Elements of Cancer Care

Individuals Receiving Cancer Care

In 1999, more than 8 million Americans, or 3 percent of the population, will require some form of care because of a diagnosis of cancer: 1.2 million of these individuals will be newly diagnosed this year and initiate treatment; some, diagnosed in previous years, will continue treatment; others, who have been successfully treated and no longer have evidence of cancer, will require follow-up; and over 500,000 people will die from cancer (ACS, 1999; Ries et al., 1997). Even larger numbers of adults in the United States will have been screened for cancer.

Cancer is characterized by abnormal cell growth, but it is really more than 100 different diseases, each with a unique profile of population at risk, symptoms, effective treatments, and prognosis. Some cancers are extremely rare, but relatively few cancer sites account for more than half (54 percent) of all new cases of cancer: prostate; breast; lung and bronchus; and colon and rectum (Table 2.1) (ACS, 1999).

Cancer most often strikes after middle age. Six of ten new cancer cases occur among those age 65 and older (Ries et al., 1997). With the aging of the "baby-boom" cohort, the number of new cancers diagnosed annually in the United States among the elderly is projected to more than double by the year 2030 (Polednak, 1994). Roughly four of ten new cases of cancer occur among working-age adults who often must meet the demands of supporting and raising a family while undergoing treatment. In terms of potential years of life lost, lost productivity, and lost earnings, cancer that strikes at younger ages has graver consequences than cancers that affect the elderly. Cancer among children is rare (e.g., 14.2 cases per 100,000 infants and children up to age 14 in 1993-1994) (NCI, 1998a); however, with the success of treating cancer in childhood, estimates are that 1 in 1,000 people reaching adulthood is a cured survivor of childhood cancer (NCI, 1997).

Cancer disproportionately affects the African-American community. Cancer incidence rates are higher for several sites, and once cancer is diagnosed, survival is poorer (Figures 2.1 and 2.2). Limitations in access to health care explain some, but not all, of these differences (see Chapter 3).

Slightly more men than women are diagnosed with cancer each year, but as women succumb to the effects of increased rates of smoking over the past two decades, they are becoming more equally represented among those with cancer (ACS, 1999).

TABLE 2.1

Estimated Number and Distribution of New Cancer Cases, United States, 1999

 

Estimated No.

Distribution (%)

All Sites

1,221,800

100.0

Prostate

179,300

14.7

Female breast

175,000

14.3

Lung and bronchus

171,600

14.0

Colon and rectum

129,400

10.6

All other sites

566,500

46.4

 

SOURCE: ACS, 1999.



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