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Volume 14

Using Tableau as a Data Visualization Tool to Explore Reoccurring Cancer Trends

Charbel Aoun
Maroun Sassine

Georgia State University

Key Words: cancer, cancer data, cancer research, cancer trends, data visualization

Abstract

Cancer has touched the lives of millions for over a century. Numerous organizations have cooperated in research and fundraising in order to find a cure for cancer. The need for an analysis of the various trends in cancer is evident in order to investigate the decline of cancer in recent years. To provide a clearer understanding of the different trends, the data visualization software, Tableau, was used to help visualize the data presented.

Introduction

Cancer is a group of diseases "characterized by the uncontrolled growth and spread of abnormal cells" (American Cancer Society, 2015a). If the intensity of the cells does not stay in a controllable condition, death is one of the possible results. Cancer results from numerous external and internal factors. "These [external or internal] factors may act together or in sequence" in order for a diagnosis to be a possibility (2015a). Many treatment options are possible, including surgery, radiation, chemotherapy, hormone therapy, immune therapy, and targeted therapy (2015a).

According to the World Health Organization (2007), an estimated eight million people died from cancer in 2010, and the number of deaths is projected to climb to twelve million by 2030. This alone is profoundly persuasive to bring cancer research to the forefront of medical investigation. Though it may seem overlooked, it is beneficial to investigate where trends occur in cancer rates. It is also beneficial to examine the factors that cause these patterns to occur, become prominent, or disappear over time.

During the investigation, numerous models were considered and analyzed. The trends were investigated and consolidated into multiple groups. These groups include cancer diagnosis and death rates in adults, children, and adolescents; cancer cases by state; and cancer deaths by country. Colored data visualization images accompany each trend. These images were produced using the software Tableau to depict the data collected on the different patterns.

Discussion

Comparing Men's and Women's Chances with Cancer

The first major trend investigated is the cancer diagnosis rates in both men and women. Both men and women are estimated to have both high new cancer cases and death cases. For 2014, male cases were estimated at 855,220 for all cancer sites while female cases were estimated at 810,320 in all sites. For cancer deaths, men experienced an estimated 310,010 deaths while women's deaths were estimated at 275,710 (American Cancer Society, 2014).

Analyzing cancer in men. The first data visualized image (see Figure 1) compares diagnosis and death percentages in men (2014).


Figure 1.

In this picture, there is a relationship displayed between the diagnosis and death rates. The color of the circles represents the diagnosis rates for the cancer types analyzed. The darker the color, the higher the diagnosis rate. This graph shows that prostate cancer is the highest diagnosed cancer in men.

Prostate cancer. In the late 1980s and early 1990s, incidence rates for prostate cancer spiked dramatically because of increased use of the prostate-specific antigen (PSA) blood test for screening (American Cancer Society, 2015a). Rates have since been declining. Cases of prostate cancer are significantly higher in men sixty-five and older than any other age group.

Prostate cancer death rates have been decreasing since the early 1990s in men of all races/ethnicities, though they remain more than twice as high in blacks as in any other group (2015a). To catch these cases before death can be rather difficult as early prostate cancer usually has no symptoms. The only well-established risk factors for prostate cancer are increasing age, African ancestry, a family history of the disease and certain inherited genetic conditions (2015a).

The second variable graphed in Figure 1 is death rates in the cancer types. The size of the circle represents the death rates for each cancer types depicted. The larger the circle, the higher mortality rate. In this case, lung cancer causes the most cancer deaths in men today. A further analysis of cancer deaths will be investigated in the section titled "Cancer Deaths in the Past 70 years."

Analyzing cancer in women. Just as the diagnosis and death rates for cancer in men were digitally presented using a bubble chart, diagnosis and death rates for women were graphed using a bubble chart as follows in Figure 2 (American Cancer Society, 2014).


Figure 2.

The first variable graphed is diagnosis rates, depicted using the color of the circles. The darker the red, the higher the diagnosis rate. In the provided data visualized image, breast cancer has the highest recorded diagnosis rate in women.

Breast cancer. Potentially modifiable factors associated with increased breast cancer risk include weight gain after the age of 18 or being overweight or obese (for postmenopausal breast cancer), physical inactivity, and alcohol consumption. In addition, recent research indicates that long-term, heavy smoking may also increase breast cancer risk, particularly among women who start smoking before their first pregnancy (American Cancer Society, 2015a). The International Agency for Research on Cancer (IARC) has concluded that shift work, particularly at night, may be associated with an increased risk of breast cancer (IARC, 2012).

Mammography can often detect breast cancer at an early stage, therefore, treatment is more effective. Numerous studies have shown that early detection with mammography saves lives and increases treatment options. Mammography will detect most breast cancers in women without symptoms, "though the sensitivity is lower for younger women" (American Cancer Society, 2015a). Mammography also results in some detection of cancer that would neither have caused harm nor been diagnosed in the absence of screening.

The second variable depicted in Figure 2 is death rates, represented by the size of the circles. Lung cancer is the cancer type causing the most death not only in men but also in women in 2014 and 2015. To understand the reason lung cancer causes the highest death rate, an investigation of deaths will be looked at next.

Cancer Deaths in the Past 70 Years

The following graph, Figure 3, represents the total number of fatalities in the United States by cancer from the year 1930 until 2010 (American Cancer Society, 2014). This legend distinguishes the cancer locations:

  • blue represents colon cancer
  • orange represents breast cancer
  • green represents leukemia
  • red represents liver cancer
  • purple represents lung cancer
  • brown represents ovarian cancer
  • pink represents pancreatic cancer
  • gray represents prostate cancer
  • olive represents stomach cancer
  • baby blue represents uterine cancer


Figure 3.

The data shows that, over time, lung cancer has climbed to exceed other types for the highest cancer death rate. To understand the reason of this, a further analysis of lung cancer is necessary.

Lung cancer. Over the past century, lung cancer rates grew to an all-time high as a result of the tobacco epidemic (American Cancer Society, 2011). Cigarette smoking is the largest cause of lung cancer, and the risk factor increases as the number of cigarettes and the number of times consumed in a particular interval increases. Cigarette consumption has increased over time due to the influence of many factors. For this reason, diagnosis and death rates have increased.

Events influencing cigarette use. The timeline of events affecting cigarette consumption stretches over a time span of more than a century. It began in 1884 and 1889, where the invention of a machine to manufacture cigarettes and the invention of the safety matches, respectively, ignited the beginning of the mass production of cigarette (Whelan, 1984). As mass production began in flourish, mass marketing of cigarettes influenced a higher consumption rate as well. As stated by Burrough and Helyar in 1990, the "introduction and mass marketing of Camel brand cigarettes by R.J. Reynolds Tobacco Company in 1913" played one of these influential roles. Almost two decades passed after this introduction before, in 1928, companies began "cigarette advertisements targeting women, including the 'Reach for a Lucky Instead of a Sweet' campaign" (Burns, 1994 and Health Advocacy Center, 1986). Also, marketing of filtered cigarettes began in 1955 (U.S. Department of Health and Human Services, 1981).

After almost a century of companies attracting customers to cigarettes, actions were taken to counteract the rise in cigarette consumption and death. Publications were first written about the "retrospective studies linking tobacco and disease [in 1950] and the prospective mortality studies linking cigarettes and lung cancer [in 1954]" (U.S. Department of Health and Human Services, 1989). After these publications, according to Freedman and Cohen (1993), the Council for Tobacco Research was founded. According to the 1964 publication by the U.S. Department of Health, Education, and Welfare, the Surgeon General released a 1964 report on smoking as it relates to health. Counter-advertising on television between 1967 and 1970 aided in the retaliatory efforts against cigarette consumption (Warner, 1977). Even with all these efforts to minimize the quantity of cigarette use, "the introduction of Virginia Slims" and other brands of cigarettes targeting women began in 1968 (Burns, 1994).

It was in the 1970s and onward that initiatives were taken to combat this epidemic. Examples include the ban on cigarette advertisements (U.S. Department of Health and Human Services, 1989), the start of the Nonsmokers' rights movement (Steinfeld, 1972), and the release of reports from the U.S. Surgeon General in 1986 on "involuntary smoking" (U.S. Department of Health and Human Services, 1986) and from the U.S. Environmental Protection Agency on "environmental tobacco smoke" (U.S. Environmental Protection Agency, 1992).

These historical events illuminate the fact that efforts have been made to lower the chances of tobacco related sickness and disease; however, the graph demonstrates that as time passed, the number of deaths from lung cancer have increased. This correlation shows the dramatic effects of tobacco upon the numerous diseases it causes including lung cancer.

Cancer Chances in the Youth Population

Although cancer is much less common among children compared to older adults, "1 in 285 children in the US will be diagnosed with the disease before the age of 20" (American Cancer Society, 2014). The types of cancers that develop in children and adolescents differ from those that develop in adults. The predominant types of pediatric cancers in children from ages 0-14 and adolescents from 15-19, are pictured below in the next data visualized image (American Cancer Society, 2014).


Figure 4.

Some of the cancers that develop in children are rarely seen in older individuals, notably those cancers that arise from embryonic cells which include "neuroblastoma (sympathetic peripheral nervous system), Wilms tumor or nephroblastoma (developing kidney), medulloblastomas (brain), rhabdomyosarcomas (muscle), and retinoblastoma (retina of the eye)" (American Cancer Society, 2014). Because these cancers occur during stages of rapid growth and development in youth, most experts strongly recommend that they are treated at medical centers that specialize in childhood cancer by multidisciplinary teams.

From 1975 to 2010, the overall incidence of pediatric cancer in the US increased slightly, by an average of 0.6% per year (Howlader, N., Noone, A.M., & Krapcho, M., 2013). Specifically, incidence rates increased for four cancer types: acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin lymphoma, and testicular germ cell tumors. Reasons for increases in incidence rates are largely unknown. It is possible that some of this increase may be due to changes in environmental factors. Improved diagnosis and access to medical care over time may also have contributed. Without medical attention, some children may die of infections or other complications of their cancers without ever being diagnosed. Death rates, on the other hand, for all childhood and adolescent cancers combined declined steadily from 1975 to 2010 by an average of 2.1% per year, resulting in an overall reduction of more than 50% (2013). Mortality declines were observed for all sites with the steepest declines in Hodgkin lymphoma, non-Hodgkin lymphoma, and acute lymphocytic leukemia.

Cancer Cases by State

The investigation continues now with broadening our perspective by looking at different cancer trends by locations as opposed to by individuals. The United States is mapped in the next visualization, Figure 5, comparing the number of cancer cases to the population as a percentage. A divergent scale was used to define the lower rates of cancer cases per population size compared to higher percentages. The green represents low percentages. As the green changes from a dark green to a light green, the percentage of cases increases. Then the color diverges from light green to light red. Then the red darkens as the percentage continues to increase, creating the map.


Figure 5.

With this in mind, we see from the map that most cancer cases occur in the northeastern region of the United States. Cancer most commonly develops in older people; "78% of all cancer diagnoses are in people 55 years of age or older" (American Cancer Society, 2015a). People who smoke, eat an unhealthy diet or are physically inactive also have a higher risk of cancer. These same risks plague American culture today. Because the population is most heavily concentrated in the northeast, this data supports the idea of greater incidence of cancer cases in densely populated areas.

Another location experiencing higher cancer rates in the United States is the southeast. As depicted, Georgia is the only state with a low percentage of cases in comparison to other states in the southeast due to the number of recorded melanoma (skin cancer) cases. For melanoma, one of the major risk factors is sun sensitivity; the skin's reaction to the presence of excessive sunlight. As most use tanning beds or tan on the beach, it is evident that many experience sunburns; however, the UVA and UVB rays that penetrate the skin cause the cells to mutate and become cancer cells. As a result, melanoma and all other skin cancer types are the most common form of cancer (2015).

Cancer Deaths by Country

As the final visualization of the investigation, Figure 6 (below) brings together data from every country. The analysis shows the number of people who have died of cancer in comparison to the population size to indicate the percentage of people who died of cancer by country. A blue-red divergent scale was used for this trend as well; blue indicates a lower percentage and red points to higher percentages.


Figure 6.

This map illustrates that developed countries have higher mortality rates than developing nations. The red nations have been recorded to have contributing factors resulting from geographic differences that include the age groups, the prevalence of risk factors, the availability and use of diagnostic tests, and the availability and quality of treatment; in which case "approximately 16% of all incident cancers worldwide are attributable to infections. This percentage is about three times higher in developing countries (23%) than in developed countries (7%)" (Cancer Genome Atlas Network, 2012).

The estimated number of cases and deaths in economically developing countries will probably grow, however, due to the adoption of lifestyles that are known to increase cancer risk – such as smoking, poor diet, physical inactivity, and fewer pregnancies. Cancers related to these factors, such as lung, breast, and colorectal cancers, are already on the rise in economically transitioning countries.

According to estimates from the International Agency for Research on Cancer, there were 14.1 million new cancer cases in 2012 worldwide, of which 8 million occurred in economically developing countries containing about 82% of the world's population (IARC, 2012). By 2030, the global burden is expected to grow to 21.7 million new cancer cases and 13 million cancer deaths simply due to the growth and aging of the population (American Cancer Society, 2015b).

Summary

Cancer knows no boundaries, yet over the years, scientists and advocates united and fought to find the reasons behind cancer and why so many are affected by it. This investigation analyzed the reasons behind the most common cancer cases in all individuals, then compared these cases in the fifty states and finally in each country. One constant remained: cancer plays a vital role in the lives of people by the millions and has done so for over a century. But hope is inevitable. So many began the fight to stop these trends and began the initiative to create new trends; trends that eradicate cancer from the world permanently.


References

American Cancer Society. (2011). Global Cancer Facts and Figures 2nd Edition. Atlanta, GA: American Cancer Society.

American Cancer Society. (2014). Cancer Facts and Figures 2014. Atlanta, GA: American Cancer Society.

American Cancer Society. (2015a). Cancer Facts and Figures 2015. Atlanta, GA: American Cancer Society.

American Cancer Society. (2015b). Global Cancer Facts & Figures 3rd Edition. Atlanta, GA: American Cancer Society.

Burns, D.M. (1991). The scientific rationale for comprehensive, community-based, smoking control strategies. Strategies To Control Tobacco Use In the United States: A Blueprint for Public Health Action in the 1990's, 1-32. Shopland, D.R., Burns, D.M., Samet, J.M., & Gritz, E.R. (Eds.). (Smoking and Tobacco Control Monographs—1. NIH Publication No. 92-3316). Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute.

Burns, D.M. (1994). Overview of office-based smoking cessation assistance. Tobacco and the Clinician: Interventions for Medical and Dental Practice, 3-11. Shopland, D.R., Burns, D.M., Cohen, S.J., Kottke, T.E., & Gritz, E.R. (Eds.). (Smoking and Tobacco Control Monograph No. 5. NIH Publication No. 94-3693). Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute.

Burrough, B., & Helyar, J. (1990). Barbarians at the Gate. New York, NY: Harper & Row.

Cancer Genome Atlas Network. (2012). Comprehensive molecular portraits of human breast tumors. Nature, 490, 61-70.

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Health Advocacy Center. (1986). Sixty Years of Deception: An Analysis and Compilation of Cigarette Ads in Time Magazine (Vol. 1). Palo Alto, CA: Health Advocacy Center.

Howlader, N., Noone, A.M., & Krapcho, M. (2013). SEER Cancer Statistics Review, 1975-2010. Retrieved from http://seer.cancer.gov/csr/1975_2010/ (Original work published in 2013)

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U.S. Department of Health and Human Services. (1986). The Health Consequences of Involuntary Smoking: A Report of the Surgeon General (DHHS Publication No. CDC 87-8398). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health.

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U.S. Department of Health, Education, and Welfare. (1964). Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (PHS Publication No. 1103). Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service.

U.S. Environmental Protection Agency. (1992). Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders (EPA/600/6-90/006F). Washington, DC: Office of Research and Development, Office of Health and Environmental Assessment.

Warner, K.E. (1977). The effect of the anti-smoking campaign on cigarette consumption. American Journal of Public Health, 67, 645-650.

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World Health Organization. (2011). [Map illustration of all cancer death rates per 100,000 people standardized by age provided by World Life Expectancy]. All Cancers Death Rate per 100,000. Retrieved from http://www.worldlifeexpectancy.com/cause-of-death/all-cancers/by-country/

Appendix

Table A1

Male Diagnosis and Death Rates

Cancer Type
Percent Males Diagnosed Percent Male Deaths
Prostate 27 10
Lung 14 28
Colon 8 8
Urinary Bladder 7 4
Skin 5 1
Kidney 5 3
Non-Hodgkin Lymphoma 4 4
Oral Cavity 4 1
Leukemia 4 5
Liver 3 5
Pancreas 1 7
Esophagus 1 4


Table A2

Female Diagnosis and Death Rates

Cancer Type
Percent Females Diagnosed Percent Female Deaths
Breast 29 15
Lung 13 26
Colon 8 9
Uterine corpus 6 3
Thyroid 6 1
Non-Hodgkin lymphoma 4 3
Skin 4 1
Kidney 3 1
Pancreas 3 7
Leukemia 3 4
Ovary 1 5
Liver 1 3
Brain 1 2

Table A3

Children and Adolescent Diagnosis and Death Rates

Cancer Type
Percent Children Diagnosed Percent Adolescents Diagnosed Description of Cancer Type
Acute lymphocytic leukemia 26 8 Cancer from white blood cells
Acute myeloid leukemia 5 4 Cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells
Bone tumor 4 7 Cancer within the bone
Brain and CNS 21 10 Cacner of the brain and central nervous system
Hodgkin lymphoma 4 15 Cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites
Melanoma 1 6 Most dangerous type of skin cancer
Neuroblastoma 7 1 Cacner tumor that develops in the nerve tissue
Non-Hodgkin lymphoma 6 8 Cancer of lymphocytes (white blood cells)
Ovarian germ cell tumors 1 2 An abnormal mass of tissue that forms in germ (egg) cells in the ovary (female reproductive gland in which the eggs are formed
Retinoblastoma 3 1 Cacner of the retina
Rhabdomyosarcoma 3 1 Cancer that forms in the soft tissues in a type of muscle called striated muscle anywhere in the body.
Testicular germ cell tumors 1 8 Cancer that forms in tissues of one or both testicles
Thyroid carcinoma 1 11 Cancer that forms in the thyroid gland. Carcinoma is a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.
Wilms tumor 5 1 A disease in which malignant (cancer) cells are found in the kidney, and may spread to the lungs, liver, or nearby lymph nodes

Table A4

Death Rates in the Past 70 Years

Year
Colon Breast Leukemia Liver Lung Ovary Pancreas Prostate Stomach Uterus
1930 61,681 37,104 3,681 17,398 8,485 8,995 10,204 21,847 100,348 36,167
1931 63,721 37,946 3,927 16,609 9,087 8,889 10,868 22,877 98,599 33,516
1932 67,091 38,586 3,960 16,233 10,265 9,245 11,707 24,704 98,369 32,680
1933 68,369 38,723 4,332 16,360 10,886 9,466 11,751 26,002 96,336 30,817
1934 71,719 39,951 4,490 16,175 12,017 10,124 12,422 28,707 95,576 30,039
1935 73,400 39,805 4,898 15,478 13,956 10,582 13,164 28,867 95,530 30,072
1936 76,453 41,037 5,011 15,402 15,247 11,163 14,228 30,435 95,194 28,784
1937 79,646 40,725 5,283 14,864 16,468 11,334 14,492 31,236 92,388 28,309
1938 82,603 42,102 5,784 14,723 18,151 11,541 15,680 33,389 91,870 27,199
1939 85,228 42,558 6,300 14,545 19,151 11,877 16,431 35,012 87,962 26,903
1940 87,627 44,595 7,199 13,891 20,705 12,517 16,090 36,266 86,903 26,852
1941 87,481 43,573 7,114 13,951 22,584 12,759 17,270 38,238 84,166 25,574
1942 88,779 44,217 7,552 14,254 24,032 13,310 17,331 36,495 85,152 25,522
1943 92,556 44,624 7,794 14,989 25,792 13,606 16,753 37,296 82,620 24,995
1944 94,172 44,325 8,123 15,480 27,594 13,900 17,657 38,618 81,253 24,664
1945 97,122 46,021 8,525 15,709 29,742 14,281 19,109 41,025 80,669 24,323
1946 97,964 46,702 9,255 14,423 33,352 14,212 19,816 42,792 79,419 23,841
1947 101,892 48,309 10,326 13,778 38,336 14,748 21,920 44,213 80,290 23,569
1948 103,519 50,748 10,934 14,354 42,485 14,970 23,663 46,844 80,932 22,885
1949 100,579 47,517 11,335 13,270 41,651 14,971 24,942 43,645 75,819 22,359
1950 99,645 48,519 12,459 13,050 45,884 15,492 25,379 44,072 74,229 21,758
1951 99,376 48,915 13,503 12,790 49,145 15,654 26,352 44,277 71,506 21,285
1952 101,360 49,764 13,941 12,744 53,709 15,739 27,578 46,742 70,510 20,593
1953 103,200 51,535 14,498 12,785 58,345 16,427 28,538 47,747 69,934 20,717
1954 103,993 51,814 15,281 12,505 61,490 16,857 30,225 49,687 68,604 20,502
1955 106,493 53,991 15,889 12,444 66,550 16,771 31,194 50,111 65,462 19,874
1956 107,589 54,492 16,596 12,511 72,189 17,452 33,935 52,317 65,282 19,583
1957 109,065 55,215 17,073 12,811 76,236 18,230 33,641 52,712 62,881 18,753
1958 109,359 54,717 18,187 12,483 80,185 18,537 34,793 51,737 61,005 18,877
1959 110,441 55,372 18,154 12,126 85,291 18,494 36,242 51,444 61,231 18,153
1960 113,195 57,452 18,940 13,023 91,010 18,790 37,170 52,970 60,169 18,013
1961 114,542 58,204 19,946 12,688 97,244 18,369 38,854 54,830 58,133 17,609
1962 115,487 58,652 19,832 12,385 103,440 18,840 40,145 55,447 55,837 17,972
1963 115,965 59,076 20,798 12,929 109,690 19,113 41,266 56,511 56,051 17,453
1964 117,017 60,685 20,702 13,097 115,219 19,765 41,040 56,441 53,036 17,225
1965 119,031 62,167 21,125 13,326 122,495 19,042 42,716 57,978 51,418 17,214
1966 120,519 62,639 21,941 13,308 130,320 19,263 43,559 57,988 49,980 16,980
1967 119,509 63,704 22,416 13,440 137,970 18,878 44,503 59,249 48,253 16,793
1968 121,147 65,029 22,460 13,556 151,159 19,067 45,598 60,375 47,360 16,614
1969 123,228 64,343 22,932 13,377 158,291 19,052 46,172 60,154 45,689 16,353
1970 123,441 65,987 22,469 13,123 166,912 19,480 46,406 61,471 44,264 16,349
1971 123,766 65,867 22,864 13,498 176,096 19,520 45,898 62,583 42,863 16,335
1972 125,728 67,830 22,805 13,433 184,499 19,520 45,560 63,792 41,890 16,792
1973 124,179 68,731 23,035 12,926 189,658 19,708 47,371 65,700 40,885 16,317
1974 127,457 68,745 23,019 13,045 198,243 20,316 47,026 65,987 40,257 16,467
1975 126,128 67,816 23,598 12,742 205,175 20,301 47,848 66,455 39,132 16,414
1976 129,949 69,322 23,615 12,864 214,765 20,713 48,352 68,834 38,506 16,353
1977 129,721 71,500 23,819 13,214 223,543 20,703 49,863 69,869 37,119 16,298
1978 132,883 70,621 24,071 13,355 232,601 21,368 49,903 72,555 36,742 16,249
1979 132,783 70,202 24,789 13,278 238,559 22,055 49,899 73,701 36,376 15,979
1980 133,835 72,030 25,560 13,179 249,038 22,041 49,925 75,623 35,747 16,133
1981 132,402 73,240 24,958 13,997 254,248 21,340 50,627 76,098 35,751 15,833
1982 132,975 74,576 25,526 14,132 264,329 22,240 50,644 77,288 35,128 15,985
1983 133,729 74,990 25,501 14,495 271,199 21,743 51,258 79,317 34,362 16,132
1984 135,363 77,585 25,156 14,621 278,038 21,460 52,267 80,327 34,410 15,800
1985 134,665 78,459 25,571 14,751 284,795 21,651 52,011 80,694 33,160 15,703
1986 132,553 78,935 25,668 15,128 290,801 21,372 52,006 83,877 32,757 15,849
1987 132,532 79,125 24,908 15,264 299,227 21,806 52,632 85,088 32,257 15,749
1988 130,562 81,177 25,866 15,892 304,890 22,249 52,582 87,741 31,818 16,381
1989 130,321 82,023 26,162 16,537 311,733 22,954 53,821 91,578 33,021 16,290
1990 130,456 82,564 26,690 16,962 319,531 23,198 54,627 96,283 32,676 16,463
1991 128,081 82,446 26,473 17,397 323,227 22,944 55,216 99,086 32,524 16,388
1992 127,497 80,578 27,284 18,360 325,118 22,695 55,844 99,958 30,599 17,085
1993 126,811 80,932 27,579 18,558 328,626 22,682 56,189 101,294 30,930 27,579
1994 125,980 80,429 27,591 19,261 327,704 22,905 56,483 100,211 30,194 27,591
1995 125,339 80,406 28,379 20,233 328,982 22,335 55,969 98,011 29,955 28,379
1996 121,987 78,231 27,845 20,685 328,570 21,746 56,485 95,468 28,906 27,845
1997 121,288 75,504 27,845 20,884 328,521 21,687 57,029 91,568 28,381 27,845
1998 120,013 74,332 27,300 21,624 328,142 21,894 58,114 88,117 27,570 27,300
1999 119,984 72,536 27,814 20,997 320,684 86,170 58,901 86,170 26,996 27,814
2000 122,176 75,055 29,063 22,573 332,952 85,777 60,383 85,777 27,088 29,063
2001 120,257 74,092 29,067 23,082 332,844 84,066 61,268 84,066 26,217 29,067
2002 118,789 73,632 29,338 23,873 332,782 82,548 61,552 82,548 25,886 29,338
2003 116,333 73,397 29,011 24,659 329,853 78,909 62,083 78,909 25,239 29,011
2004 110,973 71,737 28,695 24,888 327,064 76,715 63,539 76,715 24,888 28,695
2005 108,750 71,220 28,961 26,005 326,546 75,061 64,718 75,061 23,641 28,961
2006 107,715 70,418 28,943 25,959 321,952 72,208 65,644 72,208 23,274 28,943
2007 106,335 69,283 28,617 26,810 318,100 72,898 66,572 72,898 22,894 28,617
2008 104,608 68,725 28,889 28,281 313,521 69,942 67,509 69,942 22,503 28,889
2009 101,541 68,103 29,143 29,450 307,999 67,797 67,183 67,797 21,781 29,143
2010 100,539 67,748 28,770 30,007 304,091 67,438 68,985 67,438 21,964 28,770

Table A5

Cancer Cases by State

State
Number of cases State Population Percent of Population with Cancer Cases
Alabama 26,150 4,849,377 0.5392
Alaska 3,700 736,732 0.5022
Arizona 32,440 6,731,484 0.4819
Arkansas 15,830 2,966,369 0.5336
California 172,090 38,802,500 0.4435
Colorado 24,540 5,355,866 0.4582
Connecticut 21,970 3,596,677 0.6108
Delaware 5,280 935,614 0.5643
District of Columbia 2,800 658,893 0.4250
Florida 114,040 19,893,297 0.5733
Georgia 48,070 10,097,343 0.4761
Hawaii 6,730 1,419,561 0.4741
Idaho 8,080 1,634,464 0.4944
Illinois 65,460 12,880,580 0.5082
Indiana 35,620 6,596,855 0.5400
Iowa 17,140 3,107,126 0.5516
Kansas 14,440 2,904,021 0.4972
Kentucky 26,490 4,413,457 0.6002
Louisiana 24,100 4,649,676 0.5183
Maine 8,810 1,330,089 0.6624
Maryland 30,050 5,976,407 0.5028
Massachusetts 37,790 6,745,408 0.5602
Michigan 57,420 9,909,877 0.5794
Minnesota 29,730 5,457,173 0.5448
Mississippi 16,260 2,994,079 0.5431
Missouri 34,680 6,063,589 0.5719
Montana 5,950 1,023,579 0.5813
Nebraska 9,540 1,881,503 0.5070
Nevada 13,640 2,839,099 0.4804
New Hampshire 8,090 1,326,813 0.6097
New Jersey 51,410 8,938,175 0.5752
New Mexico 9,970 2,085,572 0.4780
New York 107,840 19,746,227 0.5461
North Carolina 50,420 9,943,964 0.5070
North Dakota 3,840 739,482 0.5193
Ohio 65,010 11,594,163 0.5607
Oklahoma 19,280 3,878,051 0.4972
Oregon 22,410 3,970,239 0.5644
Pennsylvania 81,540 12,787,209 0.6377
Rhode Island 6,040 1,055,173 0.5724
South Carolina 25,550 4,832,482 0.5287
South Dakota 4,520 853,175 0.5298
Tennessee 38,300 6,549,352 0.5848
Texas 113,630 26,956,958 0.4215
Utah 11,050 2,942,902 0.3755
Vermont 4,020 626,562 0.6416
Virginia 41,170 8,326,289 0.4945
Washington 38,130 7,061,530 0.5400
West Virginia 11,730 1,850,326 0.6339
Wisconsin 32,700 5,757,564 0.5679
Wyoming 2,860 584,153 0.4896

Table A6

Cancer Deaths by Country

Country Name
2013 Population by Country Number of Deaths by Country in 2013 Percent of Population Who Died of Cancer
Afghanistan 30,551,674 30,949 0.1013
Albania 2,773,620 4,099 0.1478
Algeria 39,208,194 34,150 0.0871
Andorra 79,218 84 0.1061
Angola 21,471,618 18,079 0.0842
Antigua and Barbuda 89,985 118 0.1307
Argentina 41,446,246 56,077 0.1353
Armenia 2,976,566 5,161 0.1734
Australia 23,130,900 27,480 0.1188
Austria 8,473,786 10,474 0.1236
Azerbaijan 9,416,598 12,684 0.1347
Bahamas, The 377,374 413 0.1094
Bahrain 1,332,171 1,164 0.0874
Bangladesh 156,594,962 164,425 0.1050
Barbados 284,644 387 0.1358
Belarus 9,466,000 12,666 0.1338
Belgium 11,195,138 14,274 0.1275
Belize 331,900 335 0.1010
Benin 10,323,474 9,074 0.0879
Bhutan 753,947 941 0.1248
Bolivia 10,671,200 9,188 0.0861
Bosnia and Herzegovina 3,829,307 4,097 0.1070
Botswana 2,021,144 1,199 0.0593
Brazil 200,361,925 229,815 0.1147
Brunei Darussalam 417,784 405 0.0969
Bulgaria 7,265,115 10,091 0.1389
Burkina Faso 16,934,839 16,376 0.0967
Burundi 10,162,532 10,732 0.1056
Cambodia 15,135,169 16,800 0.1110
Cameroon 22,253,959 17,581 0.0790
Canada 35,158,304 44,229 0.1258
African Republic 4,616,417 3,615 0.0783
Chad 12,825,314 10,453 0.0815
Chile 17,619,708 21,214 0.1204
China 1,357,380,000 1,969,558 0.1451
Colombia 48,321,405 49,336 0.1021
Comoros 734,917 655 0.0891
Congo, Rep. 67,513,677 57,792 0.0856
Costa Rica 4,447,632 3,482 0.0783
Croatia 4,872,166 5,325 0.1093
Cuba 4,252,700 7,038 0.1655
Cyprus 11,265,629 15,952 0.1416
Czech Republic 1,141,166 947 0.0830
Congo, Dem. Rep. 10,521,468 16,634 0.1581
Denmark 5,613,706 8,853 0.1577
Djibouti 872,932 752 0.0861
Dominica 72,003 112 0.1554
Dominican Republic 10,403,761 10,799 0.1038
Ecuador 15,737,878 19,090 0.1213
Egypt, Arab Rep. 82,056,378 74,261 0.0905
El Salvador 6,340,454 6,271 0.0989
Equatorial Guinea 757,014 619 0.0818
Eritrea 6,333,135 5,276 0.0833
Estonia 1,324,612 1,978 0.1493
Ethiopia 94,100,756 86,196 0.0916
Fiji 881,065 1,001 0.1136
Finland 5,439,407 5,793 0.1065
France 66,028,467 91,383 0.1384
Gabon 1,671,711 1,244 0.0744
Gambia, The 1,849,285 1,772 0.0958
Georgia 4,476,900 4,266 0.0953
Germany 80,621,788 102,793 0.1275
Ghana 25,904,598 24,299 0.0938
Greece 11,032,328 14,066 0.1275
Grenada 105,897 165 0.1555
Guatemala 15,468,203 17,943 0.1160
Guinea 11,745,189 11,839 0.1008
Guinea-Bissau 1,704,255 1,595 0.0936
Guyana 799,613 654 0.0818
Haiti 10,317,461 10,658 0.1033
Honduras 8,097,688 10,908 0.1347
Hungary 9,897,247 18,755 0.1895
Iceland 323,002 386 0.1194
India 1,252,139,596 939,105 0.0750
Indonesia 249,865,631 302,088 0.1209
Iran, Islamic Rep. 77,447,168 71,794 0.0927
Iraq 33,417,476 31,713 0.0949
Ireland 4,595,281 6,314 0.1374
Israel 8,059,400 9,494 0.1178
Italy 59,831,093 74,310 0.1242
Jamaica 2,715,000 3,386 0.1247
Japan 127,338,621 146,567 0.1151
Jordan 6,459,000 6,369 0.0986
Kazakhstan 17,037,508 25,710 0.1509
Kenya 44,353,691 50,918 0.1148
Kiribati 102,351 55 0.0535
Korea, Dem. Rep. 24,895,480 26,489 0.1064
Korea, Rep. 50,219,669 63,227 0.1259
Kuwait 3,368,572 2,112 0.0627
Kyrgyz Republic 5,719,500 6,532 0.1142
Lao PDR 6,769,727 8,577 0.1267
Latvia 2,013,385 3,145 0.1562
Lebanon 4,467,390 5,897 0.1320
Lesotho 2,074,465 1,394 0.0672
Liberia 4,294,077 3,899 0.0908
Libya 6,201,521 5,984 0.0965
Lithuania 2,956,121 4,526 0.1531
Luxembourg 543,202 670 0.1234
Macedonia, FYR 2,107,158 2,737 0.1299
Madagascar 22,924,851 27,028 0.1179
Malawi 16,362,567 15,414 0.0942
Malaysia 29,716,965 30,668 0.1032
Maldives 345,023 902 0.2615
Mali 15,301,650 17,306 0.1131
Malta 423,282 483 0.1142
Marshall Islands 52,634 61 0.1152
Mauritania 3,889,880 3,734 0.0960
Mauritius 1,296,303 1,134 0.0875
Mexico 122,332,399 99,701 0.0815
Micronesia, Fed. Sts. 103,549 87 0.0844
Moldova 3,559,000 4,655 0.1308
Monaco 37,831 46 0.1208
Mongolia 2,839,073 5,854 0.2062
Morocco 33,008,150 26,803 0.0812
Mozambique 25,833,752 23,896 0.0925
Myanmar 53,259,018 63,804 0.1198
Namibia 2,303,315 1,278 0.0555
Nepal 27,797,457 32,356 0.1164
Netherlands 16,804,224 24,719 0.1471
New Zealand 4,470,800 5,884 0.1316
Nicaragua 6,080,478 5,880 0.0967
Niger 17,831,270 13,962 0.0783
Nigeria 173,615,345 162,157 0.0934
Norway 5,084,190 6,625 0.1303
Oman 3,632,444 2,713 0.0747
Pakistan 182,142,594 172,671 0.0948
Palau 20,918 20 0.0980
Panama 3,864,170 4,104 0.1062
Papua New Guinea 7,321,262 9,379 0.1281
Paraguay 6,802,295 7,877 0.1158
Peru 30,375,603 34,993 0.1152
Philippines 98,393,574 84,323 0.0857
Poland 38,530,725 65,233 0.1693
Portugal 10,459,806 14,048 0.1343
Qatar 2,168,673 1,919 0.0885
Romania 19,963,581 28,608 0.1433
Russian Federation 143,499,861 186,263 0.1298
Rwanda 11,776,522 13,001 0.1104
Samoa 190,372 102 0.0537
San Marino 31,448 36 0.1150
Sao Tome and Principe 192,993 293 0.1516
Saudi Arabia 28,828,870 20,468 0.0710
Senegal 14,133,280 13,794 0.0976
Serbia 7,163,976 12,265 0.1712
Seychelles 89,173 136 0.1524
Sierra Leone 6,092,075 6,080 0.0998
Singapore 5,399,200 6,279 0.1163
Slovak Republic 5,414,095 8,554 0.1580
Slovenia 2,060,484 3,210 0.1558
Solomon Islands 561,231 482 0.0858
Somalia 10,495,583 10,485 0.0999
South Africa 52,981,991 82,334 0.1554
Spain 46,647,421 56,957 0.1221
Sri Lanka 20,483,000 17,267 0.0843
St. Kitts and Nevis 54,191 78 0.1443
St. Lucia 182,273 215 0.1177
St. Vincent and the Grenadines 109,373 128 0.1167
Sudan 37,964,306 27,524 0.0725
Suriname 539,276 494 0.0916
Swaziland 1,249,514 988 0.0791
Sweden 9,592,552 11,166 0.1164
Switzerland 8,081,482 9,108 0.1127
Syrian Arab Republic 22,845,550 12,634 0.0553
Tajikistan 8,207,834 6,648 0.0810
Tanzania 49,253,126 37,137 0.0754
Thailand 67,010,502 70,964 0.1059
Timor-Leste 1,178,252 1,267 0.1075
Togo 6,816,982 5,951 0.0873
Tonga 105,323 86 0.0820
Trinidad and Tobago 1,341,151 1,529 0.1140
Tunisia 10,886,500 10,505 0.0965
Turkey 74,932,641 86,098 0.1149
Turkmenistan 5,240,072 5,444 0.1039
Tuvalu 9,876 13 0.1314
Uganda 37,578,876 49,905 0.1328
Ukraine 45,489,600 50,903 0.1119
United Arab Emirates 9,346,129 5,533 0.0592
United Kingdom 64,097,085 87,813 0.1370
United States 316,128,839 391,368 0.1238
Uruguay 3,407,062 5,591 0.1641
Uzbekistan 30,241,100 21,139 0.0699
Vanuatu 252,763 244 0.0965
Venezuela, RB 30,405,207 29,797 0.0980
Vietnam 89,708,900 102,089 0.1138
Yemen, Rep. 24,407,381 20,185 0.0827
Zambia 14,538,640 15,440 0.1062
Zimbabwe 14,149,648 16,244 0.1148


Author's Note

This project would not be possible without the support of the various colleagues and resources I have worked with and used in the process of completing this manuscript.

First, I would like to thank Joe Hurley and my colleagues at the Georgia State University Collaborative University Research and Visualization Environment (CURVE) for their help in the use of the equipment and the program Tableau provided at CURVE. Without their help, the images presented in this article would not be possible.

Second, I would like to thank Preston Berger – a student at the University of Georgia that I have known for almost ten years now – for his recommendations, revisions, and additions in order to strengthen the language presented in the report.

Third, I would like to thank the co-author of this manuscript, Maroun Sassine, for his efforts and dedication to this project from the very beginning. His planning and attention to detail are admirable and beneficial to the success of the report.

Finally, and most importantly, I want to thank my family for believing in me; in always supporting me in everything that I do, and encouraging me to reach the unreachable boundaries of life and to persevere with ambition and integrity.

– Charbel Aoun