Tobacco-related Cancers in Mississippi, 2003-2019

Smoking, exposure to second-hand smoke, and use of other tobacco products are a modifiable risk factor associated with the development of certain cancers. According to the Behavioral Risk Factor Surveillance System for 2020, 20.1% of Mississippi adults report being current smokers, 20.4% report being former smokers, and 4.7% of Mississippi adults report using smokeless tobacco. Mississippi’s rate of current smoking among adults is fourth highest in the nation.¹ Tobacco use is associated with cancers of the lip, oral cavity, pharynx, stomach, colon and rectum, pancreas, trachea, lung and bronchus, cervix, kidney and renal pelvis, urinary bladder, esophagus, liver, and larynx. Tobacco use is also associated with the development of acute myeloid leukemia.³ Below are graphs of the trends in tobacco-related cancers over the period 2003 to 2019 by race and sex with a description of the trends occurring in each group both for the full time period and for the most recent period between 2015 and 2019. All analysis was done using SEER*Stat software².

While lip, oral cavity, and pharynx cancer is associated with tobacco use, it is also associated with another modifiable risk factor, alcohol use. Cancers of the oropharynx may also be associated with Human Papillomavirus (HPV) infection. Males had significantly higher rates of lip, oral cavity, and pharynx cancers than females. Over the period from 2003 to 2019, only black males experienced a significant change in incidence rates. The rate for black males decreased annually by 1.76%. The rate for black females was also slightly decreasing at an observed rate of 0.08%. The rates for white males and white females were observed to be increasing. The rate for white males increased at a rate of 0.63% annually, and the rate for white females increased at a rate of 0.74% annually.

For the latest five-year time period of 2015 to 2019, black males and black females had a similar trend to that of the overall time period of 2003 to 2019. Though not statistically significant, the rate for black males was decreasing at a rate of 3.21% annually, and the rate for black females was decreasing at a rate of 2.00% annually. White males and white females had an opposite trend compared to the full time period of 2003 to 2019. Though not statistically significant, the rate for white males decreased at a rate of 0.95% annually, and the rate for white females decreased at a rate of 0.61% annually.

While all stomach cancers may be associated with stomach cancer, cancers occurring in the gastric cardia (upper portion of the stomach next to the esophagus) may also be associated with obesity. Between 2003 and 2019, black males had significantly higher incidence rates for stomach cancer than all other groups except in 2015. The rate for stomach cancer in black males decreased significantly between 2003 and 2019 at an annual percent change of 2.72%. No other group had any significant change over time. Black females had a stable rate between 2003 and 2019. The observed change for white males was a very small decrease of 0.26% annually, and for white females, the observed change was a 0.56% annual increase.

For the latest five-year period from 2015 to 2019, none of the trends were statistically significant. Black males saw an annual increase of 5.81% in contrast to the significantly decreasing trend over the full time period. The annual increase for white females was 3.96%. In contrast, white males had an observed annual decrease of 5.06%. Black females had an observed annual decrease of 6.53% from 2015 to 2019 in contrast to the observed flat to trend over the full time period.

While pancreatic cancer is associated with tobacco use, it is also associated with another modifiable risk factor, obesity. Pancreatic cancer rates increased significantly between 2003 and 2019 for females, overall. White females experienced annual significant increase of 3.25% between 2003 and 2013 but then saw and observed 3.01% decrease between 2013 and 2019. The rate for black females increased a significant 1.65% annually. For males, the average annual percent change between 2003 and 2019 was an observed increase of 0.60%. Black males had a small observed increase of 0.05% annually. White males experienced a significant increase between 2003 and 2015 of 3.48% annually but then experienced an observed decrease annually between 2015 and 2019 of 6.29%.

For the latest five-year period of 2015-2019, the trends were decreasing for all groups except black females who saw an increasing trend. White males had a significant decrease of 6.16% annually. For black males, the most recent trend observed is a decrease of 6.99% annually, and for black females the observed trend for the most recent five years was a 1.78% increase annually. White females had an observed decrease of 2.47%.

Males had significantly higher rates of trachea, lung, and bronchus cancer than females. For most years, black males had significantly higher rates than white males. White females had significantly higher incidence rates than black females. The rates for both white males and black males decreased at a significant average annual rate between 2003 and 2019. For white males, the average annual percent decrease was 1.40%, and for black males, the annual percent decrease was 1.82%. Black females had no significant change in their rates with an annual decrease of 0.33%. In contrast to the decreasing rates of other groups, white females experienced a significant 0.45% annual increase.

Compared to the trends for the full time period from 2003 to 2019, white males, black males, and black females had similar trends for the most recent five-year time period of 2015 to 2019, though none of the trends for this shorter time period were statistically significant with the exception of white males. From 2015 to 2019, white males had a significant annual decrease of 3.33%. Black males had an observed annual decrease of 1.92%, and black females had an observed annual decrease of 1.92%. In contrast to the full time period of 2003-2019, white females had a decreasing observed trend of 2.05% annually between 2015 and 2019.

While cervical cancer is associated with tobacco use, most cervical carcinomas are associated with Human Papilloma Virus (HPV) infection. For most years, there was not a statistically significant difference in the incidence rates of cervical cancer between white females and black females, though black females did have higher observed rates through 2015. During the period between 2003 and 2019, the incidence rate for black females decreased at a significant rate of 2.75% annually. In contrast, the observed change in the incidence rate for white females was a 1.21% increase annually, though this change was not statistically significant. The incidence gap between black females and white females has been closed in the most recent years as a result of the significant decrease in rates for black females and the observed increase in rates for white females. Between 2015 and 2019, black females had an observed decrease of 1.48% annually. The rate for white females decreased 1.26% annually between 2015 and 2019, though this change was not statistically significant. 

While kidney and renal pelvis cancers are associated with tobacco use, kidney cancer is also associated with another modifiable risk factor, obesity. Males had significantly higher rates of kidney and renal pelvis cancer than females. The rates for males were similar over time. Rates for females were similar for all years except 2009, 2010, 2016, 2017, and 2019 where black females had significantly higher incidence rates. Rates for all groups increased. Over the period from 2003 to 2019, rates for white males increased annually at 2.70%. Similarly, the rates for white females increased at a rate of 1.92% annually. For black females, the incidence rate increased at a rate of 3.76% annually. Black males had an increase of 2.30% annually. All of these increases were statistically significant.

For the latest five-year period of 2015 to 2019, white males, black males and black females had similar observed trends to those for the full time period from 2003 to 2019. For white males, the trend for the last five year period was an increase of 2.55% annually. For black males, the most recent trend observed was an increase of 4.83% annually, and for black females the observed trend for the most recent five years was a 3.00% increase annually. Though white females had a significant increase annually for the full time period from 2003 to 2019, the trend for the most recent five years was an observed 0.25% annual decrease. None of the trends for this shorter period were statistically significant.

Males had significantly higher rates of urinary bladder cancer than females. Also, white males had significantly higher rates than black males. The observed annual percent change between 2003 and 2019 for all groups was small. Black males had a 0.33% increase annually in their incidence rates, and black females had a 0.91% increase annually. The other groups had observed decreases, though the decreases were small and not statistically significant. For white males, the decrease annually was only 0.27%. For white females, the annual decrease was 0.54%.

From 2015 to 2019, white males had an observed annual decrease of 2.17%, and black males had an observed annual decrease of 4.03%. White females had an observed annual increase of 4.23%, and black females had an observed annual increase of 8.88%.

While esophageal cancer is associated with tobacco use, it is also associated with another modifiable risk factor, alcohol use. Additionally, adenocarcinoma of the esophagus can be associated with obesity. Males had significantly higher rates of esophageal cancer than females. The rates were similar by race for females and similar for males beginning in 2013. The annual percent change over the period from 2003 to 2019 for white males, white females, and black females was not statistically significant. For white males, the annual percent increase was 0.25% and for white females was 0.72%. Black females had an annual decrease of 0.87%. Black males had a statistically significant annual decrease of 3.33%.

For the latest five-year time period of 2015 to 2019, white males and black males had a similar trend to what was observed for the full time period of 2003 to 2019. The trend for 2015 to 2019 for white males was an annual increase of 1.79% and for black males was an annual decrease of 2.19%, neither of which were statistically significant. For white females and black females, the trend for the most recent time period was opposite of the full time period from 2003 to 2019, though neither of the trends for 2015 to 2019 were statistically significant. White females had a decreasing trend for 2015 to 2019 of 7.78% annually, and black females had an increasing trend of 9.84% annually.

While liver cancer is associated with tobacco use, it is also associated with other modifiable risk factors, obesity and alcohol use. Like many of the other tobacco-related cancers, males had significantly higher rates of liver cancer than females. The rates were similar between the races for each sex group. For white males, the incidence rate increased significantly between 2003 and 2017 at a rate of 4.63% annually. Between 2017 and 2019, the rate for white males decreased at an observed rate of 8.73% annually. The rate for white females showed an annual decrease of 10.02% from 2003 to 2007, but then showed a significant increasing trend from 2007-2019 with an annual increase of 5.18%. The annual percent increase for black males was 1.13% and for black females was 1.42%.

For the latest five-year period of 2015 to 2019, trends were decreasing for all groups but white females. For white males, the trend for the last five year period was a decrease of 0.67% annually, and for black males, the most recent trend observed was a decrease of 10.03% annually. For black females, the decrease was a statistically significant 5.03% annually. In contrast to the other groups, white females had an observed increase of 4.25% annually between 2015 and 2019.

While laryngeal cancer is associated with excessive tobacco use, it is also associated with another modifiable risk factor, alcohol use. Laryngeal cancer is a relatively rare cancer. Thus, the rates could not be broken down by both race and sex. This graph only displays the rates by race. Over the period from 2003 to 2019, the significant annual decrease for the white population was 1.51%. For the black population, the significant annual percent change from 2003 to 2019 was a decrease of 1.31%. For the latest five-year time period of 2015 to 2019, the black populations saw a decreasing trend, while the white population had an increasing trend. These trends were not statistically significant. For the black population, the trend was an annual decrease of 1.11%, and for the white population, the trend was an annual increase of 0.54%.

Acute myeloid leukemia is a relatively rare type of cancer. Thus, the rates are only broken down by race and not sex. Rates over the period from 2003 to 2019 remained relatively stable for the black population with an observed annual increase of 0.71%. The white population saw a significant increase over this time period of 1.48% annually. The rates were similar between groups for most years.

For the latest five-year time period from 2015 to 2019, the trend for the white population was similar to the trend for the full time period from 2003 to 2019 but was not statistically significant. The white rate increased between 2015 and 2019 annually 2.63%. The rate for the black population increased between 2015 and 2019 at an annual rate of 1.51%. This is similar to the increase observed over the full time period from 2003 to 2019.

While colorectal cancer is associated with tobacco use, it is also associated with other modifiable risk factors, alcohol use (both colon and rectum cancers), obesity (both colon and rectum cancers) and lack of physical activity (only colon cancer). Black males had significantly higher rates of colorectal cancer than all other groups except for in years 2003 and 2004 where their rates were similar to those of white males. Colorectal cancer rates decreased significantly in all groups for the period between 2003 and 2019. Black females had a significant decrease of 1.86% annually, and black males had a significant decrease of 0.70% annually. White males had a significant decrease of 1.14% annually. Conversely, white females had a significant decrease between 2003 and 2011 of 2.24% and then experienced an observed increase of 0.83% annually between 2011 and 2019. This translate to an overall significant average annual decrease of 0.7% over the full time period for white females.

For the latest five-year period of 2015 to 2019, black males and black females had similar significant trends to those for the full time period from 2003 to 2019. For black males, the trend for the latest five year period was a decrease of 1.39% annually. For black females, the most recent trend observed was a decrease of 2.99% annually. White males experienced an observed decreasing trend between 2015 and 2019 of 0.74%. The trend for white females between 2015 and 2019 is similar to the trend between 2011 and 2019. The observed rate of increase for white females was 0.56%.

Definitions

Age Adjusting: A statistical method that allows comparisons of populations that take into account age-distribution differences between the populations. The 2000 U.S. standard population is used and applied to all of the time periods being considered. This assures that the rates do not reflect differences in the age distribution of the population.

Annual Percent Change (APC): The average annual percent change over several years. It is used to measure the change in rates over time. Calculating the APC involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar year.

Statistical Significance: This is a mathematical measure of the difference between groups. A difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone 95% of the time. Rate ratios were used to assess the statistical significance between groups.

Citations

¹Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2020. [accessed Apr 18, 2022]. URL: https://www.cdc.gov/brfss/brfssprevalence/index.html.

²Surveillance Research Program, National Cancer Institute SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.9.1.

³Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Tobacco and Cancer [online]. 2021. [accessed Jun 13, 2022]. URL: https://www.cdc.gov/cancer/tobacco/index.htm

Source of Data: SEER*Stat Database: MS0219. Created on 11/30/2021. Mississippi Cancer Registry 2021 Submission (2002-2019) to Centers for Disease Control and Prevention, National Program of Cancer Registries.

Acknowledgement

We acknowledge the Centers for Disease Control and Prevention for their financial support under a cooperative agreement awarded to the Mississippi Cancer Registry.