Screenshot 2023-10-21 at 21.54.45

Morbidity and Mortality Weekly Report
Surveillance Summaries / Vol. 61 / No. 1 January 20, 2012
Surveillance of Demographic Characteristics and

Health Behaviors Among Adult Cancer Survivors —
Behavioral Risk Factor Surveillance System,
United States, 2009
U.S. Department of Health and Human Services

Centers for Disease Control and Prevention
Surveillance Summaries
CONTENTS
Introduction ............................................................................................................2
Methods....................................................................................................................2
Results .......................................................................................................................4
Discussion ................................................................................................................6
Limitations ...............................................................................................................9
Conclusion ............................................................................................................ 10
References ............................................................................................................ 10
The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR 2012;61(No. SS-#):[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director
Harold W. Jaffe, MD, MA, Associate Director for Science
James W. Stephens, PhD, Director, Office of Science Quality
Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services
Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office
MMWR Editorial and Production Staff
Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist
Christine G. Casey, MD, Deputy Editor, MMWR Series Maureen A. Leahy, Julia C. Martinroe,
Teresa F. Rutledge, Managing Editor, MMWR Series Stephen R. Spriggs, Terraye M. Starr
David C. Johnson, Lead Technical Writer-Editor Visual Information Specialists
Catherine B. Lansdowne, MS, Project Editor Quang M. Doan, MBA, Phyllis H. King
Information Technology Specialists
MMWR Editorial Board
William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA
Matthew L. Boulton, MD, MPH, Ann Arbor, MI Patrick L. Remington, MD, MPH, Madison, WI
Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Barbara K. Rimer, DrPH, Chapel Hill, NC
David W. Fleming, MD, Seattle, WA John V. Rullan, MD, MPH, San Juan, PR
William E. Halperin, MD, DrPH, MPH, Newark, NJ William Schaffner, MD, Nashville, TN
King K. Holmes, MD, PhD, Seattle, WA Anne Schuchat, MD, Atlanta, GA
Deborah Holtzman, PhD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA
Timothy F. Jones, MD, Nashville, TN John W. Ward, MD, Atlanta, GA
Dennis G. Maki, MD, Madison, WI
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
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
Corresponding author: J. Michael Underwood, PhD, CDC, 4770 Buford
cancer survivors varied substantially by state.
Hwy NE, MS K-57, Atlanta, GA 30341. E-mail: [email protected]; Interpretation: Health behaviors and preventive health
Telephone: 770-488-3029; Fax: 770-488-4335.
care practices among cancer survivors vary by state and
MMWR / January 20, 2012 / Vol. 61 / No. 1 1

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 NCCCP programs use population-based data sources to

assess the effectiveness of activities related to survivorship and
A cancer survivor is a person who has received a diagnosis to conduct state-specific analyses of cancer survivor health
of cancer, from the time of diagnosis throughout the person’s behaviors. Population-based information about survivors also
life (1–3). The aging of the U.S. population has resulted in an is useful for public health practitioners, program implementers,
increase in the number of cancer diagnoses (4), and because of and researchers who assess and develop interventions to
improvements in early detection and treatment, the number improve the health and quality of life of cancer survivors.
of cancer survivors has steadily increased during the last 3 The Behavioral Risk Factor Surveillance System (BRFSS)
decades. As of 2007, nearly 12 million cancer survivors were survey is a state-based surveillance system that monitors health
living in the United States (5). behaviors, chronic diseases, injuries, access to health care, and
Cancer survivors often face long-term adverse physical, preventive health care. Core module questions are asked of all
psychosocial, and financial effects from their cancer diagnosis survey respondents in each state and territory, and each state
and treatment (2,6–10); the impact of cancer on family and territory may include select optional modules in their
members, friends, and caregivers of survivors is considered a surveys. In 2009, BRFSS added questions about previous
part of cancer survivorship (1). Cancer survivors have a greater cancer diagnoses to the core survey module. The survey also
risk for new cancers compared with persons who have never had included an optional cancer survivorship module that assessed
cancer (11,12). Various healthy lifestyle behaviors have been cancer treatment history and health insurance coverage of
shown to prevent new malignancies and decrease the chances cancer treatment for cancer survivors. Because BRFSS data are
of recurrence among cancer survivors (2,13). Prevention and obtained through respondent interviews, the cancer survivors
cessation of tobacco use (primarily cigarette smoking) (14), described in this report are all classified as cancer survivors on
regular physical activity (15), maintenance of a healthy weight the basis of self-reporting; cancer diagnoses were not confirmed.
(16–18), and routine consultation with health-care providers Therefore, these data might differ from data reported by the
about follow-up care after a cancer diagnosis (i.e., survivorship CDC’s National Program of Cancer Registries or the National
care plans) (19) have shown evidence of the ability to prevent Cancer Institute’s Surveillance, Epidemiology, and End Results
new cancers or cancer recurrence, increase survival, and (SEER) program, which both confirm diagnoses (5).
strengthen quality of life after a cancer diagnosis. Survivor- This report provides a descriptive analysis of the 2009
specific resources and support are necessary to promote positive BRFSS data among cancer survivors, including demographic
health outcomes and improve quality of life. characteristics and health behaviors, as well as cancer treatment
Increased recognition of the potential benefits of healthy history and health insurance coverage of treatment in states that
lifestyle behaviors among persons with cancer contributed to included the optional module in the 2009 survey. Although the
the development of responsive public health strategies such as effects of cancer on those who know and care for cancer survivors
the National Action Plan for Cancer Survivorship: Advancing are a component of cancer survivorship, the analyses in this report
Public Health Strategies (2), a publication cosponsored by include only the persons who received the cancer diagnosis (1).
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
Methods
(NCCCP) funds states, the District of Columbia (DC), BRFSS is an ongoing, cross-sectional, random-digit–dial
tribes and tribal organizations, selected U.S. territories, and telephone survey of noninstitutionalized adults aged ≥18
associated Pacific Island jurisdictions to develop and implement years. Trained interviewers use the standard core and optional
local comprehensive cancer control plans (20), most of which questionnaire modules to collect uniform data from all states,
include specific goals and objectives about survivorship (21). DC, and select U.S. territories. In 2009, BRFSS was conducted
2 MMWR / January 20, 2012 / Vol. 61 / No. 1

in all 50 states, DC, Guam, Puerto Rico, and the U.S. Virgin race/ethnicity (non-Hispanic white, non-Hispanic black,
Islands. The optional module on cancer survivorship was Hispanic, Asian/Pacific Islander [A/PI], American Indian/
administered by 10 states (California, Connecticut, Maryland, Alaska Native [AI/AN], other/multiracial [preferred race
Massachusetts, Nebraska, New Jersey, North Carolina, not asked], unknown or refused to answer), marital status
Oklahoma, Vermont, and Virginia). Detailed BRFSS methods (married or living together, divorced, never married, widowed,
have been described in previous publications (22,23). or separated), education level (did not graduate high school,
high school graduate, some college, or college graduate),
Questionnaire employment status (employment for wages, out of work or
unable to work, retired, or other), insurance coverage (yes or
The standard BRFSS questionnaire consists of three parts: no), and U.S. Census region of residence (Northeast, South,
1) core questions, 2) optional supplemental modules that Midwest, West, or the U.S. territories). Quality of life was
include sets of questions on specific topics, and 3) state- measured by self-reported health status (excellent, very good,
added questions. All jurisdictions ask the same core questions. good, fair, or poor), number of physically unhealthy days
Individual jurisdictions may opt to include optional modules during the past 30 days, receipt of social support (always,
and jurisdiction-added questions to address specific health- usually, sometimes, rarely, or never), and life satisfaction (very
care concerns. satisfied, satisfied, dissatisfied, or very dissatisfied).
As part of the core module, respondents were asked whether In addition, the following health risk behaviors were
they had ever been told by a doctor, nurse, or other health-care analyzed: current smoking (smoking cigarettes every day or
professional that they had cancer. Respondents who answered some days and having smoked >100 cigarettes during lifetime),
yes were asked how many different types of cancer they had, the obesity (body mass index [BMI] ≥30 kg/m2), and no leisure-
age when they were told that they had cancer, and which type time physical activity during the past 30 days. The presence
of cancer they had. If respondents reported having had more of the following chronic health conditions was assessed:
than one type of cancer, only the most recently diagnosed type cardiovascular disease (history of myocardial infarction,
was recorded. Respondents who were unsure about their history angina or coronary heart disease, or stroke), diabetes, current
of cancer, who refused to answer the question, or who reported asthma (“Have you ever been told by a doctor, nurse, or other
nonmelanoma skin cancer were excluded from the analysis. health professional that you had asthma?” “Do you still have
Of 432,607 BRFSS respondents, 411,654 answered the asthma?”), and disability (activity limitations from physical,
question regarding previous cancer diagnoses. Among these mental, and emotional problems). The following preventive
respondents, 4,252 either refused to answer the question or health care measures also were examined: ever having received
were not sure that they had ever been diagnosed with cancer pneumococcal vaccine and receipt of injected influenza vaccine
and were excluded from the analysis; in addition, 13,632 during the past 12 months. (Receipt of live, attenuated
reported having had nonmelanoma skin cancer and were influenza vaccine [LAIV] was not analyzed because most cancer
excluded from the analysis. Nonmelanoma skin cancers survivors in this analysis were not eligible to receive LAIV.)
(i.e., basal and squamous cell skin cancers) are not routinely Five states (Georgia, Hawaii, New Jersey, Tennessee,
collected in cancer registries because they do not require and Wyoming) added questions on mammography and
treatment beyond surgery (5). Papanicolaou (Pap) test use among women. Mammography
Years since diagnosis (0–5, 6–10, and >10 years) were use within the past 2 years and Pap test use (excluding women
calculated using the respondents’ current age and age at first who had received a hysterectomy) within the past 3 years were
cancer diagnosis. Type of cancer was categorized as breast, analyzed among female cancer survivors aged ≥40 years and
female genital system (cancers of the cervix, uterus, and aged ≥18 years, respectively. Eight states (Delaware, Hawaii,
ovary), head or neck (cancers of the head, neck, mouth, and Maine, Massachusetts, Nebraska, New Jersey, Oklahoma,
throat), gastrointestinal (cancers of the colon, esophagus, and Wyoming) included questions on colorectal screening,
liver, pancreas, stomach, and rectum), leukemia or lymphoma and five states (Delaware, Hawaii, Kentucky, Nebraska, and
(Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and New Jersey) included questions on prostate cancer screening.
leukemia), male genital system (cancers of the prostate and Cancer survivors aged ≥50 years were considered up to date
testis), skin (melanoma), lung, urinary tract (bladder and with screening for colorectal cancer if they had received a fecal
kidney), other cancer types (thyroid, bone, brain, heart, occult blood test within the previous year, sigmoidoscopy
neuroblastoma, and other), and unknown or refused to answer. within the past 5 years, or colonoscopy within the past 10 years.
Using data from the core module, the following characteristics Data from the 10 states that administered the cancer
were compared among cancer survivors: age at interview, sex, survivorship optional module (California, Connecticut,

Maryland, Massachusetts, Nebraska, New Jersey, North This allowed states that used optional modules on multiple
Carolina, Oklahoma, Vermont, and Virginia) were examined questionnaire versions to be included in the analysis, thereby
for the following cancer-related health care experience variables: increasing the sample size for these modules.
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 Results
insurance coverage because of a cancer diagnosis. Variables
related to cancer treatments also were examined, including Demographic Characteristics
current receipt of cancer treatment, whether respondent had Of 432,607 BRFSS respondents, 411,654 answered the
ever participated in a clinical trial, current pain from cancer or question regarding whether they had ever been told by a
treatment, and current control of cancer-related pain. doctor, nurse, or other health-care professional that they had
cancer. Among these respondents, 45,541 reported ever having
Data Collection and Processing cancer (7.2% of all respondents in all 50 states, DC, and the
U.S. territories), not including nonmelanoma skin cancer
Trained interviewers administer the BRFSS questionnaire
(Table 1). A greater proportion of women (8.4%) than men
using a computer-assisted telephone interviewing system.
(6.0%) reported ever receiving a diagnosis of cancer. A greater
Data are collected monthly by each state and territory using
proportion of cancer survivors reported having received the
disproportionate stratified random sampling in all states and
diagnosis >10 years before the survey (39.2%) than in the past
DC and simple random sampling in Guam, Puerto Rico,
5 years (36.2%) or 6–10 years before the survey (20.8%). Men
and the U.S. Virgin Islands (24). According to the guidelines
were more likely to have received the diagnosis within the last
of the Council of American Survey Research Organizations
5 years (42.1%) compared with other time periods, whereas
(CASRO), the median cooperation rate (defined as the
women were more likely to have received the diagnosis >10
percentage of persons who completed interviews among all
years before the survey (44.0%). Most cancer survivors were
eligible persons who were contacted) for the 2009 BRFSS was
non-Hispanic white (81.2%) and aged ≥50 years (78.8%).
75%; the CASRO response rate (defined as the percentage of
More male cancer survivors (74.9%) than female cancer
persons who completed interviews among all eligible persons,
survivors (57.0%) were married or living with a significant
including those who were not successfully contacted) was
other. Approximately 10% of all cancer survivors had not
52.5% (25).
graduated from high school. A total of 42.4% of cancer
survivors were retired, and 93% had insurance coverage at the
Data Weighting and Statistical Analysis time of the survey.
Statistical software was used to account for the complex Among male cancer survivors, the prevalences of
sampling design. Statistics are not presented if the sample cardiovascular disease (23.4%) and diabetes (19.6%) were
size for the numerator was <50 or if the half-width of the higher than the prevalence of cardiovascular disease (14.3%)
confidence interval was >10; however, the values are included and diabetes (14.7%) among female cancer survivors. Current
in overall total calculations. Each sample is weighted to the asthma was more prevalent among female cancer survivors
respondent’s probability of selection and the age- and sex- (13.3%) than male cancer survivors (7.5%).
specific population or the age-, sex-, and race/ethnicity-specific
population by using the 2009 postcensus projections for each Preventive Care
state. Using the public-use BRFSS data file, all estimates were
Among cancer survivors in the eight states (Delaware,
weighted to represent noninstitutionalized adults aged ≥18
Hawaii, Maine, Massachusetts, Nebraska, New Jersey,
years living within their respective state, DC, or U.S. territory.
Oklahoma, and Wyoming) that included colorectal cancer
Some of the 17 states that administered either the optional
screening questions on the survey, 77.9% (1,138) of men and
cancer survivorship module or the women’s health, colorectal
73.1% (1,912) of women reported having been screened for
cancer screening, or prostate cancer screening modules used
colorectal cancer within the recommended period. Among
multiple questionnaires. For these states, the survey weights
the five states (Georgia, Hawaii, New Jersey, Tennessee, and
provided in the multiple questionnaire data files were used.
Wyoming) that included questions on mammography and Pap
A new weight variable was created so that records from states
test use among women on the survey, 79.4% (823) of women
using multiple questionnaires could be analyzed along with
reported having been screened for cervical cancer, and 80.4%
records from states that either included these modules on their
common BRFSS survey or did not use multiple questionnaires.

(1,517) reported having been screened for breast cancer within days during the past 30 days, with wide variations by state. The
the recommended period. Approximately 57.8% of cancer highest percentage of survivors reporting ≥5 unhealthy days was
survivors reported receiving an injected influenza vaccination reported among survivors living in Kentucky (44.1%), and the
during the previous year, and 48.3% reported ever receiving a lowest was among those living in Iowa (24.7%). Half (50.2%)
pneumococcal vaccination. of cancer survivors living in the United States reported always
receiving needed social or emotional support, and 92.7% of
Types of Cancer all cancer survivors reported being very satisfied or satisfied
with their life.
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 Health Behaviors
most common primary cancer types were breast (32.4%); Smoking
cervix, uterus, ovary (24.8%); and melanoma (9.6%). The
most common primary cancer types among men were prostate Approximately 15.1% of cancer survivors aged ≥18 years in
and testis (36.1%), melanoma, (16.2%), and gastrointestinal the 50 states and DC were current cigarette smokers (Figure 1).
(10.5%). Breast cancer was the most commonly reported cancer Smoking prevalence among cancer survivors was highest in
in all racial/ethnic populations (19.3%, non-Hispanic white; Oklahoma (23.9%) and lowest in California (10.3%). Regional
23.9%, non-Hispanic black; 25.8%, A/PI; 16.1%, AI/AN; differences also were observed, with the highest prevalence
and 17.3% Hispanic) (Table 3). Of the male genital cancers, in the South (17.2%), followed by the Midwest (15.8%),
prostate cancer (33.3%) was the most commonly reported Northeast (15.1%), and West (13.0%).
cancer among all male racial/ethnic populations. Percentages Obesity
of prostate cancer were highest among non-Hispanic black men
A total of 27.5% of cancer survivors were obese (BMI ≥30
(53.6%), followed by Hispanic (34.1%) and non-Hispanic
kg/m2) (Figure 2); however, the prevalence varied widely by
white men (31.3%). Cervical cancer (14.5%) was the most
state, ranging from 15.7% in Colorado to 33.8% in Missouri.
commonly reported genital cancer among women. Percentages
Similarly, obesity prevalence among cancer survivors varied by
were highest among AI/AN women (28.9%), followed by
geographic region. Obesity was most prevalent among cancer
Hispanic (20.4%), non-Hispanic black (14.7%), and non-
survivors in the Midwest (29.8%), followed by the South
Hispanic white women (13.8%).
(28.4%), Northeast (26.0%), and West (24.5%).
Regional Differences Leisure-Time Physical Activity

Cancer prevalences were similar in the Northeast (7.8%), Approximately 31.5% of cancer survivors had not
Midwest (7.6%), and South (7.5%) U.S. Census regions; the participated in any leisure-time physical activity during the
prevalence was slightly lower in the West (6.2%) (Table 4). past 30 days (Figure 3). The highest proportion of cancer
Whereas cancer prevalence was higher among women than survivors reporting no leisure-time physical activity lived in the
men overall in the United States, states with the highest ratio of South (34.3%), followed by the Midwest (32.5%), Northeast
female-male cancer prevalence were Indiana (1.70), Oklahoma (31.3%), and West (25.5%). Among states, percentages of
(1.66), Maine (1.57), and Montana (1.52). Breast cancer was inactivity were highest in West Virginia (42.3%) and lowest
most prevalent among women in the Northeast (36.4%). in Oregon (21.4%).
Cervical cancer (17.1%) and melanoma (13.2%) were most
prevalent in the South. Prostate (34.8%) and female genital Treatment Regimens and Pain
cancers (excluding cervical cancer) were highest in the West
Among the 6,384 respondents in the 10 states that included
(11.3%).
the optional module, 12% of cancer survivors reported that
they were currently receiving treatment, with estimates ranging
Quality of Life from 9.1% to 14.0% among states (Table 6). A total of 7.5% of
When asked to describe overall health status, 68.5% of cancer cancer survivors reported ever having participated in a clinical
survivors indicated that their overall health was excellent, very trial. Whereas 10.1% of survivors reported current pain that
good, or good (Table 5). Approximately one third (31.8%) of they attributed to cancer or cancer treatment, approximately
cancer survivors reported experiencing ≥5 physically unhealthy 80.9% of these survivors reported that the pain was currently
well controlled.

Health-Care Experience Demographic Characteristics and Use of

Among the 5,593 respondents not currently undergoing Preventive Care
treatment from the 10 states that included the optional Approximately 7% of all 2009 BRFSS respondents
module, 21.2% of cancer survivors reported that the type of reported ever receiving a diagnosis of cancer from a health-
physician who provided the majority of their health care was care professional. This prevalence is slightly lower than the
either an oncologist or another cancer specialist, ranging from estimated 10% found in a recent BRFSS study (32), likely
14.3% in North Carolina to 29.3% in California (Table 7). because nonmelanoma skin cancers were included in that study.
Approximately 40.2% of cancer survivors reported receipt of a Cases of nonmelanoma skin cancer account for nearly one fifth
written summary of their cancer treatments, and 73.9% reported of all reported cancer cases. Approximately 3.5 million basal
receipt of instructions on follow-up care. Approximately 90.7% and squamous skin cancers occurred in 2006 (33).
of respondents reported that insurance covered all or part of their This report confirms findings from previous studies: the
cancer treatment. Overall, 12.0% of respondents said they had majority of cancer survivors are older (5), female (5,34),
been denied health or life insurance coverage because of their non-Hispanic white (35–37), and married (36). Cancer is
cancer diagnosis. strongly associated with aging (38), and researchers expect the
cancer survivor population to continue increasing as the U.S.
population ages (39).
Discussion There are more female than male cancer survivors, possibly
Cancer is among the most prevalent diseases diagnosed and because certain cancers among women (e.g., breast and cervical
the second leading cause of death in the United States (26). cancer) can be detected earlier through effective screening
This report presents the first population-based survey with methods and treated more successfully than many other
state-level assessment of health behaviors and demographic cancers, leading to longer survival (40). Minority populations
characteristics among cancer survivors. Although previous have higher cancer incidence rates than whites for some but
studies also have examined state-level preventive health not all cancers (41). The potential lack of BRFSS respondent
practices among cancer survivors (e.g., cancer screenings and representativeness compared with the total U.S. population,
influenza and pneumococcal vaccinations) (27,28), this is in addition to a lower death rate among white cancer survivors
the only report with data from all 50 states, DC, and U.S. compared with all other racial groups, might contribute to the
territories. higher proportion of cancer survivors among non-Hispanic
Research has indicated that cancer survivors might benefit whites observed in this study (41). Approximately 64% of
from higher levels of recommended screenings and increased cancer survivors were married, and nearly 27% were divorced
vaccine coverage because of their increased susceptibility or widowed, consistent with a previous study of cancer
to future illness (2,10). All cancer survivors in this report survivors (36). In contrast, 90% of cancer survivors in this
were recommended to have received the flu vaccine (which report graduated from high school, whereas approximately
is recommended for all persons aged >6 months), and most 80% of cancer survivors in previous studies reported graduating
were candidates for the pneumococcal vaccination (which is (35–37). This difference might be associated with a previous
recommended for adults aged > 65 years and for persons with finding that households with landline telephones (which are
certain chronic medical conditions which put them at risk for required for BRFSS participation) are associated with higher
pneumococcal infection); however, a substantial proportion educational attainment (42).
of cancer survivors did not receive these vaccines. A previous Breast cancer is the most common invasive cancer among
study of the Medicare population indicated that breast cancer U.S. women (43), and incidence rates are high across all racial/
survivors are less likely to receive preventive care (e.g., influenza ethnic groups. Black women tend to have more deaths from
vaccination, cholesterol screening, colorectal cancer screening, breast cancer (43), and the results in this report showed a
bone densitometry, and mammography) than age-, ethnicity- higher prevalence of breast cancer among non-Hispanic black
and sex-matched controls (29). Other studies also have shown women than among non-Hispanic white women. Through
that cancer survivors are less likely to receive recommended the combination of widespread mammography screening
preventive care for a broad range of chronic medical conditions, programs and improvements in therapeutic treatment agents,
and cancer screening rates decrease significantly as oncologists the proportion of long-term breast cancer survivors has
are less involved in patient treatment (30,31). 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 Because of the hazardous effects of smoking, especially among
were men of other races/ethnicities, consistent with incidence persons with cancer, promotion of smoking cessation and
data showing prostate cancer is more common among black initiation of smoking prevention measures among cancer
men (43). Although black men also tend to have higher death survivors are especially important. Studies have shown that
rates than other racial populations from prostate cancer, the health-care providers might miss opportunities to counsel
high proportion of indolent disease contributes to the relatively cancer survivors about healthy behaviors, including smoking
high (99%) overall 5-year relative survival (45). cessation (30,52). Health-care professionals should promote
smoking cessation resources and treatments to persons who
Types of Cancer continue to smoke after receiving a cancer diagnosis. CDC
recently recommended use of the U.S. Public Health Service
The patterns of cancer by type among cancer survivors in this Guidelines for Treating Tobacco Use and Dependence to decrease
report differ from estimates that are based on cancer registry tobacco use among current smokers (53). CDC recommends
data. In one such report, prostate, colorectal, and female breast a comprehensive approach to tobacco control, which includes
cancer survivors accounted for the majority of survivors (5). evidence-based tobacco prevention and cessation strategies
In this analysis, although prostate and female breast cancers (e.g., targeted media campaigns, smoking cessation counseling
also account for the majority of cancer types among male and interventions, quit lines, and medications) that are proven to
female cancer survivors, respectively, melanoma survivors be effective (53).
are the third largest group. A plausible explanation for these The obesity prevalence among cancer survivors in this
differences is that national estimates of survivors, which are report is similar to the obesity prevalence in the general U.S.
based on SEER data (45), do not include in situ melanoma population (54). Although the association between obesity
cases. In contrast, BRFSS respondents may report all types and numerous chronic diseases has been well established,
of cancer, regardless of whether the cancer was invasive. In increasing numbers of studies are linking obesity to cancer.
addition, common noncancer diagnoses such as cervical Obese cancer survivors have an increased risk for recurrence or
dysplasia and uterine fibroids might be misreported as cancer death from colon, breast, prostate, esophageal, uterine, ovarian,
by BRFSS respondents (46). Variations in cancer prevalence kidney, and pancreatic cancers (55–58). In addition, studies
by cancer type also might reflect differences in incidence, risk, have shown that obese cancer survivors with leukemia, non-
availability of screening tests and effective treatment for each Hodgkin’s lymphoma, and multiple myeloma are more likely
cancer, and whether the cancer is likely to be curable. to experience new cancers than those who are not obese (59).
Research also associates physical activity with a reduced
Health Behaviors risk for recurrence and death from certain cancers, and the
Despite significant decreases in cigarette smoking since evidence is increasing. The results in this report indicate that
1980, a 2011 CDC study indicated that 20% of U.S. adults approximately one of three cancer survivors in the United
aged ≥18 years in the general population currently smoke (47), States did not participate in any leisure-time physical activity
compared with 15% of cancer survivors in this report. Cigarette during the past 30 days. Several studies reported a 30%–60%
smoking continues to be the leading preventable cause of reduction in risk for breast cancer recurrence, cancer-specific
morbidity and mortality, resulting in approximately 443,000 death, or overall mortality with moderate physical activity,
deaths annually (47). Cancer survivors are at increased risk for equivalent to average-paced walking 2–3 hours a week (60–63).
subsequent cancers, including tobacco-related cancers (48,49). Studies also have found a 50%–60% reduction in risk for
Adverse health conditions from smoking include compromised colorectal cancer recurrence, cancer-specific death, or overall
cancer treatment efforts, delayed healing after surgery, and mortality from regular physical activity after receiving a cancer
impeded recovery of optimal daily functioning (48). In this diagnosis; however, these protective effects only occurred with
report, current smoking was reported by cancer survivors and the highest physical activity intensity and longest duration
varied substantially by state; however, certain states, such as (64,65).
California and Massachusetts, had a relatively low prevalence. Many of the studies investigating the effect of physical
The low smoking prevalence among cancer survivors in activity on cancer recurrence and mortality are observational;
California and Massachusetts is partially attributable to additional data are needed to evaluate the association.
implementation of the long-running comprehensive tobacco However, evidence describing the positive effects of physical
control program in California and mandated tobacco cessation activity on other cancer outcomes such as overall functioning,
coverage in the Massachusetts Medicaid program (47,50,51). aerobic and strength capacity, psychological well-being, and

quality of life, is more consistent (66,67). On the basis of this undergoing treatment at the time of the survey. However,
evidence, the American College of Sports Medicine released the question regarding current treatment was specific (“Are
physical activity guidelines for cancer survivors, which are you currently receiving treatment for cancer? By treatment,
consistent with the U.S. Department of Health and Human we mean surgery, radiation therapy, chemotherapy, or
Services 2008 Physical Activity Guidelines for Americans. These chemotherapy pills”). Certain respondents might have been
guidelines support the safety and efficacy of physical activity receiving medications that were indeed part of a cancer
for cancer survivors (68). The findings in this report indicate treatment regimen, but if they did not consider the medication
that many U.S. cancer survivors do not follow current physical to be a type of chemotherapy, they might have answered no
activity recommendations, possibly increasing the risk for to the question, resulting in an underestimation of cancer
poor outcomes. In addition, rates of inactivity are higher survivors currently receiving therapy. For example, many
among cancer survivors than in the general population. In women take oral antiestrogen therapy for estrogen-receptor–
2009, 24.2% of the general population reported no leisure- positive breast cancer (77). Furthermore, patients undergoing
time activity (69), compared with 31.3% of cancer survivors cancer therapy might have been less likely to participate in
in this report. Because cancer survivors are at a higher risk BRFSS, also leading to an underestimation of the proportion
for inactivity than the general population, additional effort of survivors in current treatment.
is needed to increase physical activity among cancer survivors Approximately 8% of survivors reported having participated
(68). in a clinical trial as part of their cancer treatment, more than
Although the reported variation in health-related behaviors the 4.7% of survivors from the 1992 National Health Interview
and use of clinical preventive services across the states might Survey (NHIS) (78). However, caution should be used when
be a result of differences in demographic characteristics and comparing these estimates because they are from different
the availability of state-level services for cancer survivors, they surveys, and the NHIS analysis only included survivors who
also might reflect previously reported regional and state-level had received the cancer diagnosis within the past 10 years.
differences in the general population (70). Previous studies also have shown that cancer clinical trial
participation rates are low (79). However, these findings raise
Treatment Regimens and Pain questions about whether clinical trials during the past 20 years
are more available and accepted by more persons with cancer.
Several barriers prevent cancer survivors from receiving The prevalence of current pain among survivors in this
appropriate follow-up care after completing cancer treatment, report (10.1%) was somewhat lower than that the prevalence
including lack of coordination among health-care providers, reported in a statement by a National Institutes of Health
lack of standardized follow-up medical care, and lack of State-of-the-Science panel; however, findings from that
knowledge among cancer survivors about appropriate follow-up report suggested a wide range, with estimates ranging from
(13). In 2005, the Institute of Medicine recommended 14%–100% (80). Although most survivors in this sample
that cancer patients be provided with a comprehensive reported that their pain was under control, 20% reported that
summary of their cancer treatments and recommendations it was not. Others have concluded that pain control among
for follow-up care (13). Despite this recommendation, 40% cancer patients is inadequate (81,82). Potential barriers to
of cancer survivors reported receiving a written summary effective pain management exist at the patient, health-care
of all their cancer treatments, and 74% of cancer survivors provider, and system levels (80). Suboptimal pain control
received instructions (written or oral) for follow-up care. might be an indicator of poor quality care (80), and multiple
The lack of cancer treatment summaries and follow-up care quality measures related to controlling cancer pain have been
recommendations for many cancer survivors might contribute recommended (83).
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 and Economic Factors
health care from a cancer specialist varied substantially by state, Twelve percent of cancer survivors in this study reported
a finding that might reflect a lack of consensus on the roles of being denied health or life insurance coverage because of a
cancer specialists and primary care physicians in the medical cancer diagnosis, and 7% were uninsured, a finding that is
care of cancer survivors (74–76). consistent with a previous population health survey on health
Most cancer survivors received their cancer diagnosis insurance among cancer survivors (37). Health insurance
many years before the BRFSS interview. A total of 12% were coverage among cancer survivors is of particular importance.

Previous research has shown that a lack of adequate insurance Healthcare Quality and Research, and the American Cancer
coverage might lead to more delayed or unmet medical care Society are collaborating to enhance the Medical Expenditure
needs for cancer survivors than for adults without cancer (84). Panel Survey to collect more detailed data to estimate the
Health insurance coverage is especially important for cancer economic effects on cancer survivors, the families of cancer
survivors because of the potential costs associated with cancer survivors, and society.
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 Limitations
be unable to afford copayments, prescription medications, The findings in this report are subject to several limitations.
and other necessary medical care (85). The Affordable Care First, BRFSS data are self-reported and subject to recall bias,
Act, which was enacted in 2010, might provide a solution for which could lead to inaccurate estimates of cancer prevalence
cancer survivors by increasing health insurance coverage and (100). Recall bias might be responsible for the slightly
ensuring that persons will not be denied coverage because of higher cancer prevalence observed for certain cancers when
a previous cancer diagnosis (86). compared with a recent study using cancer registry data (5).
Researchers projected that in 2010 and 2020, the United In addition, overreporting of cervical cancer is especially
States would have an estimated 13.8 and 18.1 million cancer likely because abnormal Pap tests, cervical cancer precursors,
survivors, with associated costs of cancer care of $124.6 and and cervical intraepithelial neoplasia might be misperceived
$157.8 billion, respectively (87). These projections underscore as diagnoses of cancer because of treatments used to remove
the substantial economic effects measured by direct medical the precancerous lesions (78). Second, BRFSS might not be
care costs, lost productivity, and intangible costs (such as representative of persons who do not have a landline telephone,
lesser quality of life) that cancer survivors might face. Direct which is required for BRFSS participation (42). Because of the
medical care costs include hospitalization, outpatient care, growing number households that only have cellular telephones,
physician services, prescription and nonprescription drugs, BRFSS is conducting pilot studies to include participation
nursing home and long-term care, and other medical supplies among these previously excluded households (101). Third,
(88–92). Cancer survivors also incur substantial nonmedical because the findings are limited to noninstitutionalized U.S.
care costs, such as transportation to and from health-care citizens, cancer survivors who might have had an advanced-
providers, losses in patients’ time (e.g., from spending time stage cancer and are therefore living in nursing homes, long-
receiving treatments), and other health-care services (6). Lost term–care facilities, or hospice or who are in the military are
productivity is usually measured as a morbidity cost resulting not included. Fourth, the estimates in this report are not age
from foregone earnings among employed persons or a mortality adjusted, which might contribute to state variations in cancer
cost from premature death. survivor prevalence. Fifth, because BRFSS does not assess any
Many cancer survivors are unable to resume their usual indicators of smoking dependence or intensity, no conclusions
activities, including work (7–9,93). In addition to lost can be made regarding the magnitude of tobacco use among
productivity among cancer survivors, productivity is lost cancer survivors. Sixth, because of survival bias, respondents
among the caregivers of survivors (92,94,95). Caregivers might have survived cancer for several reasons: their cancer
include spouses, relatives, friends, or others providing health was an in situ or early-stage cancer, was well differentiated,
services and other activities of daily living services to a cancer or was more responsive to treatment, or the survivors had
survivor; the economic effects associated with caregiver services better access to treatment or engaged in more positive health
are substantial (96,97). Intangible costs, which are typically behaviors. Therefore, the results might not be representative
measured by quality of life (90,91,98), are measures of cancer- of the overall cancer experience in the United States. Finally,
related pain and suffering that affect the health and well- the low cooperation rate of the BRFSS survey might limit the
being of a patient. Intangible costs also include psychosocial generalizability of the results to all cancer survivors living in
interventions to alleviate anxiety and depression among cancer the United States. However, studies have concluded that the
survivors (99). Although estimating the economic effects of survey findings are reliable and valid (102).
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

Conclusion 9. Bradley CJ, Bednarek HL, Neumark D. Breast cancer and women’s labor
supply. Health Serv Res 37:1309–28.
A large proportion of cancer survivors have comorbid 10. The Lancet. Cancer survivors: living longer, and now, better [editorial].
Lancet 2004;364:2153–4.
conditions, and many are not receiving recommended 11. Sunga AY, Eberl MM, Oeffinger KC, Hudson MM, Mahoney MC. Care
preventive care, not only for cancer screening but for influenza of cancer survivors. Am Fam Physician 2005;71:699–706.
and pneumococcal vaccinations. Furthermore, many cancer 12. Ng AK, Travis LB. Subsequent malignant neoplasms in cancer survivors.
survivors currently smoke, do not participate in adequate Cancer J 2008;14:429–34.
13. Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor:
physical activity, and are obese. Health-care providers and lost in transition. Washington, DC: National Academies Press; 2006.
patients should be aware of the importance of preventive care, 14. Johnston-Early A, Cohen MH, Minna JD, et al. Smoking abstinence
smoking cessation, regular physical activity, and maintaining a and small cell lung cancer survival. An association. JAMA
1980;244:2175–9.
healthy weight among cancer survivors, factors that have been 15. Doyle C, Kushi LH, Byers T, et al. Nutrition and physical activity during
linked to longer survival and better quality of life among cancer and after cancer treatment: an American Cancer Society guide for
survivors, as well as to decreased risk for new and recurrent informed choices. CA Cancer J Clin 2006;56:323–53.
16. Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA,
cancer. Health care for cancer survivors should include Marchbanks PA. Body mass and mortality after breast cancer diagnosis.
improvements in pain management and a written treatment Cancer Epidemiol Biomarkers Prev 2005;14:2009–14.
summary (including follow-up instructions). Modification of 17. Bassett WW, Cooperberg MR, Sadetsky N, et al. Impact of obesity on
health behaviors among cancer survivors would be facilitated prostate cancer recurrence after radical prostatectomy: data from
CaPSURE. Urology 2005;66:1060–5.
by increasing insurance coverage and access to care. 18. Haydon AM, Macinnis RJ, English DR, Giles GG. Effect of physical
The data in this report reflect variations in health behaviors activity and body size on survival after diagnosis with colorectal cancer.
and preventive health care practices that might be a result of Gut 2006;55:62–7.
19. Earle CC. Failing to plan is planning to fail: improving the quality of
availability of state-level resources for cancer survivors. These care with survivorship care plans. J Clin Oncol 2006;24:5112–6.
findings can be used by public health practitioners, researchers, 20. CDC. National Comprehensive Cancer Control Program. Atlanta, GA:
and state comprehensive cancer control planners to assess CDC; 2011. Available at http://www. cdc.gov/cancer/ncccp/about.htm.
Accessed May 26, 2011.
the need for state resources for cancer survivors and evaluate 21. Pollack LA, Greer GE, Rowland JH, et al. Cancer survivorship: a new
the effectiveness of current programmatic efforts; therefore, challenge in comprehensive cancer control. Cancer Causes Control
surveillance data among cancer survivors should be regularly 2005;16(Suppl 1):51–9.
collected at the local and national levels. Additional research on 22. Gentry EM, Kalsbeek WD, Hogelin GC, et al. The behavioral risk factor
surveys: II. Design, methods, and estimates from combined state data.
cancer survivors, including health behaviors and patient access Am J Prev Med 1985;1:9–14.
to quality care, should be conducted to address the needs of 23. CDC. Public health surveillance for behavioral risk factors in a changing
the increasing cancer survivor population in the United States. environment: recommendations from the Behavioral Risk Factor
Surveillance team. MMWR 2003;52(No. RR-9).
References 24. CDC. Behavioral Risk Factor Surveillance System: survey data information.
Atlanta, GA: CDC; 2010. Available at http://www.cdc.gov/brfss/technical_
1. CDC. Basic information about cancer survivorship. Atlanta, GA: CDC; infodata/surveydata/2009.htm. Accessed August 18, 2011.
2011. Available at http://www.cdc.gov/cancer/survivorship/basic_info. 25. CDC. Behavioral Risk Factor Surveillance System: 2009 summary data
Accessed May 26, 2011. quality report [Internet]. Atlanta, GA: CDC; 2010. Available at ftp://
2. CDC. A national action plan for cancer survivorship: advancing public ftp.cdc.gov/pub/Data/Brfss/2009_Summary_Data_Quality_Report.
health strategies. Atlanta GA: CDC; 2004. Available at http://www.cdc. pdf. Accessed July 19, 2010.
gov/cancer/survivorship/pdf/plan.pdf. Accessed November 3, 2011. 26. Kochanek KD, Xu J, Murphy SL, Miniño AM, Kung HC. Deaths:
3. National Cancer Institute. National Cancer Institute Office of Cancer preliminary data for 2009. Natl Vital Stat Rep 2011;56(4).
Survivorship fact sheet. Bethesda, MD: National Cancer Institute; 2011. 27. Richardson LC, Townsend JS, Fairley TL, et al. Use of 2001–2002
Available at http://cancercontrol.cancer.gov/ocs/ocs_factsheet.pdf. Behavioral Risk Factor Surveillance System data to characterize cancer
Accessed July 28, 2011. survivors in North Carolina. NC Med J 2011;72:20–7.
4. Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on 28. Fairley TL, Hawk H, Pierre S. Health behaviors and quality of life of
the status of cancer, 1973–1999, featuring implications of age and aging cancer survivors in Massachusetts, 2006: data use for comprehensive
on U.S. cancer burden. Cancer 2002;94:2766–92. cancer control. Prev Chronic Dis 2010;7(9) [Epub].
5. CDC. Cancer survivors—United States, 2007. MMWR 2011;60:269–72. 29. Snyder CF, Frick KD, Kantsiper ME, et al. Prevention, screening, and
6. Yabroff KR, Davis WW, Lamont EB, et al. Patient time costs associated surveillance care for breast cancer survivors compared with controls:
with cancer care. J Natl Cancer Inst 2007;99:14–23. changes from 1998 to 2002. J Clin Oncol 2009;27:1054.
7. Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML. Burden 30. Earle CC, Neville BA. Under use of necessary care among cancer
of illness in cancer survivors: findings from a population-based national survivors. Cancer 2004;101:1712–19.
sample. J Natl Cancer Inst 2004;96:1322–30. 31. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD.
8. Sasser AC, Rousculp MD, Birnbaum HG, Oster EF, Lufkin E, Mallet Preventive care for colorectal cancer survivors: a 5-year longitudinal
D. Economic burden of osteoporosis, breast cancer, and cardiovascular study. J Clinical Oncol 2008;26:1073.
disease among postmenopausal women in an employed population. 32. CDC. Surveillance of certain health behaviors and conditions among
Womens Health Issues 2005;15:97–108. states and selected local areas—Behavioral Risk Factor Surveillance
System, United States, 2009. MMWR 2011;60(No. SS-9).

33. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of 56. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight,
nonmelanoma skin cancer in the United States, 2006. Arch Dermatol obesity, and mortality from cancer in a prospectively studied cohort of
2010;146:283–7. U.S. adults. N Engl J Med 2003;348:1625–38.
34. Altekruse SF, Kosary CL, Krapcho M, et al, eds. SEER cancer statistics 57. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific
review, 1975–2007. Bethesda, MD: National Cancer Institute; 2010. excess deaths associated with underweight, overweight, and obesity.
Available at http://seer.cancer.gov/csr/1975_2007. Accessed June 8, 2011. JAMA 2007;298:2028–37.
35. Coups EJ, Ostroff JS. A population-based estimate of the prevalence of 58. Adami HO, Trichopoulos D. Obesity and mortality from cancer. N Engl
behavioral risk factors among adult cancer survivors and noncancer J Med 2003;348:1623–4.
controls. Prev Med 2005;40:702–11. 59. Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D. Cancer
36. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, incidence and mortality in relation to body mass index in the Million
health, and disability. J Gerontol A Biol Sci Med Sci 2003;58:82–91. Women Study: cohort study. BMJ 2007;335:1134.
37. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of 60. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA.
cancer survivors: examining opportunities for cancer control Physical activity and survival after breast cancer diagnosis. JAMA
intervention. J Clin Oncol 2005;23:8884–93. 2005;293:2479–86.
38. World Health Organization. Cancer fact sheet. Geneva, Switzerland: 61. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS.
World Health Organization. Available at http://www.who.int/ Prospective cohort study of lifetime physical activity and breast cancer
mediacentre/factsheets/fs297/en/index.html. Accessed June 12, 2011. survival. Int J Cancer 2009;124:1954–62.
39. Pollack LA, Rowland JH, Crammer C, Stefanek M. Introduction: 62. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and
charting the landscape of cancer survivors’ health-related outcomes and postdiagnosis physical activity on mortality in breast cancer survivors:
care. Cancer 2009;115(Suppl 18):4265–9. the health, eating, activity, and lifestyle study. J Clin Oncol
40. Garland SM, Smith JS. Human papillomavirus vaccines: current status 2008;26:3958–64.
and future prospects. Drugs 2010;70:1079–98. 63. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity
41. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J and survival after diagnosis of invasive breast cancer. Cancer Epidemiol
Clin 2010;60:277–300. Biomarkers Prev 2008;17:379.
42. Blumberg SJ, Luke JV. Wireless substitution: early release of estimates from 64. Meyerhardt JA, Giovannucci EL, Holmes MD, et al. Physical activity and
the National Health Interview Survey, July–December 2007. Hyattsville, survival after colorectal cancer diagnosis. J Clin Oncol 2006;24:3527–34.
MD: CDC, National Center for Health Statistics; 2009. Available at http:// 65. Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity
www.cdc.gov/nchs/nhis.htm. Accessed December 2, 2011. on cancer recurrence and survival in patients with stage III colon cancer:
43. CDC. United States cancer statistics: 1999–2007 incidence and mortality findings from CALGB 89803. J Clin Oncol 2006;24:3535–41.
web-based report. Atlanta, GA: CDC, National Cancer Institute; 2010. 66. Schmitz KH, Holtzman J, Courneya KS, Mâsse LC, Duval S, Kane R.
Available at www.cdc.gov/uscs. Accessed November 3, 2011. Controlled physical activity trials in cancer survivors: a systematic review
44. Soerjomataram I, Louwman MW, Ribot JG, Roukema JA, Coebergh and meta-analysis. Cancer Epidemiol Biomarkers Prev 2005;14:1588.
JW. An overview of prognostic factors for long-term survivors of breast 67. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An update
cancer. Breast Cancer Res Treat 2008;107:309–30. of controlled physical activity trials in cancer survivors: a systematic
45. Howlader N, Noone AM, Krapcho M, et al, eds. SEER cancer statistics review, review and meta-analysis. J Cancer Surviv 2010;4:87–100.
1975–2008. Bethesda, MD: National Cancer Institute; 2011. Available at http:// 68. Schmitz KH, Courneya KS, Matthews C, et al. American College of
seer.cancer.gov/csr/1975_2008. Accessed November 3, 2011. Sports Medicine roundtable on exercise guidelines for cancer survivors.
46. Breitkopf CR, Pearson HC, Breitkopf DM. Poor knowledge regarding Med Sci Sports Exerc 2010;42:1409.
the Pap test among low-income women undergoing routine screening. 69. CDC. Physical activity among Behavioral Risk Factor Surveillance
Perspect Sex Reprod Health 2005;37:78–84. System respondents. Atlanta, GA: CDC; 2011. Available at http://apps.
47. CDC. Vital signs: current cigarette smoking among adults aged ≥18 years— nccd.cdc.gov/BRFSS. Accessed July 27, 2011.
United States, 2005–2010. 2011;60:1207–12. 70. Nelson DE, Bland S, Powell-Griner E, et al. State trends in health risk
48. Klosky JL, Tyc VL, Garces-Webb DM, Buscemi J, Klesges RC, Hudson factors and receipt of clinical preventive services among U.S. adults
MM. Emerging issues in smoking among adolescent and adult cancer during the 1990s. JAMA 2002;287:2659.
survivors: a comprehensive review. Cancer 2007;110:2408–19. 71. McInnes DK, Cleary PD, Stein KD, Ding L, Mehta CC, Ayanian JZ.
49. Mariotto AB, Rowland JH, Ries LA, Scoppa S, Feuer EJ. Multiple cancer Perceptions of cancer-related information among cancer survivors: a
prevalence: a growing challenge in long-term survivorship. Cancer report from the American Cancer Society’s Studies of Cancer Survivors.
Epidemiol Biomarkers Prev 2007;16:566–71. Cancer 2008;113:1471–9.
50. CDC. Best practices for comprehensive tobacco control programs—2007. 72. Beckjord EB, Arora NK, McLaughlin W, Oakley-Girvan I, Hamilton
Atlanta, GA: CDC; 2007. Available at http://www.cdc.gov/tobacco/ AS, Hesse BW. Health-related information needs in a large and diverse
stateandcommunity/best_practices/index.htm. Accessed November 3, 2011. sample of adult cancer survivors: implications for cancer care. J Cancer
51. Land T, Warner D, Paskowsky M, et al. Medicaid coverage for tobacco Surviv Sep 2008;2:179–89.
dependence treatments in Massachusetts and associated decreases in 73. Hawkins NA, Pollack LA, Leadbetter S, et al. Informational needs of
smoking prevalence. PLoS One 2010;5:e9770. patients and perceived adequacy of information available before and
52. Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. after treatment of cancer. J Psychosocial Oncol 2008;26:1.
Provider counseling about health behaviors among cancer survivors in 74. Gage EA, Pailler M, Zevon MA, et al. Structuring survivorship care:
the United States. J Clin Oncol 2007;25:2100–6. discipline-specific clinician perspectives. J Cancer Surviv 2011;
53. Underwood JM, Townsend JS, Tai E, et al. Racial and regional disparities 5:217–25.
in lung cancer incidence. Cancer 2011 Sep 14. doi: 10.1002/cncr.26479 75. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD.
[Epub ahead of print]. Trends in follow-up and preventive care for colorectal cancer survivors.
54. CDC. Vital signs: state-specific obesity prevalence among adults— J Gen Intern Med 2008;23:254–9.
United States, 2009. MMWR 2010;59:1–5.
55. Irwin ML, McTiernan A, Baumgartner RN, et al. Changes in body fat
and weight after a breast cancer diagnosis: influence of demographic,
prognostic, and lifestyle factors. J Clin Oncol 2005;23:774–82.

76. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. 90. Rice DP. Estimating the cost of illness. Washington, DC: US
Preventive care for colorectal cancer survivors: a 5-year longitudinal Government Printing Office; 1966. Publication no. 947-6.
study. J Clin Oncol 2008;26:1073–9. 91. Gold M. Panel on cost-effectiveness in health and medicine. Med Care
77. Wu X, Richardson LC, Kahn AR, et al. Survival difference between 1996;34(Suppl):DS197-199.
non-Hispanic black and non-Hispanic white women with localized 92. Brown M, Hodgson T, Rice D. Economic impact of cancer in the United
breast cancer: the impact of guideline-concordant therapy. J Natl Med
States. In: Schottenfeld D, Fraumeni J, eds. Cancer epidemiology and
Assoc 2008;100:490–8.
78. Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship prevention. 2nd ed. New York, NY: Oxford University Press;
issues: analyses of the 1992 National Health Interview Survey. J Natl 1993:255–66.
Cancer Inst 1999;91:1480–6. 93. Chirikos TN, Russell-Jacobs A, Cantor AB. Indirect economic effects
79. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical of long-term breast cancer survival. Cancer Pract 2002;10:248–55.
trials. JAMA 2004;291:2720. 94. Given BA, Given CW, Stommel M. Family and out-of-pocket costs
80. Patrick DL, Ferketich SL, Frame PS, et al; National Institutes of Health for women with breast cancer. Cancer Pract 1994;2:187–93.
State-of-the-Science Panel. National Institutes of Health State-of-the- 95. Stommel M, Given CW, Given BA. The cost of cancer home care to
Science Conference Statement: Symptom Management in Cancer: Pain, families. Cancer 1993;71:1867–74.
Depression, and Fatigue, July 15–17, 2002. J Natl Cancer Inst 2003; 96. Hayman JA, Langa KM, Kabeto MU, et al. Estimating the cost of
95:1110–7.
informal caregiving for elderly patients with cancer. J Clin Oncol
81. Anderson KO, Mendoza TR, Valero V, et al. Minority cancer patients
and their providers: pain management attitudes and practice. Cancer 2001;19:3219–25.
2000;88:1929–38. 97. Emanuel EJ, Fairclough DL, Slutsman J, Alpert H, Baldwin D,
82. McMillan SC, Tittle M, Hagan S, Laughlin J. Management of pain and Emanuel LL. Assistance from family members, friends, paid care givers,
pain-related symptoms in hospitalized veterans with cancer. Cancer Nurs and volunteers in the care of terminally ill patients. N Engl J Med
2000;23:327–36. 1999;341:956–63.
83. Gordon DB, Dahl JL, Miaskowski C, et al. American Pain Society 98. Hodgson T, Meiners M. Cost-of-illness methodology: a guide to
recommendations for improving the quality of acute and cancer pain assessment practices and procedures. Milbank Mem Fund Q 1982;
management: American Pain Society Quality of Care Task Force. Arch 60:429–91.
Intern Med 2005;165:1574–80. 99. Jacobsen PB, Jim HS. Psychosocial interventions for anxiety and
84. Sabatino SA, Coates RJ, Uhler RJ, Alley LG, Pollack LA. Health insurance
depression in adult cancer patients: achievements and challenges. CA
coverage and cost barriers to needed medical care among U.S. adult cancer
survivors age <65 years. Cancer 2006;106:2466–75. Cancer J Clin 2008;58:214–30.
85. Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care 100. Desai MM, Bruce ML, Desai RA, Druss BG. Validity of self-reported
because of cost: assessing disparities in healthcare access among cancer cancer history: a comparison of health interview data and cancer registry
survivors living in the United States. Cancer 2010;116:3493–504. records. Am J Epidemiol 2001;153:299–306.
86. Patient Protection and Affordable Care Act of 2010. Pub. L. No. 111-148 101. CDC. Improvements to BRFSS methodology, design, and
(March 23, 2010). implementation. Atlanta, GA: CDC; 2006. Available at http://www.
87. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of cdc.gov/brfss/pubs/methodology.htm. Accessed August 29, 2011.
the cost of cancer care in the United States: 2010–2020. J Natl Cancer 102. Nelson DE, Powell-Griner E, Town M, Kovar MG. A comparison of
Inst 2011;103:117–28. national estimates from the National Health Interview Survey and the
88. Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer:
Behavioral Risk Factor Surveillance System. Am J Public Health
economic cost and quality of life. Annu Rev Public Health 2001;
22:91–113. 2003;93:1335–41.
89. Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct
costs of colon, prostate, and breast cancer care. J Natl Cancer Inst
1995;87:417–26.

TABLE 1. Demographic and health behavior characteristics of cancer survivors aged ≥18 years, by sex — Behavioral Risk Factor Surveillance
System, United States 2009
Total cancer survivors Men Women
Sample Weighted Sample Weighted Sample Weighted
Characteristic %* (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 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
Native
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 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
school (1–3 yrs)
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
See table footnotes on page 14.

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
Total cancer survivors Men Women
Characteristic %* (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 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
work
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 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
of health problems
Influenza vaccine within the 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
past 12 months§§
Ever received 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
pneumococcal vaccine
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
Both sexes Men Women
Cancer type* % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 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
and bone marrow)
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 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
(Hodgkin’s disease)
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
All races/ethnicities White, non Hispanic Black, non Hispanic
Cancer type % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 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
nodes and bone marrow)
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
See table footnotes below.
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
Asian/Pacific Islander American Indian/Alaska Native Hispanic
Cancer type % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 — — — — — — — — 5.6 (3.6–8.5) 61 56,302
nodes and bone marrow)
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
Both sexes: Men: Women:
all cancer types all cancer types all cancer types
State/Area % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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
Breast cancer prevalence among female Cervical cancer prevalence among female Other female genital system cancer
cancer survivors† cancer survivors† prevalence among female cancer survivors†
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
Colorectal cancer prevalence among Prostate cancer prevalence among male Melanoma prevalence among
cancer survivors cancer survivors† cancer survivors
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 — — — — — — — — — — — —

* 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
Health status self-rated as excellent, very good, or good ≥5 physically unhealthy days during the past 30 days
State/Area % (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
Always receive needed social or emotional support Satisfied or very satisfied with life
State/Area % (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
* 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
Participated in a Currently have physical pain caused Pain currently under
Currently receiving treatment clinical trial* by cancer or cancer treatment* control*
Sample Weighted Sample Weighted Sample Weighted Sample Weighted
State % (95% CI) size no. % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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 — — — — — — — — — — — —

* 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
Currently receiving majority of
health care from oncologist or other Received a written treatment
cancer specialist† summary from health-care provider Received instructions on follow-up care
State % (95% CI) size no. % (95% CI) size no. % (95% CI) size 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
See table footnotes below.
TABLE 7. (Continued) Health care experience* among cancer survivors aged ≥18 years (N = 5,593) — Behavioral
Risk Factor Surveillance System, 10 states, 2009
Ever denied health insurance or life insurance
Insurance covered all or part of cancer treatment coverage because of cancer
Sample Sample Weighted
State % (95% CI) size Weighted no. % (95% CI) size 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 — — — —
* 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 FIGURE 2. Prevalence of obesity* among cancer survivors aged ≥18
survivors aged ≥18 years — Behavioral Risk Factor Surveillance years — Behavioral Risk Factor Surveillance System, United States, 2009
DC
DC GU
GU PR
PR VI
VI
30.4%–33.8%
19.1%–23.9% 26.9%–30.3%
14.5%–19.0% 24.6%–26.8%
12.7%–14.4% 15.7%–24.5%
10.3%–12.6% Data suppressed†
Data suppressed*
Abbreviations: GU = Guam; PR = Puerto Rico; VI = US Virgin Islands.
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 † The sample size of the numerator was <50 or the half-width of the confidence
interval was >10. 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
DC
GU
PR
VI
34.0%–42.3%
30.8%–33.9%
26.6%–30.7%
21.4%–26.5%
Data suppressed*
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.

The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC) and is available free of
charge in electronic format. To receive an electronic copy each week, visit MMWR’s free subscription page at http://www.cdc.gov/mmwr/mmwrsubscribe.
html. Paper copy subscriptions are available through the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402;
telephone 202-512-1800.
Address all inquiries about the MMWR Series, including material to be considered for publication, to Editor, MMWR Series, Mailstop E-90, CDC, 1600
Clifton Rd., N.E., Atlanta, GA 30333 or to [email protected].
All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations
or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses
listed in MMWR were current as of the date of publication.
U.S. Government Printing Office: 2012-523-043/21098 Region IV ISSN: 1546-0738

Screenshot 2023-10-21 at 21.54.45

Uploaded by

Copyright:

Available Formats

Screenshot 2023-10-21 at 21.54.45

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Screenshot 2023-10-21 at 21.54.45

Uploaded by

Copyright:

Available Formats

Morbidity and Mortality Weekly Report

Surveillance Summaries / Vol. 61 / No. 1 January 20, 2012

Surveillance of Demographic Characteristics and

U.S. Department of Health and Human Services

Surveillance of Demographic Characteristics and Health Behaviors

MMWR / January 20, 2012 / Vol. 61 / No. 1 1

Introduction NCCCP programs use population-based data sources to

2 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 3

4 MMWR / January 20, 2012 / Vol. 61 / No. 1

Regional Differences Leisure-Time Physical Activity

MMWR / January 20, 2012 / Vol. 61 / No. 1 5

Health-Care Experience Demographic Characteristics and Use of

6 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 7

8 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 9

10 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 11

12 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 13

14 MMWR / January 20, 2012 / Vol. 61 / No. 1

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

MMWR / January 20, 2012 / Vol. 61 / No. 1 15

16 MMWR / January 20, 2012 / Vol. 61 / No. 1

See table footnotes on page 19.

MMWR / January 20, 2012 / Vol. 61 / No. 1 17

See table footnotes on page 19.

18 MMWR / January 20, 2012 / Vol. 61 / No. 1

Abbreviation: CI = confidence interval.

MMWR / January 20, 2012 / Vol. 61 / No. 1 19

20 MMWR / January 20, 2012 / Vol. 61 / No. 1

MMWR / January 20, 2012 / Vol. 61 / No. 1 21

Abbreviation: CI = confidence interval.

22 MMWR / January 20, 2012 / Vol. 61 / No. 1

FIGURE 3. Prevalence of cancer survivors aged ≥18 years reporting no

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

MMWR / January 20, 2012 / Vol. 61 / No. 1 23

U.S. Government Printing Office: 2012-523-043/21098 Region IV ISSN: 1546-0738

You might also like