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Keywords:

  • neoplasm;
  • mortality;
  • surveillance;
  • trends

Abstract

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B

BACKGROUND

Progress against cancer can be examined by analyzing long-term trends in cancer incidence and mortality. The recent directive from the U.S. Department of Health and Human Services to adopt the 2000 U.S. standard population for the age adjustment of death rates prompted the American Cancer Society to update historical cancer mortality statistics using the new standard.

METHODS

Mortality data were abstracted by race, gender, year, and age at death for 1930 through 1959 from annual volumes of Vital Statistics of the United States. For 1960 through 1998, these data were obtained from data tapes provided by the National Center for Health Statistics. Two U.S. standard million populations (1970 and 2000) were used to calculate age-adjusted rates. Average annual percent change was estimated for each decade by site, gender, and age, and the statistical significance of the change was assessed at p < 0.05.

RESULTS

After long-term increases or mostly level trends that date from the 1930s for some sites, death rates for cancers of the lung (in males), prostate, female breast, colon-rectum, pancreas, leukemia, and ovary were decreasing in the 1990s. Liver cancer death rates were increasing in the 1990s. Throughout the study period, death rates for female lung cancer increased, while death rates for stomach and uterine cancers declined.

CONCLUSIONS

The trends of decreasing cancer death rates for the leading cancer sites in the 1990s are encouraging. However, surveillance researchers must continue to monitor these declines to assess whether the progress seen in this decade persists. Efforts also must be made to study the sites with increasing trends and identify potential underlying causes. Cancer 2003;97(12 Suppl):3133–3275. Published 2003 by the American Cancer Society.

DOI 10.1002/cncr.11380

Progress against cancer can be examined by analyzing long-term trends in cancer incidence and death rates. Trends may reflect changes in population and individual cancer risk behaviors, long-term adjustments to societal norms, evolving technology, introduction of new cancer screening modalities, or consensus development of treatment guidelines followed by the increased adoption of a new treatment protocol.1 For example, increasing cigarette use among U.S. men born in 1895 through the 1940s was followed by increased lung cancer incidence and death rates 20–50 years later.2 Changes in societal norms, such as less environmental tobacco smoke at work and in public places, limited youth access to tobacco, and increased taxes on tobacco products, have influenced lung cancer trends.3 Other trends may reflect changes in technology—advances in refrigeration and food preservation may have contributed to decreasing stomach cancer death rates.4 The uptake of new and effective screening examinations among populations with historically low use often leads to increased identification of early-stage lesions and, because early-stage disease often is treated successfully, decreased cancer death rates. For example, increasing mammography screening in the mid-1980s was followed by increased trends in rates of ductal carcinoma in situ and declining trends in breast cancer death rates beginning in 1990.5, 6 The stage at cancer diagnosis may be influenced not only by improvements in screening modalities but also by availability of and access to healthcare. New and effective treatment protocols, such as progressively more effective central nervous system prophylaxis for acute lymphoblastic leukemia in children, may lead to improved survival and reduced death rates.7

Since 1963, the annual American Cancer Society (ACS) publication Cancer Facts & Figures has included long-term trends in cancer death rates from 1930 through 1998.8, 9 The recent directive from the U.S. Department of Health and Human Services to adopt the 2000 U.S. standard population for age adjustment of death rates motivated the ACS to update these cancer mortality statistics by using the more current standard population. The ACS also wanted to make detailed statistics, particularly for deaths occurring before 1960, more accessible to researchers and the public. The current monograph provides cancer death counts and rates (crude, age-specific, and age-adjusted to the 1970 and 2000 U.S. standard populations) for 10 cancer sites plus all sites combined from 1930 through 1998 by age and gender.

METHODS

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B

Mortality Data

Mortality data were abstracted by race, gender, year, and age at death for 1930 through 1959 from annual volumes of Vital Statistics of the United States.10–13 For 1960 through 1998, these data were obtained from data tapes provided by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).14

Cause of death due to specific cancers was coded on death certificates according to the prevailing International Classification of Diseases (ICD). The Fourth Revision was used for deaths in 1930 to 1938; the Fifth Revision for 1939 to 1948; the Sixth Revision for 1949 to 1957; the Seventh Revision for 1958 to 1967; the Eighth Revision, adapted for use in the United States, for 1968 to 1978; and the Ninth Revision for 1979 to 1998.15–20 Over the 69 years covered by the current analysis, the codes used to describe cancer sites changed many times. To allow analysis of comparable trends over time, efforts were made to define the cancer sites consistently over the six editions of the ICD (Appendices A–B). For this reason, some sites were broadly defined for the entire study period. In the text, colon-rectum refers to colon, rectum, anal canal, and small intestine; liver refers to liver, gallbladder, and biliary passages; lung refers to lung, bronchus, trachea, and pleura; ovary refers to ovary, fallopian tube, and broad ligament; and uterus refers to uterine cervix, uterine corpus, and uterus not otherwise specified.

Population Data

Population data were abstracted from U.S. Bureau of the Census Series PE-11 for 1930 to 1939, Series P25-311 for 1940 to 1959, Series P25-519 for 1960 to 1969, Series P25-917 for 1970 to 1979, Series P25-1095 for 1980 to 1989, and the U.S. Census website for 1990 to 1998.21–26 In all years, the population data included U.S. residents; the data for 1940 to 1979 also included armed forces overseas. For decade-years 1930 to 1950, population data were based on July census estimates; for decade-years 1960 to 1990, population data were based on April census estimates, and for other years, population data were based on July intercensal estimates.

Analysis

The 1930 to 1939 population data had been classified into 16 5-year age groups, with 75 years and older as the oldest age category.21 Therefore, the mortality data and standard populations for this decade were modified to reflect this age classification in the calculation of age-specific and age-adjusted rates. From 1940 onward, however, the mortality and population data were reported for 18 5-year age groups, with 85 years and older as the oldest age category.22–26

Data on deaths occurring in Alaska and Hawaii were not reported until those two locations achieved statehood. Therefore, the data presented here exclude mortality and population data from Alaska before 1959 and from Hawaii before 1960.

In 1930 to 1932, all existing states except Texas met the national criteria for completeness of death registration. Although 8 cities in Texas—Beaumont, Dallas, El Paso, Fort Worth, Galveston, Houston, San Antonio, and Waco—met national standards, the mortality data for these cities and the population data for all of Texas were excluded for 1930 to 1932.

Three types of death rates were calculated for the current monograph: crude (or unadjusted), age-adjusted by the direct method to the U.S. standard million population,27 and age-specific. Rates are expressed as deaths per 100,000 persons and are presented by cancer site and gender. Age-specific death counts and rates are presented for 5-year age groups except the youngest (birth to 19 years) and oldest (75 years and older for 1930 to 1939 and 85 years and older for 1940 to 1998). Rates are not presented for age and gender subgroups with death counts of fewer than five.

Two U.S. standard million populations—the 1970 and 2000 populations—were used to calculate age-adjusted rates.28 These standard populations, presented in Table 1 by 5-year age groups, routinely are used to calculate age-adjusted cancer rates. Other agencies that report mortality statistics for cancer and other diseases frequently have used a standard million population based on 10-year age groups.28

Table 1. The 1970 and 2000 U.S. Standard Populations
Age Group (Years)1970a2000b
  • a

    The 1970 U.S. standard population includes residents of the 50 states, the District of Columbia, and armed forces overseas.

  • b

    The 2000 U.S. standard population includes residents of the 50 states and the District of Columbia.

0-484,41669,135
5-998,20472,533
10-14102,30473,032
15-1993,84572,169
20-2480,56166,478
25-2966,32064,529
30-3456,24971,044
35-3954,65680,762
40-4458,95881,851
45-4959,62272,118
50-5454,64362,716
55-5949,07748,454
60-6442,40338,793
65-6934,40634,264
70-7426,78931,773
75-7918,87126,999
80-8411,24117,842
85+7,43515,508
All ages1,000,0001,000,000

The average annual percent change (AAPC) was estimated by fitting a linear regression line to the natural logarithm of the annual rates (r) using calendar year (x) as a regressor variable.29 If ln(r) = mx + b is the resulting regression equation (with slope m and y-intercept b) and j indexes the number of years from 1 to n, then the estimated slope is

  • equation image

and AAPC = 100(em − 1). Testing the hypothesis that the AAPC equals zero is equivalent to testing the hypothesis that the slope of the line represented by the equation ln(r) = mx + b equals zero; that is, the rate is not increasing or decreasing. The test statistic, m/SEm, where SEm is the estimated standard error of m, has a t distribution with degrees of freedom equal to the number of calendar years minus 2. This calculation assumes that the rates changed at a constant rate over the entire calendar-year interval, although the validity of this assumption was not evaluated in the current monograph.6 Statistical significance was assessed at p < 0.05. Other comparisons described in the results were not tested for statistical significance. All data tables and figures are available online from URL: http://www.cancer.org.

Cautions in the Interpretation of Long-Term Trends Data

Trends in cancer mortality may reflect changes in population and individual cancer risk factors, adjustments to societal norms, technological advances, and new screening and treatment protocols. In addition, changes in legislation, death registration, cause of death classification, data collection definitions and operations, and statistical methods may have influenced the observed trends.1 All of these possible explanations need to be considered in trying to interpret the data.

Trends in cancer mortality need to be scrutinized thoroughly to ensure they are not due to changes in the completeness and accuracy of death reporting or changes in coding practices. For example, in the United States, improvements in death registration in the 1930s may have contributed to the increases in cancer death rates observed at that time. In the United States, the vital records and statistics systems began at the local level in the 18th century and progressed to the state level during the 19th century before developing into a national system in the 1930s.30 To be included in the national vital statistics system, a state was required to adopt the recommended death certificate and the model law as well as to obtain 90% completeness of death registration.31 By 1930, 47 of the existing 48 states and the District of Columbia met these qualifications; in 1933, Texas also met the necessary criteria. In 1959 and 1960, Alaska and Hawaii, respectively, reported data to the national vital statistics system. The government agencies responsible for vital statistics long have emphasized the importance of high-quality data and quality control, including tests for completeness and accuracy, queries on incomplete or inconsistent entries on records, updates to classification systems, and improvement in the timeliness and utility of the data.30, 31

Valid comparison and interpretation of cancer trends requires knowledge of changes in data collection definitions and operations.1 Since the 1930s, numerous adjustments have been made to the rules for classifying underlying cause of death, definitions of specific cancers, criteria for malignancy, and even the ICD.15–20 Of all the operational factors, temporal changes in ICD rubrics could influence trends in cancer death rates the most.1 ICD has undergone 10 revisions since it was first published in 1900. ICD-10, which was implemented for the first time with the publication of preliminary 1999 mortality statistics in 2001, is the most recent.32, 33 The effects of changes in ICD classification and rules often are measured in comparability studies.34–37 For accurate interpretation of trends over time, both consistent categorization of related anatomic sites and comparability of cause of death across ICD revisions must be considered for each cancer. Under early ICD rubrics, specific cancers generally were more inclusive of related anatomic detail (e.g., ovary also included broad ligament and fallopian tube); under later ICD rubrics, codes for these related anatomic sites were added.

Combining multiple related sites together can present challenges in the interpretation of mortality trends over time. Appendix A provides the details of the site changes over time for six editions of the ICD. The sites that were aggregated in this study but not aggregated in recent cancer statistics reports6 were: colon-rectum, which refers to colon, rectum, anal canal, and small intestine; liver, which refers to liver, gallbladder, and biliary passages; lung, which refers to lung, bronchus, trachea, and pleura; ovary, which refers to ovary, fallopian tube, and broad ligament; and uterus, which refers to uterine cervix, uterine corpus, and uterus not otherwise specified (Appendix A). Recent compilations of statistics for colon-rectum do not include small intestine and anal canal; for liver, recent compilations do not include gallbladder; for lung, they do not include pleura and trachea; for ovary, they do not include fallopian tube and broad ligament; and for uterus, data are separated into uterine cervix and uterine corpus, including uterus not otherwise specified.6 Some specific subsites may account for only a small proportion of the deaths for the aggregate site and consequently have minimal effect on the magnitude of the overall rate and trends (e.g., ovary and fallopian tube); in contrast, other specific subsites may account for a large proportion of the deaths for the aggregate sites and affect both the magnitude of the overall rate and the trends (e.g., uterine cervix and uterine corpus).

Finally, statistical methods and analysis, such as updates to the standard population used for age adjustment, can affect the magnitude and trends of age-adjusted cancer rates.28 Age adjustment is a statistical method that eliminates differences in age structures and allows for comparison of rates across time or among groups with different characteristics. Cancer incidence and death rates routinely have been age-adjusted to the 1970 U.S. standard population or to the world standard population,6, 38 but in 2001, NCHS of the CDC presented preliminary rates for deaths occurring in 1999 that were age-adjusted to the 2000 U.S. standard population.28, 33 Cancer death rates based on the 2000 standard generally are higher than rates based on the 1970 standard, because the U.S. population has aged considerably since 1970 and now has larger proportions of the population in the middle and older age groups, in which cancer rates are higher. Because the standard populations serve as the weights for calculation of age-adjusted rates, differences in the age structures of the 1970 and 2000 populations directly affect the weighting scheme. Compared with the 1970 standard, the 2000 standard emphasizes death rates at older ages, when mortality is higher, and thus yields age-adjusted rates that are higher than those previously published. The higher death rates based on the 2000 standard do not, however, indicate higher absolute risk, which is best measured using crude death rates. Because age-adjusted death rates measure relative mortality (as opposed to absolute risk), the relative risks will be similar regardless of the standard population used.

Rates for persons who died at age 85 years or older should be interpreted with caution. First, because the 5-year age groups for the standard populations used for age-adjustment of rates do not extend beyond age 85 years,6, 38 the rate for this age group cannot be age-adjusted to remove the effects of aging in the population. Second, this age group has a lower percentage of histologically confirmed cancers than younger age groups, so that the death certificate may indicate cancer when cancer is not present. Evidence for this assertion is derived from the large percentage of death-certificate–only cases among persons age 85 years and older.

The choice of standard population can also affect trends in rates.28 The effect is minimal when trends in age-specific rates are parallel and greater when age-specific trends diverge over time. For example, death rates for cancer at all sites combined are significantly decreasing among persons age 75 years and younger but increasing among older persons.39 The 2000 standard emphasizes trends in older age groups,28 whereas the 1970 standard emphasizes trends in the younger age groups; for example, declining trends for many cancer sites may appear greater using the 1970 standard compared with the 2000 standard. Regardless of the standard population used, age-adjusted rates average the age-specific mortality across age groups and may obscure important age-specific trends. Thus, when trend data are examined for causes of death characterized by diverging age-specific trends, the age-specific trends (rather than age-adjusted trends) should be the primary focus of the analysis.

RESULTS AND DISCUSSION BY CANCER SITE

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B

Among the 10 selected cancer sites, the proportional contribution to overall cancer mortality appeared to decline over the past 7 decades for colon-rectum, liver, stomach, and uterus, and appeared to increase for lung (Table 2). From the 1930s through the 1990s, the proportion due to stomach cancer and cancer of the uterus appeared to decrease substantially: among males, stomach cancer accounted for about 24.6% of cancer deaths in the 1930s but only about 2.9% of cancer deaths in the 1990s, and among females, the proportion appeared to decline from about 14.5% to 2.2% for stomach cancer and from about 20.9% to 4.3% for uterine cancer. Declines in colorectal and liver cancers appeared to be smaller: for both males and females, colorectal cancer accounted for about 15% of cancer deaths in the 1930s and 11% in the 1990s, and liver cancer accounted for about 7% in the 1930s and 3% in the 1990s. In contrast, lung cancer appeared to account for about 5.3% of cancer deaths in males and 2.0% of cancer deaths in females in the 1930s, but by the last decade of the century, these percentages appeared to have increased substantially, to about 33.1% among males and 22.8% among females. The proportion of deaths due to pancreatic cancer among males appeared to increase slightly into the 1960s and then to decrease, but appeared to increase throughout all 7 decades among females. The proportions of cancer deaths due to leukemia and ovarian cancer also appeared to increase into the 1950s and 1960s and then to decrease. The contributions of female breast cancer and prostate cancer to overall cancer mortality did not appear to vary appreciably over the seven decades. Similarly, the proportion of cancer deaths due to cancer at other sites was approximately level at about 30% among males and 23% among females from the 1950s through the 1990s, although proportions for other specific sites were not examined individually.

Table 2. Percent Distribution of Cancer Deaths, by Gender, Decade, and Cancer Site, 1930-1998
Males
DecadeColon, Rectum, and Small IntestineLeukemiaLiver, Gall Bladder, and Biliary PassagesLung, Bronchus, Trachea, and PleuraPancreasStomachProstateUterine cervix, corpus, and not otherwise specifiedOvary, Fallopian Tube, and Broad LigamentOtheraTotal
1930s15.93.16.95.33.524.610.3  30.4100.0
1940s16.94.15.210.64.317.911.2  29.9100.0
1950s14.35.03.517.85.311.510.6  32.1100.0
1960s13.14.92.925.45.77.19.9  31.1100.0
1970s12.24.22.431.85.34.69.9  29.7100.0
1980s11.53.92.334.04.73.410.7  29.5100.0
1990s10.43.92.833.14.62.912.1  30.2100.0
Females
Breast
1930s14.72.08.02.02.414.517.320.93.614.6100.0
1940s16.62.96.33.03.010.517.918.14.816.8100.0
1950s16.44.04.73.64.07.418.613.46.121.8100.0
1960s16.44.33.85.75.05.219.510.16.523.5100.0
1970s15.73.93.011.25.33.619.56.96.324.6100.0
1980s13.83.72.517.85.42.718.65.05.525.0100.0
1990s11.73.52.622.85.52.217.14.35.324.9100.0

Results and discussion of the rate and trend analyses for selected cancers follow: all cancer sites combined, female breast, colon-rectum, leukemia, liver, lung, ovary, pancreas, prostate, stomach, and uterus. Of note, although the rates presented are age-adjusted to both the 1970 and 2000 standard populations, only the rates adjusted to the 2000 standard population are described in the Results and Discussion sections. 

All Cancer Sites Combined

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)45–53, 72a
1939–1948 (ICD-5)45–55, 74a, 74b
1949–1957 (ICD-6)140.0–205
1958–1967 (ICD-7)140.0–205
1968–1978 (ICD-8A)140.0–207.9
1979–1998 (ICD-9)140.0–208.9
Results

In the 1930s, cancer death rates age-adjusted to 2000 for all sites combined were higher among females than among males (Fig. 1; Table 3). By 1940, the rates were similar. From the 1940s through the 1980s, the rates among males exceeded and increasingly diverged from the rates among females. Except for the 1990s, rates among males significantly increased in all decades studied (Fig. 2). The rate of increase for males was greatest in the 1930s and then progressively slowed in subsequent decades; by the 1990s, the rates decreased significantly, by an average of 1.3% per year (Fig. 2).

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Figure 1. Death rates for all cancer sites, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 3. Deaths and Death Rates for All Cancer Sites, by Gender and Year of Death, 1930-1998, United States
inline image
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Figure 2. Average annual percent changea in death rates for all cancer sites, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Among females, cancer death rates were stable during the 1930s and then decreased during the next three decades (Fig. 2). The decline was followed by a leveling off in the 1970s and then by a statistically significant increase in the 1980s. In the last decade of the 20th century, rates among females again declined significantly.

Trends over time in cancer death rates for all sites combined varied by gender and by age. Except for the 1990s, cancer death rates among males age 60 years and older generally increased throughout the study period (Fig. 3; Tables 4, 5). Among younger men, rates generally increased during the 1930s and 1940s before leveling off and beginning to decline (Fig. 3; Table 5). In the 1970s, rates were significantly declining for men younger than age 45 years (Table 5). By the 1990s, cancer death rates were decreasing in all age groups of males; declines were statistically significant except among males ages 20 to 29 years.

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Figure 3. Male death rates for all cancer sites, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 4. Male Deaths and Death Ratesa for All Cancer Sites, by Age at and Year of Death, 1930-1998, United States
inline image
Table 5. Average Annual Percent Change in Death Rates for All Cancer Sites, by Gender and Age at Death, 1930–1998, United States
Age1930–391940–491950–591960–691970–791980–891990–98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75–79, 80–84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Males
0–43.3*1.3−1.3*−4.3*−4.8*−4.1*−3.3*
5–93.8*2.1*1.1−0.9*−4.2*−4.2*−3.2*
10–142.53.3*1.4*−1.1−2.4*−2.7*−2.6*
15–191.12.5*−0.1−0.2−3.1*−3.0*−2.3*
20–242.4*2.1*0.4−0.8−3.7*−2.9*−0.2
25–291.8*1.7*−0.4−1.0−2.3*−1.8*−1.1
30–341.21.4*0.9*−0.6−2.7*−0.5−1.7*
35–391.3*1.6*0.40.7*−2.2*−0.9*−2.2*
40–441.6*0.70.7*1.2*−1.4*−1.6*−1.5*
45–491.4*0.8*0.5*0.9*−0.1−1.4*−2.0*
50–541.7*1.5*1.0*0.6*0.9*−0.9*−2.3*
55–591.1*1.7*0.7*1.1*−0.3*−0.2−2.3*
60–640.8*1.6*1.3*0.9*0.6*0.5*−1.9*
65–691.0*0.8*1.6*1.1*0.4*0.0−1.3*
70–740.6*0.6*0.8*1.5*1.3*0.4*−0.7*
75–79a 1.0*0.31.5*0.8*0.4*−1.3*
80–84a 0.30.8*0.6*1.7*0.9*−1.0*
85+a 2.5*0.8*0.9*2.0*1.0*−0.7*
Females
0–43.8*1.3−1.2*−3.3*−4.9*−2.1*−3.1*
5–93.7*3.4*0.2−1.2−4.6*−3.2*−2.8*
10–143.3*1.90.9−1.5*−3.6*−2.8*−1.3
15–191.9*1.5−1.1−1.5*−3.6*−2.5*−2.5*
20–241.31.3−1.2*0.0−3.1*−1.3−0.7
25–291.7*−0.6−1.3*−2.1*−3.0*−1.6*−0.8
30–340.1−1.0*−0.6−1.3*−2.1*−1.1*−1.1*
35–390.5−0.5−1.1*−1.0*−2.6*−0.8*−1.5*
40–44−0.1−1.0*−1.5*−0.4*−1.7*−1.2*−1.9*
45–49−0.5−0.6*−0.8*−0.3*−1.3*−1.0*−2.5*
50–54−0.1−0.5*−0.8*0.0−0.1−0.5*−2.1*
55–59−0.2−0.1−0.9*0.5*−0.20.0−1.7*
60–64−0.4*−0.5*−0.9*−0.4*1.2*0.7*−1.0*
65–690.1−0.9*−0.2−0.10.51.0*−0.7*
70–74−0.4−0.6*−1.4*−0.30.7*1.4*0.3
75–79a 0.1−1.4*−0.3−0.21.2*0.2
80–84a −0.2−0.4*−1.0*0.6*0.7*0.7*
85+a 1.3*−0.1−0.6*0.30.8*0.5*

Trends by age over time in cancer death rates among females were different than those observed among males (Fig. 4; Tables 5, 6). Among females age 70 years and older, rates generally decreased from the 1930s through the late 1960s, leveled off, and then increased from the late 1970s onward (Table 5). The trends among females ages 55 to 69 years were similar, except for decreasing rates in the 1990s. Among younger women, cancer death rates for all sites combined generally were decreasing after the 1940s.

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Figure 4. Female death rates for all cancer sites, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 6. Female Deaths and Death Ratesa for All Cancer Sites, by Age at and Year of Death, 1930–1998, United States
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Throughout all seven decades, cancer death rates increased with age for both males and females, and the age-specific occurrence of cancer was similar for both genders (Figs. 5–8). From the 1940s through the 1990s, the peak age range at death was 85 years and older for both males and females. Among males, age-specific rates in a given decade generally were higher for each successive decade (Figs. 5, 6). For example, rates among males ages 80 to 84 years ranged from 1410.5 to 1517.5 per 100,000 in the 1940s, compared with 2040.3 to 2229.5 per 100,000 in the 1990s (Table 4). Age-specific rates among females did not follow the same pattern (Fig. 7; Table 6).

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Figure 5. Male age-specific death rates for all cancer sites, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 6. Male age-specific death rates for all cancer sites, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 7. Female age-specific death rates for all cancer sites, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 8. Female age-specific death rates for all cancer sites, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

After long-term increases dating from the 1930s, cancer death rates for all sites combined declined in the 1990s. Joinpoint analyses of trends from 1973 to 1999 indicated that increasing trends reversed to decline in 1993.6 Among males, cancer death rates decreased by 1.5% per year from 1992 through 1999. Trends among females were less pronounced, with an average annual decline of 0.6% from 1992 to 1999. By the mid-1990s, cancer death rates were declining for the 4 cancers that account for more than 50% of all cancer deaths (lung, prostate, female breast, and colon-rectum), except for lung cancer in women. In addition, cancer death rates for most of the remaining top 10 sites (pancreas in males, leukemia, stomach, ovary, and brain and other nervous system) also were decreasing.40

Trends in lung cancer death rates have a strong influence on trends for all cancer sites combined.39 In the current study, 5.3% of all cancer deaths in males and 2.0% of all cancer deaths in females were due to lung cancer in the 1930s. By the 1990s, lung cancer accounted for 33.1% of all cancer deaths in males and 22.8% of all cancer deaths in females (Table 2). Thus, the decrease in overall cancer death rates among males in the 1990s reflects the decrease in lung cancer death rates that began in 1990; declines in prostate and colorectal cancer death rates in the 1990s also contribute to the decreasing trend for all sites combined.6, 39, 40 The recent decrease among females in the 1990s is due primarily to the decrease in breast cancer death rates that began in 1989, the long-term decline in colorectal cancer death rates that began in the late 1940s, and the more recent decrease in lung cancer mortality among women younger than age 65 years.39, 40 

Female Breast Cancer

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)50
1939–1948 (ICD-5)50
1949–1957 (ICD-6)170
1958–1967 (ICD-7)170-
1968–1978 (ICD-8A)174_
1979–1998 (ICD-9)174.0–174.6, 174.8–174.9
Results

In 1998, the death rate for female breast cancer was 27.9 per 100,000 (Table 7). Breast cancer death rates increased significantly in the 1930s, were approximately level from the 1940s through the 1970s, increased significantly in the 1980s, and then decreased significantly in the 1990s (Figs. 9, 10; Table 7).

Table 7. Female Deaths and Death Rates for Cancer of the Breast, by Year of Death, 1930–1998, United States
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Figure 9. Female death rates for cancer of the breast, by year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 10. Average annual percent changea in female death rates for cancer of the breast, by decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Trends over time in breast cancer mortality varied by age (Fig. 11; Tables 8, 9). Among females ages 30 to 59 years, rates generally were level or increasing from the 1930s through the 1960s, declined in the 1970s, leveled off, and then declined significantly in the late 1980s and 1990s. Among older females, rates were level or decreasing in the 1940s and 1950s, increased significantly in the 1980s, and then decreased significantly in the 1990s. In the 1990s, rates significantly decreased across all ages, except for women younger than age 30 years, who experienced nonsignificant declines, and women age 85 years and above, who had approximately level rates (Table 9).

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Figure 11. Female death rates for cancer of the breast, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 8. Female Deaths and Death Ratesa for Cancer of the Breast, by Age at and Year of Death, 1930–1998, United States
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Table 9. Average Annual Percent Change in Female Death Rates for Cancer of the Breast, by Age at Death, 1930–1998, United States
 1930–391940–491950–591960–691970–791980–891990–98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75–79, 80–84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • na = not applicable; estimated annual percent change was not calculated because one or more age-specific rates was equal to zero.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Age
0–19−3.3na−5.1−4.4na−14.8na
20–24−2.53.3−1.9−0.7−4.5−3.4−5.9
25–293.0*1.30.00.1−4.9*−1.5−2.2
30–340.00.80.5−0.3−0.9−1.5*−1.7*
35–390.81.5*−0.3−0.6−1.30.2−2.7*
40–440.60.1−0.20.4−1.4*0.1−3.8*
45–49−0.1−0.10.9*0.5*−1.3*0.1−2.9*
50–540.00.30.6*0.3−0.2−0.6*−2.4*
55–590.10.20.21.6*−0.5*−0.5*−2.6*
60–640.4−1.1*0.01.1*0.8*0.6−2.9*
65–691.6*−0.90.50.5*0.40.6*−3.1*
70–740.5−0.3−1.2*0.20.9*1.4*−1.6*
75–79a 0.4−1.5*−0.2−0.6*1.3*−1.8*
80–84a −0.6−0.1−1.4*0.41.3*−0.7*
85+a 1.50.0−1.2*−0.21.1*0.1

In each of the seven decades, breast cancer death rates increased with age and consistently peaked among the oldest women (Figs. 12, 13); however, the shape of the age-specific curve varied slightly over time. Among females ages 45 to 64 years, age-specific rates were higher in the 1960s and through the 1970s than in the 1990s. Among older women, age-specific rates were higher during the 1980s and 1990s than during the 1960s and 1970s.

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Figure 12. Female age-specific death rates for cancer of the breast, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 13. Female age-specific death rates for cancer of the breast, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

The National Cancer Institute reported a significant decline in breast cancer mortality that began in 1989.6, 41, 42 Breast cancer death rates peaked at about 33 per 100,000 in the late 1980s, decreased on average by 1.4% per year in the early part of the 1990s, and then decreased more rapidly (by 3.2% per year) from 1995 to 1999.6 Possible explanations offered for the recent decline include the increased use of adjuvant therapies and the increasingly widespread inclusion of breast cancer screening in routine medical care.41, 42

Before this downturn, the long-term trend in breast cancer death rates had been described as relatively stable,41, 43, 44 even back as far as the 1930s,44 except for some variations that probably were related to birth cohort patterns that, in turn, may have reflected temporal changes in reproductive behaviors.45 Several recent studies reported slightly increasing rates averaging 0.2% per year (p < 0.05) from 1973 to 1989.46–48 However, joinpoint analyses of death rates from 1973 to 1999 found approximately level rates from 1973 through 1979 and then significantly increasing rates from 1979 through 1989 (0.6% per year).6 This more detailed examination of the trends indicated that the slightly increasing trend previously reported for the entire period from 1973 to 1989 was confined to the 1980s.

The reasons for the increasing trends in breast cancer death rates in the 1980s are not well understood, although they appear to be confined primarily to women age 60 years and older.45, 48 The increasing trends may be related to other established risk factors for breast cancer, possibly including changes in reproductive patterns, use of hormone replacement therapy, and postmenopausal obesity.

Internationally, breast cancer rates vary substantially, with the highest rates found in the United States, Canada, and Northern Europe, and the lowest rates found among Asian and African women.49–51 Evidence that factors in early life influence risk is suggested by migration studies.49 Breast cancer incidence and death rates among migrant populations appear to increase substantially after arrival in the United States. 

Cancer of the Colon, Rectum, Anal Canal, and Small Intestine

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)46c, 46d
1939–1948 (ICD-5)46c, 46d, 46e
1949–1957 (ICD-6)152, 153, 154
1958–1967 (ICD-7)152.0, 152.7–152.9, 153.0–153.3, 153.7–153.9, 154-
1968–1978 (ICD-8A)152.0–152.2, 152.8–152.9, 153.0–153.3, 153.8–153.9, 154.0–154.2
1979–1998 (ICD-9)152.0–152.3, 152.8–152.9, 153.0–153.9, 154.0–154.2, 154.8, 159.0
Results

In the 1930s, death rates for cancers of the colon, rectum, anal canal, and small intestine (hereafter referred to as colon-rectum) were slightly higher among females than among males, and trends for both genders were significantly increasing (Figs. 14, 15; Table 10). Beginning in the late 1930s, however, the rate of increase among females began to slow, and in the 1940s, rates among females crossed over the rates among males. After rates among females peaked at 35.2 per 100,000 in 1947, they declined significantly in all subsequent decades (Fig. 15; Table 10). Among males, death rates for colorectal cancer peaked in 1948 at 35.8 per 100,000 but then were approximately level for the next three decades before declining significantly in the 1980s and 1990s (Figs. 14, 15; Table 10). In 1998, the colorectal cancer death rate was 26.1 per 100,000 among males and 18.6 per 100,000 among females (Table 10).

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Figure 14. Death rates for cancer of the colon, rectum, anal canal, and small intestine, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 15. Average annual percent changea in death rates for cancer of the colon, rectum, anal canal, and small intestine, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 10. Deaths and Death Rates for Cancer of the Colon, Rectum, Anal Canal, and Small Intestine, by Gender and Year of Death, 1930-1998, United States
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Examination of temporal trends in mortality from colorectal cancer by age also revealed differences by gender (Figs. 16, 17; Tables 11–13). In the 1930s, rates increased significantly among both males and females age 40 years and older (Table 12). Among females, rates began to decline for some age groups in the 1940s. Thereafter, except for some leveling off among the oldest women in the 1950s through the 1980s, rates among females generally decreased from the late 1940s until the 1990s, regardless of age (Fig. 17; Tables 12, 13). In contrast, declines among males were not consistent across different ages until the 1980s and 1990s (Fig. 16; Table 12). Decreases in colorectal cancer death rates among males began earlier among younger men than among older men. In the 1980s and 1990s, rates among males were decreasing in most age groups.

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Figure 16. Male death rates for cancer of the colon, rectum, anal canal, and small intestine, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 17. Female death rates for cancer of the colon, rectum, anal canal, and small intestine, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 11. Male Deaths and Death Ratesa for Cancer of the Colon, Rectum, Anal Canal, and Small Intestine, by Age at and Year of Death, 1930-1998, United States
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Table 12. Average Annual Percent Change in Death Rates for Cancer of the Colon, Rectum, Anal Canal, and Small Intestine, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Males
0-19-1.31.8-7.7*-5.3-6.7-8.2*4.5
20-24-1.13.3-3.3-5.5*-7.1*-2.22.4
25-290.7-2.3-2.4-2.2-1.1-3.4*-0.3
30-341.3-1.90.01.2-1.8-1.72.1*
35-393.2*-0.4-2.6*-1.3-0.9-2.0*-2.3*
40-442.9*-1.9*-1.2*-0.20.6-2.3*-0.9
45-493.0*-0.9-1.5*-1.0*-0.7-1.4*-0.9
50-543.1*-0.5-0.6-0.40.0-0.7*-1.7*
55-592.5*-0.2-0.8*0.3-1.1*-1.0*-2.0*
60-643.4*0.1-0.4-0.2-0.3-0.3-1.6*
65-693.6*0.20.00.0-0.2-1.3*-1.8*
70-743.0*0.5-0.30.30.6*-0.7*-1.7*
75-79a 1.4*0.10.6*-0.3-1.2*-3.0*
80-84a 1.3*0.40.20.7*-0.9*-2.6*
85+a 5.0*1.6*0.61.7*-0.6*-2.6*
Females
0-192.4-3.2-10.1*-6.8*-0.1-3.5-2.3
20-242.7-1.8-2.3-6.6*0.2-2.00.2
25-290.6-1.6-0.7-0.9-3.1-5.1*-0.2
30-340.1-2.0*-2.9*-0.3-1.8-1.40.4
35-390.8-1.4-2.2*-2.3*-2.5-1.7*-0.7
40-441.4*-1.8*-3.0*-1.8*-1.8-2.9*-1.1*
45-492.0*-0.7-1.8*-2.1*-1.7*-2.5*-1.0
50-541.9*-0.1-1.3*-1.4*-1.8*-1.7*-2.6*
55-592.3*0.1-1.1*-1.2*-1.7*-2.2*-2.2*
60-641.5*-0.3-1.2*-1.4*-0.4-1.7*-1.7*
65-691.8*-0.6-0.5-0.7*-1.2*-1.7*-2.0*
70-741.8*-0.4-1.1*-0.9*-0.7*-1.6*-1.7*
75-79a 0.6-1.3*-0.9*-0.9*-1.7*-2.0*
80-84a 0.8-0.7*-1.3*0.0-1.9*-1.6*
85+a 3.3*0.3-0.7*0.1-0.3-0.9*
Table 13. Female Deaths and Death Ratesa for Cancer of the Colon, Rectum, Anal Canal, and Small Intestine, by Age at and Year of Death, 1930-1998, United States
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In each of 7 decades, colorectal cancer death rates increased with age for both males and females, except for males age 85 years and older in the 1940s (Figs. 18–21). That is, the peak age range at death from this cancer was 85 years and older, with the same exception that was mentioned previously. In general, except for the 1930s and 1940s, age-specific rates among females in each successive decade were lower than rates for females of the same ages in the previous decade (Fig. 21). Among males, age-specific rates in the 1990s generally were lower than rates for males of the same ages in other decades (Fig. 19).

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Figure 18. Male age-specific death rates for cancer of the colon, rectum, anal canal, and small intestine, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 19. Male age-specific death rates for cancer of the colon, rectum, anal canal, and small intestine, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 20. Female age-specific death rates for cancer of the colon, rectum, anal canal, and small intestine, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 21. Female age-specific death rates for cancer of the colon, rectum, anal canal, and small intestine, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

Reasons for the declines in colorectal cancer mortality rates likely differ for recent years compared with earlier years. Since the early 1970s, advances have been made in the treatment of colorectal cancer, and these advances have had the potential to bring about reductions in colorectal cancer mortality.42, 52 Surgical techniques, including ‘no-touch’ procedures developed during the 1970s and 1980s, lowered the morbidity and mortality from abdominoperineal resection,42 and adjuvant chemotherapy became more widely used after a 1990 consensus conference.42, 53 Colorectal cancer screening may have contributed to the decline in mortality in recent years through detection of disease at an earlier stage,54 although the prevalence of colorectal screening has not been high.42

The extent to which other protective factors,42 such as genetics55 and increased fruit and vegetable consumption,56 aspirin use,57 physical activity,58, 59 and hormone replacement therapy for women,60 contribute to either recent or earlier declines in colorectal cancer incidence and mortality is not well understood. Why the decline among females began about 3 decades before the decline among males is also not clear but may be related to estrogen use (first prescribed to women in the 1940s)61 and aspirin use (women have a higher prevalence of analgesic drug use).62 Further research is needed to understand these differences.

Colorectal cancer rates vary widely internationally.50, 51 Incidence and death rates are highest in the developed regions of the world—Australia, New Zealand, North America, Northern and Western Europe, and Japan—and lowest in Asia and Africa. Geographic variation in colorectal cancer rates may be related to environmental factors, particularly diet. Studies in migrant populations also support diet as a contributing factor63, 64: cancer rates in migrant populations rapidly approach those in the host country populations, frequently during the migrants' generation.43 

Leukemia

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)72a
1939–1948 (ICD-5)74a, 74b
1949–1957 (ICD-6)204
1958–1967 (ICD-7)204.0–204.4
1968–1978 (ICD-8A)204.0–204.1, 204.9, 205.0–205.1, 205.9, 206.0–206.1, 206.9, 207.0–207.2, 207.9
1979–1998 (ICD-9)202.4, 204.0–204.2, 204.8–204.9, 205.0–205.3, 205.8–205.9, 206.0–206.2, 206.8–206.9, 207.0–207.2, 207.8, 208.0–208.2, 208.8–208.9
Results

Male and female death rates for leukemia increased significantly from the 1930s through the 1960s and decreased slightly from the 1970s through the 1990s (Figs. 22, 23; Table 14). Rates among females declined significantly in the last 3 decades, while the decline among males was significant only during the 1980s (Fig. 23). The leukemia death rate peaked at 11.3 per 100,000 in the late 1960s for males, and in 1998, the rate was 10.1 per 100,000 (Table 14). Among females, the rate peaked in 1968 at 6.9 per 100,000, and in 1998, the rate was 5.9 per 100,000.

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Figure 22. Death rates for leukemia, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 23. Average annual percent changea in death rates for leukemia, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 14. Deaths and Death Rates for Leukemia, by Gender and Year of Death, 1930-1998, United States
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Trends in leukemia death rates varied over time by age but did not differ appreciably by gender. For persons younger than age 20 years, rates generally increased in the 1930s and 1940s, leveled off during the 1950s and 1960s, and then decreased in the next three decades (Tables 15–17). In the 1980s and 1990s, rates were significantly decreasing for nearly all age groups younger than age 20 years (Table 16). Rates for persons ages 20 to 59 years increased during the 1930s and 1940s, leveled off during the 1950s, and then continued to be level or declined during the later decades. For persons ages 60 to 69 years, leukemia death rates were significantly increasing from the 1930s through about the 1950s and then generally leveled off in the decades that followed. For persons ages 70 to 79 years, rates increased through the 1960s or 1970s before leveling off. Finally, for males age 80 years and older, leukemia death rates continued to increase through the 1970s and then leveled off (Fig. 24; Table 16). For females ages 80 to 84 years, trends increased through the 1960s and then were approximately level; for older females, trends increased in all decades except the 1970s and the 1990s (Figs. 24, 25; Table 16).

Table 15. Male Deaths and Death Ratesa for Leukemia, by Age at and Year of Death, 1930-1998, United States
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Table 16. Average Annual Percent Change in Death Rates for Leukemia, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Males
0-45.1*1.0-1.7*-4.9*-7.6*-4.4*-4.5*
5-93.1*2.6*2.3*-0.8-5.2*-5.7*-5.1*
10-142.71.9*1.4-1.1-1.4-3.0*-3.6*
15-191.73.4*-0.30.0-1.8-3.1*-4.6*
20-241.12.11.3-1.60.3-0.90.3
25-295.1*2.9*-0.3-2.6*-1.3-2.8*-1.5
30-345.5*3.4*-0.30.2-1.2-0.9-2.5
35-392.21.21.5-0.1-1.1-2.6*-1.5
40-443.9*1.90.2-0.3-1.4-0.8-1.1
45-495.3*2.0*0.0-0.9-0.1-1.7*-1.7*
50-545.5*2.0*0.4-1.00.3-1.4*-2.5*
55-592.5*3.3*0.10.2-1.2*-0.6-1.9*
60-646.0*5.1*1.6*-0.60.1-0.3-0.6
65-695.3*4.3*2.9*0.0-0.7-0.2-0.1
70-746.9*6.3*2.6*1.1*0.1-0.10.5
75-79a 8.5*4.1*1.8*-0.60.10.1
80-84a 5.6*6.2*1.7*1.3*-0.40.2
85+a 13.0*7.2*4.3*2.2*-0.8-0.5
Females
0-47.4*1.0-1.6*-3.9*-7.7*-1.9-2.8
5-94.9*4.3*1.7-0.4-5.9*-5.4*-5.4*
10-146.1*3.6*0.4-2.6*-2.7*-3.0*0.3
15-194.6*1.50.7-2.0-4.0*-3.9*-4.0*
20-245.32.20.40.3-0.5-2.3-0.4
25-292.91.1-2.0-1.4-2.7*-2.7*-1.9
30-344.12.0*-0.1-1.7-0.9-3.3*-2.1
35-393.2*1.7*0.11.1-1.5-3.1*-4.4*
40-445.4*0.4-2.1*0.20.6-2.1*-1.6
45-492.8*0.9-0.4-1.6*-0.6-1.7*-3.1*
50-545.0*2.1*0.1-0.60.2-0.6-2.4*
55-592.74.3*-0.5-1.0-1.4*0.1-1.7*
60-643.6*2.40.4-1.9*0.2-0.1-0.2
65-695.8*5.0*2.2*-0.3-1.1-0.1-0.7
70-745.6*5.0*3.3*0.6-0.70.20.4
75-79a 6.3*2.6*1.2*-0.5-0.9*0.1
80-84a 7.5*6.6*1.9*0.0-0.20.1
85+a 11.3*6.2*5.0*0.90.7*-0.5
Table 17. Female Deaths and Death Ratesa for Leukemia, by Age at and Year of Death, 1930-1998, United States
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Figure 24. Male death rates for leukemia, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 25. Female death rates for leukemia, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Age-specific patterns of leukemia death rates varied across all seven decades (Figs. 26–29). For both genders, the age range in which rates peaked increased from 75 to 79 years in the 1940s to 85 years and older from the 1960s through the 1990s. In general, from the 1930s through the 1950s and 1960s, leukemia death rates for each age group generally were higher in each successive decade (Tables 17, 19). From the 1970s through the 1990s, death rates for each age group were lower in each successive decade than for persons younger than about age 60 years (Tables 17, 19) and were similar across these decades for older persons, except for those age 80 years and older (Figs. 27, 29).

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Figure 26. Male age-specific death rates for leukemia, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 27. Male age-specific death rates for leukemia, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 28. Female age-specific death rates for leukemia, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 29. Female age-specific death rates for leukemia, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

The four major subtypes of leukemia—acute lymphoblastic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia—were given increased attention in medical records and on death certificates only after the implementation of ICD-8 in 1968 (Appendix A).65 Despite the refinement in ICD coding, death certificates may not contain the leukemia cell type, and the level of specification varies substantially within countries and internationally.

The four cell-type groupings of leukemia have different incidence and mortality patterns by age.65 Acute lymphoblastic leukemia peaks once in early childhood (age 2 to 4 years) and again in the elderly (age 85 years and older), whereas chronic myeloid leukemia shows rapid increases between young adulthood (age 25 to 29 years) and the elderly (age 80 to 84 years). In studies that considered all leukemia combined, death rates from leukemia varied by age: these studies reported decreases among children and adolescents beginning in the 1950s, smaller declines among young adults, stability among the middle-aged, and increases among the elderly.66, 67

Decreased leukemia death rates in the youngest age groups generally have been attributed to advances in therapies,66 particularly for acute lymphoblastic leukemia. Childhood leukemia mortality has decreased significantly since the mid-20th century in the United States and in most countries.65

Increased leukemia death rates among adults have been attributed to several different factors, including improvements in cancer registration and diagnosis,66 increased cigarette smoking,66 exposure to hazardous occupational factors such as benzene, styrene, and butadiene,65 environmental agents,65, 67 and ionizing radiation.68 Steady increases in the incidence of acute myeloid leukemia in developed countries and in industrial metropolitan areas suggest the effects of occupational or environmental factors.65 Dairy farming, raising poultry or livestock, and selected crops (including soybean, corn, and grains) may expose farm workers to crop and animal insecticides, herbicides, and fertilizers, as well as viruses. 

Cancer of the Liver, Gallbladder, and Biliary Passages

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)46e
1939–1948 (ICD-5)46f
1949–1957 (ICD-6)155, 156
1958–1967 (ICD-7)155.0–155.1, 155.8, 156– (or 156.1)
1968–1978 (ICD-8A)155.0–155.1, 156.0–156.2, 156.9, 197.8
1979–1998 (ICD-9)155.0–155.2, 156.0–156.2, 156.8–156.9
Results

From the 1930s through the early 1960s, death rates for cancers of the liver, gallbladder, and biliary passages (hereafter referred to as liver cancer) were higher in females than in males; thereafter, rates were higher in males (Fig. 30; Table 18). In 1998, the liver cancer death rate was 8.0 per 100,000 in males and 4.4 per 100,000 in females. Rates among males declined significantly from the 1930s through the 1970s but then increased significantly, by 1.1% per year in the 1980s and by 2.0% per year from 1990 to 1998 (Fig. 31). The lowest rate for males was in the mid-to-late 1970s (5.9 deaths per 100,000) (Table 18). Rates among females decreased significantly from the 1930s through the 1980s and then increased significantly in the 1990s (0.6% per year) (Fig. 31). The lowest rate for females occurred in the late 1980s (4.1 deaths per 100,000) (Table 18).

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Figure 30. Death rates for cancer of the liver, gallbladder, and biliary passages, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 18. Deaths and Death Rates for Cancer of the Liver, Gallbladder, and Biliary Passages, by Gender and Year of Death, 1930-1998, United States
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Table 19. Male Deaths and Death Ratesa for Cancer of the Liver, Gallbladder, and Bililary Passages, by Age at and Year of Death, 1930-1998, United States
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Figure 31. Average annual percent changea in death rates for cancer of the liver, gallbladder, and biliary passages, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Among males, trends over time in liver cancer mortality varied by age but generally decreased from the 1930s into the 1970s and then began to increase (Fig. 32; Tables 19, 20). For males ages 40 to 84 years, rates generally decreased during the 1930s through the 1970s (Table 20). During the 1990s, however, the rates increased sharply, with the largest significant increases observed among males ages 40 to 54 (ages 40 to 44, 3.6% per year; ages 45 to 49, 9.2% per year; ages 50 to 54, 4.9% per year) (Table 20).

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Figure 32. Male death rates for cancer of the liver, gallbladder, and biliary passages, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 20. Average Annual Percent Change in Death Rates for Cancer of the Liver, Gallbladder, and Biliary Passages, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
Males
0-190.00.7-0.9-2.41.0-4.7-1.2
20-240.0-0.44.69.2-4.5-5.21.8
25-29-2.9-2.2-5.5-1.32.6-0.28.9*
30-34-3.3*1.0-1.6-1.0-5.2*0.4-2.3
35-39-1.8-0.6-1.40.5-2.14.5-0.2
40-44-3.7*-0.4-2.8*0.3-2.61.03.6*
45-49-3.5*0.0-4.3*-1.3-1.4-0.59.2*
50-54-2.4*-1.0-1.8*-0.7-0.30.84.9*
55-59-3.4*-1.5-2.9*-0.8-2.2*2.0*2.6*
60-64-3.0*-0.7-1.7*-1.8*-1.5*1.7*2.3*
65-69-3.2*-1.9*-1.1-0.4-1.11.6*2.3*
70-74-3.8*-2.4*-2.2*-1.1*-0.40.82.0*
75-79a -1.2-3.0*-0.2-1.9*0.50.9*
80-84a -2.2*-1.7*-0.3-1.2*1.9*1.4*
85+a -2.3*-2.8*0.70.30.90.0
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Females
0-19-1.70.4-0.1-2.9-1.4-4.5*-2.6
20-24-1.3-2.2-6.414.4*-1.9-5.50.8
25-29-3.4-4.3-9.9*2.61.0-5.63.6
30-34-3.9-3.3-7.3*0.9-5.1-3.34.1
35-39-3.5*-3.7-5.2*-3.6-1.94.0-2.3
40-44-2.0*-3.0-5.4*-2.5-2.9*0.11.4
45-49-4.5*-3.4*-4.3*-1.8-0.7-1.4-1.0*
50-54-4.1*-3.1*-4.7*-1.7*-2.6*0.10.4
55-59-3.9*-2.1*-4.3*-2.1*-1.8-0.1-0.2
60-64-4.1*-2.1*-3.6*-4.5*-2.5*-1.01.2*
65-69-3.6*-2.5*-2.2*-2.0*-3.2*-0.91.7*
70-74-4.2*-2.7*-3.6*-2.9*-2.6*-1.8*1.0
75-79a -2.9*-3.4*-2.3*-2.0*-0.70.7*
80-84a -2.9*-2.2*-2.0*-2.8*-1.3*0.7
85+a -1.5-1.3-1.8*-1.7*-0.2-0.3

Temporal trends in liver cancer mortality among females also varied by age but generally decreased from the 1930s to the 1970s before leveling off or increasing in later decades (Fig. 33; Tables 20, 21). The decreases were sharper and were sustained for a longer time than were the decreases observed among males (Table 20). During the 1930s through the 1970s, rates among females were significantly decreasing in nearly all age groups 35 years and older. By the 1990s, trends were approximately level in most age groups, except for significantly decreasing trends among females ages 45 to 49 years and significantly increasing trends among females ages 60 to 69 and 75 to 79 years.

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Figure 33. Female death rates for cancer of the liver, gallbladder, and biliary passages, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 21. Female Deaths and Death Ratesa for Cancer of the Liver, Gallbladder, and Biliary Passages, by Age at and Year of Death, 1930-1998, United States
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Patterns of age-specific liver cancer death rates varied across all seven decades and were different for males and females (Figs. 34–37). In general, age-specific rates in a given decade were lower for each successive decade, except for males in the 1990s. Among males, rates peaked at ages 80 to 84 years during the 1940s and 1950s but at age 85 years and older during later decades (Fig. 34). For males age 85 years and older, the rate in the 1990s fell between the rates from the 1940s and 1950s. Among females, liver cancer death rates peaked at ages 80 to 84 years in the 1940s and at age 85 years and older thereafter (Fig. 36). Rates in the 1990s among females were similar to those in the 1980s.

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Figure 34. Male age-specific death rates for cancer of the liver, gallbladder, and biliary passages, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 35. Male age-specific death rates for cancer of the liver, gallbladder, and biliary passages, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 36. Female age-specific death rates for cancer of the liver, gallbladder, and biliary passages, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 37. Female age-specific death rates for cancer of the liver, gallbladder, and biliary passages, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

Liver cancer occurs predominantly in males, whereas gallbladder cancer is more frequent in females.69 A primary risk factor for gallbladder cancer is the presence of gallstones, which have been associated with obesity, multiple pregnancies, and exogenous estrogens.70

Although liver cancer is one of the three most common causes of cancer mortality in the world, it is rare among adults born in the United States.69 Worldwide, the hepatitis B virus is associated with 80% of liver cancers.69 Studies of Chinese and Japanese male migrants to the United States show that liver cancer death rates are higher than those in U.S. white populations, possibly because of hepatitis B exposure in Asia.71 In geographic locations where hepatitis B prevalence is low, hepatitis C infection is likely to be the major risk factor for liver cancer.69 In Western countries such as the United States, where hepatitis B or C infection is uncommon, about 3–10% of liver cancers are associated with cirrhosis induced by alcohol. In the United States, alcohol consumption increased from the end of Prohibition in 1933 to a peak in the early 1980s, and it has decreased since then.72 The increase in liver cancer death rates among males beginning in the 1980s may be related to the increases in alcohol and tobacco consumption observed during the 1930s through the 1970s.73 Other risk factors for liver cancer include aflatoxin exposure, occupational vinyl chloride exposure, and oral contraceptive use.69 

Cancer of the Lung, Bronchus, Trachea, and Pleura

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)47b, 47c
1939–1948 (ICD-5)47b–47f
1949–1957 (ICD-6)162, 163
1958–1967 (ICD-7)162.0–162.2, 162.8, 163–
1968–1978 (ICD-8A)162.0–162.1, 163.0
1979–1998 (ICD-9)162.0, 162.2–162.5, 162.8–162.9, 163.0–163.1, 163.8–163.9
Results

From the 1940s through the 1990s, death rates for cancer of the lung, bronchus, trachea, and pleura (hereafter referred to as lung cancer) were 2 to 5 times greater among males than among females (Fig. 38; Table 22). Rates among males increased significantly throughout the first 6 decades and then reversed to decline significantly in the 1990s by about 1.6% per year (Fig. 39). The rate of increase among males slowed in each decade from 10.8% per year in the 1930s to 0.7% per year in the 1980s. The number of deaths due to lung cancer in males also declined during the 1990s. The largest number of lung cancer deaths was 92,885, in 1993, compared with 91,776 in 1998 (Table 22). In contrast, rates among females increased throughout the entire study period. The rate of increase was low in the 1950s, was more than 6% per year during the 1960s and 1970s, and appeared to be slowing again in the 1990s (1.4% per year) (Fig. 39).

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Figure 38. Death rates for cancer of the lung, bronchus, trachea, and pleura, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 22. Deaths and Death Rates for Cancer of the Lung, Bronchus, Trachea, and Pleura, by Gender and Year of Death, 1930-1998, United States
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Figure 39. Average annual percent changea in death rates for cancer of the lung, bronchus, trachea, and pleura, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Trends in lung cancer death rates varied by gender and age (Figs. 40, 41; Tables 23–25). Among males who were at least 85 years old, rates increased through the 1980s, although more slowly, and appeared to level off in the 1990s (Fig. 40; Table 24). Among males ages 60 to 84 years, rates increased from the 1930s through the 1980s before beginning to decline. Among younger men, rates peaked in earlier decades. Lung cancer death rates increased throughout the study period for females age 65 years and older (Fig. 41; Tables 24, 25); in all decades except the 1950s, these rates were significantly increasing (Table 24). Although the rates among these females were significantly increasing in the 1990s, the rate of increase was less than what was seen in the 1980s. Among females ages 45 to 59 years, rates generally increased from the 1930s through the 1980s before decreasing significantly in the 1990s (Table 24). The average annual percent decrease in the 1990s ranged from 1.6% per year among females ages 55 to 59 years to 4.2% per year among females ages 45 to 49 years.

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Figure 40. Male death rates for cancer of the lung, bronchus, trachea, and pleura, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 41. Female death rates for cancer of the lung, bronchus, trachea, and pleura, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 23. Male Deaths and Death Ratesa for Cancer of the Lung, Bronchus, Trachea, and Pleura, by Age at and Year of Death, 1930-1998, United States
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Table 24. Average Annual Percent Change in Death Rates for Cancer of the Lung, Bronchus, Trachea, and Pleura, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
Males
0-192.2−5.0−6.1*1.9−9.2*−5.6−9.3
20-24−1.2−3.1−6.71.7−7.8*−6.9*1.4
25-291.8−2.70.6−3.8−3.2−2.2−0.9
30-345.9*0.24.4*−0.7−4.2*−0.3−3.2
35-396.4*3.8*4.1*3.7*−3.9*−4.1*−3.4*
40-448.1*4.1*3.7*4.4*−1.7*−3.8*−2.3*
45-4910.8*4.8*3.4*3.6*0.4−2.9*−5.2*
50-5411.5*7.3*4.0*2.8*1.9*−1.5*−4.3*
55-5912.8*8.7*4.7*2.9*0.7*−0.1−3.8*
60-6411.2*9.4*6.2*3.2*1.8*0.8*−2.8*
65-6911.2*9.5*7.9*4.2*1.5*0.3*−1.7*
70-749.4*10.3*7.8*5.7*3.0*0.9*−0.4
75-79a 9.6*7.4*7.5*3.2*1.3*−1.1*
80-84a 10.3*7.7*6.9*5.0*2.4*−0.6*
85+a 11.4*6.4*6.7*5.5*3.0*0.1
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Females
0-192.1−5.5−6.13.1−7.7−2.01.0
20-24−2.6−5.4−9.812.6*−1.96.5−4.2
25-292.8−1.61.61.01.03.0−2.3
30-344.8*0.42.3*2.8−1.20.00.3
35-391.51.95.0*6.1*−0.8−3.5*0.4
40-443.5*0.74.5*6.7*2.7*−2.0*−0.1
45-494.7*1.84.7*8.0*4.3*−0.6−4.2*
50-545.9*1.73.3*9.0*4.9*1.3*−2.8*
55-595.5*2.6*1.9*9.5*5.7*2.9*−1.6*
60-643.5*2.3*0.87.4*8.6*4.4*0.0
65-696.0*3.8*1.3*6.9*8.6*5.0*1.3*
70-746.4*4.6*0.15.6*8.1*6.8*2.7*
75-79a 8.6*0.24.6*6.0*7.7*3.0*
80-84a 8.5*1.5*4.0*5.4*6.9*5.1*
85+a 9.5*2.1*3.7*4.0*4.2*4.7*
Table 25. Female Deaths and Death Ratesa for Cancer of the Lung, Bronchus, Trachea, and Pleura, by Age at and Year of Death, 1930-1998, United States
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From the 1930s through the 1990s, age-specific lung cancer death rates among males were progressively higher in each successive decade (Figs. 42, 43). During the 1930s and 1940s, rates among males were less than 100 per 100,000, regardless of age (Fig. 42). By the 1980s and 1990s, however, rates were about 170 per 100,000 among males ages 55 to 59 years and nearly 600 per 100,000 among males ages 80 to 84 years (Fig. 42; Table 23). Across decades, the changing patterns of age-specific lung cancer death rates among females lagged behind the corresponding rates among males (Figs. 42–45). Among females, age-specific rates remained below 50 per 100,000 through the 1960s; by the 1990s, however, rates among females ages 55 to 59 years were about 78 per 100,000 and were more than 200 per 100,000 among females ages 80 to 84 years (Fig. 44; Table 25). Among males, the peak age range increased from 60 to 64 years in the 1940s to 80 to 84 years in the 1990s (Fig. 42); among females, the peak age varied over time (Fig. 44).

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Figure 42. Male age-specific death rates for cancer of the lung, bronchus, trachea, and pleura, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 43. Male age-specific death rates for cancer of the lung, bronchus, trachea, and pleura, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 44. Female age-specific death rates for cancer of the lung, bronchus, trachea, and pleura, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 45. Female age-specific death rates for cancer of the lung, bronchus, trachea, and pleura, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

As much as 90% of all lung cancer is caused by tobacco smoking, including active cigarette smoking, pipe and cigar smoking, and exposure to environmental tobaccco smoke.39, 74, 75 Other exposures, such as radon and asbestos, also increase risk.76 The epidemic of lung cancer in the 20th century largely reflects birth cohort patterns of active cigarette smoking.77, 78 The uptake in cigarette smoking occurred first among males and later among females and then for several decades followed a generational pattern in which successive birth cohorts began smoking at progressively younger ages and a larger proportion of adults became smokers.2 Among men born from 1895 through World War II, 70–80% were cigarette smokers at some time during their lifetime, and many smoked heavily. The prevalence of smoking among women lagged behind the prevalence among men and peaked at 55% in the cohort of women born between 1935 and 1944.

Experimentation with cigarette smoking and nicotine addiction usually occurs in adolescence or during early adulthood, and patterns of smoking behaviors established then tend to persist as the birth cohort ages.79 This phenomenon accounts for the clear birth cohort progression in smoking prevalence and the progression in age-specific lung cancer death rates 20 to 50 years later. The pattern of declining lung cancer death rates in males and the leveling off of lung cancer death rates in females reflect historical patterns of cigarette smoking.77, 78 

Cancer of the Ovary, Fallopian Tube, and Broad Ligament

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)49a
1939–1948 (ICD-5)49a, 49b
1949–1957 (ICD-6)175
1958–1967 (ICD-7)175.0–175.1, 175.8–175.9
1968–1978 (ICD-8A)183.0–183.1, 183.9
1979–1998 (ICD-9)183.0, 183.2–183.5, 183.8–183.9
Results

Death rates for cancer of the ovary, fallopian tube, and broad ligament (hereafter referred to as ovarian cancer) significantly increased from the 1930s through the 1950s, leveled off during the 1960s, declined significantly in the 1970s, and leveled off in the 1980s (Figs. 46, 47; Table 26). In the 1990s, ovarian cancer death rates again were significantly declining, by an average of 0.9% per year. Rates peaked in 1969 and 1970, at 10.5 deaths per 100,000; in 1998, the rate was 8.9 deaths per 100,000.

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Figure 46. Female death rates for cancer of the ovary, fallopian tube, and broad ligament, by year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 47. Average annual percent changea in death rates for cancer of the ovary, fallopian tube, and broad ligament, by decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 26. Female Deaths and Death Rates for Cancer of the Ovary, Fallopian Tube, and Broad Ligament, by Year of Death, 1930-1998, United States
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Trends over time in ovarian cancer death rates varied by age (Fig. 48; Tables 27, 28). Rates for the oldest women increased throughout the entire study period, although the rate of increase declined over time from 5.9% per year in the 1940s to 0.5% per year in the 1990s (Table 28). Trends among females ages 75 to 84 years generally increased from the 1930s through the 1980s and were level thereafter. Trends among females ages 65 to 74 years were increasing from the 1930s through the 1950s, level in the 1960s and 1970s, increasing in the 1980s, and decreasing in the 1990s. Patterns among females younger than age 65 years were similar to trends among females of all ages combined, including increases in the early decades followed by approximately level rates in the 1960s and declines in later decades. From the 1970s through the 1990s, ovarian cancer death rates were significantly decreasing for most women ages 35 to 64 years.

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Figure 48. Female death rates for cancer of the ovary, fallopian tube, and broad ligament, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 27. Female Deaths and Death Ratesa for Cancer of the Ovary, Fallopian Tube, and Broad Ligament, by Age at and Year of Death, 1930-1998, United States
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Table 28. Average Annual Percent Change in Female Death Rates for Cancer of the Ovary, Fallopian Tube, Broad Ligament, by Age at Death, 1930-1998, United States
 1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Age
0-190.6−0.9−0.10.2−5.5*−11.9*−3.0
20-241.60.31.01.7−4.3−2.7−1.9
25-292.8−2.00.9−3.1−3.3*0.7−1.0
30-345.5*−0.2−0.21.2−4.2*−0.81.4
35-393.8*0.6−1.4*−1.1−5.6*−1.2−2.9*
40-443.4*0.7−0.4−1.2−4.1*−2.5−1.8*
45-493.4*1.9*0.6−0.7−3.5*−2.5*−2.6*
50-545.0*2.1*0.90.2−1.3*−2.4*−2.1*
55-594.5*2.6*1.2*0.2−1.7*−1.3*−2.0*
60-644.6*2.0*1.6*−0.1−0.4−0.4−1.5*
65-695.6*3.0*2.9*0.1−0.31.0*−1.9*
70-746.7*3.2*1.5*0.60.21.3*−0.4
75-79a 5.8*1.8*1.3*−0.70.7*0.2
80-84a 4.0*4.2*1.7*2.4*1.4*0.9
85+a 5.9*5.6*2.4*1.3*1.8*0.5*

Patterns of age-specific ovarian cancer death rates varied across all seven decades (Figs. 49, 50). The peak age range increased from 65 to 69 years in the 1930s to 80 to 84 years in the 1990s. Across all decades, age-specific rates among females age 70 years and older were progressively higher in each succeeding decade (Fig. 50).

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Figure 49. Female age-specific death rates for cancer of the ovary, fallopian tube, and broad ligament, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 50. Female age-specific death rates for cancer of the ovary, fallopian tube, and broad ligament, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

Similar patterns of decline in ovarian cancer death rates have been observed among young women internationally.80 These decreases may be related to increased use of oral contraceptives, increases in oophorectomy, or changes in treatment protocols. The widespread use of oral contraceptives in the 1960s may have contributed to the declines80; the pill has been shown to decrease the risk of ovarian cancer by half, and the protection may last as long as 15 years after discontinuation of use.81 In addition, from 1988 through 1993, the percentage of females who had a hysterectomy with concomitant bilateral oophorectomy increased significantly, thereby reducing the number of females at risk of developing ovarian cancer.82

Changes over time in how ovarian cancer is diagnosed and treated also may have influenced trends in ovarian cancer death rates. Improved access to care, tumor visualization, and consequent microscopic confirmation of disease may have contributed to decreasing rates among young females.80 Compared with diagnoses made in earlier time periods, more aggressive diagnosis and treatment in recent decades probably occurred at an earlier stage of disease, leading to better survival. Improvements in treating germ cell tumors, the predominant type of ovarian cancer in women younger than age 45 years, also may have played a role.

In contrast, the increasing trends in ovarian cancer death rates among older females may be related to stage of disease at diagnosis and to changes in fertility patterns during the first half of the 20th century. Diagnoses of ovarian cancer among older women usually occur at a more advanced stage and thus may contribute to the still-increasing trends at these ages.83

Moreover, low parity has been associated with an increased risk of developing and dying of ovarian cancer,84–86 and in the United States, from the mid-1910s to the mid-1940s (before the introduction of oral contraceptives), fertility declined from approximately 3.5 to 2 children per woman.87 

Cancer of the Pancreas

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)46f
1939–1948 (ICD-5)46g
1949–1957 (ICD-6)157
1958–1967 (ICD-7)157–
1968–1978 (ICD-8A)157.0, 157.8–157.9
1979–1998 (ICD-9)157.0–157.4, 157.8–157.9
Results

Pancreatic cancer death rates among males increased significantly from the 1930s through the 1960s, were stable in the 1970s, and declined significantly beginning in the 1980s (Figs. 51, 52; Table 29). The rate peaked in 1968, at 14.2 per 100,000; in 1998, the rate was 12.3 per 100,000. Pancreatic cancer death rates among females increased significantly from the 1930s through the 1970s and appeared to be level during the 1980s and 1990s. In 1998, the rate among females was 9.3 per 100,000.

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Figure 51. Death rates for cancer of the pancreas, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 52. Average annual percent changea in death rates for cancer of the pancreas, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 29. Deaths and Death Rates for Cancer of the Pancreas, by Gender and Year of Death, 1930-1998, United States
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Trends over time varied by age among males (Fig. 53; Tables 30, 31). Pancreatic death rates for men younger than age 45 years remained low throughout the 7 decades (Table 30). For males ages 45 to 79 years, rates generally increased from the 1930s through the 1960s and then leveled off, with significant declines in some age groups in subsequent decades. For males age 80 years and older, steep increasing trends in the early decades were followed by a slower but still upward progression into the 1970s and 1980s, followed by a subsequent leveling off.

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Figure 53. Male death rates for cancer of the pancreas, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 30. Male Deaths and Death Ratesa for Cancer of the Pancreas, by Age at and Year of Death, 1930-1998, United States
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Table 31. Average Annual Percent Change in Death Rates for Cancer of the Pancreas, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • na = not applicable; estimated annual percent change was not calculated because one or more age-specific rates was equal to zero.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Males
0-19−9.8*−1.16.2−11.9*2.1nana
20-244.7−14.9*na2.1−2.6−11.111.7
25-29−3.69.4−4.9−2.0−1.1−2.2−4.7
30-341.9−2.32.20.2−6.4*−1.3−2.7
35-391.70.81.60.3−3.4−1.6−2.4
40-441.61.51.5*1.5−2.0−1.4−0.8
45-492.7*1.32.1*0.6−1.8*−1.7*−0.8
50-543.6*2.9*2.4*0.2−0.7−1.30.3
55-593.3*4.1*1.2*0.7*−1.9*−1.5*−0.7
60-643.7*3.9*2.7*0.4−0.1−0.6*−0.5
65-694.5*3.2*2.8*1.0*−0.9*−0.6*−0.8
70-745.8*3.0*3.1*1.3*−0.1−0.9*−0.4
75-79a 5.9*2.4*1.7*0.0−0.6*−1.0*
80-84a 5.1*3.6*1.2*1.2*−0.4−0.4
85+a 8.2*3.6*2.5*0.80.6*0.0
Females
0-19−4.6na−4.24.27.5nana
20-24nana1.5na−6.9na−4.0
25-291.3−4.5−2.8−7.40.7−5.8−4.8
30-343.20.70.8−1.31.8−2.72.0
35-391.62.13.0−2.4−2.9−1.21.7
40-441.03.1*2.7*0.5−2.6*−3.5*1.5
45-490.81.21.5−0.1−0.8−2.1*−1.7
50-541.2−0.51.5*0.40.0−1.0−0.8
55-591.90.91.0*1.4*−0.3−0.1−0.8*
60-640.22.3*1.9*0.51.3−0.30.2
65-694.0*1.3*2.1*1.1*0.3−0.2−0.8
70-744.2*1.50.8*1.0*0.70.7*0.1
75-79a 3.9*1.1*1.2*0.20.6*0.0
80-84a 3.7*2.9*0.11.2*0.7−0.1
85+a 8.1*2.9*0.50.71.6*0.5*

Declines in pancreatic cancer death rates were not observed for as many age groups among females compared with what was seen among males (Fig. 54; Tables 31, 32). For women younger than age 45 years, rates remained low throughout the study period (Table 32). Among females ages 45 to 59 years, rates appeared to increase from the 1930s through the 1950s or 1960s and then declined from the 1970s into the 1990s; in general, trends were not statistically significant. Rates for females ages 60 to 69 years increased from the 1930s through the 1960s, followed by a leveling of death rates through the 1990s. Rates for females ages 70 to 79 years old showed a steady upward progression from the 1930s through the 1950s, a slower, nonsignificant upward progression during the 1960s through the 1980s, and a leveling off in the 1990s. For females age 80 years and older, rates generally increased throughout the study period, except in the 1960s.

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Figure 54. Female death rates for cancer of the pancreas, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 32. Female Deaths and Death Ratesa for Cancer of the Pancreas, by Age at and Year of Death, 1930-1998, United States
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Patterns of age-specific pancreatic cancer death rates varied by gender across all seven decades (Figs. 55–58). Among males, age-specific rates in a specific decade generally were higher in each successive decade from the 1930s through the 1950s; in later decades, patterns in age-specific rates across decades were more variable (Fig. 56). Among females, age-specific rates generally were higher in each successive decade (Fig. 58). For both genders, rates peaked at ages 80 to 84 years in the 1940s and at age 85 years and older from the 1960s through the 1990s (Figs. 55, 57).

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Figure 55. Male age-specific death rates for cancer of the pancreas, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 56. Male age-specific death rates for cancer of the pancreas, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 57. Female age-specific death rates for cancer of the pancreas, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 58. Female age-specific death rates for cancer of the pancreas, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

The single most consistent risk factor for pancreatic cancer is cigarette smoking.88–90 Per capita cigarette consumption in the United States increased dramatically in the 1940s, peaked in 1963, and then decreased after publication of the first U.S. Surgeon General's report in 1964, which linked cigarette smoking to lung cancer.75, 91 (The 1989 Surgeon General's report mentions the relationship between smoking and other site-specific cancers, including cancer of the pancreas.75) Although different in magnitude, the patterns for male and female pancreatic cancer death rates are similar to those for lung cancer death rates. Cigarette smoking peaked among males before it did among females; the subsequent declines in smoking may explain some of the recent decline in pancreatic cancer death rates among males and the stabilization of rates among females. However, the reasons for the downturn in male pancreatic cancer rates, which began in the 1960s, are not understood fully; smoking prevalence in males was only beginning to decline at that time.39 Other factors that may increase the risk of pancreatic cancer include alcohol,92 diet,88 and a history of diabetes mellitus.93

Pancreatic cancer is difficult to diagnose. In addition to the possible effects of smoking, the increasing trends observed among females over all 7 decades and among males from the 1930s through the 1960s may be related to greater accuracy in diagnosis, as evidenced through increases in microscopically confirmed cases during this time.43

The occurrence of pancreatic cancer varies 30-fold internationally.89 The highest death rates occur in Northern Europe and the United States, and the lowest rates occur in Asia. Mortality rates in Japan currently are comparable to rates in Western countries. 

Cancer of the Prostate

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)51c
1939–1948 (ICD-5)51b
1949–1957 (ICD-6)177
1958–1967 (ICD-7)177–
1968–1978 (ICD-8A)185_
1979–1998 (ICD-9)185_
Results

Prostate cancer death rates increased significantly in the 1930s and 1940s, were level in the next 2 decades, and increased again in the 1970s and 1980s before reversing to decline significantly in the 1990s (Figs. 59, 60; Table 33).

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Figure 59. Male death rates for cancer of the prostate, by year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 60. Average annual percent changea in death rates for cancer of the prostate, by decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 33. Male Deaths and Death Rates for Cancer of the Prostate, by Year of Death, 1930-1998, United States
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Trends over time in prostate cancer mortality varied by age (Fig. 61; Tables 34, 35). In the 1930s, prostate cancer death rates were significantly increasing among males ages 50 to 54 years and age 60 years and older (Table 35). In the 1940s, rates increased significantly among males age 75 years and older. No clear age-specific patterns were observed from the 1950s through the 1960s. In the 1970s, prostate cancer rates were significantly increasing among males age 80 years and older, but in the 1980s, the age range of significantly increasing rates was markedly expanded— rates were significantly increasing among males age 55 years and older. However, between 1990 and 1998, prostate cancer death rates reversed to decline significantly in all age groups that had experienced increasing rates in the 1980s, except for the oldest age group.

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Figure 61. Male death rates for cancer of the prostate, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 34. Male Deaths and Death Ratesa for Cancer of the Prostate, by Age at and Year of Death, 1930-1998, United States
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Table 35. Average Annual Percent Change in Male Death Rates for Cancer of the Prostate, by Age at Death, 1930-1998, United States
 1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • na = not applicable; estimated annual percent change was not calculated because one or more age-specific rates was equal to zero.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Age
0-19na-2.0-9.6*-2.0-6.6-2.6na
20-240.0na1.4nananana
25-294.1na-12.2nananana
30-34-0.30.5nananana1.9
35-39-1.6-5.9-5.5-8.1-7.3-5.11.6
40-441.8-3.4-3.8-3.8-7.3-2.35.1*
45-490.1-2.5*-3.11.2-0.1-2.02.2
50-542.9*0.2-2.5*-1.2-0.40.1-2.1*
55-591.2-0.7-1.0-0.2-0.31.1*-2.9*
60-641.9*-1.0-0.3-0.10.31.1*-4.1*
65-692.8*-1.20.50.20.20.9*-4.0*
70-743.9*-0.4-0.10.10.7*1.2*-3.6*
75-79a 1.4*-0.60.20.40.7*-3.1*
80-84a 1.4*0.8-0.31.0*1.2*-2.5*
85+a 5.6*1.4*0.42.2*1.5*-0.7

In all 7 decades, prostate cancer death rates increased with age; that is, the peak age range at death was 85 years and older (Figs. 62, 63). Except for the oldest age groups (80 to 84 years and 85 years and older), rates at specific ages did not change appreciably over time (Fig. 63).

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Figure 62. Male age-specific death rates for cancer of the prostate, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 63. Male age-specific death rates for cancer of the prostate, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

The etiology of prostate cancer is not well understood but has been postulated to be related to hormonal factors, family history, and diet.94 Understanding the influence of specific factors on trends in prostate cancer death rates is challenging, and specific temporal trends may be related to screening, treatment, and other factors.95–101

Interpretations regarding the effects of screening on the recent declines in prostate cancer mortality have been controversial.96–100 Declining trends in the incidence of late-stage disease96, 97 and increasing trends in local/regional-stage disease97 may be related to screening, treatment, misclassification of cause of death, or other factors. The recent decline, however, could occur only with very short lead times and therefore probably cannot be explained by screening.98 In addition, the regions of the United States with the greatest decreases in prostate cancer mortality appear to be the ones with relatively low use of screening,99 and mortality trends in several countries are inconsistent with an effect of screening.100, 101

The influence of treatment such as radiation, brachytherapy, cryotherapy, and nerve-sparing radical prostatectomy on mortality and quality of life are similarly unclear.46, 96 Substantial evidence for use of androgen suppression therapies in treating late-stage prostate cancer is available from clinical trials,101 and the adoption of these treatments may have contributed to recent declines in prostate cancer death rates.

Finally, the declines may be an artifact resulting from the misattribution of cause of death.98 Attribution bias could have occurred if the cause of death was labeled incorrectly as prostate cancer for men with a recent diagnosis who should have been coded as dying of other causes. A fixed proportion of cases with misattributed causes of death would result in a mortality pattern that approximately corresponded to the incidence pattern of an increase followed by a decline in the 1990s. 

Cancer of the Stomach

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)46b
1939–1948 (ICD-5)46b
1949–1957 (ICD-6)151
1958–1967 (ICD-7)151–
1968–1978 (ICD-8A)151.0–151.1, 151.8–151.9
1979–1998 (ICD-9)151.0–151.6, 151.8–151.9
Results

Over the 7 decades of the study, stomach cancer death rates among males declined significantly, by 85% (from 46.3 per 100,000 in 1930 to 6.8 per 100,000 in 1998) (Fig. 64; Table 36). The largest declines occurred during the 1950s (3.6% per year) and 1960s (4.1% per year) (Fig. 65). Similarly, stomach cancer death rates for females decreased significantly, by 90%, over the same time period, from 35.2 per 100,000 in 1930 to 3.4 per 100,000 in 1998 (Fig. 64; Table 36). The largest declines in female stomach cancer death rates occurred during the 1950s (−4.4% per year) and 1960s (−4.5% per year) (Fig. 65).

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Figure 64. Death rates for cancer of the stomach, by gender and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 36. Deaths and Death Rates for Cancer of the Stomach, by Gender and Year of Death, 1930-1998, United States
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Figure 65. Average annual percent changea in death rates for cancer of the stomach, by gender and decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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For both genders, trends in stomach cancer death rates decreased for all age groups throughout the study period (Figs. 66, 67; Tables 37–39). With few exceptions, the rates of decline were statistically significant for all age groups in each decade (Table 38). The rates for males ages 80 to 84 years were higher than the rates for males age 85 years and older from 1940 through 1944, similar from 1945 through 1954, and lower for the remainder of the study period (Fig. 66). The rates of decline among males and females were greater in the earlier decades than in later decades.

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Figure 66. Male death rates for cancer of the stomach, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 67. Female death rates for cancer of the stomach, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 37. Male Deaths and Death Ratesa for Cancer of the Stomach, by Age at and Year of Death, 1930-1998, United States
inline image
Table 38. Average Annual Percent Change in Death Rates for Cancer of the Stomach, by Gender and Age at Death, 1930-1998, United States
Age1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • na = not applicable; estimated annual percent change was not calculated because one or more age-specific rates was equal to zero.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Males
0-191.46.3-11.3*-3.1-1.5nana
20-24-1.90.5-0.3-4.7-4.4-2.7-5.6
25-29-2.6*-3.0-3.4-2.2-3.5-5.94.9
30-34-2.4-3.7-2.4-3.9-1.10.42.1
35-39-4.0*-1.7-3.3-5.5*-4.7*1.0-2.6
40-44-1.9*-4.3*-4.0*-3.8*-3.0*-1.1-3.8*
45-49-2.4*-3.4*-4.1*-3.5*-3.3*-2.5*-3.4*
50-54-1.4*-2.9*-4.5*-4.6*-1.8*-0.8-4.5*
55-59-2.0*-2.5*-5.2*-3.2*-3.3*-0.8-3.7*
60-64-2.0*-2.4*-4.4*-4.7*-2.9*-1.8*-3.5*
65-69-1.9*-2.3*-3.8*-4.9*-3.4*-2.1*-3.4*
70-74-2.2*-2.1*-3.4*-4.5*-2.9*-2.1*-3.2*
75-79a -1.8*-3.7*-4.1*-3.4*-2.3*-3.3*
80-84a -1.8*-2.9*-3.8*-3.1*-2.7*-2.3*
85+a 0.2-2.7*-3.0*-3.0*-2.3*-3.1*
Females
0-19-0.8-12.3*na-6.4nana-3.8
20-24-3.1-1.30.6-2.76.8na2.0
25-29-2.5-4.2-3.5-1.30.41.82.7
30-34-4.5*-2.9*-3.3-4.3-3.40.21.7
35-39-3.5*-3.8*-3.2*-2.9*-6.0*-2.01.0
40-44-5.0*-4.3*-2.6*-4.3*-3.8*-3.7*1.1
45-49-4.9*-4.1*-4.0*-3.7*-4.4*-3.4*-1.0
50-54-3.7*-3.9*-5.4*-3.4*-3.4*-3.2*-3.5*
55-59-3.3*-3.7*-5.4*-3.5*-3.6*-3.0*-3.3*
60-64-3.2*-3.4*-4.6*-5.4*-2.5*-2.4*-3.4*
65-69-3.5*-4.5*-4.4*-5.1*-3.2*-2.4*-2.4*
70-74-3.4*-4.1*-5.0*-4.4*-3.2*-3.2*-2.5*
75-79a -3.3*-5.2*-4.6*-4.2*-2.8*-2.9*
80-84a -2.6*-4.1*-5.0*-3.3*-2.6*-2.2*
85+a -1.4*-2.8*-4.4*-2.6*-1.9*-2.6*
Table 39. Female Deaths and Death Ratesa for Cancer of the Stomach, by Age at and Year of Death, 1930-1998, United States
inline image

Patterns of age-specific death rates for stomach cancer in males and females varied across all seven decades (Figs. 68–71). Among males, the peak age range increased from 80 to 84 years in the 1940s to 85 years and older beginning in the 1950s (Fig. 68). Among females, the peak age range remained consistent at age 85 years and older from the 1940s onward (Fig. 70). Age-specific rates for a given decade generally were lower than the rates for the same ages in the previous decade (Figs. 69, 71).

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Figure 68. Male age-specific death rates for cancer of the stomach, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 69. Male age-specific death rates for cancer of the stomach, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 70. Female age-specific death rates for cancer of the stomach, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 71. Female age-specific death rates for cancer of the stomach by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

Declining stomach cancer incidence and death rates have been observed internationally.102 The rapid decline in rates suggests an influence of primarily environmental rather than genetic factors.103 Findings from migrant studies, in which second-generation migrants have stomach cancer rates similar to the rates observed in the host country rather than in their native country, provide further evidence of an environmental influence.103 Additionally, healthier eating habits (e.g., increased fruit and vegetable consumption, decreased consumption of foods preserved with salt or by smoking), decreases in salt intake, and widespread availability of refrigeration may have contributed to declines in stomach cancer death rates.102 In addition, rates of Helicobacter pylori infection, a cause of chronic active gastritis and a contributing factor in the development of stomach cancer, have been reduced by improved sanitation and more adequate housing.104 

Cancer of the Uterus

Table  . 
Year (ICD Version)ICD Codes
1930–1938 (ICD-4)48, 55b
1939–1948 (ICD-5)48a, 48b
1949–1957 (ICD-6)171, 172, 173, 174
1958–1967 (ICD-7)171-, 172-, 173-, 174-
1968–1978 (ICD-8A)180_, 181_, 182.0, 182.9
1979–1998 (ICD-9)179_, 180.0–180.1, 180.8–180.9, 181_, 182.0–182.1, 182.8
Results

Death rates for cancer of the uterine cervix, corpus, and uterus not otherwise specified (hereafter referred to as uterus) declined dramatically over time; rates in the 1930s (36.3 per 100,000 in 1930) were 5 times higher than rates in the 1990s (7.2 per 100,000 in 1998) (Fig. 72; Table 40, 41, 42). The largest changes in rates occurred during the 1950s (−3.1% per year), 1960s (−3.5% per year), and 1970s (−3.6% per year) (Fig. 73).

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Figure 72. Female death rates for cancer of the uterus, by year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 40. Female Deaths and Death Rates for Cancer of the Uterus,a by Year of Death, 1930-1998, United States
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Table 41. Female Deaths and Death Ratesa for Cancer of the Uterus,b by Age at and Year of Death, 1930-1998, United States
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Figure 73. Average annual percent changea in death rates for cancer of the uterus, by decade of death, 1930–1998, United States. aAverage annual percent change is based on rates adjusted to 2000 or 1970 U.S. standard population. *Average annual percent change is significantly different from zero (p < 0.05). Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 74. Female death rates for cancer of the uterus, by age at and year of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Table 42. Average Annual Percent Change in Female Death Rates for Cancer of the Uterus, by Age at Death, 1930-1998, United States
 1930-391940-491950-591960-691970-791980-891990-98
  • *

    Average annual percent change is significantly different from zero (p < 0.05).

  • a

    Rates cannot be calculated for 75-79, 80-84, and 85+ because population data are only available for 75+ from 1930 to 1939.

  • na = not applicable; estimated annual percent change was not calculated because one or more age-specific rates was equal to zero.

  • Source: Vital Statistics of the United States [ref. 10–14]; see also Cautions in the Interpretations of Long-Term Trends Data.

Age
0-19-4.0-2.1-5.8-0.6-14.2*na-6.3
20-24-1.7-2.3-3.9*-3.7*-4.5-1.20.7
25-291.6-4.0*-3.3*-4.8*-5.5*-1.8*3.1
30-34-0.6-3.8*-1.4-4.7*-5.8*0.3-1.2*
35-390.6-2.9*-3.0*-4.4*-5.8*-1.1-1.7*
40-44-1.3*-2.8*-4.4*-4.0*-5.4*-1.9*-2.2*
45-49-1.5*-2.0*-4.5*-4.0*-6.7*-1.9*-0.8
50-54-1.1*-2.4*-3.9*-4.7*-4.7*-2.3*-1.7*
55-59-1.3*-1.6*-3.2*-3.7*-3.7*-3.5*-1.4*
60-64-1.2*-1.9*-2.8*-4.4*-2.6*-3.4*-0.6
65-69-0.4-2.4*-2.0*-2.7*-3.0*-2.0*-1.8*
70-74-0.5-1.7*-3.1*-2.8*-3.0*-1.9*-1.7*
75-79a -1.4-3.3*-2.0*-3.1*-1.8*-1.5*
80-84a -1.0*-2.7*-3.5*-1.4*-1.9*-1.1
85+a 0.5-1.4*-2.2*-2.0*-2.2*-0.1

Patterns of age-specific death rates for uterine cancers varied across all seven decades (Figs. 75, 76). The peak age was 80 to 84 years in the 1940s and 85 years and older beginning in the 1950s. Throughout the study period, age-specific rates in each successive decade were lower than in the previous decade (Fig. 76). During the 1930s, females younger than age 45 years had rates that were less than 20 per 100,000; by the 1990s, females younger than age 65 years had rates that were less than 20 per 100,000.

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Figure 75. Female age-specific death rates for cancer of the uterus, separated by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Figure 76. Female age-specific death rates for cancer of the uterus, by age at and decade of death, 1930–1998, United States. Source: Vital Statistics of the United States10–14; see also the section entitled “Cautions in the Interpretation of Long-Term Trends Data” in the current article.

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Discussion

Although the risk factors, etiology, and prevention strategies for cervical cancer are different than those for cancer of the uterine corpus, mortality due to these cancers (plus uterus not otherwise specified) was combined in the current analysis, because separating causes of death reported with respect to these sites was not possible in the early decades. It is noteworthy that the proportion of uterine cancers not specifically categorized as cervix or corpus on death certificates affects the magnitude of the rates for uterine cervix and corpus, although the proportion of tumors not specified as one or the other has decreased markedly over time.46

Mortality due to cancers of the uterine cervix and corpus has been declining since the late 1940s.42, 43 Joinpoint analyses demonstrated that cervical cancer mortality rates declined significantly, by 4.6% per year from 1973 through 1982 and by 1.6% per year from 1982 through 1997; the average annual decline of 5.4% from 1997 to 1999 was not statistically significant.6 Also, death rates due to cancer of the uterine corpus (also called endometrial cancer) declined significantly, by 1.6% per year from 1973 through 1989 and by 0.4% per year from 1989 through 1999.6 Joinpoint analyses of this time interval by age revealed that the largest decrease occurred among women younger than age 50 years from 1973 through 1985 (rate of decrease, 5.0% per year).

The overall decline in death rates for cervical cancer probably is attributable primarily to the introduction of the Papanicolaou (Pap) test in the 1950s and its subsequent broad use, which resulted in increased detection of precancerous lesions of the cervix and earlier detection of invasive tumors.105 A similar early detection tool does not exist for endometrial cancer, but improved treatment methods over time may have influenced the declining trends in endometrial cancer death rates.106

Exogenous hormones may have influenced trends in uterine cancer mortality rates. Widespread introduction of oral contraceptives during the 1960s may have played a role in the decreases in endometrial cancer death rates in recent decades.106 Oral contraceptive use decreases the risk of developing endometrial cancer by half, and this protection lasts at least 15 years after use is stopped.107 The literature regarding the relationship between the pill and cervical cancer has been more difficult to assess,108 but widespread pill use probably did not have a large impact on cervical cancer trends.

Similarly, estrogen replacement therapy did not appear to have a large effect on trends in endometrial cancer mortality. Although a trend of increasing endometrial cancer incidence followed the trend of increasing use of estrogen replacement therapy, particularly among perimenopausal and postmenopausal women, there was not a concomitant increase in endometrial cancer mortality.106

The slowing in the rate of decline in uterine cancer death rates during the 1980s and 1990s may have been influenced by the steadily high prevalence of Pap smear screening in the population in the 1990s109 and by approximately level rates of hysterectomy.82 Hysterectomy is one of the most frequently performed surgeries among U.S. females,82, 110 and it reduces the number of women who are at risk for developing this cancer.

Acknowledgements

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B

The authors thank Kevin Reed of the Centers for Disease Control and Prevention; Emily Brouwer of the University of North Carolina at Chapel Hill; April Harris of the American Cancer Society; Andrea Thomas of Sylvester Comprehensive Cancer Center at the University of Miami for abstracting and/or checking the mortality and/or population data; Janet Weaver of JMW Graphic Design, Inc., for her work on the enhancement of the graphics; and Louis Apicella of the Centers for Disease Control and Prevention for his extensive assistance with the analysis.

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  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B
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APPENDIX A

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B
Table APPENDIX A. Abbreviated version of International Classification of Diseases (ICD) death codes by cancer site, including all cancers sites combined
CANCER SITEICD-4 (1930-1938)ICD-5 (1939-1948)ICD-6 (1949-1957)ICD-7 (1958-1967)ICD-8A (1968-1978)ICD-9 (1979-1998)
  • a

    Uterine corpus and uterine cervix are presented as one cancer site because they cannot be separated until 1946.

All Cancer Sites45-53, 72a45-55, 74a, 74b140.0-205140.0-205140.0-207.9140.0-208.9
Female Breast5050170170-174_174.0-174.6, 174.8-174.9
Colon, Rectum, Anal Canal, and Small Intestine46c, 46d46c, 46d, 46e152, 153, 154152.0, 152.7-152.9, 153.0-153.3, 153.7-153.9, 154-152.0-152.2, 152.8-152.9, 153.0-153.3, 153.8-153.9, 154.0-154.2152.0-152.3, 152.8-152.9, 153.0-153.9, 154.0-154.2, 154.8, 159.0
Leukemia72a74a, 74b204204.0-204.4204.0-204.1, 204.9, 205.0-205.1, 205.9, 206.0-206.1, 206.9, 207.0-207.2, 207.9202.4, 204.0-204.2, 204.8-204.9, 205.0-205.3, 205.8-205.9, 206.0-206.2, 206.8-206.9, 207.0, 207.2, 207.8, 208.0-208.2, 208.8-208.9
Liver, Gallbladder, and Biliary Passages46e46f155, 156155.0-155.1, 155.8, 156- (or 156.1)155.0-155.1, 156.0-156.2, 156.9, 197.8155.0-155.2, 156.0-156.2, 156.8-156.9
Lung, Bronchus, Trachea, and Pleura47b, 47c47b-47f162, 163162.0-162.2, 162.8, 163-162.0-162.1, 163.0162.0, 162.2-162.5,162.8-162.9, 163.0-163.1, 163.8-163.9
Ovary, Fallopian Tube, and Broad Ligament49a49a, 49b175175.0-175.1, 175.8-175.9183.0-183.1, 183.9183.0, 183.2-183.5, 183.8-183.9
Pancreas46f46g157157-157.0, 157.8-157.9157.0-157.4, 157.8-157.9
Prostate51c51b177177-185_185_
Stomach46b46b151151-151.0-151.1, 151.8-151.9151.0-151.6, 151.8-151.9
Uterusa (combined)48, 55b48a, 48b171, 172, 173, 174171-, 172-, 173-, 174-180_, 181_, 182.0, 182.9179_, 180.0-180.1, 180.8-180.9, 181_, 182.0-182.1, 182.8

APPENDIX B

  1. Top of page
  2. Abstract
  3. METHODS
  4. RESULTS AND DISCUSSION BY CANCER SITE
  5. Acknowledgements
  6. REFERENCES
  7. APPENDIX A
  8. APPENDIX B
Table APPENDIX B. Complete version of International Classification of Diseases (ICD) death codes by cancer site
SiteICD-4 (1930-1938)ICD-5 (1939-1948)ICD-6 (1949-1957)ICD-7 (1958-1967)ICD-8A (1968-1978)ICD-9 (1979-1998)
  1. Note: ICD code for anus was not included after 1948. ICD code for duodenum was included beginning in 1939. See note for stomach cancer.

  2. Note: ICD code for mediastinum and other respiratory was not included after 1948.

  3. Note: ICD code for duodenum was not included after 1938.

Female breastCancers and other malignant tumors 50 Of the breast50 Cancer of the breast Cancer of the mammary gland Cancer of nipple Paget's disease of nipple170 Malignant neoplasm of breast Cancer en cuirasse Malignant neoplasm of:  mammary gland  breast  nipple Paget's disease of:  breast  nipple170- Malignant neoplasm of breast Cancer en cuirasse Malignant neoplasm of:  mammary gland  breast  nipple Paget's disease of:  breast  nipple174_ Malignant neoplasm of breast Breast (male) (female)  connective tissue  skin  soft parts Mammary gland Nipple Paget's disease of:  breast  nipple174Malignant neoplasm of female breast Includes:  breast (female)   connective tissue   soft parts  Paget's disease of:  breast  nipple Excludes: skin of breast (172.5, 173.5) 174.0Nipple and areola 174.1 Central portion 174.2Upper-inner quadrant 174.3Lower-inner quadrant 174.4Upper-outer quadrant 174.5Lower-outer quadrant 174.6Axillary tail 174.8 Other Malignant neoplasm of contiguous or overlapping    sites of breast whose point of origin cannot be    determined Ectopic sites 174.9Breast, unspecified
Colon, rectum, anal canal,    and small intestine46 Cancer and other malignant tumors    of the digestive tract and    peritoneum 46c Intestines (except duodenum,    rectum, anus) 46d Rectum and anus46 Cancer of the digestive organs and    peritoneum 46cDuodenum Cancer of duodenum 46d Rectum and anus Cancer of anus lower sigmoid flexure Cancer of rectosigmoid junction  rectum 46e Intestines (except duodenum and rectum) Cancer of appendix  cecum  colon  ileocecal valve  ileum intestinal glands Cancer of the intestines (except duodenum    and rectum)  jejunum  sigmoid flexure  upper sigmoid flexure152 Malignant neoplasm of small intestine, including    duodenum Malignant neoplasm of:  duodenum  ileum Malignant neoplasm of:  jejunum  small intestine 153 Malignant neoplasm of large intestine, except rectum Malignant neoplasm of:  appendix  caecum  caput coli  cecum  colon Malignant neoplasm of:  hepatic flexure  ileocaecum  large intestine  sigmoid flexure  splenic flexure 154 Malignant neoplasm of rectum Excludes malignant neoplasm of anus (191) Malignant neoplasm of:  anal canal (not anus)  rectosigmoid (junction)  rectum152 Malignant neoplasm of small intestine, including    duodenum 152.0Duodenum Malignant neoplasm of duodenum 152.7Other specified parts of small intestine Malignant neoplasm of:  ileum  jejunum 152.8Multiple parts of the small intestine Malignant neoplasm of duodenum and other    specified part of small intestine 152.9Part unspecified Malignant neoplasm of small intestine NOS 153 Malignant neoplasm of large intestine, except  rectum 153.0 Caecum, appendix, and ascending colon Malignant neoplasm of:  appendix  ascending colon  caecum Malignant neoplasm of:  caput coli  ileocaecum 153.1Transverse colon, including hepatic and slenic    flexures Malignant neoplasm of:  hepatic flexure  splenic flexure  transverse colon152 Malignant neoplasm of small intestine, including    duodenum 152.0Duodenum 152.1 Ileum 152.2 Jejunum 152.8Other specified parts Excludes: ileocaecal valve (153.0) 152.9Part unspecified 153 Malignant neoplasm of large intestine, except  rectum 153.0 Caecum, appendix, and ascending colon  caput coli  ileocaecal valve 153.1 Transverse colon, including hepatic and splenic    flexures 153.2 Descending colon 153.3 Sigmoid colon Sigmoid (flexure) Excludes: rectosigmoid junction (154.0) 153.8 Large intestine (including colon), part    unspecified 153.9 Intestinal tract, part unspecified 154 Malignant neoplasm of rectum and rectosigmoid    junction 154.0 Rectosigmoid junction 154.1 Rectum 154.2 Anal canal Anal sphincter Excludes: anus (skin)152 Malignant neoplasm of small intestine, including    duodenum 152.0Duodenum 152.1Jejunum 152.2Ileum Excludes: ileocaecal valve (153.4) 152.3Meckel's diverticulum 152.8Other Malignant neoplasm of contiguous or overlapping    sites of small intestine whose point of origin    cannot be determined Duodenojejunal junction 152.9Small intestine, unspecified 153 Malignant neoplasm of colon 153.0Hepatic flexure 153.1Transverse colon 153.2Descending colon 153.3 Sigmoid colon Sigmoid (flexure) Excludes: rectosigmoid junction (154.0) 153.4Cecum Ileocecal valve 153.5Appendix 153.6Acsending colon 153.7Splenic flexure 153.8 Other Malignant neoplasm of contiguous or overlapping    sites of colon whose point of origin cannot be    determined
    153.2 Descending colon Malignant neoplasm of descending colon 153.3 Sigmoid junction Malignant neoplasm of sigmoid (colon) (flexure) 153.7 Multiple parts of large intestine Malignant neoplasm of sites classifiable to more    than one of the above subdivisions 153.8 Large intestine (including colon), part    unspecified Malignant neoplasm of:  colon NOS  large intestine NOS 153.9 Intestinal tract, part unspecified Malignant neoplasm of intestine, NOS 154- Malignant neoplasm of rectum Excludes malignant neoplasm of anus (190.5,191.5) Malignant neoplasm of:  anal canal (not anus)  rectosigmoid (junction)  rectum(172.6, 173.6)153.9Colon, unspecified Large intestine NOS 154 Malignant neoplams of rectum, rectosigmoid    junction and anus 154.0Rectosigmoid junction Rectosigmoid (colon) Colon with rectum 154.1Rectum Rectal ampulla 154.2 Anal canal Anal sphnicter 154.8 Other Malignant neoplasm of contiguous or overlapping    sites of colon whose point of origin cannot be    determined Anorectum Cloacognic zone 159 Malignant neoplasm of other and ill-defined sites    within the digestive organs and peritoneum 159.0Intestinal tract, part unspecified Intestine NOS
LeukemiaDiseases of the blood and blood-    making organs 72a True leukemias74 Leukemias and aleukemias Excludes:  Pseudo leukemia (Hodgkin's disease) (44b)  Infantile pseudoleukemia (73d)  Agranulocytosis (76a) 74a Leukemias Leukemia Leukocythemia Lymphatic leukemia Lymphochloroma Lymphoid leukemia Myelogenous leukemia Myeloid leukemia 74b Aleukemias Aleukemia Aleukemic leukemia204 Leukaemia and aleukaemia Excludes agranulocytosis 204.0 Lymphatic aleukemia Leukaemia, leukaemia, leukocythaemia, leukosis:  lymphatic (acute)  lymphoblastic (acute)  lymphoid (acute) Lymphocythaemia 204.1 Myeloid leukaemia Leukaemia, aleukamia, leukocythaemia, leukosis:  eosinophilic (acute)  myeloblastic (acute)  myelogenous (acute)  myeloid (acute) Myelaemia Myelocythaemia Myelosis, leukopenic 204.2 Monocytic leukaemia Leukaemia, aleukamia, leukocythaemia, leukosis:  monocytic (acute)  monoblastic (acute) 204.3 Acute leukaemia, unspecified type Leukaemia, aleukaemia, leukocythaemia, leukosis:  acute, unspecified as to type 204.4 Other and unspecified leukaemia Leukaemia, aleukaemia, leukocythaemia, leukosis:  not acute, unspecified as to type Megakaryocytic leukaemia204 Leukaemia and aleukaemia Excludes agranulocytosis (297) 204.0 Lymphatic leukaemia Excludes the listed conditions if specified as acute    (204.3) Leukeamia, aleukaemia, leukocythaemia,    leukosis:  lymphatic  lymphoblastic  lymphoid Lymphocythaemia 204.1 Myeloid leukaemia Excludes listed conditions if specified as acute    (204.3) Leukeamia, aleukaemia, leukocythaemia,    leukosis:  eosinophilic  myeloblastic  myelogenous  myeloid Myelaemia Myelocythaemia Myelosis, leukopenic 204.2 Monocytic leukaemia Leukeamia, aleukaemia, leukocythaemia,    leukosis:  monoblastic (acute)  monocytic (acute)204 Lymphatic leukaemia Includes:  aleukaemia, leukaemia (aleukaemic):   lymphatic   lymphoblastic   lymphogenous   lymphoid 204.0 Acute 204.1 Chronic 204.9 Unspecified 205 Myeloid leukemia Includes:  aleukaemia, leukaemia (aleukaemic):   granulocytic   myeloblastic   myelocytic   myelogenous   myelosclerotic   myelosis, aleukaemic 205.0 Acute 205.1 Chronic 205.9 Unspecified 206 Monocytic leukemia Includes:  aleukaemia, leukaemia (aleukaemic):   histiocytic   monoblastic   monocytic 206.0 Acute202 Other malignant neoplasm of lymphoid and    histiocytic tissue 202.4 Leukaemic Reticuloendotheliosis Hairy-cell leukaemia 204 Lymphoid leukaemia Includes leukaemia:  lymphatic  lymphocytic 204.0 Acute Excludes: acute exacerbation of chronic lymphoid    leukaemia (204.1) 204.1 Chronic 204.2 Subacute 204.8Other 204.9 Unspecified 205 Myeloid leukemia Includes leukaemia:  granulocytic  myelogenous 205.0 Acute Excludes: acute exacerbation of chronic myeloid    leukaemia (205.1) 205.1Chronic 205.2 Subacute 205.3 Myeloid sarcoma Chloroma Granulocytic sarcoma
     206.1 Chronic 206.9 Unspecified 
   Acute erythraemia (Di Giglielmo's disease) (Note: ICD code 204 listed in Vital Statistics volumes; for    completeness, more detailed codes listed in this    table)204.3 Acute leukaemia Leukeamia, aleukaemia, leukocythaemia,    leukosis:  acute, unspecified as to type Any condition in 204.0 or 204.1 specified as acute 204.4 Other and unspecified leukaemia Acute erythraemia (Di Guglielmo's disease) Leukaemia, aleukaemia, leukocythaemia,    leukosis:  not acute, unspecified as to type Megakaryocytic leukaemia207 Other and unspecified leukemia Includes:  aleukaemia, leukaemia (aleukaemic):   NOS   giant cell   megakaryocytic   stem cell 207.0 Leukaemia, acute 207.1 Luekaemia, chronic 207.2 Acute erythraemia  di Guglielmo's disease  erythraemic myelosis (acute) 207.9 Leukaemia, unspecified205.8Other 205.9 Unspecified 206 Monocytic leukaemia Includes:  monocytoid leukaemia 206.0 Acute Excludes: acute exacerbation of chronic monocytic    leukemia (206.1) 206.1 Chronic 206.2 Subacute 206.8 Other 206.9 Unspecified 207 Other specified leukaemia Excludes: leukaemic reticuloendotheloisis (202.4) Plasma cell leukaemia (203.1) 207.0 Acute erythraemia and erythroleukaemia Acute erythraemic myelosis Di Guglielmo's disease 207.2Megakaryocytic leukaemia 207.8Other specified leukaemia Lymphosarcoma cell leukaemia 208 Leukaemia of unspecified cell type 208.0Acute Excludes: acute exacerbation of chronic unspecified    leukaemia (208.1) Acute leukamia NOS Blast cell leukaemia Stem cell leukaemia 208.1Chronic Chronic leukaemia NOS 208.2Subacute Subacute leukaemia NOS 208.8Other 208.9Unspecified Leukaemia NOS
Liver, gall-bladder, and    biliary passages46 Cancer and other malignant tumors    of the digestive tract and    peritonuem 46e Liver and biliary passages46 Cancer of the digestive organs and    peritoneum 46f Liver and biliary passages Cancer of bile duct  gall duct  gallbladder Cancer of liver  Vater's ampulla155 Malignant neoplasm of biliary passages and of liver    (stated to be primary site) Malignant neoplasm of:  ampulla of Vater  biliary duct, passage, or cystic duct Malignant neoplasm of:  gallbladder  gall ducts  liver, stated to be primary site 156 Malignant neoplasm of liver (secondary and    unspecified) Malignant neoplasm of liver:  not stated whether primary or secondary  primary site not specified155 Malignant neoplasm of biliary passages and of    liver (stated to be primary site) 155.0 Liver Malignant neoplasm, stated to be primary site of:  biliary canals, interlobular  canaliculi, biliferous  gall duct, intrahepatic  bile duct or passage  liver 155.1 Gallbladder and extrahepatic gall ducts,    including ampulla of Vater Malignant neoplasm of:  ampulla of Vatter biliary duct or passage:   NOS   extrahepatic155 Malignant neoplasm of liver and intrahepatic bile    ducts, specified as primary 155.0 Liver Carcinoma:  liver, specified as primary  hepatocellular  liver cell Hepatoblastoma 155.1 Intrahepatic bile ducts Canaliculi biliferi Interlobular:  bile ducts  biliary canals Intrahepatic:  canaliculi155 Malignant neoplasm of liver and intrahepatic bile    ducts 155.0Liver, primary Carcinoma:  liver, specified as primary  hepatocellular  liver cell Hepatoblastoma 155.1Intrahepatic bile ducts Canaliculi biliferi Interlobular:  bile ducts  biliary canals Intrahepatic:  biliary passages
   This title is not to be used for primary death classification if the site of the primary neoplasm is known. Not to be used for primary morbidity classification if a primary neoplasm of known site is present.  cystic duct (common) Malignant neoplasm of:  gallbladder  gall duct:   NOS   extrahepatic   hepatic duct biliary passages  gall duct 156 Malignant neoplasm of gallbladder and bile ducts 156.0Gallbladder 156.1Extrahepatic bile ducts Biliary duct or passages (extrahepatic) Common bile ductcanaliculi  gall duct 155.2 Liver, not specified as primary or secondary 156 Malignant neoplasm of gallbladder and    extrahepatic bile ducts 156.0 Gallbladder 156.1 Malignant neoplasm of extrahepatic bile ducts
    155.8 Multiple sites Malignant neoplasm of sites classifiable to both the    above subdivisions 156- Malignant neoplasm of liver (secondary and    unspecified) Malignant neoplasm of liver:  not stated whether primary or secondary  secondary, primary site not specified This title is not to be used for primary death classification if the site of the primary neoplasm is known. Not to be used for primary morbidity classification if a primary neoplasm of known site is present. (Note: This was coded as 156.1 in the actual NCHS data, so 156.1 was used to capture these deaths.)Cystic duct Hepatic duct 156.2Ampula of Vater 156.9 Biliary tract, unspecified 197 Secondary malignant neoplasm of respiratory and digestive systems 197.8Liver, unspecifiedBiliary duct or passage NOS Common bile duct Cystic duct Hepatic duct 156.2 Ampulla of Vater 156.8 Other Malignant neoplasm of contiguous or overlapping    sites of liver whose point of origin cannot be    determined 156.9 Biliary tract, part unspecified Malignant neoplasm involving both intrahepatic    and extrahepatic bile duct
Lung, bronchus, trachea,    and pleura47 Cancer and other malignant tumors    of the respiratory system47b Lungs and pleura 47cOther respiratory organs47 Cancer of the respiratory system 47bTrachea Cancer of trachea 47cBronchus Bronchogenic cancer Cancer of bronchus 47d Lung Cancer of lung Pulmonary cancer 47e Pleura Cancer of pleura 47fMediastinum and unspecified sites Cancer of mediastinal gland Mediastinum Cancer of the respiratory system (part not    specified)162 Malignant neoplasm of trachea, and of bronchus and    lung specified as primary Bronchogenic carcinoma Malignant neoplasm of:  bronchus (specified as primary site)  lung (specified as primary site)  pleura (specified as primary site)  pulmonary (specified as  primary site)  trachea:  NOS  primary Pancoast's tumour unless specified as benign 163 Malignant neoplasm of lung and bronchus, unspecified as to whether primary or secondary Malignant neoplasm of:  bronchus (unspecified as to whether primary or    secondary)  lung (unspecified as to whether primary or secondary)  pleura (unspecified as to whether primary or    secondary)  pulmonary (unspecified as to whether primary or    secondary)162 Malignant neoplasm of bronchus and of trachea,    and of lung specified as primary 162.0 Trachea Malignant neoplasm of trachea  NOS  primary 162.1Bronchus and lung Bronchogenic carcinoma Malignant neoplasm of:  bronchus:   NOS   primary  lung (specified as primary)  pulmonary (specified as primary) Pancoast's tumour, unless specified as benign 162.2 Pleura Malignant neoplasm of pleura specified as primary 162.8 Multiple sites Malignant neoplasm of sites classifiable to more    than one of the above subdivisions 163- Malignant neoplasm of lung, unspecified as to    whether primary or secondary Malignant neoplasm of:  lung (unspecified as to whether primary or    secondary)  pleura (unspecified as to whether primary or    secondary)162 Malignant neoplasm of trachea, bronchus, and    lung 162.0Trachea Cartilage of trachea Mucosa of trachea 162.1 Bronchus and lung Malignant neoplasm of bronchus, lung  NOS  primary Bronchogenic carcinoma Pulmonary carcinoma Pancoast's tumour, unless specified as benign 163 Malignant neoplasm of other and unspecified    respiratory organs 163.0Pleura162 Malignant neoplasm of trachea, bronchus, and    lung 162.0 Trachea 162.2Main bronchus Carina Hilus 162.3 Upper lobe, bronchus or lung 162.4 Middle lobe, bronchus or lung 162.5 Lower lobe, bronchus or lung 162.8 Other Malignant neoplasm of contiguous or overlapping    sites of bronchus or lung whose point of origin    cannot be determined 162.9 Bronchus and lung, unspecified 163 Malignant neoplasm of pleura 163.0Parietal 163.1Visceral 163.8Other Malignant neoplasm of contiguous or overlapping    sites of pleura whose point of origin cannot be    determined 163.9Pleura, unspecified
     pulmonary (unspecified as to whether primary or    secondary)  
Ovary, Fallopian tube, and    broad ligament49 Cancer and other malignant tumors    of other female genital organs 49a Ovary and Fallopian tube49 Cancer of the female genital organs 49a Ovary Cancer of ovary Teratoma of ovary 49b Fallopian tube and parametrium Cancer of Fallopian tube Cancer of parametrium175 Malignant neoplasm of ovary, Fallopian tube, and    broad ligament Malignant neoplasm of:  broad ligament  Fallopian tube  ovary  oviduct  uterine ligament Malignant teratoma (cystic) of:  broad ligament  Fallopian tube  ovary  oviduct175 Malignant neoplasm of ovary, Fallopian tube,    and broad ligament 175.0 Ovary Malignant neoplasm of ovary Malignant teratoma (cystic) of ovary 175.1 Fallopian tube and broad ligament Malignant neoplasm of:  broad ligament  Fallopian tube  oviduct  uterine ligament Malignant teratoma (cystic) of:  broad ligament  fallopian tube  oviduct 175.8Multiple sites Malignant neoplasm of sites classifiable to both the    above subdivisions 175.9 Site unspecified Malignant neoplasm of uterine adnexa NOS183 Malignant neoplasm of ovary, Fallopian tube,    and broad ligament 183.0 Ovary Dysgerminoma Malignant teratoma (cystic of ovary) 183.1 Fallopian tube and broad ligament Oviduct ligament Round ligament Uterine ligament Utero-ovarian ligament Uterosacral ligament 183.9 Part unspecified Uterine adnexa NOS183 Malignant neoplasm of ovary and other uterine    adnexa 183.0 Ovary 183.2 Fallopian tube Oviduct Uterine tube 183.3 Broad ligament 183.4 Parametrium Uterine ligament NOS 183.5 Round ligament 183.8 Other Malignant neoplasm of contiguous or overlapping    sites of ovary whose point of origin cannot be    determined 183.9 Uterine adnexa, unspecified
Pancreas46 Cancer and other malignant tumors    of digestive tract and     peritonium 46f Pancreas46 Cancer of the digestive organs and    peritoneum 46g Pancreas Cancer of pancreas157 Malignant neoplasm of pancreas Malignant islet cell tumour of pancreas Malignant neoplasm of pancreas157- Malignant neoplasm of pancreas Malignant islet cell tumour of pancreas Malignant neoplasm of pancreas157 Malignant neoplasm of pancreas 157.0 Head 157.8Other specified parts Body of pancreas Neck of pancreas Tail of pancreas 157.9 Unspecified157 Malignant neoplasm of pancreas 157.0 Head of pancreas 157.1 Body of pancreas 157.2 Tail of pancreas 157.3 Pancreatic duct Duct of:  Santorini  Wirsung 157.4 Islets of Langerhans Islets of Langerhans, any part of pancreas 157.8 Other Malignant neoplasm of contiguous or overlapping    sites of pancreas whose point of origin cannot    be determined 157.9 Part unspecified
Prostate51 Cancer and other malignant tumors    of the male genitourinary     organs 51c Prostate51 Cancer of the male genital organs 51b Prostate Cancer of prostate177 Malignant neoplasm of prostate Malignant neoplasm of the prostate gland177- Malignant neoplasm of prostate Malignant neoplasm of prostate (gland)185_ Malignant neoplasm of prostate185_ Malignant neoplasm of prostate (excludes    seminal vesicles)
StomachCancer and other malignant tumors of    the digestive tract and    peritoneum46b Stomach and duodenum46 Cancer of the digestive system and    peritoneum 46b Stomach Cancer of cardiac orifice of stomach pylorus Cancer of the stomach Gastric cancer151 Malignant neoplasm of stomach Carcinoma ventriculi Gastric cancer Malignant neoplasm of:  cardia  cardiac orifice151- Malignant neoplasm of stomach Carcinoma ventriculi Gastric cancer Malignant neoplasm of:  cardia  cardiac orifice151 Malignant neoplasm of stomach 151.0 Cardia Cardiac orifice 151.1 Pylorus 151.8 Other specified parts Curvature (greater) (lesser) of stomach151 Malignant neoplasm of stomach 151.0 Cardia Cardiac orifice Cardio-esophageal junction 151.1 Pylorus Prepylorus
   Malignant neoplasm of:  pylorus  stomach (fundus)Malignant neoplasm of:  pylorus  stomach (fundus)Fundus of stomach 151.9 Part unspecified Carcinoma ventriculi Gastric cancerPyloric canal 151.2 Pyloric antrum Antrum of stomach NOS 151.3 Fundus of stomach 151.4 Body of stomach 151.5 Lesser curvature, unspecified Lesser curvature, not classifiable to 151.1-151.4 151.6 Greater curvature, unspecified Greater curvature, not classifiable to 151.0-151.4
      151.8 Other Malignant neoplasm of contiguous or overlapping    sites of stomach whose point of origin cannot    be determined Anterior wall, not classifiable to 151.0-151.4 Posterior wall, not classifiable to 151.0-151.4 151.9 Stomach, unspecified Carcinoma ventriculi Gastric cancer
Uterusa (combined) aUterine corpus and uterine cervix are presented as one cancer site because they cannot be separated until 1946.48 Cancer and other malignant tumor    of the uterus 55b Cancers and other malignant    tumors of uterus (nature    unspecified)48 Cancer of the uterus 48aCervix Cancer of cervix (of uterus) 48bOther and unspecified sites Cancer of fundus (of uterus)  placenta  uterus Cancer of womb  Deciduoma malignum  Syncytioma171 Malignant neoplasm of cervix uteri Malignant neoplasm of:  cervix (uteri)  external os uteri 172 Malignant neoplasm of corpus uteri Malignant neoplasm of:  body of uterus  corpus uteri  fundus of uterus 173 Malignant neoplasm of other parts of uterus,    including chorionepithelioma Chorionepithelioma Chorionic carcinoma Deciduoma malignum Malignant change in uterine fibroid Malignant neoplasm of placenta Syncytioma malignum 174 Malignant neoplasm of uterus, unspecified Malignant neoplasm of uterus, unspecified part171- Malignant neoplasm of cervix uteri Malignant neoplasm of:  cervix (uteri)  external os uteri 172- Malignant neoplasm of corpus uteri Malignant neoplasm of:  body of uterus  corpus uteri  fundus of uterus 173- Malignant neoplasm of other parts of uterus,    including chorionepithelioma (excludes    chorionepithelioma in males) Chorionepithelioma Chorionic carcinoma Deciduoma malignum Malignant change in uterine fibroid Malignant neoplasm of placenta Syncytioma (malignum) 174- Malignant neoplasm of uterus, unspecified Malignant neoplasm of uterus NOS180_ Malignant neoplasm of cervix uteri 181_ Malignant neoplasm of Chorionepithelioma Choriocarcinoma Deciduoma malignum Malignant neoplasm of placenta 182 Other malignant neoplasm of uterus 182.0 Corpus uteri Body of uterus Endometrium Fundus of uterus Myometrium 182.9 Uterus, unspecified Malignant change in uterine fibroid179_ Malignant neoplasm of uterus, part unspecified 180 Malignant neoplasm of cervix uteri 180.0 Endocervix Cervical canal Endocervical canal Endocervical gland 180.1 Exocervix 180.8Other Malignant neoplasm of contiguous or overlapping    sites of cervix uteri whose point of origin    cannot be determined 180.9 Cervix uteri, unspecified 181_ Malignant neoplasm of placenta Choriocarcinoma NOS Chorioepithelioma NOS Excludes:  chorioadenoma (destruens)  hydatidform mole  malignant 182 Malignant neoplasm of body of uterus 182.0 Corpus uteri, except isthmus Cornu Endometrium Fundus Myometrium 182.1 Isthmus Lower uterine segment 182.8 Other Malignant neoplasm of contiguous or overlapping    sites of body of uterus whose point of origin    cannot be determined