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        Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.

        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.

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        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.


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