 287 19.4 244 18.1 38 31.5 65-69 1,049 37.8 554 45.1 489 42.8 63 79.9 495 32.0 432 30.2 61 55.2 70-74 1,290 52.1 610 58.8 543 55.8 67 108.9 680 47.3 608 45.4 69 74.6 75-79 1,282 66.0 600 79.7 561 79.3 38 89.5 682 57.3 622 55.8 59 82.0 80-84 1,002 78.9 351 79.1 335 80.2 16 65.3 651 78.8 597 77.0 50 102.6 85+ 924 88.5 274 92.3 248 88.8 26 160.3 650 87.0 600 85.4 49 115.5 * Includes any unknowns. NOTE: Rates are per 100,000 population (1992-1996) for each specified group. FIGURE 7-E Average Annual Age-Specific Death Rates by Sex and Race 200 150 Rate per 100,000 100 50 0 Under 5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 73

Cancer of the Pancreas: INCIDENCE TABLE 7-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 6,797 3,249 9.3 0.3 3,548 6.8 0.2 Adams 35 17 7.2 3.4 18 5.6 2.6 Juniata 9 3 4.6 5.2 6 8.5 6.8 Allegheny 859 401 9.7 0.9 458 6.8 0.6 Lackawanna 134 58 8.5 2.2 76 6.7 1.5 Armstrong 53 30 11.9 4.3 23 5.5 2.2 Lancaster 168 77 6.7 1.5 91 5.6 1.2 Beaver 128 66 10.7 2.6 62 6.9 1.7 Lawrence 60 29 8.7 3.2 31 6.7 2.4 Bedford 24 10 6.4 4.0 14 6.4 3.4 Lebanon 75 39 10.8 3.4 36 6.7 2.2 Berks 164 86 8.2 1.7 78 5.2 1.2 Lehigh 157 82 9.2 2.0 75 6.1 1.4 Blair 80 34 8.5 2.9 46 8.4 2.4 Luzerne 240 108 10.1 1.9 132 7.6 1.3 Bradford 37 20 10.6 4.6 17 6.4 3.0 Lycoming 49 27 8.0 3.0 22 4.4 1.8 Bucks 229 109 7.8 1.5 120 6.3 1.1 McKean 25 8 5.3 3.7 17 7.6 3.6 Butler 78 48 10.8 3.1 30 5.2 1.9 Mercer 76 36 9.1 3.0 40 6.6 2.0 Cambria 100 54 9.9 2.6 46 5.5 1.6 Mifflin 22 8 5.5 3.8 14 6.6 3.5 Cameron 0 0 - - 0 - - Monroe 60 36 11.9 3.9 24 5.9 2.4 Carbon 32 17 7.9 3.8 15 5.5 2.8 Montgomery 428 214 10.2 1.4 214 7.1 1.0 Centre 35 15 5.7 2.9 20 5.4 2.4 Montour 8 6 11.9 9.5 2 3.1 4.3 Chester 161 91 9.3 1.9 70 5.6 1.3 Northampton 148 73 9.9 2.3 75 6.9 1.6 Clarion 19 11 9.1 5.4 8 5.1 3.5 Northumberland 62 24 7.1 2.8 38 7.6 2.4 Clearfield 47 23 9.3 3.8 24 6.3 2.5 Perry 20 9 8.1 5.3 11 7.7 4.6 Clinton 14 5 4.8 4.2 9 5.6 3.7 Philadelphia 1,058 472 12.0 1.1 586 9.2 0.7 Columbia 32 16 8.9 4.4 16 6.5 3.2 Pike 17 12 10.9 6.2 5 4.8 4.2 Crawford 47 26 10.2 3.9 21 5.2 2.2 Potter 6 5 9.5 8.3 1 1.2 2.4 Cumberland 91 45 7.9 2.3 46 5.7 1.6 Schuylkill 85 42 8.0 2.4 43 4.9 1.5 Dauphin 136 57 8.8 2.3 79 8.5 1.9 Snyder 19 11 10.6 6.3 8 6.6 4.6 Delaware 279 128 8.2 1.4 151 6.3 1.0 Somerset 34 16 6.8 3.3 18 4.8 2.2 Elk 23 9 8.4 5.5 14 9.7 5.1 Sullivan 6 0 - - 6 16.7 13.4 Erie 147 62 8.2 2.0 85 8.2 1.7 Susquehanna 19 9 6.9 4.5 10 5.5 3.4 Fayette 81 42 8.8 2.7 39 5.5 1.7 Tioga 13 6 4.7 3.8 7 3.0 2.2 Forest 2 2 7.9 10.9 0 - - Union 18 9 9.0 5.9 9 6.9 4.5 Franklin 60 32 8.5 2.9 28 5.4 2.0 Venango 42 23 13.0 5.3 19 7.8 3.5 Fulton 10 7 16.7 12.4 3 7.6 8.6 Warren 24 12 8.4 4.8 12 5.5 3.1 Greene 17 10 7.6 4.7 7 4.9 3.6 Washington 123 57 8.5 2.2 66 6.6 1.6 Huntingdon 27 14 11.4 6.0 13 7.4 4.0 Wayne 42 18 13.3 6.1 24 12.0 4.8 Indiana 41 24 9.4 3.8 17 5.0 2.4 Westmoreland 248 114 9.0 1.7 134 8.1 1.4 Jefferson 45 16 9.8 4.8 29 11.6 4.2 Wyoming 16 8 11.1 7.7 8 8.2 5.7 York 153 71 7.3 1.7 82 6.2 1.3 NOTES: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. Rates based on less than 20 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 1992-1996 - Page 74

Cancer of the Pancreas: MORTALITY TABLE 7-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 7,217 3,361 9.5 0.3 3,856 7.1 0.2 Adams 38 20 8.6 3.8 18 5.6 2.6 Juniata 7 2 3.2 4.4 5 7.6 6.7 Allegheny 891 407 9.8 1.0 484 7.0 0.6 Lackawanna 168 71 10.0 2.3 97 7.9 1.6 Armstrong 57 35 13.4 4.4 22 5.1 2.1 Lancaster 217 97 8.3 1.7 120 7.0 1.3 Beaver 112 58 9.0 2.3 54 5.9 1.6 Lawrence 63 29 8.3 3.0 34 6.9 2.3 Bedford 27 10 6.1 3.8 17 7.9 3.8 Lebanon 75 33 8.9 3.0 42 7.5 2.3 Berks 169 84 8.0 1.7 85 5.8 1.2 Lehigh 164 78 8.7 1.9 86 6.6 1.4 Blair 83 38 9.2 2.9 45 8.0 2.3 Luzerne 255 115 10.6 1.9 140 7.4 1.2 Bradford 41 21 11.2 4.8 20 5.9 2.6 Lycoming 60 29 8.6 3.1 31 5.5 1.9 Bucks 249 113 8.2 1.5 136 7.2 1.2 McKean 27 13 8.3 4.5 14 5.4 2.8 Butler 73 39 8.7 2.7 34 5.7 1.9 Mercer 83 33 8.3 2.8 50 7.9 2.2 Cambria 94 45 8.0 2.3 49 5.6 1.6 Mifflin 20 7 4.6 3.4 13 5.2 2.8 Cameron 1 1 4.7 9.2 0 - - Monroe 66 37 12.4 4.0 29 7.3 2.7 Carbon 34 21 10.3 4.4 13 4.7 2.6 Montgomery 460 218 10.3 1.4 242 7.4 0.9 Centre 33 13 5.0 2.7 20 5.7 2.5 Montour 14 8 16.1 11.2 6 6.0 4.8 Chester 181 96 9.8 2.0 85 6.4 1.4 Northampton 157 67 9.1 2.2 90 7.8 1.6 Clarion 20 12 10.0 5.7 8 4.8 3.3 Northumberland 66 32 9.7 3.4 34 6.2 2.1 Clearfield 48 25 10.3 4.0 23 6.0 2.5 Perry 16 9 8.0 5.2 7 4.7 3.5 Clinton 14 8 7.1 4.9 6 3.5 2.8 Philadelphia 1,093 479 12.0 1.1 614 9.0 0.7 Columbia 35 13 6.9 3.8 22 9.5 4.0 Pike 18 10 9.6 6.0 8 6.9 4.8 Crawford 49 28 11.1 4.1 21 4.7 2.0 Potter 10 4 7.8 7.6 6 7.7 6.2 Cumberland 90 43 7.6 2.3 47 5.4 1.5 Schuylkill 107 53 10.1 2.7 54 6.5 1.7 Dauphin 138 56 8.6 2.3 82 8.7 1.9 Snyder 17 8 7.8 5.4 9 7.3 4.8 Delaware 321 143 9.0 1.5 178 7.0 1.0 Somerset 52 29 11.2 4.1 23 5.7 2.3 Elk 23 9 8.5 5.6 14 9.4 4.9 Sullivan 3 0 - - 3 6.6 7.5 Erie 149 62 8.1 2.0 87 7.9 1.7 Susquehanna 19 8 6.1 4.2 11 5.4 3.2 Fayette 78 42 8.8 2.7 36 4.7 1.5 Tioga 21 11 8.5 5.0 10 5.5 3.4 Forest 3 2 7.9 10.9 1 3.1 6.1 Union 24 13 13.7 7.4 11 9.1 5.4 Franklin 73 28 7.4 2.7 45 8.1 2.4 Venango 37 19 10.9 4.9 18 6.7 3.1 Fulton 10 8 19.1 13.2 2 4.6 6.4 Warren 26 14 10.3 5.4 12 5.1 2.9 Greene 23 12 9.4 5.3 11 7.4 4.4 Washington 122 53 8.0 2.2 69 6.9 1.6 Huntingdon 28 16 12.6 6.2 12 6.4 3.6 Wayne 40 18 13.6 6.3 22 9.9 4.1 Indiana 44 21 7.9 3.4 23 6.0 2.5 Westmoreland 255 130 10.1 1.7 125 7.4 1.3 Jefferson 51 18 11.2 5.2 33 13.4 4.6 Wyoming 24 16 21.8 10.7 8 8.4 5.8 York 151 71 7.3 1.7 80 6.0 1.3 NOTES: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. Rates based on less than 20 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 1992-1996 - Page 75