Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

The content, links, and pdfs are no longer maintained and might be outdated.

  • The content on this page is being archived for historic and reference purposes only.
  • For current, updated information see the MMWR website.

Surveillance of Demographic Characteristics and Health Behaviors Among Adult Cancer Survivors — Behavioral Risk Factor Surveillance System, United States, 2009

J. Michael Underwood, PhD

Julie S. Townsend, MS

Sherri L. Stewart, PhD

Natasha Buchannan, PhD

Donatus U. Ekwueme, PhD

Nikki A. Hawkins, PhD

Jun Li, MD, PhD

Brandy Peaker, MD

Lori A. Pollack, MD

Thomas B. Richards, MD

Sun Hee Rim, MPH

Elizabeth A. Rohan, PhD

Susan A. Sabatino, MD

Judith L. Smith, PhD

Eric Tai, MD

George-Ann Townsend, MEd

Arica White, PhD

Temeika L. Fairley, PhD

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC



Corresponding author: J. Michael Underwood, PhD, CDC, 4770 Buford Hwy NE, MS K-57, Atlanta, GA 30341. E-mail: jmunderwood@cdc.gov; Telephone: 770-488-3029; Fax: 770-488-4335.


Abstract

Problem/Condition: Approximately 12 million people are living with cancer in the United States. Limited information is available on national and state assessments of health behaviors among cancer survivors. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this report provides a descriptive state-level assessment of demographic characteristics and health behaviors among cancer survivors aged ≥18 years.

Reporting Period Covered: 2009

Description of System: BRFSS is an ongoing, state-based, random-digit–dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years. BRFSS collects information on health risk behaviors and use of preventive health services related to leading causes of death and morbidity. In 2009, BRFSS added questions about previous cancer diagnoses to the core module. The 2009 BRFSS also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage for cancer survivors. In 2009, all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands administered the core cancer survivorship questions, and 10 states administered the optional supplemental cancer survivorship module. Five states added questions on mammography and Papanicolaou (Pap) test use, eight states included questions on colorectal screening, and five states included questions on prostate cancer screening.

Results: An estimated 7.2% of the U.S. general population aged ≥18 years reported having received a previous cancer diagnosis (excluding nonmelanoma skin cancer). A total of 78.8% of cancer survivors were aged ≥50 years, and 39.2% had received a diagnosis of cancer >10 years previously. A total of 57.8% reported receiving an influenza vaccination during the previous year, and 48.3% reported ever receiving a pneumococcal vaccination. At the time of the interview, 6.8% of cancer survivors had no health insurance, and 12% had been denied health insurance, life insurance, or both because of their cancer diagnosis. The prevalence of cardiovascular disease was higher among male cancer survivors (23.4%) than female cancer survivors (14.3%), as was the prevalence of diabetes (19.6% and 14.7%, respectively). Overall, approximately 15.1% of cancer survivors were current cigarette smokers, 27.5% were obese, and 31.5% had not engaged in any leisure-time physical activity during the past 30 days. Demographic characteristics and health behaviors among cancer survivors varied substantially by state.

Interpretation: Health behaviors and preventive health care practices among cancer survivors vary by state and demographic characteristics. A large proportion of cancer survivors have comorbid conditions, currently smoke, do not participate in any leisure-time physical activity, and are obese. In addition, many are not receiving recommended preventive care, including cancer screening and influenza and pneumococcal vaccinations.

Public Health Action: Health-care providers and patients should be aware of the importance of preventive care, smoking cessation, regular physical activity, and maintaining a healthy weight for cancer survivors. The findings in this report can help public health practitioners, researchers, and comprehensive cancer control programs evaluate the effectiveness of program activities for cancer survivors, assess the needs of cancer survivors at the state level, and allocate appropriate resources to address those needs.

Introduction

A cancer survivor is a person who has received a diagnosis of cancer, from the time of diagnosis throughout the person's life (1–3). The aging of the U.S. population has resulted in an increase in the number of cancer diagnoses (4), and because of improvements in early detection and treatment, the number of cancer survivors has steadily increased during the last 3 decades. As of 2007, nearly 12 million cancer survivors were living in the United States (5).

Cancer survivors often face long-term adverse physical, psychosocial, and financial effects from their cancer diagnosis and treatment (2,6–10); the impact of cancer on family members, friends, and caregivers of survivors is considered a part of cancer survivorship (1). Cancer survivors have a greater risk for new cancers compared with persons who have never had cancer (11,12). Various healthy lifestyle behaviors have been shown to prevent new malignancies and decrease the chances of recurrence among cancer survivors (2,13). Prevention and cessation of tobacco use (primarily cigarette smoking) (14), regular physical activity (15), maintenance of a healthy weight (16–18), and routine consultation with health-care providers about follow-up care after a cancer diagnosis (i.e., survivorship care plans) (19) have shown evidence of the ability to prevent new cancers or cancer recurrence, increase survival, and strengthen quality of life after a cancer diagnosis. Survivor-specific resources and support are necessary to promote positive health outcomes and improve quality of life.

Increased recognition of the potential benefits of healthy lifestyle behaviors among persons with cancer contributed to the development of responsive public health strategies such as the National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (2), a publication cosponsored by Livestrong (formerly the Lance Armstrong Foundation) and CDC, and From Cancer Patient to Cancer Survivor: Lost in Transition (13), by the Institute of Medicine. In addition, CDC's National Comprehensive Cancer Control Program (NCCCP) funds states, the District of Columbia (DC), tribes and tribal organizations, selected U.S. territories, and associated Pacific Island jurisdictions to develop and implement local comprehensive cancer control plans (20), most of which include specific goals and objectives about survivorship (21). NCCCP programs use population-based data sources to assess the effectiveness of activities related to survivorship and to conduct state-specific analyses of cancer survivor health behaviors. Population-based information about survivors also is useful for public health practitioners, program implementers, and researchers who assess and develop interventions to improve the health and quality of life of cancer survivors.

The Behavioral Risk Factor Surveillance System (BRFSS) survey is a state-based surveillance system that monitors health behaviors, chronic diseases, injuries, access to health care, and preventive health care. Core module questions are asked of all survey respondents in each state and territory, and each state and territory may include select optional modules in their surveys. In 2009, BRFSS added questions about previous cancer diagnoses to the core survey module. The survey also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage of cancer treatment for cancer survivors. Because BRFSS data are obtained through respondent interviews, the cancer survivors described in this report are all classified as cancer survivors on the basis of self-reporting; cancer diagnoses were not confirmed. Therefore, these data might differ from data reported by the CDC's National Program of Cancer Registries or the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, which both confirm diagnoses (5).

This report provides a descriptive analysis of the 2009 BRFSS data among cancer survivors, including demographic characteristics and health behaviors, as well as cancer treatment history and health insurance coverage of treatment in states that included the optional module in the 2009 survey. Although the effects of cancer on those who know and care for cancer survivors are a component of cancer survivorship, the analyses in this report include only the persons who received the cancer diagnosis (1).

Methods

BRFSS is an ongoing, cross-sectional, random-digit–dial telephone survey of noninstitutionalized adults aged ≥18 years. Trained interviewers use the standard core and optional questionnaire modules to collect uniform data from all states, DC, and select U.S. territories. In 2009, BRFSS was conducted in all 50 states, DC, Guam, Puerto Rico, and the U.S. Virgin Islands. The optional module on cancer survivorship was administered by 10 states (California, Connecticut, Maryland, Massachusetts, Nebraska, New Jersey, North Carolina, Oklahoma, Vermont, and Virginia). Detailed BRFSS methods have been described in previous publications (22,23).

Questionnaire

The standard BRFSS questionnaire consists of three parts: 1) core questions, 2) optional supplemental modules that include sets of questions on specific topics, and 3) state-added questions. All jurisdictions ask the same core questions. Individual jurisdictions may opt to include optional modules and jurisdiction-added questions to address specific health-care concerns.

As part of the core module, respondents were asked whether they had ever been told by a doctor, nurse, or other health-care professional that they had cancer. Respondents who answered yes were asked how many different types of cancer they had, the age when they were told that they had cancer, and which type of cancer they had. If respondents reported having had more than one type of cancer, only the most recently diagnosed type was recorded. Respondents who were unsure about their history of cancer, who refused to answer the question, or who reported nonmelanoma skin cancer were excluded from the analysis.

Of 432,607 BRFSS respondents, 411,654 answered the question regarding previous cancer diagnoses. Among these respondents, 4,252 either refused to answer the question or were not sure that they had ever been diagnosed with cancer and were excluded from the analysis; in addition, 13,632 reported having had nonmelanoma skin cancer and were excluded from the analysis. Nonmelanoma skin cancers (i.e., basal and squamous cell skin cancers) are not routinely collected in cancer registries because they do not require treatment beyond surgery (5).

Years since diagnosis (0–5, 6–10, and >10 years) were calculated using the respondents' current age and age at first cancer diagnosis. Type of cancer was categorized as breast, female genital system (cancers of the cervix, uterus, and ovary), head or neck (cancers of the head, neck, mouth, and throat), gastrointestinal (cancers of the colon, esophagus, liver, pancreas, stomach, and rectum), leukemia or lymphoma (Hodgkin's lymphoma, non-Hodgkin's lymphoma, and leukemia), male genital system (cancers of the prostate and testis), skin (melanoma), lung, urinary tract (bladder and kidney), other cancer types (thyroid, bone, brain, heart, neuroblastoma, and other), and unknown or refused to answer.

Using data from the core module, the following characteristics were compared among cancer survivors: age at interview, sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander [A/PI], American Indian/Alaska Native [AI/AN], other/multiracial [preferred race not asked], unknown or refused to answer), marital status (married or living together, divorced, never married, widowed, or separated), education level (did not graduate high school, high school graduate, some college, or college graduate), employment status (employment for wages, out of work or unable to work, retired, or other), insurance coverage (yes or no), and U.S. Census region of residence (Northeast, South, Midwest, West, or the U.S. territories). Quality of life was measured by self-reported health status (excellent, very good, good, fair, or poor), number of physically unhealthy days during the past 30 days, receipt of social support (always, usually, sometimes, rarely, or never), and life satisfaction (very satisfied, satisfied, dissatisfied, or very dissatisfied).

In addition, the following health risk behaviors were analyzed: current smoking (smoking cigarettes every day or some days and having smoked >100 cigarettes during lifetime), obesity (body mass index [BMI] ≥30 kg/m2), and no leisure-time physical activity during the past 30 days. The presence of the following chronic health conditions was assessed: cardiovascular disease (history of myocardial infarction, angina or coronary heart disease, or stroke), diabetes, current asthma ("Have you ever been told by a doctor, nurse, or other health professional that you had asthma?" "Do you still have asthma?"), and disability (activity limitations from physical, mental, and emotional problems). The following preventive health care measures also were examined: ever having received pneumococcal vaccine and receipt of injected influenza vaccine during the past 12 months. (Receipt of live, attenuated influenza vaccine [LAIV] was not analyzed because most cancer survivors in this analysis were not eligible to receive LAIV.)

Five states (Georgia, Hawaii, New Jersey, Tennessee, and Wyoming) added questions on mammography and Papanicolaou (Pap) test use among women. Mammography use within the past 2 years and Pap test use (excluding women who had received a hysterectomy) within the past 3 years were analyzed among female cancer survivors aged ≥40 years and aged ≥18 years, respectively. Eight states (Delaware, Hawaii, Maine, Massachusetts, Nebraska, New Jersey, Oklahoma, and Wyoming) included questions on colorectal screening, and five states (Delaware, Hawaii, Kentucky, Nebraska, and New Jersey) included questions on prostate cancer screening. Cancer survivors aged ≥50 years were considered up to date with screening for colorectal cancer if they had received a fecal occult blood test within the previous year, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years.

Data from the 10 states that administered the cancer survivorship optional module (California, Connecticut, Maryland, Massachusetts, Nebraska, New Jersey, North Carolina, Oklahoma, Vermont, and Virginia) were examined for the following cancer-related health care experience variables: type of physician providing the majority of their care, receipt of treatment summary or follow-up instructions, insurance coverage of cancer treatment, and denial of health or life insurance coverage because of a cancer diagnosis. Variables related to cancer treatments also were examined, including current receipt of cancer treatment, whether respondent had ever participated in a clinical trial, current pain from cancer or treatment, and current control of cancer-related pain.

Data Collection and Processing

Trained interviewers administer the BRFSS questionnaire using a computer-assisted telephone interviewing system. Data are collected monthly by each state and territory using disproportionate stratified random sampling in all states and DC and simple random sampling in Guam, Puerto Rico, and the U.S. Virgin Islands (24). According to the guidelines of the Council of American Survey Research Organizations (CASRO), the median cooperation rate (defined as the percentage of persons who completed interviews among all eligible persons who were contacted) for the 2009 BRFSS was 75%; the CASRO response rate (defined as the percentage of persons who completed interviews among all eligible persons, including those who were not successfully contacted) was 52.5% (25).

Data Weighting and Statistical Analysis

Statistical software was used to account for the complex sampling design. Statistics are not presented if the sample size for the numerator was <50 or if the half-width of the confidence interval was >10; however, the values are included in overall total calculations. Each sample is weighted to the respondent's probability of selection and the age- and sex-specific population or the age-, sex-, and race/ethnicity-specific population by using the 2009 postcensus projections for each state. Using the public-use BRFSS data file, all estimates were weighted to represent noninstitutionalized adults aged ≥18 years living within their respective state, DC, or U.S. territory. Some of the 17 states that administered either the optional cancer survivorship module or the women's health, colorectal cancer screening, or prostate cancer screening modules used multiple questionnaires. For these states, the survey weights provided in the multiple questionnaire data files were used. A new weight variable was created so that records from states using multiple questionnaires could be analyzed along with records from states that either included these modules on their common BRFSS survey or did not use multiple questionnaires. This allowed states that used optional modules on multiple questionnaire versions to be included in the analysis, thereby increasing the sample size for these modules.

Results

Demographic Characteristics

Of 432,607 BRFSS respondents, 411,654 answered the question regarding whether they had ever been told by a doctor, nurse, or other health-care professional that they had cancer. Among these respondents, 45,541 reported ever having cancer (7.2% of all respondents in all 50 states, DC, and the U.S. territories), not including nonmelanoma skin cancer (Table 1). A greater proportion of women (8.4%) than men (6.0%) reported ever receiving a diagnosis of cancer. A greater proportion of cancer survivors reported having received the diagnosis >10 years before the survey (39.2%) than in the past 5 years (36.2%) or 6–10 years before the survey (20.8%). Men were more likely to have received the diagnosis within the last 5 years (42.1%) compared with other time periods, whereas women were more likely to have received the diagnosis >10 years before the survey (44.0%). Most cancer survivors were non-Hispanic white (81.2%) and aged ≥50 years (78.8%). More male cancer survivors (74.9%) than female cancer survivors (57.0%) were married or living with a significant other. Approximately 10% of all cancer survivors had not graduated from high school. A total of 42.4% of cancer survivors were retired, and 93% had insurance coverage at the time of the survey.

Among male cancer survivors, the prevalences of cardiovascular disease (23.4%) and diabetes (19.6%) were higher than the prevalence of cardiovascular disease (14.3%) and diabetes (14.7%) among female cancer survivors. Current asthma was more prevalent among female cancer survivors (13.3%) than male cancer survivors (7.5%).

Preventive Care

Among cancer survivors in the eight states (Delaware, Hawaii, Maine, Massachusetts, Nebraska, New Jersey, Oklahoma, and Wyoming) that included colorectal cancer screening questions on the survey, 77.9% (1,138) of men and 73.1% (1,912) of women reported having been screened for colorectal cancer within the recommended period. Among the five states (Georgia, Hawaii, New Jersey, Tennessee, and Wyoming) that included questions on mammography and Pap test use among women on the survey, 79.4% (823) of women reported having been screened for cervical cancer, and 80.4% (1,517) reported having been screened for breast cancer within the recommended period. Approximately 57.8% of cancer survivors reported receiving an injected influenza vaccination during the previous year, and 48.3% reported ever receiving a pneumococcal vaccination.

Types of Cancer

Cancers of the breast (19.5%) were the most common cancers among all survivors, followed by female (14.8%) and male (14.6%) genital cancers (Table 2). Among women, the most common primary cancer types were breast (32.4%); cervix, uterus, ovary (24.8%); and melanoma (9.6%). The most common primary cancer types among men were prostate and testis (36.1%), melanoma, (16.2%), and gastrointestinal (10.5%). Breast cancer was the most commonly reported cancer in all racial/ethnic populations (19.3%, non-Hispanic white; 23.9%, non-Hispanic black; 25.8%, A/PI; 16.1%, AI/AN; and 17.3% Hispanic) (Table 3). Of the male genital cancers, prostate cancer (33.3%) was the most commonly reported cancer among all male racial/ethnic populations. Percentages of prostate cancer were highest among non-Hispanic black men (53.6%), followed by Hispanic (34.1%) and non-Hispanic white men (31.3%). Cervical cancer (14.5%) was the most commonly reported genital cancer among women. Percentages were highest among AI/AN women (28.9%), followed by Hispanic (20.4%), non-Hispanic black (14.7%), and non-Hispanic white women (13.8%).

Regional Differences

Cancer prevalences were similar in the Northeast (7.8%), Midwest (7.6%), and South (7.5%) U.S. Census regions; the prevalence was slightly lower in the West (6.2%) (Table 4). Whereas cancer prevalence was higher among women than men overall in the United States, states with the highest ratio of female-male cancer prevalence were Indiana (1.70), Oklahoma (1.66), Maine (1.57), and Montana (1.52). Breast cancer was most prevalent among women in the Northeast (36.4%). Cervical cancer (17.1%) and melanoma (13.2%) were most prevalent in the South. Prostate (34.8%) and female genital cancers (excluding cervical cancer) were highest in the West (11.3%).

Quality of Life

When asked to describe overall health status, 68.5% of cancer survivors indicated that their overall health was excellent, very good, or good (Table 5). Approximately one third (31.8%) of cancer survivors reported experiencing ≥5 physically unhealthy days during the past 30 days, with wide variations by state. The highest percentage of survivors reporting ≥5 unhealthy days was reported among survivors living in Kentucky (44.1%), and the lowest was among those living in Iowa (24.7%). Half (50.2%) of cancer survivors living in the United States reported always receiving needed social or emotional support, and 92.7% of all cancer survivors reported being very satisfied or satisfied with their life.

Health Behaviors

Smoking

Approximately 15.1% of cancer survivors aged ≥18 years in the 50 states and DC were current cigarette smokers (Figure 1). Smoking prevalence among cancer survivors was highest in Oklahoma (23.9%) and lowest in California (10.3%). Regional differences also were observed, with the highest prevalence in the South (17.2%), followed by the Midwest (15.8%), Northeast (15.1%), and West (13.0%).

Obesity

A total of 27.5% of cancer survivors were obese (BMI ≥30 kg/m2) (Figure 2); however, the prevalence varied widely by state, ranging from 15.7% in Colorado to 33.8% in Missouri. Similarly, obesity prevalence among cancer survivors varied by geographic region. Obesity was most prevalent among cancer survivors in the Midwest (29.8%), followed by the South (28.4%), Northeast (26.0%), and West (24.5%).

Leisure-Time Physical Activity

Approximately 31.5% of cancer survivors had not participated in any leisure-time physical activity during the past 30 days (Figure 3). The highest proportion of cancer survivors reporting no leisure-time physical activity lived in the South (34.3%), followed by the Midwest (32.5%), Northeast (31.3%), and West (25.5%). Among states, percentages of inactivity were highest in West Virginia (42.3%) and lowest in Oregon (21.4%).

Treatment Regimens and Pain

Among the 6,384 respondents in the 10 states that included the optional module, 12% of cancer survivors reported that they were currently receiving treatment, with estimates ranging from 9.1% to 14.0% among states (Table 6). A total of 7.5% of cancer survivors reported ever having participated in a clinical trial. Whereas 10.1% of survivors reported current pain that they attributed to cancer or cancer treatment, approximately 80.9% of these survivors reported that the pain was currently well controlled.

Health-Care Experience

Among the 5,593 respondents not currently undergoing treatment from the 10 states that included the optional module, 21.2% of cancer survivors reported that the type of physician who provided the majority of their health care was either an oncologist or another cancer specialist, ranging from 14.3% in North Carolina to 29.3% in California (Table 7). Approximately 40.2% of cancer survivors reported receipt of a written summary of their cancer treatments, and 73.9% reported receipt of instructions on follow-up care. Approximately 90.7% of respondents reported that insurance covered all or part of their cancer treatment. Overall, 12.0% of respondents said they had been denied health or life insurance coverage because of their cancer diagnosis.

Discussion

Cancer is among the most prevalent diseases diagnosed and the second leading cause of death in the United States (26). This report presents the first population-based survey with state-level assessment of health behaviors and demographic characteristics among cancer survivors. Although previous studies also have examined state-level preventive health practices among cancer survivors (e.g., cancer screenings and influenza and pneumococcal vaccinations) (27,28), this is the only report with data from all 50 states, DC, and U.S. territories.

Research has indicated that cancer survivors might benefit from higher levels of recommended screenings and increased vaccine coverage because of their increased susceptibility to future illness (2,10). All cancer survivors in this report were recommended to have received the flu vaccine (which is recommended for all persons aged >6 months), and most were candidates for the pneumococcal vaccination (which is recommended for adults aged > 65 years and for persons with certain chronic medical conditions which put them at risk for pneumococcal infection); however, a substantial proportion of cancer survivors did not receive these vaccines. A previous study of the Medicare population indicated that breast cancer survivors are less likely to receive preventive care (e.g., influenza vaccination, cholesterol screening, colorectal cancer screening, bone densitometry, and mammography) than age-, ethnicity- and sex-matched controls (29). Other studies also have shown that cancer survivors are less likely to receive recommended preventive care for a broad range of chronic medical conditions, and cancer screening rates decrease significantly as oncologists are less involved in patient treatment (30,31).

Demographic Characteristics and Use of Preventive Care

Approximately 7% of all 2009 BRFSS respondents reported ever receiving a diagnosis of cancer from a health-care professional. This prevalence is slightly lower than the estimated 10% found in a recent BRFSS study (32), likely because nonmelanoma skin cancers were included in that study. Cases of nonmelanoma skin cancer account for nearly one fifth of all reported cancer cases. Approximately 3.5 million basal and squamous skin cancers occurred in 2006 (33).

This report confirms findings from previous studies: the majority of cancer survivors are older (5), female (5,34), non-Hispanic white (35–37), and married (36). Cancer is strongly associated with aging (38), and researchers expect the cancer survivor population to continue increasing as the U.S. population ages (39).

There are more female than male cancer survivors, possibly because certain cancers among women (e.g., breast and cervical cancer) can be detected earlier through effective screening methods and treated more successfully than many other cancers, leading to longer survival (40). Minority populations have higher cancer incidence rates than whites for some but not all cancers (41). The potential lack of BRFSS respondent representativeness compared with the total U.S. population, in addition to a lower death rate among white cancer survivors compared with all other racial groups, might contribute to the higher proportion of cancer survivors among non-Hispanic whites observed in this study (41). Approximately 64% of cancer survivors were married, and nearly 27% were divorced or widowed, consistent with a previous study of cancer survivors (36). In contrast, 90% of cancer survivors in this report graduated from high school, whereas approximately 80% of cancer survivors in previous studies reported graduating (35–37). This difference might be associated with a previous finding that households with landline telephones (which are required for BRFSS participation) are associated with higher educational attainment (42).

Breast cancer is the most common invasive cancer among U.S. women (43), and incidence rates are high across all racial/ethnic groups. Black women tend to have more deaths from breast cancer (43), and the results in this report showed a higher prevalence of breast cancer among non-Hispanic black women than among non-Hispanic white women. Through the combination of widespread mammography screening programs and improvements in therapeutic treatment agents, the proportion of long-term breast cancer survivors has increased considerably over the last several decades (5,44). For prostate cancer, a significantly higher proportion of non-Hispanic black men were prostate cancer survivors than were men of other races/ethnicities, consistent with incidence data showing prostate cancer is more common among black men (43). Although black men also tend to have higher death rates than other racial populations from prostate cancer, the high proportion of indolent disease contributes to the relatively high (99%) overall 5-year relative survival (45).

Types of Cancer

The patterns of cancer by type among cancer survivors in this report differ from estimates that are based on cancer registry data. In one such report, prostate, colorectal, and female breast cancer survivors accounted for the majority of survivors (5). In this analysis, although prostate and female breast cancers also account for the majority of cancer types among male and female cancer survivors, respectively, melanoma survivors are the third largest group. A plausible explanation for these differences is that national estimates of survivors, which are based on SEER data (45), do not include in situ melanoma cases. In contrast, BRFSS respondents may report all types of cancer, regardless of whether the cancer was invasive. In addition, common noncancer diagnoses such as cervical dysplasia and uterine fibroids might be misreported as cancer by BRFSS respondents (46). Variations in cancer prevalence by cancer type also might reflect differences in incidence, risk, availability of screening tests and effective treatment for each cancer, and whether the cancer is likely to be curable.

Health Behaviors

Despite significant decreases in cigarette smoking since 1980, a 2011 CDC study indicated that 20% of U.S. adults aged ≥18 years in the general population currently smoke (47), compared with 15% of cancer survivors in this report. Cigarette smoking continues to be the leading preventable cause of morbidity and mortality, resulting in approximately 443,000 deaths annually (47). Cancer survivors are at increased risk for subsequent cancers, including tobacco-related cancers (48,49). Adverse health conditions from smoking include compromised cancer treatment efforts, delayed healing after surgery, and impeded recovery of optimal daily functioning (48). In this report, current smoking was reported by cancer survivors and varied substantially by state; however, certain states, such as California and Massachusetts, had a relatively low prevalence.

The low smoking prevalence among cancer survivors in California and Massachusetts is partially attributable to implementation of the long-running comprehensive tobacco control program in California and mandated tobacco cessation coverage in the Massachusetts Medicaid program (47,50,51). Because of the hazardous effects of smoking, especially among persons with cancer, promotion of smoking cessation and initiation of smoking prevention measures among cancer survivors are especially important. Studies have shown that health-care providers might miss opportunities to counsel cancer survivors about healthy behaviors, including smoking cessation (30,52). Health-care professionals should promote smoking cessation resources and treatments to persons who continue to smoke after receiving a cancer diagnosis. CDC recently recommended use of the U.S. Public Health Service Guidelines for Treating Tobacco Use and Dependence to decrease tobacco use among current smokers (53). CDC recommends a comprehensive approach to tobacco control, which includes evidence-based tobacco prevention and cessation strategies (e.g., targeted media campaigns, smoking cessation counseling interventions, quit lines, and medications) that are proven to be effective (53).

The obesity prevalence among cancer survivors in this report is similar to the obesity prevalence in the general U.S. population (54). Although the association between obesity and numerous chronic diseases has been well established, increasing numbers of studies are linking obesity to cancer. Obese cancer survivors have an increased risk for recurrence or death from colon, breast, prostate, esophageal, uterine, ovarian, kidney, and pancreatic cancers (55–58). In addition, studies have shown that obese cancer survivors with leukemia, non-Hodgkin's lymphoma, and multiple myeloma are more likely to experience new cancers than those who are not obese (59).

Research also associates physical activity with a reduced risk for recurrence and death from certain cancers, and the evidence is increasing. The results in this report indicate that approximately one of three cancer survivors in the United States did not participate in any leisure-time physical activity during the past 30 days. Several studies reported a 30%–60% reduction in risk for breast cancer recurrence, cancer-specific death, or overall mortality with moderate physical activity, equivalent to average-paced walking 2–3 hours a week (60–63). Studies also have found a 50%–60% reduction in risk for colorectal cancer recurrence, cancer-specific death, or overall mortality from regular physical activity after receiving a cancer diagnosis; however, these protective effects only occurred with the highest physical activity intensity and longest duration (64,65).

Many of the studies investigating the effect of physical activity on cancer recurrence and mortality are observational; additional data are needed to evaluate the association. However, evidence describing the positive effects of physical activity on other cancer outcomes such as overall functioning, aerobic and strength capacity, psychological well-being, and quality of life, is more consistent (66,67). On the basis of this evidence, the American College of Sports Medicine released physical activity guidelines for cancer survivors, which are consistent with the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans. These guidelines support the safety and efficacy of physical activity for cancer survivors (68). The findings in this report indicate that many U.S. cancer survivors do not follow current physical activity recommendations, possibly increasing the risk for poor outcomes. In addition, rates of inactivity are higher among cancer survivors than in the general population. In 2009, 24.2% of the general population reported no leisure-time activity (69), compared with 31.3% of cancer survivors in this report. Because cancer survivors are at a higher risk for inactivity than the general population, additional effort is needed to increase physical activity among cancer survivors (68).

Although the reported variation in health-related behaviors and use of clinical preventive services across the states might be a result of differences in demographic characteristics and the availability of state-level services for cancer survivors, they also might reflect previously reported regional and state-level differences in the general population (70).

Treatment Regimens and Pain

Several barriers prevent cancer survivors from receiving appropriate follow-up care after completing cancer treatment, including lack of coordination among health-care providers, lack of standardized follow-up medical care, and lack of knowledge among cancer survivors about appropriate follow-up (13). In 2005, the Institute of Medicine recommended that cancer patients be provided with a comprehensive summary of their cancer treatments and recommendations for follow-up care (13). Despite this recommendation, 40% of cancer survivors reported receiving a written summary of all their cancer treatments, and 74% of cancer survivors received instructions (written or oral) for follow-up care. The lack of cancer treatment summaries and follow-up care recommendations for many cancer survivors might contribute to the finding that cancer survivors have many unmet cancer-related health information needs (71–73). The prevalence of cancer survivors who reported receiving the majority of their health care from a cancer specialist varied substantially by state, a finding that might reflect a lack of consensus on the roles of cancer specialists and primary care physicians in the medical care of cancer survivors (74–76).

Most cancer survivors received their cancer diagnosis many years before the BRFSS interview. A total of 12% were undergoing treatment at the time of the survey. However, the question regarding current treatment was specific ("Are you currently receiving treatment for cancer? By treatment, we mean surgery, radiation therapy, chemotherapy, or chemotherapy pills"). Certain respondents might have been receiving medications that were indeed part of a cancer treatment regimen, but if they did not consider the medication to be a type of chemotherapy, they might have answered no to the question, resulting in an underestimation of cancer survivors currently receiving therapy. For example, many women take oral antiestrogen therapy for estrogen-receptor–positive breast cancer (77). Furthermore, patients undergoing cancer therapy might have been less likely to participate in BRFSS, also leading to an underestimation of the proportion of survivors in current treatment.

Approximately 8% of survivors reported having participated in a clinical trial as part of their cancer treatment, more than the 4.7% of survivors from the 1992 National Health Interview Survey (NHIS) (78). However, caution should be used when comparing these estimates because they are from different surveys, and the NHIS analysis only included survivors who had received the cancer diagnosis within the past 10 years. Previous studies also have shown that cancer clinical trial participation rates are low (79). However, these findings raise questions about whether clinical trials during the past 20 years are more available and accepted by more persons with cancer.

The prevalence of current pain among survivors in this report (10.1%) was somewhat lower than that the prevalence reported in a statement by a National Institutes of Health State-of-the-Science panel; however, findings from that report suggested a wide range, with estimates ranging from 14%–100% (80). Although most survivors in this sample reported that their pain was under control, 20% reported that it was not. Others have concluded that pain control among cancer patients is inadequate (81,82). Potential barriers to effective pain management exist at the patient, health-care provider, and system levels (80). Suboptimal pain control might be an indicator of poor quality care (80), and multiple quality measures related to controlling cancer pain have been recommended (83).

Health Care and Economic Factors

Twelve percent of cancer survivors in this study reported being denied health or life insurance coverage because of a cancer diagnosis, and 7% were uninsured, a finding that is consistent with a previous population health survey on health insurance among cancer survivors (37). Health insurance coverage among cancer survivors is of particular importance. Previous research has shown that a lack of adequate insurance coverage might lead to more delayed or unmet medical care needs for cancer survivors than for adults without cancer (84). Health insurance coverage is especially important for cancer survivors because of the potential costs associated with cancer and for the multiple comorbid conditions described in this and another report (36). Because of financial hardships, such as lack of adequate insurance coverage, cancer survivors might be unable to afford copayments, prescription medications, and other necessary medical care (85). The Affordable Care Act, which was enacted in 2010, might provide a solution for cancer survivors by increasing health insurance coverage and ensuring that persons will not be denied coverage because of a previous cancer diagnosis (86).

Researchers projected that in 2010 and 2020, the United States would have an estimated 13.8 and 18.1 million cancer survivors, with associated costs of cancer care of $124.6 and $157.8 billion, respectively (87). These projections underscore the substantial economic effects measured by direct medical care costs, lost productivity, and intangible costs (such as lesser quality of life) that cancer survivors might face. Direct medical care costs include hospitalization, outpatient care, physician services, prescription and nonprescription drugs, nursing home and long-term care, and other medical supplies (88–92). Cancer survivors also incur substantial nonmedical care costs, such as transportation to and from health-care providers, losses in patients' time (e.g., from spending time receiving treatments), and other health-care services (6). Lost productivity is usually measured as a morbidity cost resulting from foregone earnings among employed persons or a mortality cost from premature death.

Many cancer survivors are unable to resume their usual activities, including work (7–9,93). In addition to lost productivity among cancer survivors, productivity is lost among the caregivers of survivors (92,94,95). Caregivers include spouses, relatives, friends, or others providing health services and other activities of daily living services to a cancer survivor; the economic effects associated with caregiver services are substantial (96,97). Intangible costs, which are typically measured by quality of life (90,91,98), are measures of cancer-related pain and suffering that affect the health and well-being of a patient. Intangible costs also include psychosocial interventions to alleviate anxiety and depression among cancer survivors (99). Although estimating the economic effects of cancer on cancer survivors is important for assessing and planning for the future, the available population-based surveys (including BRFSS) do not directly address this variable. As a result, CDC, the National Cancer Institute, the Agency for Healthcare Quality and Research, and the American Cancer Society are collaborating to enhance the Medical Expenditure Panel Survey to collect more detailed data to estimate the economic effects on cancer survivors, the families of cancer survivors, and society.

Limitations

The findings in this report are subject to several limitations. First, BRFSS data are self-reported and subject to recall bias, which could lead to inaccurate estimates of cancer prevalence (100). Recall bias might be responsible for the slightly higher cancer prevalence observed for certain cancers when compared with a recent study using cancer registry data (5). In addition, overreporting of cervical cancer is especially likely because abnormal Pap tests, cervical cancer precursors, and cervical intraepithelial neoplasia might be misperceived as diagnoses of cancer because of treatments used to remove the precancerous lesions (78). Second, BRFSS might not be representative of persons who do not have a landline telephone, which is required for BRFSS participation (42). Because of the growing number households that only have cellular telephones, BRFSS is conducting pilot studies to include participation among these previously excluded households (101). Third, because the findings are limited to noninstitutionalized U.S. citizens, cancer survivors who might have had an advanced-stage cancer and are therefore living in nursing homes, long-term–care facilities, or hospice or who are in the military are not included. Fourth, the estimates in this report are not age adjusted, which might contribute to state variations in cancer survivor prevalence. Fifth, because BRFSS does not assess any indicators of smoking dependence or intensity, no conclusions can be made regarding the magnitude of tobacco use among cancer survivors. Sixth, because of survival bias, respondents might have survived cancer for several reasons: their cancer was an in situ or early-stage cancer, was well differentiated, or was more responsive to treatment, or the survivors had better access to treatment or engaged in more positive health behaviors. Therefore, the results might not be representative of the overall cancer experience in the United States. Finally, the low cooperation rate of the BRFSS survey might limit the generalizability of the results to all cancer survivors living in the United States. However, studies have concluded that the survey findings are reliable and valid (102).

Conclusion

A large proportion of cancer survivors have comorbid conditions, and many are not receiving recommended preventive care, not only for cancer screening but for influenza and pneumococcal vaccinations. Furthermore, many cancer survivors currently smoke, do not participate in adequate physical activity, and are obese. Health-care providers and patients should be aware of the importance of preventive care, smoking cessation, regular physical activity, and maintaining a healthy weight among cancer survivors, factors that have been linked to longer survival and better quality of life among cancer survivors, as well as to decreased risk for new and recurrent cancer. Health care for cancer survivors should include improvements in pain management and a written treatment summary (including follow-up instructions). Modification of health behaviors among cancer survivors would be facilitated by increasing insurance coverage and access to care.

The data in this report reflect variations in health behaviors and preventive health care practices that might be a result of availability of state-level resources for cancer survivors. These findings can be used by public health practitioners, researchers, and state comprehensive cancer control planners to assess the need for state resources for cancer survivors and evaluate the effectiveness of current programmatic efforts; therefore, surveillance data among cancer survivors should be regularly collected at the local and national levels. Additional research on cancer survivors, including health behaviors and patient access to quality care, should be conducted to address the needs of the increasing cancer survivor population in the United States.

References

  1. CDC. Basic information about cancer survivorship. Atlanta, GA: CDC; 2011. Available at http://www.cdc.gov/cancer/survivorship/basic_info. Accessed May 26, 2011.
  2. CDC. A national action plan for cancer survivorship: advancing public health strategies. Atlanta GA: CDC; 2004. Available at http://www.cdc.gov/cancer/survivorship/pdf/plan.pdf. Accessed November 3, 2011.
  3. National Cancer Institute. National Cancer Institute Office of Cancer Survivorship fact sheet. Bethesda, MD: National Cancer Institute; 2011. Available at http://cancercontrol.cancer.gov/ocs/ocs_factsheet.pdf. Accessed July 28, 2011.
  4. Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer 2002;94:2766–92.
  5. CDC. Cancer survivors—United States, 2007. MMWR 2011;60:269–72.
  6. Yabroff KR, Davis WW, Lamont EB, et al. Patient time costs associated with cancer care. J Natl Cancer Inst 2007;99:14–23.
  7. Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 2004;96:1322–30.
  8. Sasser AC, Rousculp MD, Birnbaum HG, Oster EF, Lufkin E, Mallet D. Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Womens Health Issues 2005;15:97–108.
  9. Bradley CJ, Bednarek HL, Neumark D. Breast cancer and women's labor supply. Health Serv Res 37:1309–28.
  10. The Lancet. Cancer survivors: living longer, and now, better [editorial]. Lancet 2004;364:2153–4.
  11. Sunga AY, Eberl MM, Oeffinger KC, Hudson MM, Mahoney MC. Care of cancer survivors. Am Fam Physician 2005;71:699–706.
  12. Ng AK, Travis LB. Subsequent malignant neoplasms in cancer survivors. Cancer J 2008;14:429–34.
  13. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2006.
  14. Johnston-Early A, Cohen MH, Minna JD, et al. Smoking abstinence and small cell lung cancer survival. An association. JAMA 1980;244:2175–9.
  15. Doyle C, Kushi LH, Byers T, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 2006;56:323–53.
  16. Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA. Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 2005;14:2009–14.
  17. Bassett WW, Cooperberg MR, Sadetsky N, et al. Impact of obesity on prostate cancer recurrence after radical prostatectomy: data from CaPSURE. Urology 2005;66:1060–5.
  18. Haydon AM, Macinnis RJ, English DR, Giles GG. Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 2006;55:62–7.
  19. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol 2006;24:5112–6.
  20. CDC. National Comprehensive Cancer Control Program. Atlanta, GA: CDC; 2011. Available at http://www. cdc.gov/cancer/ncccp/about.htm. Accessed May 26, 2011.
  21. Pollack LA, Greer GE, Rowland JH, et al. Cancer survivorship: a new challenge in comprehensive cancer control. Cancer Causes Control 2005;16(Suppl 1):51–9.
  22. Gentry EM, Kalsbeek WD, Hogelin GC, et al. The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data. Am J Prev Med 1985;1:9–14.
  23. CDC. Public health surveillance for behavioral risk factors in a changing environment: recommendations from the Behavioral Risk Factor Surveillance team. MMWR 2003;52(No. RR-9).
  24. CDC. Behavioral Risk Factor Surveillance System: survey data information. Atlanta, GA: CDC; 2010. Available at http://www.cdc.gov/brfss/technical_infodata/surveydata/2009.htm. Accessed August 18, 2011.
  25. CDC. Behavioral Risk Factor Surveillance System: 2009 summary data quality report [Internet]. Atlanta, GA: CDC; 2010. Available at ftp://ftp.cdc.gov/pub/Data/Brfss/2009_Summary_Data_Quality_Report.pdf. Accessed July 19, 2010.
  26. Kochanek KD, Xu J, Murphy SL, Miniño AM, Kung HC. Deaths: preliminary data for 2009. Natl Vital Stat Rep 2011;56(4).
  27. Richardson LC, Townsend JS, Fairley TL, et al. Use of 2001–2002 Behavioral Risk Factor Surveillance System data to characterize cancer survivors in North Carolina. NC Med J 2011;72:20–7.
  28. Fairley TL, Hawk H, Pierre S. Health behaviors and quality of life of cancer survivors in Massachusetts, 2006: data use for comprehensive cancer control. Prev Chronic Dis 2010;7(9) [Epub].
  29. Snyder CF, Frick KD, Kantsiper ME, et al. Prevention, screening, and surveillance care for breast cancer survivors compared with controls: changes from 1998 to 2002. J Clin Oncol 2009;27:1054.
  30. Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer 2004;101:1712–19.
  31. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clinical Oncol 2008;26:1073.
  32. CDC. Surveillance of certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2009. MMWR 2011;60(No. SS-9).
  33. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010;146:283–7.
  34. Altekruse SF, Kosary CL, Krapcho M, et al, eds. SEER cancer statistics review, 1975–2007. Bethesda, MD: National Cancer Institute; 2010. Available at http://seer.cancer.gov/csr/1975_2007. Accessed June 8, 2011.
  35. Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 2005;40:702–11.
  36. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci 2003;58:82–91.
  37. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 2005;23:8884–93.
  38. World Health Organization. Cancer fact sheet. Geneva, Switzerland: World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs297/en/index.html. Accessed June 12, 2011.
  39. Pollack LA, Rowland JH, Crammer C, Stefanek M. Introduction: charting the landscape of cancer survivors' health-related outcomes and care. Cancer 2009;115(Suppl 18):4265–9.
  40. Garland SM, Smith JS. Human papillomavirus vaccines: current status and future prospects. Drugs 2010;70:1079–98.
  41. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277–300.
  42. Blumberg SJ, Luke JV. Wireless substitution: early release of estimates from the National Health Interview Survey, July–December 2007. Hyattsville, MD: CDC, National Center for Health Statistics; 2009. Available at http://www.cdc.gov/nchs/nhis.htm. Accessed December 2, 2011.
  43. CDC. United States cancer statistics: 1999–2007 incidence and mortality web-based report. Atlanta, GA: CDC, National Cancer Institute; 2010. Available at www.cdc.gov/uscs. Accessed November 3, 2011.
  44. Soerjomataram I, Louwman MW, Ribot JG, Roukema JA, Coebergh JW. An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 2008;107:309–30.
  45. Howlader N, Noone AM, Krapcho M, et al, eds. SEER cancer statistics review, 1975–2008. Bethesda, MD: National Cancer Institute; 2011. Available at http://seer.cancer.gov/csr/1975_2008. Accessed November 3, 2011.
  46. Breitkopf CR, Pearson HC, Breitkopf DM. Poor knowledge regarding the Pap test among low-income women undergoing routine screening. Perspect Sex Reprod Health 2005;37:78–84.
  47. CDC. Vital signs: current cigarette smoking among adults aged ≥18 years—United States, 2005–2010. 2011;60:1207–12.
  48. Klosky JL, Tyc VL, Garces-Webb DM, Buscemi J, Klesges RC, Hudson MM. Emerging issues in smoking among adolescent and adult cancer survivors: a comprehensive review. Cancer 2007;110:2408–19.
  49. Mariotto AB, Rowland JH, Ries LA, Scoppa S, Feuer EJ. Multiple cancer prevalence: a growing challenge in long-term survivorship. Cancer Epidemiol Biomarkers Prev 2007;16:566–71.
  50. CDC. Best practices for comprehensive tobacco control programs—2007. Atlanta, GA: CDC; 2007. Available at http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm. Accessed November 3, 2011.
  51. Land T, Warner D, Paskowsky M, et al. Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. PLoS One 2010;5:e9770.
  52. Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 2007;25:2100–6.
  53. Underwood JM, Townsend JS, Tai E, et al. Racial and regional disparities in lung cancer incidence. Cancer 2011 Sep 14. doi: 10.1002/cncr.26479 [Epub ahead of print].
  54. CDC. Vital signs: state-specific obesity prevalence among adults—United States, 2009. MMWR 2010;59:1–5.
  55. Irwin ML, McTiernan A, Baumgartner RN, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 2005;23:774–82.
  56. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625–38.
  57. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007;298:2028–37.
  58. Adami HO, Trichopoulos D. Obesity and mortality from cancer. N Engl J Med 2003;348:1623–4.
  59. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007;335:1134.
  60. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA 2005;293:2479–86.
  61. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer 2009;124:1954–62.
  62. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 2008;26:3958–64.
  63. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 2008;17:379.
  64. Meyerhardt JA, Giovannucci EL, Holmes MD, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 2006;24:3527–34.
  65. Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 2006;24:3535–41.
  66. Schmitz KH, Holtzman J, Courneya KS, Mâsse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2005;14:1588.
  67. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2010;4:87–100.
  68. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010;42:1409.
  69. CDC. Physical activity among Behavioral Risk Factor Surveillance System respondents. Atlanta, GA: CDC; 2011. Available at http://apps.nccd.cdc.gov/BRFSS. Accessed July 27, 2011.
  70. Nelson DE, Bland S, Powell-Griner E, et al. State trends in health risk factors and receipt of clinical preventive services among U.S. adults during the 1990s. JAMA 2002;287:2659.
  71. McInnes DK, Cleary PD, Stein KD, Ding L, Mehta CC, Ayanian JZ. Perceptions of cancer-related information among cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors. Cancer 2008;113:1471–9.
  72. Beckjord EB, Arora NK, McLaughlin W, Oakley-Girvan I, Hamilton AS, Hesse BW. Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care. J Cancer Surviv Sep 2008;2:179–89.
  73. Hawkins NA, Pollack LA, Leadbetter S, et al. Informational needs of patients and perceived adequacy of information available before and after treatment of cancer. J Psychosocial Oncol 2008;26:1.
  74. Gage EA, Pailler M, Zevon MA, et al. Structuring survivorship care: discipline-specific clinician perspectives. J Cancer Surviv 2011;5:217–25.
  75. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med 2008;23:254–9.
  76. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol 2008;26:1073–9.
  77. Wu X, Richardson LC, Kahn AR, et al. Survival difference between non-Hispanic black and non-Hispanic white women with localized breast cancer: the impact of guideline-concordant therapy. J Natl Med Assoc 2008;100:490–8.
  78. Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst 1999;91:1480–6.
  79. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials. JAMA 2004;291:2720.
  80. Patrick DL, Ferketich SL, Frame PS, et al; National Institutes of Health State-of-the-Science Panel. National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15–17, 2002. J Natl Cancer Inst 2003;95:1110–7.
  81. Anderson KO, Mendoza TR, Valero V, et al. Minority cancer patients and their providers: pain management attitudes and practice. Cancer 2000;88:1929–38.
  82. McMillan SC, Tittle M, Hagan S, Laughlin J. Management of pain and pain-related symptoms in hospitalized veterans with cancer. Cancer Nurs 2000;23:327–36.
  83. Gordon DB, Dahl JL, Miaskowski C, et al. American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 2005;165:1574–80.
  84. Sabatino SA, Coates RJ, Uhler RJ, Alley LG, Pollack LA. Health insurance coverage and cost barriers to needed medical care among U.S. adult cancer survivors age <65 years. Cancer 2006;106:2466–75.
  85. Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer 2010;116:3493–504.
  86. Patient Protection and Affordable Care Act of 2010. Pub. L. No. 111-148 (March 23, 2010).
  87. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 2011;103:117–28.
  88. Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 2001;22:91–113.
  89. Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995;87:417–26.
  90. Rice DP. Estimating the cost of illness. Washington, DC: US Government Printing Office; 1966. Publication no. 947-6.
  91. Gold M. Panel on cost-effectiveness in health and medicine. Med Care 1996;34(Suppl):DS197-199.
  92. Brown M, Hodgson T, Rice D. Economic impact of cancer in the United States. In: Schottenfeld D, Fraumeni J, eds. Cancer epidemiology and prevention. 2nd ed. New York, NY: Oxford University Press; 1993:255–66.
  93. Chirikos TN, Russell-Jacobs A, Cantor AB. Indirect economic effects of long-term breast cancer survival. Cancer Pract 2002;10:248–55.
  94. Given BA, Given CW, Stommel M. Family and out-of-pocket costs for women with breast cancer. Cancer Pract 1994;2:187–93.
  95. Stommel M, Given CW, Given BA. The cost of cancer home care to families. Cancer 1993;71:1867–74.
  96. Hayman JA, Langa KM, Kabeto MU, et al. Estimating the cost of informal caregiving for elderly patients with cancer. J Clin Oncol 2001;19:3219–25.
  97. Emanuel EJ, Fairclough DL, Slutsman J, Alpert H, Baldwin D, Emanuel LL. Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. N Engl J Med 1999;341:956–63.
  98. Hodgson T, Meiners M. Cost-of-illness methodology: a guide to assessment practices and procedures. Milbank Mem Fund Q 1982;60:429–91.
  99. Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin 2008;58:214–30.
  100. Desai MM, Bruce ML, Desai RA, Druss BG. Validity of self-reported cancer history: a comparison of health interview data and cancer registry records. Am J Epidemiol 2001;153:299–306.
  101. CDC. Improvements to BRFSS methodology, design, and implementation. Atlanta, GA: CDC; 2006. Available at http://www.cdc.gov/brfss/pubs/methodology.htm. Accessed August 29, 2011.
  102. Nelson DE, Powell-Griner E, Town M, Kovar MG. A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. Am J Public Health 2003;93:1335–41.

TABLE 1. Demographic and health behavior characteristics of cancer survivors aged ≥18 years, by sex — Behavioral Risk Factor Surveillance System, United States 2009

Characteristic

Total cancer survivors

Men

Women

%*

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

Total

7.2

(7.1–7.4)

45,541

16,062,667

6.0

(5.8–6.2)

15,719

6,473,938

8.4

(8.2–8.6)

29,822

9,588,729

Years since diagnosis

≤5 yrs

36.2

(35.4–37.1)

15,379

5,822,630

42.1

(40.7–43.6)

6,406

2,728,532

32.3

(31.2–33.3)

8,973

3,094,098

6–10 yrs

20.8

(20.1–21.6)

9,047

3,346,909

22.6

(21.3–23.9)

3,583

1,463,463

19.6

(18.8–20.5)

5,464

1,883,446

>10 yrs

39.2

(38.4–40.1)

19,159

6,299,258

32.1

(30.8–33.4)

5,177

2,075,636

44.0

(43.0–45.1)

13,982

4,223,622

Unknown or don't know

3.7

(3.4–4.0)

1,956

593,870

3.2

(2.8–3.7)

553

206,307

4.0

(3.7–4.4)

1,403

387,563

Age at interview (yrs)

18–29

3.2

(2.7–3.7)

453

508,241

2.3

(1.6–3.2)

83

146,198

3.8

(3.2–4.4)

370

362,042

30–39

6.1

(5.5–6.7)

1,378

980,679

4.2

(3.4–5.3)

233

273,339

7.4

(6.7–8.2)

1,145

707,339

40–49

11.4

(10.8–12.0)

3,483

1,830,682

7.4

(6.6–8.4)

706

481,314

14.1

(13.2–15.0)

2,777

1,349,368

50–64

31.0

(30.2–31.8)

13,656

4,980,839

30.4

(29.0–31.8)

4,248

1,965,662

31.4

(30.5–32.4)

9,408

3,015,177

65–74

21.7

(21.1–22.4)

12,538

3,491,080

25.3

(24.2–26.5)

4,983

1,640,652

19.3

(18.5–20.1)

7,555

1,850,428

≥75

26.1

(25.4–26.8)

13,739

4,185,609

30.0

(28.8–31.2)

5,405

1,941,363

23.4

(22.6–24.2)

8,334

2,244,245

Unknown/refused

0.5

(0.4–0.6)

294

85,539

0.4

(0.3–0.6)

61

25,409

0.6

(0.5–0.8)

233

60,129

Race/Ethnicity

White, non-Hispanic

81.2

(80.3–82.1)

39,686

13,047,059

82.2

(80.7–83.7)

13,790

5,323,997

80.5

(79.4–81.7)

25,896

7,723,062

Black, non-Hispanic

7.8

(7.1–8.4)

2,503

1,246,610

7.4

(6.4–8.4)

847

476,464

8.0

(7.2–8.9)

1,656

770,146

Hispanic

6.3

(5.7–7.0)

1,524

1,012,231

5.6

(4.7–6.7)

459

365,259

6.7

(6.0–7.6)

1,065

646,972

American Indian/Alaska Native

1.7

(1.4–1.9)

716

267,555

1.3

(0.9–1.7)

194

82,589

1.9

(1.6–2.3)

522

184,966

Asian/Pacific Islander

1.6

(1.2–2.1)

514

257,229

1.8

(1.1–2.8)

160

115,214

1.5

(1.1–1.9)

354

142,016

Other or multiracial

0.8

(0.7–1.0)

309

131,547

0.9

(0.6–1.3)

128

58,494

0.8

(0.6–1.0)

181

73,053

Unknown or refused

0.6

(0.5–0.7)

289

100,436

0.8

(0.6–1.0)

141

51,921

0.5

(0.4–0.7)

148

48,515

Marital status

Married/living together

64.2

(63.4–65.0)

23,971

10,313,261

74.9

(73.6–76.2)

10,508

4,851,629

57.0

(55.9–58.0)

13,463

5,461,632

Divorced

11.6

(11.1–12.1)

6,908

1,859,130

8.7

(7.9–9.5)

1,844

561,136

13.5

(12.9–14.2)

5,064

1,297,994

Never married

7.0

(6.4–7.6)

2,879

1,118,044

6.5

(5.6–7.5)

944

419,719

7.3

(6.6–8.1)

1,935

698,325

Widowed

15.2

(14.7–15.7)

10,864

2,441,337

8.5

(7.9–9.2)

2,173

551,385

19.7

(19.0–20.5)

8,691

1,889,952

Separated

1.8

(1.6–2.1)

769

292,729

1.3

(1.0–1.6)

210

81,019

2.2

(1.9–2.6)

559

211,710

Education

<High school

10.0

(9.5–10.5)

4,646

1,602,784

9.0

(8.3–9.9)

1,599

585,539

10.6

(9.9–11.4)

3,047

1,017,245

High school graduate or GED

28.7

(28.0–29.5)

14,061

4,614,762

26.7

(25.5–28.0)

4,406

1,730,141

30.1

(29.1–31.1)

9,655

2,884,621

Some college or technical school (1–3 yrs)

27.3

(26.5–28.1)

12,444

4,382,522

24.9

(23.5–26.2)

3,713

1,609,601

28.9

(28.0–29.9)

8,731

2,772,922

College graduate (≥4 yrs)

33.8

(33.0–34.6)

14,313

5,429,339

39.1

(37.7–40.5)

5,979

2,531,544

30.2

(29.2–31.3)

8,334

2,897,795


TABLE 1. (Continued) Demographic and health behavior characteristics of self-reported cancer survivors aged ≥18 years, by sex — Behavioral Risk Factor Surveillance System, United States 2009

Characteristic

Total cancer survivors

Men

Women

%*

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

Employment

Employed for wages

34.6

(33.8–35.5)

13,719

5,565,366

34.7

(33.2–36.3)

4,645

2,248,424

34.6

(33.5–35.7)

9,074

3,316,941

Out of work or unable to work

14.2

(13.6–14.9)

6,036

2,283,019

11.5

(10.5–12.6)

1,583

744,942

16.0

(15.2–16.9)

4,453

1,538,078

Retired

42.4

(41.5–43.2)

22,390

6,806,185

52.5

(51.0–54.0)

9,398

3,397,729

35.5

(34.6–36.5)

12,992

3,408,456

Other

8.6

(8.0–9.1)

3,297

1,373,776

1.0

(0.7–1.6)

63

67,727

13.6

(12.8–14.5)

3,234

1,306,049

Insurance coverage

Yes

93.0

(92.4–93.5)

43,046

14,938,414

94.3

(93.4–95.2)

15,094

6,107,834

92.1

(91.3–92.8)

27,952

8,830,580

No

6.8

(6.3–7.4)

2,421

1,090,994

5.4

(4.6,6.3)

602

350,558

7.7

(7.0–8.5)

1,819

740,436

Chronic conditions

Cardiovascular disease

18.0

(17.4–18.6)

8,962

2,890,570

23.4

(22.3–24.7)

4,001

1,518,057

14.3

(13.7–15.0)

4,961

1,372,513

Diabetes

16.7

(16.0–17.3)

8,086

2,674,835

19.6

(18.5–20.7)

3,115

1,267,312

14.7

(14.0–15.4)

4,971

1,407,523

Current asthma

10.9

(10.4 –11.5)

4,986

1,756,367

7.5

(6.7–8.3)

1,146

482,789

13.3

(12.6–14.0)

3,840

1,273,578

Cancer screenings

Cervical§ (n = 1,065)

79.4

(75.4–82.9)

823

382,531

Colorectal (n = 4,146)

75.1

(72.8–77.2)

3,050

843,740

77.9

(74.0–81.4)

1,138

359,289

73.1

(70.3–75.7)

1,912

484,451

Breast** (n = 1,920)

80.4

(77.4–83.0)

1,517

580,689

Prostate†† (n = 898)

81.7

(77.5–85.2)

700

248,036

Other

Activity limitations because of health problems

35.3

(34.5–36.1)

16,850

5,666,446

34.0

(32.6–35.4)

5,525

2,200,270

36.1

(35.1–37.2)

11,325

3,466,177

Influenza vaccine within the past 12 months§§

57.8

(56.9–58.7)

28,501

9,281,437

62.3

(60.8–63.8)

10,430

4,032,535

54.7

(53.6–55.8)

18,071

5,248,902

Ever received pneumococcal vaccine

48.3

(47.4–49.1)

24,874

7,751,436

49.8

(48.3–51.2)

8,840

3,222,560

47.2

(46.1–48.3)

16,034

4,528,876

Abbreviations: CI = confidence interval; GED = general educational development.

* Percentages might not total 100% because unknown and refused categories were excluded.

Five states (Georgia, Hawaii, New Jersey, Tennessee, and Wyoming) included questions on mammography and Papanicolaou (Pap) test use among women. Eight states (Delaware, Hawaii, Maine, Massachusetts, Nebraska, New Jersey, Oklahoma, and Wyoming) included colorectal cancer screening questions. Five states (Delaware, Hawaii, Kentucky, Nebraska, and New Jersey) included prostate cancer screening questions among men.

§ Cervical cancer screening: prevalence estimate of women aged ≥18 years who received a Pap test within the past 3 years, excluding women who had received a hysterectomy.

Colorectal cancer screening: prevalence estimate of men and women aged ≥50 years who received a fecal occult blood test within the past year, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years.

** Breast cancer screening: prevalence estimate of women aged ≥40 years who received mammography screening within the past 2 years.

†† Prostate cancer screening: prevalence estimate of men aged ≥50 years who received a prostate-specific antigen test within the past 2 years (proxy measure for discussion about prostate cancer risk).

§§ Injectable influenza vaccine only.


TABLE 2. Prevalence of cancer survivors aged ≥18 years, by sex and type of cancer — Behavioral Risk Factor Surveillance System, United States, 2009

Cancer type*

Both sexes

Men

Women

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

All types

100.0

— 

45,541

16,062,667

100.0

— 

15,719

6,473,938

100.0

— 

29,822

9,588,729

Breast

19.5

(18.9–20.2)

10,314

3,135,383

0.4

(0.3–0.6)

66

25,435

32.4

(31.4–33.4)

10,248

3,109,948

Female genital system

14.8

(14.2–15.5)

6,594

2,377,247

NA 

NA 

NA 

NA 

24.8

(23.8–25.8)

6,594

2,377,247

Cervical

8.7

(8.2–9.2)

3,512

1,392,855

NA 

NA 

NA

NA

14.5

(13.7–15.4)

3,512

1,392,855

Uterine

3.2

(2.9–3.5)

1,778

518,305

NA 

NA 

NA

NA

5.4

(4.9–5.9)

1,778

518,305

Ovarian

2.9

(2.6–3.3)

1,304

466,087

NA 

NA 

NA

NA

4.9

(4.3–5.4)

1,304

466,087

Male genital

14.6

(13.9–15.2)

6,016

2,337,392

36.1

(34.7–37.5)

6,016

2,337,392

NA 

NA 

NA

NA

Prostate

13.4

(12.8–14.0)

5,713

2,153,172

33.3

(31.9–34.6)

5,713

2,153,172

 NA

NA 

 NA

NA 

Testicular

1.1

(0.9–1.5)

303

184,220

2.8

(2.2–3.6)

303

184,220

 NA

NA 

 NA

NA 

Other cancer types§

12.9

(12.3–13.5)

5,321

2,073,380

13.3

(12.2–14.3)

1,758

858,337

12.7

(11.9–13.4)

3,563

1,215,043

Other

8.9

(8.4–9.5)

3,655

1,434,360

10.0

(9.1–10.9)

1,353

646,077

8.2

(7.6–8.9)

2,302

788,283

Thyroid

2.7

(2.4–3.0)

1,195

429,033

1.7

(1.3–2.1)

216

108,035

3.3

(3.0–3.7)

979

320,998

Bone

0.7

(0.5–0.9)

249

110,416

0.9

(0.6–1.5)

103

59,945

0.5

(0.4–0.8)

146

50,471

Brain

0.6

(0.4–0.8)

193

93,969

0.7

(0.5–0.9)

79

42,154

0.5

(0.4–0.8)

114

51,815

Melanoma

12.3

(11.8–12.8)

5,571

1,971,310

16.2

(15.3–17.2)

2,627

1,049,745

9.6

(9.1–10.2)

2,944

921,565

Gastrointestinal

8.3

(7.8–8.7)

4,063

1,326,236

10.5

(9.7–11.3)

1,764

677,381

6.8

(6.3–7.3)

2,299

648,855

Colon (intestine)

6.2

(5.8–6.6)

3,074

1,000,723

7.6

(6.9–8.3)

1,264

490,332

5.3

(4.9–5.8)

1,810

510,390

Rectal

0.5

(0.4–0.6)

257

76,851

0.6

(0.4–0.8)

111

36,878

0.4

(0.3–0.6)

146

39,974

Stomach

0.5

(0.4–0.6)

237

73,788

0.7

(0.5–0.9)

111

42,830

0.3

(0.2–0.4)

126

30,957

Liver

0.4

(0.3–0.5)

169

66,426

0.6

(0.4–0.8)

91

39,390

0.3

(0.2–0.4)

78

27,036

Pancreatic

0.4

(0.3–0.5)

167

61,153

0.5

(0.4–0.8)

78

35,511

0.3

(0.2–0.4)

89

25,641

Esophageal

0.3

(0.2–0.4)

159

47,296

0.5

(0.4–0.7)

109

32,440

0.2

(0.1–0.2)

50

14,856

Leukemia/Lymphoma (lymph nodes and bone marrow)

5.1

(4.7–5.6)

1,846

823,072

6.9

(6.0–7.9)

793

445,353

3.9

(3.5–4.4)

1,053

377,720

Non-Hodgkin's lymphoma

1.9

(1.6–2.3)

696

309,034

2.6

(2.0–3.5)

297

170,366

1.4

(1.2–1.7)

399

138,668

Hodgkin's lymphoma (Hodgkin's disease)

1.7

(1.5–2.0)

539

276,828

2.3

(1.8–2.9)

232

149,014

1.3

(1.1–1.6)

307

127,814

Leukemia (blood)

1.5

(1.3–1.7)

611

237,209

1.9

(1.5–2.5)

264

125,972

1.2

(1.0–1.4)

347

111,237

Urinary tract

3.8

(3.5–4.1)

1,787

612,395

6.4

(5.8–7.0)

1,044

411,989

2.1

(1.8–2.4)

743

200,406

Bladder

2.3

(2.1–2.5)

1,140

367,569

4.1

(3.7–4.6)

736

267,086

1.0

(0.9–1.2)

404

100,483

Renal (kidney)

1.5

(1.3–1.7)

647

244,826

2.2

(1.9–2.7)

308

144,903

1.0

(0.8–1.3)

339

99,923

Lung

2.8

(2.4–3.2)

1,252

445,055

3.1

(2.5–3.8)

480

199,879

2.6

(2.1–3.0)

772

245,176

Head/Neck, all

1.8

(1.6–2.0)

675

286,539

2.7

(2.3–3.2)

357

174,805

1.2

(1.0–1.4)

318

111,734

Head and neck

0.7

(0.5–0.8)

247

106,612

0.9

(0.7–1.3)

122

60,727

0.5

(0.4–0.6)

125

45,886

Pharyngeal (throat)

0.6

(0.5–0.7)

249

96,759

1.0

(0.8–1.3)

151

66,784

0.3

(0.2–0.4)

98

29,975

Oral

0.5

(0.4–0.7)

179

83,167

0.7

(0.5–1.1)

84

47,293

0.4

(0.2–0.6)

95

35,874

Unknown/Refused

4.2

(3.9–4.6)

2,102

674,658

4.5

(3.9–5.2)

814

293,624

4.0

(3.6–4.4)

1,288

381,034

Abbreviations: CI = confidence interval; NA = not applicable.

* For cancer survivors who reported more than one cancer diagnosis, the cancer type reported was the most recently diagnosed cancer.

Male and female genital cancer calculations use sex-specific denominators.

§ Includes soft tissue cancers of the heart and neuroblastoma.

Response category of other; cancer type not specified.


TABLE 3. Prevalence of selected types of cancer among cancer survivors aged ≥18 years, by race/ethnicity — Behavioral Risk Factor Surveillance System, United States, 2009

Cancer type

All races/ethnicities 

White, non Hispanic

Black, non Hispanic

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

All types

100

45,541

16,062,667

100

39,686

13,047,059

100

2,503

1,246,610

Both sexes

Breast*

19.5

(18.9–20.2)

10,314

3,135,383

19.3

(18.6–19.9)

8,919

2,512,599

23.9

(20.6–27.6)

657

298,090

Melanoma

12.3

(11.8–12.8)

5,571

1,971,310

14.3

(13.7–14.9)

5,343

1,864,099

Gastrointestinal

8.3

(7.8–8.7)

4,063

1,326,236

8.1

(7.7–8.5)

3,474

1,055,679

11.3

(8.9–14.2)

280

140,855

Colorectal

6.7

(6.3–7.1)

3,331

1,077,574

6.7

(6.3–7.1)

2,868

873,132

8.6

(6.5–11.3)

229

106,979

Leukemia/Lymphoma (lymph nodes and bone marrow)

5.1

(4.7–5.6)

1,846

823,072

5.2

(4.8–5.7)

1,639

680,943

3.7

(2.3–5.9)

71

46,307

Urinary tract

3.8

(3.5–4.1)

1,787

612,395

3.9

(3.6–4.3)

1,595

514,353

2.5

(1.6–3.7)

72

30,642

Lung

2.8

(2.4–3.2)

1,252

445,055

2.6

(2.3–2.8)

1,093

336,311

4.5

(2.5–8.1)

87

56,648

Head/Neck, all

1.8

(1.6–2.0)

675

286,539

1.9

(1.7–2.2)

598

249,037

Genital

29.4

(28.5–30.2)

12,610

4,714,639

27.7

(26.9–28.5)

10,572

3,614,127

36.6

(32.6–40.9)

918

456,432

Other cancer types

12.9

(12.3–13.5)

5,321

2,073,380

13.2

(12.6–13.8)

4,724

1,716,464

9.8

(7.3–13.0)

211

121,954

Unknown/Refused

4.2

(3.9–4.6)

2,102

674,658

3.9

(3.5–4.2)

1,729

503,446

4.7

(3.4–6.4)

142

58,659

Male genital§

36.1

(34.7–37.5)

6,016

2,337,392

34.1

(32.8–35.4)

5,038

1,814,591

54.6

(47.4–61.5)

542

260,014

Prostate

33.3

(31.9–34.6)

5,713

2,153,172

31.3

(30.1–32.6)

4,768

1,668,261

53.6

(46.5–60.6)

535

255,401

Female genital§

24.8

(23.8–25.8)

6,594

2,377,247

23.3

(22.4–24.3)

5,534

1,799,536

25.5

(21.0–30.6)

376

196,418

Cervical

14.5

(13.7–15.4)

3,512

1,392,855

13.8

(13.0–14.6)

2,914

1,066,854

14.7

(11.6–18.4)

212

112,898


TABLE 3. (Continued) Prevalence of selected types of cancer among cancer survivors aged ≥18 years, by race/ethnicity — Behavioral Risk Factor Surveillance System, United States, 2009

Cancer type

Asian/Pacific Islander

American Indian/Alaska Native

Hispanic

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

All types

100

514

257,229

100

716

267,555

100

1,524

1,012,231

Both sexes

Breast*

25.8

(17.0–37.2)

173

66,493

16.1

(11.3–22.3)

130

42,957

17.3

(13.6–21.7)

333

174,875

Melanoma

4.2

(2.7–6.6)

72

43,005

Gastrointestinal

5.8

(3.2–10.1)

50

14,801

6.1

(3.2–11.2)

66

16,193

8.4

(6.3–11.1)

143

85,111

Colorectal

6.4

(4.6–8.7)

112

64,293

Leukemia/Lymphoma (lymph nodes and bone marrow)

5.6

(3.6–8.5)

61

56,302

Urinary tract

4.3

(2.8–6.6)

52

43,500

Lung

Head/Neck, all

Genital

42.3

(34.9–50.1)

266

113,208

36.1

(31.1–41.3)

514

365,119

Other cancer types

17.4

(9.8–29.0)

63

44,821

12.0

(7.5–18.6)

75

32,083

12.7

(9.8–16.3)

179

128,744

Unknown/Refused

9.6

(5.5–16.4)

52

25,708

6.1

(4.4–8.5)

109

62,209

Male genital§

35.2

(27.1–44.2)

194

128,565

Prostate

34.1

(26.1–43.2)

183

124,635

Female genital§

41.1

(32.7–50.1)

200

76,028

36.6

(30.5–43.1)

320

236,554

Cervical

28.9

(21.6–37.6)

132

53,477

20.4

(15.3–26.6)

178

131,943

Abbreviation: CI = confidence interval.

* Breast cancer includes prevalence among men and women (see Table 2).

Data suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.

§ Male and female genital cancer calculations use sex-specific denominators.

Includes brain, bone, thyroid, heart, neuroblastoma, and the response category of other.


TABLE 4. Prevalence of cancer among adults aged ≥18 years and of selected types of cancer among survivors aged ≥18 years, by geographic area and sex — Behavioral Risk Factor Surveillance System, United States, 2009

State/Area

Both sexes:
all cancer types

Men:
all cancer types

Women:
all cancer types

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

United States

7.2

(7.1–7.4)

45,541

16,062,667

6.0

(5.8–6.2)

15,719

6,473,938

8.4

(8.2–8.6)

29,822

9,588,729

Northeast

7.8

(7.5–8.2)

8,308

3,071,587

6.6

(6.1–7.0)

2,797

1,229,108

9.0

(8.5–9.5)

5,511

1,842,480

Connecticut

7.8

(7.0–8.6)

713

198,922

6.3

(5.4–7.5)

230

78,108

9.1

(8.0–10.3)

483

120,814

Maine

8.3

(7.7–9.0)

912

83,571

6.4

(5.6–7.3)

291

30,834

10.1

(9.1–11.0)

621

52,738

Massachusetts

7.9

(7.3–8.4)

1,638

354,376

6.6

(5.8–7.5)

543

140,138

9.0

(8.2–9.8)

1,095

214,238

New Hampshire

7.9

(7.2–8.7)

719

78,466

6.6

(5.7–7.8)

252

32,494

9.1

(8.1–10.2)

467

45,972

New Jersey

7.1

(6.5–7.6)

1,175

434,637

5.6

(5.0–6.4)

372

166,388

8.4

(7.6–9.2)

803

268,249

New York

8.0

(7.2–8.8)

737

1,085,201

6.8

(5.8–7.9)

265

436,084

9.0

(8.0–10.2)

472

649,117

Pennsylvania

8.0

(7.4–8.7)

997

732,099

6.9

(6.0–7.8)

354

301,296

9.1

(8.2–10.1)

643

430,803

Rhode Island

8.6

(7.9–9.4)

726

67,752

7.8

(6.7–8.9)

255

29,082

9.4

(8.4–10.4)

471

38,669

Vermont

7.8

(7.1–8.5)

691

36,564

6.4

(5.5–7.5)

235

14,683

9.0

(8.1–10.0)

456

21,880

Midwest

7.6

(7.4–7.9)

10,817

3,641,856

6.4

(6.0–6.7)

3,767

1,478,857

8.8

(8.4–9.1)

7,050

2,162,998

Illinois

6.6

(6.0–7.3)

584

609,703

5.1

(4.4–6.0)

199

229,928

8.0

(7.0–9.1)

385

379,776

Indiana

7.8

(7.1–8.5)

953

340,682

5.7

(4.9–6.6)

306

121,090

9.7

(8.7–10.8)

647

219,592

Iowa

7.6

(6.9–8.4)

607

165,486

6.1

(5.1–7.3)

200

64,777

9.0

(8.1–10.1)

407

100,710

Kansas

7.4

(7.0–7.8)

1,975

150,090

5.9

(5.4–6.6)

634

58,825

8.8

(8.2–9.4)

1,341

91,265

Michigan

8.3

(7.7–9.0)

1,080

609,507

7.1

(6.1–8.3)

385

253,698

9.4

(8.6–10.3)

695

355,809

Minnesota

6.3

(5.7–6.9)

548

247,281

5.5

(4.7–6.6)

199

108,305

7.0

(6.2–7.8)

349

138,976

Missouri

8.7

(7.8–9.8)

582

356,235

7.3

(6.1–8.8)

190

142,327

10.0

(8.7–11.5)

392

213,908

Nebraska

7.5

(6.9–8.2)

1,802

95,274

6.4

(5.6–7.3)

676

39,363

8.6

(7.7–9.6)

1,126

55,910

North Dakota

6.9

(6.1–7.8)

432

32,561

5.9

(4.9–7.2)

148

13,838

7.9

(6.8–9.1)

284

18,723

Ohio

7.8

(7.2–8.5)

1,052

652,156

7.1

(6.2–8.0)

371

279,896

8.5

(7.7–9.4)

681

372,260

South Dakota

7.5

(6.8–8.2)

725

43,029

6.7

(5.7–7.8)

264

18,821

8.3

(7.4–9.3)

461

24,208

Wisconsin

8.5

(7.5–9.7)

477

339,851

7.5

(6.1–9.3)

195

147,990

9.5

(8.0–11.2)

282

191,861

South

7.5

(7.3–7.8)

14,445

6,020,906

6.3

(6.0–6.7)

4,853

2,440,227

8.6

(8.3–9.0)

9,592

3,580,679

Alabama 

8.6

(7.7–9.6)

704

289,563

7.8

(6.4–9.5)

201

126,527

9.3

(8.3–10.5)

503

163,037

Arkansas

8.1

(7.2–9.1)

463

161,381

6.3

(5.1–7.7)

133

60,045

9.7

(8.4–11.2)

330

101,336

Delaware

7.7

(6.8–8.6)

486

51,211

6.6

(5.4–8.0)

173

20,968

8.6

(7.4–10.0)

313

30,243

District of Columbia

6.9

(6.1–7.7)

393

30,195

6.4

(5.4–7.7)

163

13,231

7.3

(6.3–8.5)

230

16,964

Florida

9.1

(8.4–10.0)

1,575

1,229,137

8.5

(7.3–9.8)

583

549,346

9.8

(8.8–10.8)

992

679,791

Georgia

6.8

(6.0–7.7)

574

458,292

5.4

(4.3–6.8)

188

174,436

8.1

(7.1–9.3)

386

283,855

Kentucky

8.7

(7.8–9.6)

1084

269,046

7.4

(6.2–8.9)

281

109,998

9.8

(8.8–11.1)

803

159,048

Louisiana

7.4

(6.8–8.1)

914

238,633

6.1

(5.2–7.0)

307

93,029

8.6

(7.8–9.6)

607

145,604

Maryland

7.3

(6.7–8.0)

936

295,707

6.8

(5.8–7.9)

350

130,116

7.8

(7.0–8.7)

586

165,592

Mississippi

7.4

(6.8–8.0)

1,219

150,994

6.7

(5.9–7.6)

426

64,183

8.0

(7.3–8.8)

793

86,811

North Carolina

7.7

(7.1–8.4)

1,435

511,429

5.9

(5.1–6.8)

471

188,560

9.5

(8.6–10.4)

964

322,869

Oklahoma

7.9

(7.3–8.5)

892

209,424

5.9

(5.2–6.8)

280

76,403

9.8

(8.9–10.7)

612

133,021

South Carolina

8.1

(7.4–8.9)

1,077

264,278

7.0

(5.9–8.3)

393

108,709

9.2

(8.2–10.3)

684

155,568

Tennessee

6.2

(5.5–6.9)

532

294,773

4.3

(3.5–5.2)

142

98,172

7.9

(7.0–9.0)

390

196,601

Texas

6.4

(5.8–7.0)

1,134

1,055,889

5.2

(4.4–6.1)

392

418,304

7.5

(6.6–8.5)

742

637,585

Virginia

7.1

(6.3–8.0)

523

400,245

6.1

(5.1–7.3)

200

165,530

8.1

(6.9–9.4)

323

234,715

West Virginia

7.8

(7.1–8.6)

504

110,709

6.2

(5.3–7.3)

170

42,671

9.3

(8.2–10.4)

334

68,038

West

6.2

(5.9–6.4)

11,534

3,216,012

5.0

(4.7–5.3)

4,146

1,281,120

7.3

(7.0–7.7)

7,388

1,934,892

Alaska

6.6

(5.4–8.1)

188

31,718

5.2

(3.6–7.4)

65

12,811

8.2

(6.5–10.2)

123

18,906

Arizona

8.0

(7.0–9.0)

675

366,802

7.0

(5.7–8.4)

281

158,445

9.0

(7.6–10.6)

394

208,357

California

4.7

(4.4–5.1)

1420

1,324,908

3.6

(3.2–4.0)

481

495,660

5.9

(5.4–6.4)

939

829,249

Colorado

6.4

(5.9–6.9)

1141

215,050

5.0

(4.4–5.7)

387

83,492

7.7

(7.1–8.5)

754

131,557

Hawaii

6.7

(6.0–7.4)

602

63,509

5.3

(4.4–6.4)

210

24,904

8.1

(7.1–9.2)

392

38,605

Idaho

7.4

(6.7–8.2)

567

79,149

5.8

(4.8–6.9)

192

30,625

9.0

(8.0–10.3)

375

48,524

Montana

8.4

(7.6–9.2)

852

59,716

6.6

(5.8–7.6)

305

23,413

10.0

(8.9–11.3)

547

36,303

Nevada

8.3

(7.1–9.6)

433

151,327

7.1

(5.4–9.1)

142

65,194

9.5

(8.0–11.3)

291

86,134

New Mexico

7.3

(6.7–7.9)

885

101,106

5.9

(5.1–6.8)

301

39,909

8.6

(7.8–9.5)

584

61,197

Oregon

9.3

(8.2–10.4)

549

253,768

7.9

(6.4–9.6)

191

105,352

10.6

(9.3–12.1)

358

148,416

Utah

6.0

(5.4–6.5)

896

109,049

5.2

(4.5–6.0)

360

47,192

6.7

(6.0–7.6)

536

61,858

Washington

8.8

(8.3–9.2)

2645

428,322

7.5

(6.9–8.1)

993

181,301

10.0

(9.3–10.7)

1652

247,021

Wyoming

8.2

(7.5–9.0)

681

31,588

6.6

(5.6–7.7)

238

12,823

9.8

(8.8–10.9)

443

18,765

Territories

3.8

(3.3–4.3)

437

112,306

3.2

(2.6–4.0)

156

44,626

4.3

(3.6–5.1)

281

67,680

Guam

2.8

(2.1–3.8)

55

2,956

—*

Puerto Rico

3.8

(3.3–4.4)

252

106,647

3.2

(2.6–4.0)

87

42,373

4.3

(3.6–5.2)

165

64,274

U.S. Virgin Islands

3.9

(3.2–4.8)

130

2,703

4.3

(3.1–5.8)

54

1,382

3.5

(2.7–4.6)

76

1,322


TABLE 4. (Continued) Prevalence of cancer among adults aged ≥18 years and of selected types of cancer among survivors aged ≥18 years, by geographic area and sex — Behavioral Risk Factor Surveillance System, United States, 2009

State/Area

Breast cancer prevalence among female cancer survivors

Cervical cancer prevalence among female cancer survivors

Other female genital system cancer prevalence among female cancer survivors

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

United States

32.4

(31.4–33.4)

10,248

3,109,948

14.5

(13.7–15.4)

3,512

1,392,855

10.3

(9.6–11.0)

3,082

984,392

Northeast

36.4

(33.7–39.2)

1,951

670,248

10.5

(9.0–12.2)

532

193,291

9.4

(7.9–11.1)

511

172,871

Connecticut

38.3

(32.5–44.5)

184

46,287

Maine

30.9

(26.5–35.5)

192

16,272

15.8

(12.6–19.7)

91

8,342

13.0

(10.3–16.3)

85

6,863

Massachusetts

34.2

(30.5–38.2)

390

73,356

10.7

(8.2–13.9)

111

22,876

9.4

(7.0–12.6)

105

20,176

New Hampshire

34.4

(29.3–40.0)

166

15,831

New Jersey

34.6

(30.3–39.1)

291

92,785

10.9

(7.5–15.6)

75

29,351

5.9

(4.3–8.0)

55

15,778

New York

39.5

(33.1–46.2)

183

256,211

Pennsylvania

34.8

(30.0–39.8)

233

149,762

13.0

(9.7–17.3)

69

55,960

11.8

(8.6–16.1)

70

50,841

Rhode Island

32.8

(28.1–37.9)

155

12,684

Vermont

32.3

(27.7–37.2)

157

7,060

12.3

(9.3–16.1)

60

2,694

Midwest

32.6

(30.8–34.5)

2,448

705,540

12.6

(11.2–14.3)

773

273,183

9.8

(8.7–11.1)

757

212,764

Illinois

33.1

(27.5–39.2)

131

125,632

Indiana

29.9

(25.5–34.7)

213

65,660

21.2

(16.0–27.6)

94

46,574

11.8

(8.6–16.1)

79

25,975

Iowa

32.9

(28.0–38.3)

141

33,180

Kansas

31.3

(28.5–34.1)

469

28,525

17.6

(14.8–20.9)

170

16,103

10.4

(8.7–12.4)

148

9,487

Michigan

30.6

(26.8–34.7)

238

108,878

14.7

(11.2–19.0)

80

52,165

6.7

(4.9–9.1)

50

23,726

Minnesota

37.1

(31.6–42.9)

133

51,509

Missouri

31.9

(25.8–38.7)

131

68,292

14.9

(9.8–21.9)

54

31,816

Nebraska

33.0

(28.2–38.2)

403

18,450

14.7

(10.4–20.3)

103

8,208

7.3

(5.6–9.5)

118

4,070

North Dakota

29.8

(24.1–36.3)

95

5,579

Ohio

31.4

(27.1–36.1)

226

117,033

11.6

(8.2–16.3)

63

43,318

8.9

(6.7–11.7)

65

33,054

South Dakota

33.5

(28.2–39.2)

160

8,103

13.0

(9.4–17.7)

55

3,142

14.3

(10.5–19.2)

61

3,467

Wisconsin

38.9

(31.0–47.5)

108

74,697

South

30.8

(29.2–32.4)

3,224

1,101,678

17.1

(15.6–18.7)

1,213

613,128

10.3

(9.1–11.7)

1,003

369,707

Alabama 

28.0

(22.8–34.0)

148

45,705

18.8

(14.0–24.9)

66

30,718

12.0

(8.9–16.0)

68

19,553

Arkansas

30.8

(24.9–37.4)

112

31,230

Delaware

40.5

(33.3–48.1)

120

12,243

District of Columbia

31.8

(25.6–38.9)

82

5,403

Florida

30.5

(26.2–35.1)

306

207,073

16.4

(12.5–21.4)

135

111,712

9.9

(6.9–14.1)

93

67,530

Georgia

32.1

(26.2–38.5)

132

91,059

20.3

(14.5–27.6)

53

57,569

Kentucky

27.6

(23.0–32.8)

246

43,887

16.2

(11.7–21.9)

105

25,736

16.4

(11.7–22.6)

100

26,148

Louisiana

28.9

(24.7–33.5)

200

42,092

17.3

(12.9–22.7)

72

25,171

10.9

(7.9–14.8)

66

15,822

Maryland

32.1

(27.6–37.0)

217

53,157

12.5

(8.9–17.4)

54

20,719

Mississippi

29.1

(25.3–33.2)

256

25,244

16.6

(13.0–20.8)

96

14,373

12.9

(9.9–16.6)

94

11,186

North Carolina

35.8

(31.3–40.6)

339

115,615

11.7

(8.7–15.4)

100

37,671

13.2

(10.0–17.2)

123

42,599

Oklahoma

28.5

(24.7–32.7)

215

37,948

22.4

(17.7–27.8)

101

29,753

10.4

(7.9–13.7)

65

13,855

South Carolina

30.3

(25.8–35.2)

239

47,144

18.8

(14.0–24.7)

85

29,198

8.4

(6.0–11.5)

66

13,003

Tennessee

27.1

(22.1–32.7)

131

53,281

22.8

(17.2–29.7)

69

44,905

Texas

30.7

(25.7–36.1)

262

195,587

17.8

(13.4–23.4)

95

113,769

12.3

(8.1–18.3)

67

78,293

Virginia

33.0

(26.7–40.0)

120

77,431

West Virginia

25.8

(21.1–31.2)

99

17,580

21.9

(16.9–28.0)

58

14,921

16.8

(12.9–21.7)

58

11,459

West

31.6

(29.6–33.7)

2,509

610,990

15.9

(14.2–17.7)

969

307,107

11.3

(9.9–13.0)

773

219,353

Alaska

Arizona

31.9

(25.3–39.2)

135

66,405

California

33.3

(29.4–37.5)

357

276,385

16.0

(12.9–19.7)

130

132,946

13.7

(10.8–17.1)

114

113,279

Colorado

31.5

(27.6–35.7)

253

41,404

16.9

(13.5–21.0)

98

22,261

13.5

(10.8–16.7)

99

17,740

Hawaii

42.6

(36.6–48.9)

174

16,458

Idaho

28.1

(22.5–34.5)

110

13,645

18.5

(13.7–24.5)

56

8,985

Montana

32.3

(27.3–37.8)

188

11,729

14.3

(10.3–19.6)

71

5,205

12.1

(9.0–16.1)

71

4,385

Nevada

28.7

(21.4–37.3)

86

24,728

20.8

(14.2–29.3)

59

17,898

New Mexico

34.2

(29.6–39.2)

209

20,943

17.7

(13.9–22.2)

86

10,811

10.5

(7.8–14.0)

71

6,423

Oregon

24.7

(20.0–30.0)

108

36,589

Utah

28.2

(23.7–33.1)

173

17,420

17.4

(12.8–23.3)

67

10,772

11.9

(8.8–15.9)

61

7,375

Washington

29.5

(26.6–32.4)

528

72,754

19.1

(15.4–23.5)

205

47,173

7.5

(6.0–9.4)

127

18,627

Wyoming

26.1

(21.9–30.8)

140

4,905

16.3

(12.4–21.1)

59

3,057

12.2

(9.1–16.0)

55

2,281

Territories

31.8

(24.8–39.6)

116

21,492

Guam

Puerto Rico

31.3

(24.1–39.6)

67

20,120

U.S. Virgin Islands


TABLE 4. (Continued) Prevalence of cancer among adults aged ≥18 years and of selected types of cancer among survivors aged ≥18 years, by geographic area and sex — Behavioral Risk Factor Surveillance System, United States, 2009

State/Area

Colorectal cancer prevalence among cancer survivors

Prostate cancer prevalence among male cancer survivors

Melanoma prevalence among cancer survivors

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

United States

6.7

(6.3–7.1)

3,331

1,077,574

33.3

(31.9–34.6)

5,713

2,153,172

12.3

(11.8–12.8)

5,571

1,971,310

Northeast

6.6

(5.7–7.7)

608

204,244

33.6

(30.6–36.8)

952

413,251

10.8

(9.7–12.0)

900

333,003

Connecticut

29.0

(22.6–36.5)

85

22,664

7.8

(5.6–10.9)

55

15,578

Maine

6.1

(4.7–7.9)

67

5,089

31.1

(25.3–37.5)

92

9,585

14.8

(11.9–18.3)

114

12,353

Massachusetts

6.4

(5.0–8.2)

110

22,671

28.2

(23.5–33.5)

175

39,498

10.2

(8.2–12.4)

151

35,986

New Hampshire

7.1

(5.3–9.6)

56

5,600

31.2

(24.4–38.8)

85

10,129

12.2

(8.9–16.5)

77

9,584

New Jersey

8.1

(6.3–10.5)

88

35,345

32.2

(26.5–38.5)

113

53,597

8.6

(6.7–10.8)

103

37,208

New York

38.9

(32.0–46.3)

112

169,666

11.6

(9.3–14.5)

96

126,159

Pennsylvania

9.1

(6.9–11.8)

92

66,291

31.4

(25.9–37.4)

121

94,535

11.4

(9.3–13.9)

127

83,162

Rhode Island

7.6

(5.7–10.2)

57

5,174

33.0

(26.9–39.7)

94

9,594

10.4

(7.9–13.6)

68

7,068

Vermont

27.1

(21.6–33.5)

75

3,983

16.1

(13.3–19.5)

109

5,905

Midwest

6.8

(6.1–7.6)

844

247,183

32.7

(30.2–35.2)

1,357

483,479

12.4

(11.4–13.5)

1,287

452,023

Illinois

32.4

(25.4–40.4)

65

74,603

10.8

(8.2–14.0)

65

65,626

Indiana

7.3

(5.5–9.6)

76

24,809

31.3

(24.9–38.4)

106

37,893

11.6

(9.3–14.3)

116

39,371

Iowa

9.6

(7.2–12.6)

58

15,839

26.1

(20.0–33.3)

68

16,893

15.9

(11.8–21.2)

74

26,357

Kansas

5.8

(4.8–6.9)

142

8,642

34.1

(29.8–38.8)

240

20,084

14.4

(12.3–16.7)

260

21,601

Michigan

5.7

(4.3–7.5)

68

34,588

33.8

(27.4–40.8)

142

85,691

16.6

(13.9–19.7)

164

101,126

Minnesota

38.3

(30.8–46.4)

84

41,430

11.1

(8.4–14.4)

59

27,369

Missouri

35.6

(27.3–44.9)

74

50,653

15.4

(11.8–19.7)

77

54,743

Nebraska

6.2

(4.8–7.9)

147

5,902

31.0

(25.4–37.1)

236

12,187

15.8

(12.5–19.7)

221

15,057

North Dakota

37.9

(29.5–47.1)

62

5,248

Ohio

7.8

(6.0–10.1)

82

50,809

25.7

(20.7–31.3)

99

71,795

8.2

(6.4–10.4)

87

53,230

South Dakota

10.3

(7.9–13.3)

74

4,439

36.7

(29.8–44.2)

105

6,909

9.7

(7.2–12.9)

65

4,179

Wisconsin

40.6

(31.1–50.9)

76

60,094

11.7

(8.1–16.7)

51

39,860

South

6.9

(6.2–7.6)

1100

414,269

32.4

(30.0–34.8)

1,791

789,578

13.2

(12.3–14.2)

1,859

794,674

Alabama 

8.3

(5.9–11.5)

61

23,989

31.4

(22.8–41.5)

67

39,742

11.8

(9.0–15.3)

96

34,143

Arkansas

33.1

(24.8–42.5)

52

19,853

16.7

(12.2–22.4)

55

26,929

Delaware

29.1

(21.7–37.7)

60

6,095

11.8

(8.8–15.8)

59

6,061

District of Columbia

41.6

(33.4–50.2)

73

5,499

Florida

7.0

(5.0–9.6)

98

85,508

31.2

(24.7–38.4)

188

171,142

13.2

(10.9–16.0)

218

162,433

Georgia

29.9

(21.7–39.7)

62

52,209

10.0

(7.3–13.5)

60

45,852

Kentucky

6.6

(5.0–8.8)

96

17,870

22.7

(16.9–29.8)

86

24,950

16.2

(12.6–20.5)

136

43,532

Louisiana

9.3

(7.1–12.2)

88

22,311

40.7

(33.9–47.9)

138

37,843

11.1

(8.3–14.7)

100

26,497

Maryland

6.7

(4.8–9.3)

59

19,881

30.1

(24.1–36.8)

114

39,153

10.5

(8.4–13.2)

106

31,190

Mississippi

8.3

(6.4–10.6)

106

12,532

36.7

(31.3–42.4)

187

23,555

14.4

(11.8–17.4)

168

21,699

North Carolina

6.3

(4.9–8.1)

100

32,322

31.8

(26.2–38.0)

173

60,023

14.8

(12.1–18.1)

214

75,920

Oklahoma

5.7

(4.3–7.6)

58

12,018

37.8

(31.5–44.5)

107

28,898

11.0

(8.9–13.6)

94

23,036

South Carolina

6.8

(5.0–9.2)

82

17,894

33.2

(26.4–40.7)

150

36,087

15.3

(12.0–19.3)

155

40,385

Tennessee

29.2

(21.4–38.5)

50

28,711

13.1

(9.8–17.2)

64

38,589

Texas

5.5

(3.9–7.7)

71

58,151

34.5

(27.7–42.0)

148

144,377

14.4

(11.8–17.6)

186

152,528

Virginia

34.4

(26.3–43.5)

72

56,927

12.7

(9.6–16.8)

61

50,971

West Virginia

10.6

(7.8–14.3)

52

11,784

34.0

(26.8–42.0)

64

14,515

10.4

(7.8–13.8)

51

11,563

West

6.3

(5.4–7.2)

741

201,522

34.8

(32.2–37.6)

1,527

446,136

12.1

(11.1–13.2)

1,509

388,822

Alaska

Arizona

39.4

(30.6–49.0)

104

62,459

13.3

(9.6–18.1)

85

48,903

California

7.6

(5.9–9.8)

105

101,163

37.1

(31.7–42.8)

204

183,733

9.4

(7.6–11.6)

134

125,010

Colorado

6.9

(5.3–8.9)

81

14,880

36.6

(30.9–42.7)

150

30,545

16.1

(13.6–19.1)

171

34,668

Hawaii

33.1

(25.2–42.0)

77

8,232

7.7

(5.7–10.3)

65

4,887

Idaho

34.9

(27.0–43.7)

67

10,679

16.4

(12.5–21.3)

81

12,996

Montana

5.4

(4.0–7.4)

55

3,243

37.0

(30.7–43.7)

119

8,655

15.0

(12.1–18.5)

115

8,952

Nevada

9.4

(6.6–13.2)

52

14,185

New Mexico

6.8

(5.1–9.1)

65

6,915

31.9

(26.1–38.3)

102

12,711

14.9

(12.2–18.1)

125

15,108

Oregon

27.6

(20.9–35.4)

70

29,062

17.2

(13.6–21.6)

87

43,704

Utah

28.4

(23.1–34.3)

122

13,386

19.7

(16.1–23.8)

163

21,445

Washington

5.2

(4.3–6.3)

152

22,249

33.6

(30.1–37.3)

360

60,925

11.7

(10.3–13.3)

305

50,145

Wyoming

6.6

(4.9–8.9)

52

2,096

29.1

(23.1–35.9)

79

3,730

19.2

(15.6–23.5)

112

6,074

Territories

Guam

Puerto Rico

U.S. Virgin Islands

Abbreviation: CI = confidence interval.

* Data suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.

For breast, cervical, and other female genital system cancers, prevalence estimates are for women only. For prostate cancer, prevalence estimates are for men only.


TABLE 5. Quality of life indicators among cancer survivors aged ≥18 years, by geographic area — Behavioral Risk Factor Surveillance System, United States, 2009

State/Area

Health status self-rated as excellent, very good, or good

≥5 physically unhealthy days during the past 30 days

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

United States

68.5

(67.7–69.3)

30,476

11,002,112

31.8

(31.0–32.6)

14,494

5,107,819

Northeast

70.7

(68.7–72.7)

5,815

2,173,044

29.8

(27.8–31.7)

2,512

913,939

Connecticut

75.0

(70.3–79.1)

519

149,099

25.7

(21.5–30.5)

193

51,185

Maine

71.4

(67.9–74.7)

638

59,677

30.0

(26.5–33.7)

273

25,050

Massachusetts

73.0

(70.0–75.9)

1,134

258,802

28.0

(25.1–31.2)

518

99,358

New Hampshire

71.1

(66.9–75.0)

497

55,824

29.1

(25.0–33.6)

213

22,831

New Jersey

73.6

(70.3–76.6)

836

319,719

26.8

(23.6–30.3)

319

116,528

New York

69.2

(64.4–73.6)

516

750,992

31.1

(26.8–35.7)

237

337,285

Pennsylvania

68.7

(64.6–72.5)

662

503,016

31.7

(27.9–35.7)

335

231,783

Rhode Island

71.1

(67.2–74.7)

493

48,174

29.7

(26.0–33.6)

227

20,094

Vermont

75.9

(71.7–79.6)

520

27,742

26.9

(23.2–30.9)

197

9,826

Midwest

67.6

(65.9–69.1)

7,298

2,460,369

32.7

(31.1–34.4)

3,358

1,191,136

Illinois

64.9

(59.6–69.8)

394

395,471

37.0

(32.1–42.2)

206

225,627

Indiana

67.9

(63.8–71.8)

620

231,460

35.0

(31.0–39.2)

358

119,189

Iowa

69.3

(64.8–73.4)

415

114,627

24.7

(21.1–28.7)

166

40,852

Kansas

68.9

(66.2–71.5)

1,337

103,419

31.3

(28.5–34.2)

606

46,950

Michigan

69.6

(65.9–73.0)

713

424,081

30.4

(26.3–34.9)

330

185,344

Minnesota

73.0

(67.8–77.6)

405

180,527

26.2

(21.6–31.3)

136

64,709

Missouri

67.6

(62.2–72.6)

373

240,828

35.3

(30.1–40.9)

218

125,730

Nebraska

74.5

(71.1–77.7)

1,246

71,018

27.6

(24.1–31.3)

526

26,252

North Dakota

71.6

(66.0–76.6)

306

23,310

26.0

(20.7–32.0)

108

8,455

Ohio

61.4

(57.5–65.2)

648

400,413

35.5

(31.8–39.5)

356

231,762

South Dakota

72.1

(67.8–76.0)

504

31,024

26.1

(22.3–30.4)

194

11,236

Wisconsin

71.9

(65.1–77.7)

337

244,193

30.9

(25.2–37.2)

154

105,031

South

66.9

(65.5–68.3)

8,988

4,028,132

32.3

(30.9–33.8)

4,911

1,945,825

Alabama

61.9

(56.6–67.0)

398

179,261

34.7

(29.8–39.9)

261

100,368

Arkansas

59.2

(53.2–64.9)

258

95,481

35.5

(30.0–41.4)

173

57,256

Delaware

74.0

(68.9–78.5)

336

37,875

29.7

(24.8–35.1)

158

15,217

District of Columbia

72.4

(67.1–77.2)

282

21,873

26.5

(22.0–31.7)

114

8,014

Florida

70.8

(66.9–74.4)

1,027

869,979

27.7

(24.2–31.4)

488

340,235

Georgia

63.7

(57.7–69.3)

344

291,943

37.8

(31.6–44.4)

208

173,067

Kentucky

56.9

(51.6–62.0)

562

153,075

44.1

(38.9–49.4)

484

118,585

Louisiana

62.6

(58.5–66.6)

531

149,473

33.5

(29.6–37.7)

320

79,982

Maryland

71.5

(67.2–75.4)

667

211,348

31.1

(27.0–35.5)

285

92,008

Mississippi

62.3

(58.6–65.7)

714

93,997

29.7

(26.5–33.1)

406

44,785

North Carolina

70.2

(66.4–73.7)

954

358,837

28.8

(25.2–32.8)

430

147,536

Oklahoma

60.2

(56.1–64.1)

535

126,003

38.0

(34.1–42.1)

335

79,628

South Carolina

65.7

(61.0–70.0)

683

173,507

29.3

(25.1–33.9)

319

77,470

Tennessee

58.5

(53.0–63.8)

301

172,488

40.5

(35.1–46.0)

212

119,247

Texas

69.6

(65.4–73.5)

763

734,980

32.3

(27.7–37.2)

362

340,685

Virginia

73.8

(69.1–78.1)

358

295,565

27.2

(22.3–32.6)

152

108,678

West Virginia

56.4

(51.5–61.2)

275

62,445

38.9

(34.3–43.7)

204

43,066

West

71.3

(69.6–72.9)

8,158

2,292,655

31.7

(30.1–33.4)

3,577

1,020,314

Alaska

73.3

(62.9–81.6)

138

23,248

—*

Arizona

71.3

(65.7–76.3)

451

261,526

28.8

(23.7–34.4)

216

105,469

California

69.3

(65.9–72.5)

1,026

918,674

34.7

(31.4–38.2)

460

459,662

Colorado

75.2

(72.0–78.1)

840

161,671

26.5

(23.4–29.8)

305

57,002

Hawaii

72.9

(67.4–77.8)

460

46,305

30.0

(25.1–35.4)

164

19,055

Idaho

70.2

(65.2–74.7)

394

55,547

36.2

(31.2–41.6)

191

28,661

Montana

71.4

(67.4–75.1)

585

42,655

30.4

(26.6–34.4)

284

18,127

Nevada

67.2

(59.8–73.8)

299

101,670

33.5

(26.8–40.8)

138

50,642

New Mexico

67.2

(63.3–70.9)

578

67,952

36.5

(32.6–40.5)

327

36,910

Oregon

76.2

(71.3–80.4)

406

193,344

29.7

(24.9–34.9)

173

75,298

Utah

73.3

(69.4–76.9)

628

79,978

31.2

(27.3–35.4)

301

34,001

Washington

74.2

(72.0–76.3)

1,879

317,768

28.1

(25.9–30.4)

794

120,242

Wyoming

70.7

(66.5–74.5)

474

22,319

25.8

(22.1–29.8)

183

8,139


TABLE 5. (Continued) Quality of life indicators among cancer survivors aged ≥18 years, by geographic area — Behavioral Risk Factor Surveillance System, United States, 2009

State/Area

Always receive needed social or emotional support

Satisfied or very satisfied with life

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

United States

50.2

(49.3–51.1)

22,225

8,067,485

92.7

(92.2–93.1)

42,114

14,886,915

Northeast

47.4

(45.3–49.6)

3,936

1,456,490

92.7

(91.6–93.7)

7,655

2,847,895

Connecticut

48.9

(43.9–53.9)

348

97,221

93.8

(90.5–96.0)

673

186,605

Maine

47.9

(44.0–51.8)

415

40,038

92.6

(90.3–94.4)

843

77,374

Massachusetts

48.7

(45.2–52.3)

785

172,741

91.6

(89.6–93.2)

1,479

324,596

New Hampshire

48.2

(43.5–52.9)

337

37,814

93.7

(91.6–95.3)

660

73,519

New Jersey

51.9

(48.1–55.7)

608

225,508

92.5

(90.3–94.3)

1,091

402,126

New York

43.8

(38.9–48.8)

321

475,481

92.9

(90.4–94.9)

677

1,008,640

Pennsylvania

48.8

(44.7–52.9)

457

357,223

92.4

(90.0–94.2)

914

676,435

Rhode Island

49.6

(45.3–54.0)

346

33,631

94.7

(92.7–96.2)

678

64,178

Vermont

46.0

(41.7–50.4)

319

16,834

94.1

(92.1–95.7)

640

34,421

Midwest

49.9

(48.2–51.5)

5,192

1,816,330

93.1

(92.1–93.9)

10,096

3,389,553

Illinois

49.3

(44.3–54.3)

291

300,553

95.0

(91.3–97.2)

558

579,096

Indiana

48.7

(44.4–53.1)

451

165,997

92.4

(89.9–94.3)

875

314,660

Iowa

48.1

(43.2–53.1)

278

79,650

95.2

(93.2–96.7)

570

157,567

Kansas

47.8

(45.0–50.7)

941

71,756

92.5

(90.5–94.0)

1,833

138,781

Michigan

46.8

(42.6–51.1)

490

285,504

94.2

(92.4–95.5)

1,005

574,020

Minnesota

52.1

(47.0–57.1)

285

128,779

95.4

(93.4–96.9)

515

235,949

Missouri

51.0

(45.3–56.6)

290

181,640

91.2

(86.3–94.5)

543

324,909

Nebraska

48.3

(44.1–52.5)

850

46,012

93.0

(90.3–95.0)

1,700

88,625

North Dakota

52.9

(47.0–58.7)

218

17,216

95.8

(93.2–97.4)

411

31,183

Ohio

53.7

(49.9–57.6)

530

350,474

90.8

(88.2–92.9)

953

592,157

South Dakota

46.1

(41.5–50.8)

330

19,848

96.4

(94.4–97.6)

692

41,458

Wisconsin

49.7

(43.0–56.4)

238

168,902

91.6

(87.0–94.6)

441

311,147

South

51.2

(49.6–52.7)

7,254

3,081,401

92.3

(91.4–93.0)

13,251

5,555,069

Alabama

50.6

(44.9–56.2)

365

146,424

90.0

(84.8–93.5)

641

260,567

Arkansas

45.2

(39.4–51.2)

213

73,004

92.0

(88.5–94.6)

420

148,533

Delaware

53.4

(47.5–59.2)

263

27,346

92.5

(89.2–94.8)

441

47,370

District of Columbia

36.4

(31.0–42.0)

137

10,978

94.4

(91.3–96.5)

367

28,512

Florida

50.7

(46.4–54.9)

753

622,791

91.8

(89.3–93.8)

1,432

1,128,657

Georgia

51.4

(45.2–57.6)

301

235,669

94.9

(92.5–96.6)

539

434,992

Kentucky

49.4

(44.2–54.6)

520

132,818

88.4

(83.0–92.2)

968

237,716

Louisiana

57.6

(53.3–61.8)

506

137,421

91.6

(89.0–93.6)

839

218,561

Maryland

49.4

(44.9–53.9)

452

145,959

92.5

(90.0–94.4)

868

273,622

Mississippi

54.1

(50.3–57.8)

655

81,667

91.6

(89.0–93.6)

1,121

138,323

North Carolina

51.8

(47.7–55.8)

738

264,924

92.5

(90.0–94.5)

1,324

473,309

Oklahoma

47.3

(43.3–51.3)

420

99,022

90.3

(87.2–92.7)

813

189,108

South Carolina

43.2

(38.5–47.9)

500

114,059

90.1

(86.3–92.9)

989

238,159

Tennessee

59.3

(53.8–64.6)

322

174,870

92.0

(88.7–94.4)

483

271,073

Texas

52.0

(47.2–56.8)

570

549,284

94.7

(92.3–96.3)

1,068

999,678

Virginia

51.4

(45.6–57.1)

263

205,631

91.6

(87.6–94.4)

479

366,526

West Virginia

53.8

(48.8–58.6)

276

59,534

90.7

(87.3–93.2)

459

100,365

West

51.0

(49.3–52.8)

5,594

1,641,703

92.9

(91.9–93.8)

10,702

2,987,307

Alaska

59.8

(50.0–68.9)

97

18,968

94.9

(88.9–97.7)

178

30,085

Arizona

51.1

(45.1–57.1)

343

187,457

92.9

(89.5–95.3)

628

340,720

California

51.4

(47.8–54.9)

685

680,797

93.4

(91.4–94.9)

1,321

1,236,966

Colorado

48.6

(44.9–52.2)

531

104,409

92.1

(89.8–93.9)

1,054

198,015

Hawaii

50.1

(44.7–55.5)

294

31,817

94.3

(91.5–96.2)

565

59,892

Idaho

50.1

(44.8–55.3)

276

39,636

93.5

(90.2–95.7)

531

73,987

Montana

47.7

(43.1–52.3)

387

28,486

92.0

(89.3–94.0)

785

54,928

Nevada

57.2

(49.9–64.3)

214

86,617

88.6

(79.9–93.8)

399

134,101

New Mexico

46.2

(42.1–50.3)

408

46,697

91.0

(88.4–93.1)

811

92,021

Oregon

50.7

(44.9–56.5)

284

128,699

93.9

(89.9–96.4)

517

238,299

Utah

55.6

(51.2–59.9)

451

60,606

92.5

(90.1–94.3)

821

100,839

Washington

49.1

(46.5–51.8)

1,273

210,343

92.7

(91.3–94.0)

2,442

397,249

Wyoming

54.4

(49.8–58.9)

351

17,171

95.6

(93.6–97.1)

650

30,206

Abbreviation: CI = confidence interval.

* Data suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


TABLE 6. Treatment-related factors among cancer survivors aged ≥18 years (N = 6,384) — Behavioral Risk Factor Surveillance System, 10 states, 2009

State

Currently receiving treatment

Participated in a clinical trial*

Currently have physical pain caused by cancer or cancer treatment*

Pain currently under control*

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

Total

12.0

(10.4–13.7)

713

449,415

7.5

(6.1–9.1)

388

245,879

10.1

(8.6–11.9)

484

333,872

80.9

(74.3–86.1)

389

269,994

California

12.9

(9.2–17.8)

52

160,062

Connecticut

10.8

(8.2–14.0)

82

21,335

Maryland

Massachusetts

11.4

(8.3–15.6)

56

38,767

Nebraska

9.1

(6.1–13.3)

54

8,127

New Jersey

14.0

(10.9–17.8)

89

63,333

North Carolina

9.7

(7.7–12.1)

148

48,691

Oklahoma

11.8

(8.5–16.2)

50

27,142

Vermont

10.1

(7.8–12.9)

65

3,691

Virginia

12.4

(8.9–17.0)

69

49,159

Abbreviation: CI = confidence interval.

* Only includes cancer survivors not currently undergoing treatment (n = 5,593).

Data suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


TABLE 7. Health care experience* among cancer survivors aged ≥18 years (N = 5,593) — Behavioral Risk Factor Surveillance System, 10 states, 2009

State

Currently receiving majority of health care from oncologist or other cancer specialist

Received a written treatment summary from health-care provider

Received instructions on follow-up care

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

Total

21.2

(18.8–23.7)

896

696,724

40.2

(37.6–42.9)

2,007

1,323,807

73.9

(71.6–76.0)

3,963

2,431,944

California

29.3

(23.3–36.0)

97

314,713

47.6

(41.0–54.3)

172

511,693

75.3

(69.3–80.5)

290

809,652

Connecticut

22.6

(18.0–28.1)

114

39,938

34.4

(29.4–39.8)

203

60,706

73.6

(68.4–78.3)

464

129,964

Maryland

15.7

(11.1–21.7)

55

38,604

43.4

(36.5–50.5)

128

106,511

75.6

(69.5–80.8)

263

185,630

Massachusetts

19.7

(14.4–26.3)

83

59,007

31.1

(25.1–37.8)

142

93,050

72.3

(66.2–77.7)

325

216,559

Nebraska

16.5

(10.3–25.3)

56

13,361

36.6

(29.1–44.8)

163

29,597

63.1

(55.8–69.7)

310

51,043

New Jersey

21.6

(17.0–26.9)

103

82,952

34.9

(29.3–40.9)

171

134,031

74.6

(69.3–79.3)

374

286,800

North Carolina

14.3

(11.8–17.4)

182

64,468

36.7

(32.6–40.9)

481

164,796

71.5

(67.5–75.1)

889

321,486

Oklahoma

§

42.6

(35.9–49.6)

147

86,096

66.6

(60.5–72.2)

241

134,587

Vermont

18.6

(14.9–23.1)

95

6,111

40.0

(35.5–44.7)

232

13,101

78.4

(74.5–81.9)

471

25,709

Virginia

15.6

(11.8–20.3)

69

53,841

36.0

(30.5–41.9)

168

124,226

78.4

(73.2–82.8)

336

270,515


TABLE 7. (Continued) Health care experience* among cancer survivors aged ≥18 years (N = 5,593) — Behavioral Risk Factor Surveillance System, 10 states, 2009

State

Insurance covered all or part of cancer treatment

Ever denied health insurance or life insurance coverage because of cancer

%

(95% CI)

Sample size

Weighted no.

%

(95% CI)

Sample size

Weighted no.

Total

90.7

(88.9–92.2)

5,130

2,984,587

12.0

(9.9–14.4)

489

393,340

California

91.2

(86.3–94.4)

364

980,237

Connecticut

95.5

(92.2–97.5)

597

168,553

Maryland

88.9

(82.7–93.0)

341

218,359

Massachusetts

90.6

(85.9–93.8)

428

271,395

Nebraska

90.9

(85.2–94.6)

479

73,554

New Jersey

91.8

(87.5–94.6)

471

352,611

North Carolina

89.7

(86.5–92.3)

1,133

403,371

Oklahoma

85.7

(77.7–91.1)

337

172,682

Vermont

91.9

(88.6–94.3)

576

30,087

Virginia

90.9

(86.3–94.1)

404

313,738

Abbreviation: CI = confidence interval.

* Only includes cancer survivors not currently undergoing treatment (n = 5,593).

Cancer specialists include cancer surgeons, gynecologic oncologists, medical oncologists, and radiation oncologists.

§ Data suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


FIGURE 1. Prevalence of current cigarette smoking among cancer survivors aged ≥18 years — Behavioral Risk Factor Surveillance System, United States, 2009

This figure is a U.S. map showing the prevalence of current cigarette smoking among cancer survivors aged =18 years. Approximately 15.1% of cancer survivors aged =18 years in the 50 states and DC were current cigarette smokers. Smoking prevalence among cancer survivors was highest in Oklahoma (23.9%) and lowest in California (10.3%). Regional differences also were observed, with the highest prevalence in the South (17.2%), followed by the Midwest (15.8%), Northeast (15.1%), and West (13.0%). Data are not shown for the District of Columbia, Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Abbreviations: GU = Guam; PR = Puerto Rico; VI = US Virgin Islands.

* The sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Alternate Text: This figure is a U.S. map showing the prevalence of current cigarette smoking among cancer survivors aged =18 years. Approximately 15.1% of cancer survivors aged =18 years in the 50 states and DC were current cigarette smokers. Smoking prevalence among cancer survivors was highest in Oklahoma (23.9%) and lowest in California (10.3%). Regional differences also were observed, with the highest prevalence in the South (17.2%), followed by the Midwest (15.8%), Northeast (15.1%), and West (13.0%). Data are not shown for the District of Columbia, Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


FIGURE 2. Prevalence of obesity* among cancer survivors aged ≥18 years — Behavioral Risk Factor Surveillance System, United States, 2009

This figure is a U.S. map showing the prevalence of obesity among cancer survivors aged =18 years. A total of 27.5% of cancer survivors were obese (body mass index =30 kg/m2); however, the prevalence varied widely by state, ranging from 15.7% in Colorado to 33.8% in Missouri. Obesity prevalence among cancer survivors varied by geographic region. Obesity was most prevalent among cancer survivors in the Midwest (29.8%), followed by the South (28.4%), Northeast (26.0%), and West (24.5%). Data are not shown for Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Abbreviations: GU = Guam; PR = Puerto Rico; VI = US Virgin Islands.

* Body mass index ≥30 kg/m2.

The sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Alternate Text: This figure is a U.S. map showing the prevalence of obesity among cancer survivors aged =18 years. A total of 27.5% of cancer survivors were obese (body mass index =30 kg/m2); however, the prevalence varied widely by state, ranging from 15.7% in Colorado to 33.8% in Missouri. Obesity prevalence among cancer survivors varied by geographic region. Obesity was most prevalent among cancer survivors in the Midwest (29.8%), followed by the South (28.4%), Northeast (26.0%), and West (24.5%). Data are not shown for Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


FIGURE 3. Prevalence of cancer survivors aged ≥18 years reporting no leisure-time physical activity during the past 30 days — Behavioral Risk Factor Surveillance System, United States, 2009

This figure is a U.S. map showing the prevalence of cancer survivors aged =18 years reporting no leisure-time physical activity during the past 30 days. Approximately 31.5% of cancer survivors had not participated in any leisure-time physical activity during the past 30 days. The highest proportion of cancer survivors reporting no leisure-time physical activity lived in the South (34.3%), followed by the Midwest (32.5%), Northeast (31.3%), and West (25.5%). Among states, percentages of inactivity were highest in West Virginia (42.3%) and lowest in Oregon (21.4%). Data are not shown for Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Abbreviations: GU = Guam; PR = Puerto Rico; VI = US Virgin Islands.

* The sample size of the numerator was <50 or the half-width of the confidence interval was >10.

Alternate Text: This figure is a U.S. map showing the prevalence of cancer survivors aged =18 years reporting no leisure-time physical activity during the past 30 days. Approximately 31.5% of cancer survivors had not participated in any leisure-time physical activity during the past 30 days. The highest proportion of cancer survivors reporting no leisure-time physical activity lived in the South (34.3%), followed by the Midwest (32.5%), Northeast (31.3%), and West (25.5%). Among states, percentages of inactivity were highest in West Virginia (42.3%) and lowest in Oregon (21.4%). Data are not shown for Guam, Puerto Rico, or the US Virgin Islands; these data were suppressed because the sample size of the numerator was <50 or the half-width of the confidence interval was >10.


Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

 

File Formats Help:

How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? double arrows.

USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #