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Information Provided by the National Center for Health Statistics on the Potential Reductions in Mortality from Cancer, by Ethnic Group



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F Information Provided by the National Center for Health Statistics on the Potential Reductions in Mortality from Cancer, by Ethnic Group

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DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Health Statistics 6525 Belcrest Road Hyattsville, Maryland 20782 September 16, 1998 M. Alfred Haynes, M.D., M.P.H. Chair, Committee on Cancer Research Among Minorities and the Medically Underserved Institute of Medicine 2101 Constitution Avenue, N.W. Washington, D.C. 20418 Dear Dr. Haynes: I am writing in response to your letter of July 24, 1998 in which you asked for an analysis of cancer mortality based on race. Please find enclosed a statement of the methodology we used including several caveats, a summary table, and a detailed table demonstrating the reduction in cancer deaths that could be achieved if differences by race or ethnicity could be eliminated. A few notes on what we've done: You asked us if we could illustrate the number and percent of deaths that would be avoided if all race or ethnic groups shared the same mortality risks for specific cancer sites. You also asked that we consider that the ''best" mortality experience be the one that all groups could, at least hypothetically, experience. We departed somewhat from the methodology you recommended in the letter with respect to sex, rates, and race: First, in consultation with NCI, we performed the calculations separately by sex because of the major differences in cancer experience by sex. Second, we used age-adjusted death rates to select a "best" group, and age-specific death rates to calculate the "excess" deaths. Third, we combined both the Asian and Pacific Islander and American Indians into a total Asian and Pacific Island group and a total American Indian group. These groups were formed to stabilize estimates, to use groups for which we have estimates of the degree to which race has been misreported, and to use the most recent data available, which is only available for the broad groups. Even with these steps, we do have some serious reservations about the procedures used and resulting conclusions because race and ethnicity-specific death rates are known to be substantially too low for certain racial/ethnic groups. The consequence is that excess deaths presented here may be substantially greater than would be the case if the rates were not a function of these errors. Indeed, we are most concerned about using the American Indian rates as a baseline or "best rate" group. Given the errors in reporting, it is difficult to believe that other groups could achieve these rates. The two kinds of errors in reported death rates include serious misclassification of race and ethnicity and misreporting of age, particularly among the elderly. These problems occur on the death certificate and also on censuses and surveys.

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Given our concerns we decided to make two estimates (Method A and Method B). In Method A, for those sites for which the American Indian rates were "best," we chose the race/ethnic group that was the next lowest in death rate for that cancer site. In Method B, we used American Indian rates when they were the "best." Two sets of tables are provided, but we strongly prefer those that are not based on American Indians as the "best'' or target rate (Method A). While Method A are preferred estimates, this method does not make any adjustment for known race misclassification. Overall we expect that the estimated number of "excess" deaths from cancer would be around ten percent fewer for women and closer to twenty percent for men. This percentage would vary by cancer site. Please note that I strongly believe this exercise can be useful. As I mentioned on the phone, I view differences in cancer mortality risk as, first and foremost, reflecting a variety of cancer causes and differential group responses to risk factors. Illustrating the differences between groups provides clues to form hypotheses on cancer causes, risk factors or biology. Secondly, for some cancer sites, we understand the causes and processes of cancer development sufficiently to be able to say how one group can achieve the lower risk shown by another group. Perhaps the best example I know of in the second case is the low rates of cancer among Mormons in Utah and Los Angeles, which reflect life-style choices that could be replicated in other populations. All of us at NCHS are appreciative to our NCI colleagues who made available their SEER database and helped us make the calculations. Please contact Mr. Maurer or Drs. Hoyert or Rosenberg (301-436-8884) if you have any additional questions. Sincerely, Edward J. Sondik, Ph.D. Director National Center for Health Statistics Enclosures cc: Brian Smedley Jeff Maurer Donna Hoyert, Ph.D. Harry Rosenberg, Ph.D. Lynn Ries Brenda Edwards, Ph.D. Mary Anne Freedman Jennifer Madans, Ph.D. Richard Klausner, M.D.

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Methodology and Caveats The methodology that we used in computing the requested approach is as follows: 1)   Our basic data included 1990–95 age-adjusted death rates (using a 1970 population standard), age-specific deaths and death rates, and populations by race and ethnicity following the structure of the 1996 SEER publication cited in your letter (produced by NCI using NCHS and Census data) 2)   Method A: For specific cancer sites, we selected the group with the smallest age-adjusted death rate separately by sex. The groups for which the age-adjusted death rates were compared included white, black, Asian and Pacific Islander, Hispanic (total), and Non-Hispanic (total).   Method B: For specific cancer sites, we selected the group with the smallest age-adjusted death rate separately by sex. The groups for which the age-adjusted death rates were compared included white, black, American Indian, Asian and Pacific Islander, Hispanic (total), and Non-Hispanic (total). 3)   For each cancer site, we multiplied the age-specific death rate for the "best" group by the population of each of the race or ethnic groups to determine an "expected" number of deaths. 4)   For each cancer site, we subtracted the "expected" number of deaths from the "observed" number of deaths to determine a value for deaths that would not have occurred. 5)   For each cancer site, we also divided the "expected" number of deaths by the "observed" number of deaths, subtracted 1 from the quotient, and multiply by 100. This yields the percent difference in observed and expected deaths. 6)   For all cancers combined (shown in the summary table), we summed the expected and observed deaths by sex and calculated the "excess" and percent difference from the summation for specific sites. 7)   The detail table expresses the number of deaths for the full time period. The summary table express the number of deaths per year.

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Caveats of this approach include the following: 1)   Quality of data varies by race and ethnicity in both death certificate data and Census data. The quality of data for the white and black populations are good in contrast to that for other groups. American Indian is estimated to be underreported on the death certificate by more than 20% (probably greater than this) and Asian and Pacific Islander is underreported by about 10%. With respect to population data, perhaps, the most serious problem is the 33% increase in the American Indian population between 1960 and 1990 that reflects increased preference to self-report as an American Indian. 2)   Age-specific death rates, especially those for the elderly, are underestimates. 3)   Hispanic origin and race are separate items. We picked the best rates going across these two variables, but show the deaths for both Hispanic origin and race. 4)   Hispanic origin was not reported on all State death certificates in this time period. The rates used in the calculation were based on 46 States and the District of Columbia. The observed deaths count was inflated to a national total by using the reciprocal of the fraction of the Hispanic population living in these 46 States and D.C. 5)   The number of events, particularly at young ages for certain minority groups, are small. This would affect the stability of the rates. To counter that tendency, we used data for the 1990–95 time period. In the summary table, we have expressed the number of deaths in terms of a single year of data. 6)   The reduction for all cancer sites combined differs depending on whether the values are summed across specific cancer sites or is done separately. The reduction is greater when the values are summed.

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) Men Women All cancers   All cancers   Best group rates (varies by site)   Best group rates (varies by site)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 140,449 276,146     TOTAL 126,225 247,702     White 125,372 239,397     White 111,714 217,628     Black 11,479 32,505     Black 11,428 26,456     American Indian 672 753     American Indian 590 716     Asian Pacific Islander 2,926 3,492     Asian Pacific Islander 2,492 2,903     Hispanic 6,916 8,374     Hispanic 6,103 7,358     Non-Hispanic 133,533 267,772     Non-Hispanic 120,122 240,344       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 135,697 -49     TOTAL 121,477 -49     White 114,024 -48     White 105,913 -49     Black 21,026 -65     Black 15,027 -57     American Indian 81 -11     American Indian 126 -18     Asian Pacific Islander 566 -16     Asian Pacific Islander 411 -14     Hispanic 1,458 -17     Hispanic 1,255 -17     Non-Hispanic 134,239 -50     Non-Hispanic 120,222 -50 Lung and bronchus Lung and bronchus   Best group rates (Hispanic)   Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 40,971 91,673     TOTAL 19,699 54,951     White 36,643 79,943     White 17,526 49,416     Black 3,296 10,578     Black 1,725 4,890     American Indian 191 239     American Indian 86 149     Asian Pacific Islander 841 914     Asian Pacific Islander 362 495     Hispanic 1,947 1,947     Hispanic 886 886     Non-Hispanic 39,024 89,726     Non-Hispanic 18,813 54,065       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 50,702 -55     TOTAL 35,252 -64     White 43,300 -54     White 31,890 -65     Black 7,281 -69     Black 3,165 -65     American Indian 48 -20     American Indian 63 -42     Asian Pacific Islander 73 -8     Asian Pacific Islander 133 -27     Hispanic (0) 0     Hispanic (0) 0     Non-Hispanic 50,702 -57     Non-Hispanic 35,252 -65

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) Pancreas Pancreas   Best group rates (As & Pac Islander) Best group rates (As & Pacific Islander)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 9,008 12,610     TOTAL 9,179 13,512     White 8,062 10,951     White 8,183 11,664     Black 721 1,449     Black 794 1,650     American Indian 42 27     American Indian 39 34     Asian Pacific Islander 183 183     Asian Pacific Islander 163 163     Hispanic 424 440     Hispanic 403 441     Non-Hispanic 8,584 12,169     Non-Hispanic 8,775 13,071       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 3,601 -29     TOTAL 4,333 -32     White 2,889 -26     White 3,481 -30     Black 728 -50     Black 856 -52     American Indian (15) 56     American Indian (5) 14     Asian Pacific Islander (0) 0     Asian Pacific Islander 0 -0     Hispanic 16 -4     Hispanic 38 -9     Non-Hispanic 3,585 -29     Non-Hispanic 4,295 -33   Ovary   Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 6,403 13,081       White 5,614 11,888       Black 611 1,012       American Indian 33 35       Asian Pacific Islander 146 146       Hispanic 341 413       Non-Hispanic 6,062 12,668         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 6,678 -51       White 6,275 -53       Black 401 -40       American Indian 2 -6       Asian Pacific Islander (0) 0       Hispanic 72 -18       Non-Hispanic 6,605 -52

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A)   Breast   Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 18,236 43,513       White 15,917 38,045       Black 1,783 4,932       American Indian 98 98       Asian Pacific Islander 438 438       Hispanic 1,017 1,328       Non-Hispanic 17,219 42,184         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 25,277 -58       White 22,128 -58       Black 3,149 -64       American Indian (0) 0       Asian Pacific Islander 0 -0       Hispanic 311 -23       Non-Hispanic 24,966 -59 Colon/rectum Colon/rectum   Best group rates (Hispanic) Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 16,753 28,310     TOTAL 15,954 28,919     White 14,964 24,974     White 14,215 25,303     Black 1,361 2,910     Black 1,386 3,244     American Indian 80 66     American Indian 69 71     Asian Pacific Islander 349 360     Asian Pacific Islander 284 302     Hispanic 814 814     Hispanic 709 709     Non-Hispanic 15,939 27,495        Non-Hispanic 15,245 28,210       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 11,556 -41     TOTAL 12,964 -45     White 10,009 -40     White 11,088 -44     Black 1,550 -53     Black 1,857 -57     American Indian (14) 21     American Indian 2 -2     Asian Pacific Islander 11 -3     Asian Pacific Islander 17 -6     Hispanic (0) 0     Hispanic (0) 0     Non-Hispanic 11,556 -42     Non-Hispanic 12,964 -46

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) Stomach Stomach   Best group rates (White) Best group rates (White)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 7,329 8,198     TOTAL 5,004 5,634     White 6,539 6,540     White 4,463 4,463     Black 599 1,327     Black 432 928     American Indian 35 38     American Indian 21 25     Asian Pacific Islander 155 293     Asian Pacific Islander 88 219     Hispanic 362 519     Hispanic 220 374     Non-Hispanic 6,967 7,679     Non-Hispanic 4,784 5,260       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 869 -11     TOTAL 630 -11     White 0 -0     White 0 -0     Black 728 -55     Black 495 -53     American Indian 3 -8     American Indian 4 -14     Asian Pacific Islander 138 -47     Asian Pacific Islander 131 -60     Hispanic 157 -30     Hispanic 154 -41     Non-Hispanic 712 -9     Non-Hispanic 476 -9   Cervix   Best group rates (White)         Expected deaths Observed deaths       TOTAL 3,976 4,578       White 3,438 3,439       Black 410 997       American Indian 23 34       Asian Pacific Islander 105 109       Hispanic 245 336       Non-Hispanic 3,731 4,242         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 602 -13       White 0 -0       Black 588 -59       American Indian 10 -30       Asian Pacific Islander 4 -4       Hispanic 91 -27       Non-Hispanic 511 -12

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Kidney/renal/pel Kidney/renal/pel   Best group rates (As Pac Islander) Best group rates (As Pacific Islander)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 2,433 6,350     TOTAL 1,685 4,099     White 2,163 5,715     White 1,501 3,678     Black 204 550     Black 146 369     American Indian 12 31     American Indian 7 23     Asian Pacific Islander 54 54     Asian Pacific Islander 30 30     Hispanic 127 257     Hispanic 75 150     Non-Hispanic 2,306 6,093     Non-Hispanic 1,610 3,949       Estimated excess excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 3,917 -62     TOTAL 2,414 -59     White 3,552 -62     White 2,177 -59     Black 346 -63     Black 222 -60     American Indian 19 -61     American Indian 15 -68     Asian Pacific Islander 0 -0     Asian Pacific Islander 0 -0     Hispanic 130 -51     Hispanic 75 -50     Non-Hispanic 3,786 -62     Non-Hispanic 2,339 -59 Other   Best group (Asian or Pacific Islander)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 43,975 88,231     TOTAL 42,373 75,355     White 39,044 77,673     White 37,556 66,372     Black 3,738 9,352     Black 3,814 7,950     American Indian 225 238     American Indian 196 225     Asian Pacific Islander 968 968     Asian Pacific Islander 808 808     Hispanic 2,363 3,026     Hispanic 2,036 2,462     Non-Hispanic 41,612 85,205     Non-Hispanic 40,337 72,893       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 44,256 -50     TOTAL 32,981 -44     White 38,629 -50     White 28,816 -43     Black 5,614 -60     Black 4,136 -52     American Indian 13 -6     American Indian 29 -13     Asian Pacific Islander 0 -0     Asian Pacific Islander (0) 0     Hispanic 662 -22     Hispanic 425 -17     Non-Hispanic 43,594 -51     Non-Hispanic 32,556 -45

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) Prostate     Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 14,221 34,070       White 12,826 28,261       Black 1,082 5,477       American Indian 59 78       Asian Pacific Islander 254 254       Hispanic 587 917       Non-Hispanic 13,634 33,153         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 19,849 -58       White 15,436 -55       Black 4,394 -80       American Indian 19 -24       Asian Pacific Islander (0) 0       Hispanic 330 -36       Non-Hispanic 19,519 -59   Nasopharynx Nasopharynx   Best group rates (Hispanic)   Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 299 450     TOTAL 145 233     White 264 312     White 128 186     Black 26 62     Black 13 24     American Indian 2 6     American Indian 1 2     Asian Pacific Islander 7 71     Asian Pacific Islander 3 21     Hispanic 17 17     Hispanic 7 7     Non-Hispanic 282 433     Non-Hispanic 137 226       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 151 -33     TOTAL 88 -38     White 47 -15     White 58 -31     Black 36 -58     Black 10 -44     American Indian 4 -71     American Indian 1 -66     Asian Pacific Islander 63 -90     Asian Pacific Islander 18 -86     Hispanic 0 -0     Hispanic 0 -0     Non-Hispanic 151 -35     Non-Hispanic 88 -39

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Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) Liver & intrahepatic bile Liver & intrahepatic bile   Best group rates (White)   Best group rates (White)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 5,340 5,936     TOTAL 3,571 3,829     White 4,759 4,759     White 3,174 3,174     Black 440 752     Black 315 461     American Indian 26 31     American Indian 16 21     Asian Pacific Islander 114 394     Asian Pacific Islander 66 174     Hispanic 269 429     Hispanic 163 252     Non-Hispanic 5,071 5,507     Non-Hispanic 3,407 3,577       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 596 -10     TOTAL 258 -7     White (0) 0     White 0 -0     Black 312 -41     Black 146 -32     American Indian 4 -15     American Indian 5 -23     Asian Pacific Islander 280 -71     Asian Pacific Islander 108 -62     Hispanic 160 -37     Hispanic 89 -35     Non-Hispanic 436 -8     Non-Hispanic 169 -5

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Summary table of annual reductions ''possible" for cancer (Method B) Men Women All cancers All cancers   Best group rates (varies by site) Best group rates (varies by site)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 133,397 276,146     TOTAL 125,214 247,702     White 119,013 239,397     White 110,822 217,628     Black 10,942 32,505     Black 11,335 26,456     American Indian 643 753     American Indian 585 716     Asian Pacific Islander 2,799 3,492     Asian Pacific Islander 2,471 2,903     Hispanic 6,624 8,374     Hispanic 6,052 7,358     Non-Hispanic 126,773 267,772     Non-Hispanic 119,161 240,344       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 142,749 -52     TOTAL 122,488 -49     White 120,383 -50     White 106,806 -49     Black 21,562 -66     Black 15,120 -57     American Indian 110 -15     American Indian 131 -18     Asian Pacific Islander 693 -20     Asian Pacific Islander 431 -15     Hispanic 1,750 -21     Hispanic 1,306 -18     Non-Hispanic 140,999 -53     Non-Hispanic 121,182 -50 Lung and bronchus Lung and bronchus   Best group rates (Hispanic) Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 40,971 91,673     TOTAL 19,699 54,951     White 36,643 79,943     White 17,526 49,416     Black 3,296 10,578     Black 1,725 4,890     American Indian 191 239     American Indian 86 149     Asian Pacific Islander 841 914     Asian Pacific Islander 362 495     Hispanic 1,947 1,947     Hispanic 886 886     Non-Hispanic 39,024 89,726     Non-Hispanic 18,813 54,065       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 50,702 -55     TOTAL 35,252 -64     White 43,300 -54     White 31,890 -65     Black 7,281 -69     Black 3,165 -65     American Indian 48 -20     American Indian 63 -42     Asian Pacific Islander 73 -8     Asian Pacific Islander 133 -27     Hispanic (0) 0     Hispanic (0) 0     Non-Hispanic 50,702 -57     Non-Hispanic 35,252 -65

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Summary table of annual reductions "possible" for cancer (Method B)   Breast   Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 18,236 43,513       White 15,917 38,045       Black 1,783 4,932       American Indian 98 98       Asian Pacific Islander 438 438       Hispanic 1,017 1,328       Non-Hispanic 17,219 42,184         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 25,277 -58       White 22,128 -58       Black 3,149 -64       American Indian (0) 0       Asian Pacific Islander 0 -0       Hispanic 311 -23       Non-Hispanic 24,966 -59 Colon/rectum Colon/rectum   Best group rates (American Indian) Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 13,258 28,310     TOTAL 15,954 28,919     White 11,805 24,974     White 14,215 25,303     Black 1,100 2,910     Black 1,386 3,244     American Indian 65 66     American Indian 69 71     Asian Pacific Islander 288 360     Asian Pacific Islander 284 302     Hispanic 676 814     Hispanic 709 709     Non-Hispanic 12,582 27,495     Non-Hispanic 15,245 28,210       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 15,052 -53     TOTAL 12,964 -45     White 13,169 -53     White 11,088 -44     Black 1,811 -62     Black 1,857 -57     American Indian 0 -0     American Indian 2 -2     Asian Pacific Islander 72 -20     Asian Pacific Islander 17 -6     Hispanic 138 -17     Hispanic (0) 0     Non-Hispanic 14,914 -54     Non-Hispanic 12,964 -46

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Summary table of annual reductions "possible" for cancer (Method B) Pancreas Pancreas   Best group rates (Mer Indian) Best group rates (American Indian)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 5,504 12,610     TOTAL 8,168 13,512     White 4,910 10,951     White 7,290 11,664     Black 450 1,449     Black 701 1,650     American Indian 27 27     American Indian 34 34     Asian Pacific Islander 117 183     Asian Pacific Islander 142 163     Hispanic 273 440     Hispanic 353 441     Non-Hispanic 5,232 12,169     Non-Hispanic 7,815 13,071       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 7,105 -56     TOTAL 5,344 -40     White 6,041 -55     White 4,374 -37     Black 999 -69     Black 950 -58     American Indian 0 -0     American Indian 0 -0     Asian Pacific Islander 65 -36     Asian Pacific Islander 20 -13     Hispanic 167 -38     Hispanic 88 -20     Non-Hispanic 6,938 -57     Non-Hispanic 5,255 -40   Ovary     Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 6,403 13,081       White 5,614 11,888       Black 611 1,012       American Indian 33 35       Asian Pacific Islander 146 146       Hispanic 341 413       Non-Hispanic 6,062 12,668         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 6,678 -51       White 6,275 -53       Black 401 -40       American Indian 2 -6       Asian Pacific Islander (0) 0       Hispanic 72 -18       Non-Hispanic 6,605 -52

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Summary table of annual reductions "possible" for cancer (Method B) Stomach Stomach   Best group rates (White) Best group rates (White)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 7,329 8,198     TOTAL 5,004 5,634     White 6,539 6,540     White 4,463 4,463     Black 599 1,327     Black 432 928     American Indian 35 38     American Indian 21 25     Asian Pacific Islander 155 293     Asian Pacific Islander 88 219     Hispanic 362 519     Hispanic 220 374     Non-Hispanic 6,967 7,679     Non-Hispanic 4,784 5,260       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 869 -11     TOTAL 630 -11     White 0 -0     White 0 -0     Black 728 -55     Black 495 -53     American Indian 3 -8     American Indian 4 -14     Asian Pacific Islander 138 -47     Asian Pacific Islander 131 -60     Hispanic 157 -30     Hispanic 154 -41     Non-Hispanic 712 -9     Non-Hispanic 476 -9   Cervix   Best group rates (White)         Expected deaths Observed deaths       TOTAL 3,976 4,578       White 3,438 3,439       Black 410 997       American Indian 23 34       Asian Pacific Islander 105 109       Hispanic 245 336       Non-Hispanic 3,731 4,242         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 602 -13       White 0 -0       Black 588 -59       American Indian 10 -30       Asian Pacific Islander 4 -4       Hispanic 91 -27       Non-Hispanic 511 -12

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Summary table of annual reductions "possible" for cancer (Method B) Kidney/renal/pel Kidney/renal/pel   Best group rates (As Pac Islander) Best group rates (As Pacific Islander)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 2,433 6,350     TOTAL 1,685 4,099     White 2,163 5,715     White 1,501 3,678     Black 204 550     Black 146 369     American Indian 12 31     American Indian 7 23     Asian Pacific Islander 54 54     Asian Pacific Islander 30 30     Hispanic 127 257     Hispanic 75 150     Non-Hispanic 2,306 6,093     Non-Hispanic 1,610 3,949       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 3,917 -62     TOTAL 2,414 -59     White 3,552 -62     White 2,177 -59     Black 346 -63     Black 222 -60     American Indian 19 -61     American Indian 15 -68     Asian Pacific Islander 0 -0     Asian Pacific Islander 0 -0     Hispanic 130 -51     Hispanic 75 -50     Non-Hispanic 3,786 -62     Non-Hispanic 2,339 -59 Other Other   Best group (Asian or Pacific Islander) Best group rates (As Pacific Islander)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 43,975 88,231     TOTAL 42,373 75,355     White 39,044 77,673     White 37,556 66,372     Black 3,738 9,352     Black 3,814 7,950     American Indian 225 238     American Indian 196 225     Asian Pacific Islander 968 968     Asian Pacific Islander 808 808     Hispanic 2,363 3,026     Hispanic 2,036 2,462     Non-Hispanic 41,612 85,205     Non-Hispanic 40,337 72,893       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 44,256 -50     TOTAL 32,981 -44     White 38,629 -50     White 28,816 -43     Black 5,614 -60     Black 4,136 -52     American Indian 13 -6     American Indian 29 -13     Asian Pacific Islander 0 -0     Asian Pacific Islander (0) 0     Hispanic 662 -22     Hispanic 425 -17     Non-Hispanic 43,594 -51     Non-Hispanic 32,556 -45

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Summary table of annual reductions "possible" for cancer (Method B) Prostate     Best group rates (As Pacific Islander)         Expected deaths Observed deaths       TOTAL 14,221 34,070       White 12,826 28,261       Black 1,082 5,477       American Indian 59 78       Asian Pacific Islander 254 254       Hispanic 587 917       Non-Hispanic 13,634 33,153         Estimated excess deaths Percent difference in observed and expected deaths       TOTAL 19,849 -58       White 15,436 -55       Black 4,394 -80       American Indian 19 -24       Asian Pacific Islander (0) 0       Hispanic 330 -36       Non-Hispanic 19,519 -59   Nasopharynx Nasopharynx   Best group rates (Hispanic)   Best group rates (Hispanic)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 299 450     TOTAL 145 233     White 264 312     White 128 186     Black 26 62     Black 13 24     American Indian 2 6     American Indian 1 2     Asian Pacific Islander 7 71     Asian Pacific Islander 3 21     Hispanic 17 17     Hispanic 7 7     Non-Hispanic 282 433     Non-Hispanic 137 226       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 151 -33     TOTAL 88 -38     White 47 -15     White 58 -31     Black 36 -58     Black 10 -44     American Indian 4 -71     American Indian 1 -66     Asian Pacific Islander 63 -90     Asian Pacific Islander 18 -86     Hispanic 0 -0     Hispanic 0 -0     Non-Hispanic 151 -35     Non-Hispanic 88 -39

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Summary table of annual reductions "possible" for cancer (Method B) Liver & Intrahepatic bile Liver & Intrahepatic bile   Best group rates (White)   Best group rates (White)       Expected deaths Observed deaths       Expected deaths Observed deaths     TOTAL 5,340 5,936     TOTAL 3,571 3,829     White 4,759 4,759     White 3,174 3,174     Black 440 752     Black 315 461     American Indian 26 31     American Indian 16 21     Asian Pacific Islander 114 394     Asian Pacific Islander 66 174     Hispanic 269 429     Hispanic 163 252     Non-Hispanic 5,071 5,507     Non-Hispanic 3,407 3,577       Estimated excess deaths Percent difference in observed and expected deaths       Estimated excess deaths Percent difference in observed and expected deaths     TOTAL 596 -10     TOTAL 258 -7     White (0) 0     White 0 -0     Black 312 -41     Black 146 -32     American Indian 4 -15     American Indian 5 -23     Asian Pacific Islander 280 -71     Asian Pacific Islander 108 -62     Hispanic 160 -37     Hispanic 89 -35     Non-Hispanic 436 -8     Non-Hispanic 169 -5

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