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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are standardized by age to the 2000 United States standard million population. A total of 1,479,350 new cancer cases and 562,340 deaths from cancer are projected to occur in the United States in 2009. Overall cancer incidence rates decreased in the most recent time period in both men (1.8% per year from 2001 to 2005) and women (0.6% per year from 1998 to 2005), largely because of decreases in the three major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and in two major cancer sites in women (breast and colorectum). Overall cancer death rates decreased in men by 19.2% between 1990 and 2005, with decreases in lung (37%), prostate (24%), and colorectal (17%) cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2005 decreased by 11.4%, with decreases in breast (37%) and colorectal (24%) cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates has resulted in the avoidance of about 650,000 deaths from cancer over the 15-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years of age. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. CA Cancer J Clin 2009;59:225-249. ? 2009 American Cancer Society, Inc.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Cancer is a major public health problem in the United States and many other parts of the world. Currently, one in four deaths in the United States is due to cancer. In this article, we provide an overview of cancer statistics, including updated incidence, mortality and survival rates, and expected numbers of new cancer cases and deaths in 2009.

Materials and Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Data Sources

Mortality data from 1930 to 2006 in the United States were obtained from the National Center for Health Statistics (NCHS).1 Incidence data for long-term trends (1975–2005), 5-year relative survival rates, and data on lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, covering about 26% of the US population.2, 3, 4, 5 Incidence data (1995–2005) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Center for Disease Control (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR). State-specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and NPCR. Population data were obtained from the US Census Bureau.7 Causes of death were coded and classified according to the International Classification of Diseases (ICD-8, ICD-9, and ICD-10).8, 9, 10 Cancer cases were classi fied according to the International Classification of Diseases for Oncology.11

Estimated New Cancer Cases

The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3–4 years behind the current year because of the time required for data collection and compilation. Estimated new cancer cases in the current year (2009) were projected by using a spatiotemporal model12 on the basis of incidence data from 1995 through 2005 from 41 states and the District of Columbia that met NAACCR's high-quality data standard for incidence, covering about 85% of the US population. The method also considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer-screening behaviors as predictors of incidence, and accounts for expected delays in case reporting.

Estimated Cancer Deaths

We used the state-space prediction method13 to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2009. Projections are based on underlying cause-of-death from death certificates as reported to the NCHS.1 This model projects the number of cancer deaths expected to occur in 2009 on the basis of the number that occurred each year from 1969 to 2006 in the United States and in each state separately.

Other Statistics

We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2006. Causes of death for 2006 were coded and classified according to ICD-10.8 This report also provides updated statistics on trends in cancer incidence and mortality rates, the probability of developing cancer, and 5-year relative-survival rates for selected cancer sites based on data from 1975 through 2005.3 All age-adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population.

The long-term incidence rates and trends (1975 to 2005) are adjusted for delays in reporting where possible. Delayed reporting primarily affects the most recent 1–3 years of incidence data (in this case, 2003–2005), especially for cancers such as melanoma, leukemia, and prostate that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and many specific cancer sites.14 Delay-adjusted rates provide a more accurate assessment of trends in the most recent years for which data are available. Long-term incidence and mortality trends (1975–2005) for selected cancer sites were previously published in the 2008 Annual Report to the Nation on the Status of Cancer.15

We also provide the contribution of individual cancer sites to the total decrease in overall cancer death rates since 1990 in men and since 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age-standardized cancer death rates over these time intervals. The total number of cancer deaths avoided was calculated by applying the age-specific cancer death rates in the peak year for the age-standardized cancer death rates (1990 for males and 1991 for females) to the corresponding age-specific populations in the subsequent years through 2005 to obtain the number of expected deaths in each calendar year had the death rates not decreased. We then summed the difference between the number of expected and observed deaths in each age group and calendar year for men and women separately to obtain the total number of cancer deaths avoided over the 14-year (women) or 15-year (men) interval.

Selected Findings

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Expected Numbers of New Cancer Cases

Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the United States in 2009. The overall estimate of about 1.5 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal-cell and squamous-cell cancers of the skin. More than 1 million additional cases of basal-cell and squamous-cell skin cancers, about 62,280 cases of breast carcinoma in situ, and 53,120 cases of melanoma in situ are expected to be newly diagnosed in 2009. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2009*
 ESTIMATED NEW CASESESTIMATED DEATHS
BOTH SEXESMALEFEMALEBOTH SEXESMALEFEMALE
  • *

    Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  • About 62,280 female carcinoma in situ of the breast and 53,120 melanoma in situ will be newly diagnosed in 2009.

  • Estimated deaths for colon and rectum cancers are combined.

  • More deaths than cases may suggest lack of specificity in recording underlying cause of death on death certificates.

  • Source: Estimated new cases are based on 1995–2005 incidence rates from 41 states and the District of Columbia as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 85% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

All Sites1,479,350766,130713,220562,340292,540269,800
Oral cavity & pharynx35,72025,24010,4807,6005,2402,360
 Tongue10,5307,4703,0601,9101,240670
 Mouth10,7506,4504,3001,8101,110700
 Pharynx12,61010,0202,5902,2301,640590
 Other oral cavity1,8301,3005301,6501,250400
Digestive system275,720150,020125,700135,83076,02059,810
 Esophagus16,47012,9403,53014,53011,4903,040
 Stomach21,13012,8208,31010,6206,3204,300
 Small intestine6,2303,2402,9901,110580530
 Colon106,10052,01054,09049,92025,24024,680
 Rectum40,87023,58017,290   
 Anus, anal canal, & anorectum5,2902,1003,190710260450
 Liver & intrahepatic bile duct22,62016,4106,21018,16012,0906,070
 Gallbladder & other biliary9,7604,3205,4403,3701,2502,120
 Pancreas42,47021,05021,42035,24018,03017,210
 Other digestive organs4,7801,5503,2302,1707601,410
Respiratory system236,990129,710107,280163,79092,24071,550
 Larynx12,2909,9202,3703,6602,900760
 Lung & bronchus219,440116,090103,350159,39088,90070,490
 Other respiratory organs5,2603,7001,560740440300
Bones & joints2,5701,4301,1401,470800670
Soft tissue (including heart)10,6605,7804,8803,8201,9601,860
Skin (excluding basal & squamous)74,61042,92031,69011,5907,6703,920
 Melanoma-skin68,72039,08029,6408,6505,5503,100
 Other nonepithelial skin5,8903,8402,0502,9402,120820
Breast194,2801,910192,37040,61044040,170
Genital system282,690201,97080,72056,16028,04028,120
 Uterine cervix11,270 11,2704,070 4,070
 Uterine corpus42,160 42,1607,780 7,780
 Ovary21,550 21,55014,600 14,600
 Vulva3,580 3,580900 900
 Vagina & other genital, female2,160 2,160770 770
 Prostate192,280192,280 27,36027,360 
 Testis8,4008,400 380380 
 Penis & other genital, male1,2901,290 300300 
Urinary system131,01089,64041,37028,10018,8009,300
 Urinary bladder70,98052,81018,17014,33010,1804,150
 Kidney & renal pelvis57,76035,43022,33012,9808,1604,820
 Ureter & other urinary organs2,2701,400870790460330
Eye & orbit2,3501,2001,150230120110
Brain & other nervous system22,07012,01010,06012,9207,3305,590
Endocrine system39,33011,07028,2602,4701,1001,370
 Thyroid37,20010,00027,2001,630690940
 Other endocrine2,1301,0701,060840410430
Lymphoma74,49040,63033,86020,79010,63010,160
 Hodgkin lymphoma8,5104,6403,8701,290800490
 Non-Hodgkin lymphoma65,98035,99029,99019,5009,8309,670
Myeloma20,58011,6808,90010,5805,6404,940
Leukemia44,79025,63019,16021,87012,5909,280
 Acute lymphocytic leukemia5,7603,3502,4101,400740660
 Chronic lymphocytic leukemia15,4909,2006,2904,3902,6301,760
 Acute myeloid leukemia12,8106,9205,8909,0005,1703830
 Chronic myeloid leukemia5,0502,9302,120470220250
 Other leukemia5,6803,2302,4506,6103,8302,780
Other & unspecified primary sites31,49015,29016,20044,51023,92020,590
Table 2. Age-standardized Incidence Rates for All Cancers Combined, 2001–2005, and Estimated New Cases* for Selected Cancers by State, United States, 2009
STATEINCIDENCE RATEALL CASESFEMALE BREASTUTERINE CERVIXCOLON & RECTUMUTERINE CORPUSLEUKEMIALUNG & BRONCHUSMELANOMA OF THE SKINNON-HODGKIN LYMPHOMAPROSTATEURINARY BLADDER
  • *

    Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  • Rates are per 100,000 and age adjusted to the 2000 US standard population.

  • Estimate is fewer than 50 cases.

  • §

    Combined incidence rate is not available.

  • Note: These model-based estimates are calculated by using incidence rates from 41 states and the District of Columbia as reported by NAACCR. They are offered as a rough guide and should be interpreted with caution. State estimates may not add to the US total because of rounding and exclusion of states with fewer than 50 cases.

  • Source: North American Association of Central Cancer Registries (NAACCR), based on data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. Rates for Alabama, Louisiana, Mississippi, and Texas are for cases diagnosed through June 2005.

Alabama449.224,0902,9701902,4805105904,0409309502,800960
Alaska466.12,530370250707035080110360120
Arizona416.827,6003,4702102,6806608103,9601,4601,2503,5301,460
Arkansas455.414,8001,8201301,5403104202,5805006802,140610
California446.2152,17021,7401,35014,6804,2304,57017,9109,0807,14020,7906,870
Colorado447.120,3402,8401501,8605307202,2401,2609203,070940
Connecticut508.320,6502,7901101,9506605402,7201,2609202,4001,120
Delaware507.34,690600440140120800220190550220
Dist. of Columbia§2,6003402608050370709038090
Florida470.3102,21012,65080010,4202,5903,18017,7904,9204,64012,3805,490
Georgia465.539,0805,3703403,7509301,0806,1502,0401,5605,2101,400
Hawaii426.86,40087050710200160740320260860220
Idaho462.26,8008106301702508203803301,170340
Illinois487.460,9607,6104806,4301,9601,9409,1802,0102,9007,5903,100
Indiana469.531,3203,7102203,2609709305,3601,1701,4203,2501,550
Iowa481.016,7402,080901,8005005902,6209107502,330870
Kansas§13,0801,790901,2904003802,1106106001,970620
Kentucky512.824,0602,8401802,6205906904,6501,2609802,9101,070
Louisiana497.722,1702,7001902,3304306603,6506309603,160910
Maine527.29,0001,080508702702701,3904803601,130500
Maryland§26,6503,6601902,6208406404,0601,3101,1203,5801,110
Massachusetts514.936,0804,8002003,3801,1401,0005,1202,0301,6104,2002,010
Michigan509.153,5506,4803205,0201,7001,6908,1902,2402,4707,0102,810
Minnesota481.023,6703,2801402,5208108903,3108901,1304,9101,200
Mississippi§14,1501,8201301,4802703602,3403805401,990540
Missouri467.730,0903,8802203,1008708805,6001,2601,2503,6201,450
Montana477.65,340640520140170730220240810270
Nebraska474.48,8101,200609502702901,2304204001,410450
Nevada471.712,0201,3501101,2402703801,9104804801,660630
New Hampshire507.07,6301,0107302402101,100460310910420
New Jersey515.747,9206,4404104,5901,6201,3806,2502,5302,1606,0602,640
New Mexico421.08,8301,090808102103109704603601,400350
New York489.1101,55013,5308709,9703,5103,14013,5503,7104,54012,5205,360
North Carolina§42,2705,4703404,2301,0301,1506,6702,1901,7306,1301,790
North Dakota458.73,20041035090110420110140560180
Ohio§62,4207,3403906,0601,9301,95010,6902,0802,8006,5102,990
Oklahoma466.418,1102,3401401,8604005803,2206908202,190770
Oregon472.819,2102,6801101,7805704902,6101,2209102,5101,020
Pennsylvania503.674,1709,3805007,5902,5502,20010,4803,4403,3308,1304,160
Rhode Island514.56,250810590190180900340260650370
South Carolina475.222,1002,8201702,1505205903,6801,0908702,910880
South Dakota474.54,120530440120140590180180740230
Tennessee§32,5703,9702403,4907201,0005,3701,4101,3704,7901,380
Texas454.998,20013,0909809,8002,2203,47014,1503,8204,53013,1303,720
Utah411.88,8801,080607702503306206004401,570360
Vermont§3,550480330120100500200140540190
Virginia440.334,1504,8502403,3801,0208405,3301,7901,4504,8301,430
Washington499.032,2904,5201902,8909609904,1301,9701,5404,6801,660
West Virginia490.510,2301,180701,0703302902,0304504201,210510
Wisconsin§27,5603,4801602,7701,0009803,9601,0401,3102,7701,530
Wyoming447.92,5003002407070320130110390130
United States476.61,479,350192,37011,270146,97042,16044,790219,44068,72065,980192,28070,980

Figure 1 indicates the most common cancers expected to occur in men and women in 2009. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 50% of all newly diagnosed cancers. Prostate cancer alone accounts for 25% (192,280) of incident cases in men. On the basis of cases diagnosed between 1996 and 2004, an estimated 91% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which 5-year relative survival approaches 100%.

thumbnail image

Figure 1. Ten Leading Cancer Types for Estimated New Cancer Cases and Deaths, by Sex, United States, 2009.

*Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10.

Download figure to PowerPoint

The three most commonly diagnosed types of cancer among women in 2009 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 27% (192,370) of all new cancer cases among women.

Expected Number of Cancer Deaths

Table 1 also shows the expected number of deaths from cancer projected for 2009 for men, women, and both sexes combined. It is estimated that about 562,340 Americans will die from cancer, corresponding to more than 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common fatal cancers. These four cancers account for almost half of the total cancer deaths among men and women (Fig. 1). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 26% of all female cancer deaths in 2009. Table 3 provides the estimated number of cancer deaths in 2009 by state for selected cancer sites.

Table 3. Age-standardized Death Rates for All Cancers Combined, 2001–2005, and Estimated Deaths* for Selected Cancers by State, United States, 2009
STATEDEATH RATEALL SITESBRAIN & OTHER NERVOUS SYSTEMFEMALE BREASTCOLON & RECTUMLEUKEMIALIVERLUNG & BRONCHUSNON-HODGKIN LYMPHOMAOVARYPANCREASPROSTATE
  • *

    Rounded to the nearest 10.

  • Rates are per 100,000 and age adjusted to the 2000 US standard population.

  • Estimate is fewer than 50 deaths.

  • Note: State estimates may not add to US total due to rounding and exclusion of states with fewer than 50 deaths.

  • Source: US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

Alabama206.29,9002007009403402803,140290270550510
Alaska186.5830607022050
Arizona167.510,2602807409704103602,820350290630580
Arkansas207.36,2301304105802501902,160200130400340
California173.154,6001,4604,0304,8302,2002,45012,7501,9001,5803,7402,780
Colorado166.46,7402005206703002101,670230210430350
Connecticut184.36,9901504805502702101,810220180540390
Delaware204.31,8605011015070505905011090
Dist. of Columbia209.597070100502406060
Florida180.141,2708102,7303,4601,6501,30012,2101,5609702,4702,280
Georgia194.214,9703201,1301,3705504004,660460400870800
Hawaii152.22,270140210801205708050170100
Idaho173.42,45090160200120806308050200160
Illinois197.623,2204701,7702,2609507006,4607706001,5601,150
Indiana205.112,8202908601,1305203504,000420340770520
Iowa185.96,3601604006003001501,760280170380330
Kansas187.05,2901503705102001401,620180150330210
Kentucky222.79,4101505908403202403,430300210500390
Louisiana221.08,8102106909103103302,700310210530450
Maine206.83,19080180260110809809070200160
Maryland196.610,3202008109403903202,880300260690550
Massachusetts193.413,1402708701,0704904203,610430350880540
Michigan195.320,4504901,3501,7208206105,8407105201,250820
Minnesota178.89,0202306007603702602,380320240580410
Mississippi211.96,0901604306002201902,030180140350300
Missouri201.912,6202708901,1005303604,100430290750660
Montana186.61,9805012017090505507050120120
Nebraska179.63,360802103501508089013090190200
Nevada197.14,6001203305001401601,340130120280230
New Hampshire193.02,62070170220100707506060170130
New Jersey193.416,4803201,4701,5806105404,1906104501,080660
New Mexico167.33,3008024032012015071011090220210
New York179.934,1907902,5503,1101,3801,2108,7801,4309702,3601,470
North Carolina196.118,5503301,3101,4106404705,6305304301,090860
North Dakota176.31,300801205037090100
Ohio204.124,3505501,7902,2108906407,3007405801,4301,200
Oklahoma200.17,4201705206002902002,390240170380280
Oregon192.07,3802105006102902102,140330220470390
Pennsylvania198.528,6905502,0702,5501,0807908,0901,0907601,9201,440
Rhode Island194.72,2205013016090705607060120100
South Carolina200.79,1001906407803302502,880310210530420
South Dakota182.81,640100150604507050100100
Tennessee211.213,3403509101,1404803504,520440310730570
Texas184.936,0308502,5703,1401,4301,6509,7801,3008902,1201,700
Utah140.92,7601002602401307048013090190170
Vermont183.61,15080120603507060
Virginia194.713,9202901,1401,2705003904,250410380880620
Washington187.111,2103807909404504103,090410340710680
West Virginia213.44,530902804301401101,500180120210140
Wisconsin186.711,1702607509005003202,910400300710500
Wyoming180.09906010026060
United States189.8562,34012,92040,17049,92021,87018,160159,39019,50014,60035,24027,360

Regional Variations in Cancer Rates

Table 4 depicts cancer incidence rates for selected cancer sites by state. By far, the largest variation in incidence among the cancer sites listed in Table 4 is seen for lung cancer, where rates (cases per 100,000 population) range from 39.6 in men and 22.4 in women in Utah to 136.2 in men and 76.2 in women in Kentucky. This variation reflects the large and continuing differences in smoking prevalence among states. Utah ranks lowest in adult-smoking prevalence and Kentucky highest. In contrast, state variation in the incidence rates of other cancer sites shown in Table 4 was smaller in both absolute and proportionate terms. For prostate and female breast cancers in particular, variation in incidence reflects differences in the use of screening tests in addition to differences in disease occurrence.

Table 4. Cancer Incidence Rates* by Site and State, United States, 2001–2005
STATEALL SITESBREASTCOLON AND RECTUMLUNG AND BRONCHUSNON-HODGKIN LYMPHOMAPROSTATEURINARY BLADDER
MALEFEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEMALEFEMALE
  • *

    Per 100,000, age adjusted to the 2000 US standard population.

  • This state's registry has submitted 5 years of data and passed rigorous criteria for each single year's data, including completeness of reporting, nonduplication of records, percentage unknown in critical data fields, percentage of cases registered with information from death certificates only, and internal consistency among data items.

  • This state's registry did not submit incidence data to the North American Association of Central Cancer Registries for 2001–2005.

  • §

    Case ascertainment for this state's registry is incomplete for the years 2001–2005.

  • Source: North American Association of Central Cancer Registries, based on data collected by cancer registries participating in the National Cancer Institute's Surveillence, Epidemiology, and End Results program and Centers for Disease Control's National Program of Cancer Registries.

Alabama555.6377.6114.262.241.9109.552.520.514.0150.731.17.7
Alaska533.2410.6127.961.346.082.462.823.516.1151.339.47.2
Arizona461.7363.0109.849.436.369.848.818.613.2116.635.08.7
Arkansas558.2381.5114.059.243.6113.459.021.915.1158.133.18.9
California518.2396.4124.753.839.867.047.522.615.5152.634.48.3
Colorado512.7401.7125.951.541.063.046.021.416.3159.435.09.1
Connecticut589.5454.3137.465.247.982.558.825.517.8166.644.612.5
Delaware601.7438.6126.462.646.497.866.222.516.7175.542.411.0
Dist. of Columbia
Florida549.3410.1116.757.743.491.460.821.915.5143.138.710.0
Georgia571.3395.2120.660.142.6104.153.420.614.2163.633.08.1
Hawaii484.9385.9126.062.442.567.838.918.912.7129.325.16.2
Idaho543.5399.0118.252.038.569.646.721.517.2168.838.48.5
Illinois580.1426.8124.168.048.593.157.823.816.3159.540.810.4
Indiana552.3414.9117.764.647.3105.362.222.616.0136.937.29.3
Iowa560.9428.3125.467.250.589.352.423.517.0147.340.69.8
Kansas
Kentucky612.5447.1120.570.351.4136.276.222.416.9144.438.19.8
Louisiana624.9409.5120.970.148.3111.358.222.916.2180.235.68.7
Maine621.6460.6130.667.749.199.865.724.518.6166.848.712.9
Maryland
Massachusetts604.0455.9133.867.648.486.063.024.117.1170.246.512.9
Michigan608.0440.2127.061.045.794.361.325.018.5186.442.510.7
Minnesota568.8418.6129.357.943.171.449.226.418.1185.940.010.5
Mississippi (2002–2005)555.6365.5105.862.945.2110.150.919.913.0161.928.37.4
Missouri545.3414.6123.064.746.1105.461.821.815.9131.536.29.2
Montana561.2412.3122.655.441.578.257.923.215.0182.441.99.3
Nebraska557.0417.9127.868.548.084.548.824.016.9157.337.810.0
Nevada539.9415.8116.056.943.184.369.521.915.0148.743.011.2
New Hampshire586.7451.9132.361.746.982.361.524.418.1162.747.913.5
New Jersey612.5451.5129.868.350.080.956.025.917.7183.946.012.2
New Mexico490.7367.7111.750.835.459.138.518.414.0149.328.07.0
New York575.7432.7124.663.447.280.553.724.316.9165.942.111.2
North Carolina
North Dakota543.8396.7122.568.344.174.947.122.615.3170.836.79.9
Ohio543.8413.6121.962.745.897.258.922.816.2145.638.79.7
Oklahoma551.3409.2126.461.243.9107.463.822.316.2147.033.88.1
Oregon533.4430.0134.754.441.779.960.424.117.5151.440.310.4
Pennsylvania593.9444.0125.768.449.691.655.724.817.3161.444.611.3
Rhode Island616.7446.9127.567.846.894.559.525.016.7161.651.612.9
South Carolina589.6395.2119.263.544.9103.852.320.614.5172.332.67.7
South Dakota568.5406.0125.563.846.780.345.022.417.4183.039.78.3
Tennessee§496.9377.4115.357.742.2105.056.419.414.2120.331.57.8
Texas546.5390.9116.359.540.590.451.222.216.1146.630.27.4
Utah493.1348.2112.946.334.139.622.422.915.8185.029.16.4
Vermont
Virginia515.6376.4119.556.742.386.151.919.613.1154.132.18.3
Washington571.2447.7138.954.641.480.560.026.918.4167.741.610.4
West Virginia576.0433.6115.370.651.7117.069.422.316.0139.440.011.4
Wisconsin
Wyoming515.5394.8117.949.443.662.647.220.616.3171.241.59.5
United States562.3417.3123.661.244.887.355.423.216.3158.238.49.8

Trends in Cancer Incidence and Mortality

Figures 2 to 5 depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites and for the four most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates decreased by 1.8% per year from 2001–2005 in males and by 0.6% per year from 1998–2005 in females. Death rates for all cancer sites combined decreased by 2.0% per year from 2001–2005 in males and by 1.6% per year in females from 2002–2005, compared with declines of 1.5% per year in males from 1993–2001 and 0.8% per year in females from 1994–2002.

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Figure 2. Annual Age-adjusted Cancer Incidence and Death Rates for All Sites by Sex, United States, 1975–2005.

Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. Source: Incidence, Surveillance, Epidemiology, and End Results (SEER) program (www.seer.cancer.gov). Delay-adjusted incidence database, SEER incidence delay-adjusted rates from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released in April 2008, based on the November 2007 SEER data submission. Mortality, US mortality data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

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Figure 3. Annual Age-adjusted Cancer Incidence Rates among Males and Females for Selected Cancers, United States, 1975– 2005.

Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (www.seer.cancer.gov). Delay-adjusted incidence database, SEER Incidence Delay-Adjusted Rates, from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2008, based on the November 2007 SEER data submission.

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Figure 4. Annual Age-adjusted Cancer Death Rates among Males for Selected Cancers, United States, 1930–2005.

Rates are age adjusted to the 2000 US population. Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US mortality data, 1960 to 2005, US Mortality Vol. 1930–1959, National Cancer Institute, Centers for Disease Control and Prevention, 2008.

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Figure 5. Annual Age-adjusted Cancer Death Rates* among Females for Selected Cancers, United States, 1930–2005.

*Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Source: US mortality data, 1960 to 2005, US Mortality Vol. 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

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Table 5. Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975–2005
 TREND 1TREND 2TREND 3TREND 4TREND 5
YEARSAPC*YEARSAPC*YEARSAPC*YEARSAPC*YEARSAPC*
  • Trends were analyzed by Joinpoint Regression Program, version 3.2.0, with a maximum of four joinpoints (ie, five line segments).

  • *

    Annual percentage change (APC) based on incidence (delay adjusted) and mortality rates age adjusted to the 2000 US standard population.

  • The APC is significantly different from zero.

  • Source: Jemal, et al.15

All sites          
 Incidence          
  Male and female1975–19891.21989–19922.81992–1995−2.41995–19990.91999–2005−0.8
  Male1975–19891.31989–19925.21992–1995−4.81995–20010.32001–2005−1.8
  Female1975–1979−0.31979–19871.61987–19950.11995–19981.41998–2005−0.6
 Death          
  Male and female1975–19900.51990–1993−0.31993–2002−1.12002–2005−1.8  
  Male1975–19791.01979–19900.31990–1993−0.51993–2001−1.52001–2005−2.0
  Female1975–19900.61990–1994−0.21994–2002−0.82002–2005−1.6  
Lung and bronchus          
 Incidence          
  Male1975–19821.51982–1991−0.51991–2005−1.8    
  Female1975–19825.61982–19913.41991–20050.5    
 Death          
  Male1975–19782.51978–19841.21984–19900.41990–1993−1.11993–2005−1.9
  Female1975–19826.01982–19904.21990–19951.71995–20030.32003–2005−0.9
Colon and rectum          
 Incidence          
  Male1975–19851.11985–19911.21991–1995−3.11995–19981.91998–2005−2.8
  Female1975–19850.31985–1995−1.91995–19981.91998–2005−2.2  
 Death          
  Male1975–19780.81978–1984−0.41984–1990−1.31990–2002−2.02002–2005−4.3
  Female1975–1984−1.01984–2002−1.82002–2005−4.3    
Female breast          
 Incidence1975–1980−0.61980–19874.01987–1994−0.21994–19991.71999–2005−2.2
 Death1975–19900.41990–1995−1.81995–1998−3.31998–2005−1.8  
Prostate          
 Incidence1975–19882.61988–199216.51992–1995−11.51995–20012.12001–2005−4.4
 Death1975–19870.91987–19913.01991–1994−0.61994–2005−4.1  

Mortality rates have continued to decrease across all four major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2005 after increasing for many decades (Table 5). Similarly, incidence trends decreased for all four major cancer sites except for lung cancer in women, in whom rates are still increasing although at a much slower rate than in the previous years. The lag in the temporal trend of lung cancer rates in women compared with men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked about 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2005 largely reflects increases in screening that can detect and remove precancerous polyps. The decrease in the breast cancer incidence rate since 1999 likely reflects a combination of two factors: the decrease in use of menopausal hormone therapy among postmenopausal women and delayed diagnosis because of decreased mammography utilization.16–17 The sharp decrease in prostate cancer incidence rates (by 4.4% per year from 2001–2005) may reflect recent stabilization of prostate-specific antigen (PSA) testing, which has resulted in decreased detection, or reduced number of undiagnosed cases.18–20

Table 6 shows the contribution of individual cancer sites to the total decrease in overall cancer death rates. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2005, death rates from cancer decreased by 19.2% among men and by 11.4% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in cancer death rates, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use during the past 50 years, while the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment. Between 1990–1991 and 2005, death rates increased for liver cancer in both men and women, for esophageal cancer and melanoma in men, and for lung and pancreatic cancer in women.

Table 6. Contribution of Indvidual Cancer Sites to Decreases in Cancer Death Rates, 1990–2005 for Males and 1991–2005 for Females
MALESDEATH RATES PER 100,000CHANGECONTRIBUTION (%)
1990*2005ABSOLUTEPERCENT
  • *

    Death rates from cancer peaked in 1990 for men and in 1991 for women.

  • This calculation is based on each cancer site's contribution to the increasing or decreasing portion of the total cancer death rate, depending on the individual site's trend; it does not represent the contribution to the net decrease in cancer death rates.

All malignant cancers279.82226.11−53.71−19.19 
Decreasing     
 Lung and bronchus90.5669.39−21.17−23.3837.0
 Prostate38.5624.65−13.91−36.0724.3
 Colon and rectum30.7720.98−9.79−31.8217.1
 Pancreas12.5912.36−0.23−1.830.4
 Leukemia10.719.70−1.01−9.431.8
 Non-Hodgkin lymphoma9.978.77−1.20−12.042.1
 Urinary bladder7.977.56−0.41−5.140.7
 Kidney and renal pelvis6.165.92−0.24−3.900.4
 Brain and other nervous system5.975.31−0.66−11.061.2
 Stomach8.865.24−3.62−40.866.3
 Myeloma4.834.48−0.35−7.250.6
 Oral cavity and pharynx5.613.84−1.77−31.553.1
 Larynx2.972.24−0.73−24.581.3
 Soft tissue including heart1.521.43−0.09−5.920.2
 Hodgkin lymphoma0.850.50−0.35−41.180.6
 Gallbladder0.600.46−0.14−23.330.2
 Small intestine0.500.44−0.06−12.000.1
 Other24.5823.13−1.45−5.902.5
 Total  57.18 100.0
Increasing     
 Esophagus7.167.940.7810.8922.5
 Liver and intrahepatic bile duct5.277.762.4947.2571.8
 Melanoma of the skin3.804.000.205.265.8
 Total  3.47 100.0
 DEATH RATE PER 100,000CHANGECONTRIBUTION (%)
FEMALES1991*2005ABSOLUTEPERCENT
All malignant cancers175.30155.34−19.96−11.39 
Decreasing     
 Breast32.6924.00−8.69−26.5836.5
 Colon and rectum20.3014.62−5.68−27.9823.9
 Ovary9.518.62−0.89−9.363.7
 Non-Hodgkin lymphoma6.745.49−1.25−18.555.3
 Leukemia6.325.40−0.92−14.563.9
 Corpus and uterus, NOS4.184.10−0.08−1.910.3
 Brain and other nervous system4.113.52−0.59−14.362.5
 Myeloma3.262.89−0.37−11.351.6
 Kidney and renal pelvis2.952.72−0.23−7.801.0
 Stomach4.012.71−1.30−32.425.5
 Cervix Uteri3.492.42−1.07−30.664.5
 Urinary bladder2.342.21−0.13−5.560.5
 Melanoma of the skin1.821.80−0.02−1.100.1
 Esophagus1.811.66−0.15−8.290.6
 Oral cavity and pharynx2.031.43−0.60−29.562.5
 Soft tissue including heart1.281.15−0.13−10.160.5
 Gallbladder1.090.80−0.29−26.611.2
 Other17.9716.57−1.40−7.795.9
 Total  23.79 100.0
Increasing     
 Lung and bronchus37.6140.592.987.9277.8
 Pancreas9.289.450.171.834.4
 Liver and intrahepatic bile duct2.513.190.6827.0917.8
 Total  3.83 100.0

Recorded Number of Deaths from Cancer in 2006

A total of 559,888 cancer deaths were recorded in the United States in 2006, the most recent year for which actual data are available, accounting for about 23% of all deaths (Table 7). Despite a decrease in age-standardized death rates, there were 568 more cancer deaths reported in 2006 than in 2005 due to the growth and aging of the population (Table 8). This is because the decrease in the age-standardized death rates did not offset the influence of the aging and growth of the population on the total number of cancer deaths. When causes of death are ranked within age groups separated into 20-year intervals, cancer is one of the five leading causes of death in all age groups among both males and females (Table 9). Cancer is the leading cause of death among women ages 40 to 79 years and among men ages 60 to 79 years. It is also the leading cause of death among men and women younger than age 85 years (Fig. 6). A total of 474,808 persons younger than age 85 years died from cancer in the United States in 2006, compared with 394,257 deaths from heart disease.

Table 7. Fifteen Leading Causes of Death, United States, 2006
RANKCAUSE OF DEATHNO. OF DEATHSPERCENTAGE (%) OF TOTAL DEATHSDEATH RATE*
  • *

    Rates are per 100,000 population and age adjusted to the 2000 US standard population.

  • Includes primary and secondary hypertension.

  • Note: Percentages may not total 100 because of rounding. In accordance with the National Center for Health Statistics' cause-of-death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked.

  • Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

 All Causes2,426,264100.0776.5
1Heart diseases631,63626.0200.2
2Cancer559,88823.1180.7
3Cerebrovascular diseases137,1195.743.6
4Chronic lower respiratory diseases124,5835.140.5
5Accidents (unintentional injuries)121,5995.039.8
6Diabetes mellitus72,4493.023.3
7Alzheimer disease72,4323.022.6
8Influenza & pneumonia56,3262.317.8
9Nephritis, nephrotic syndrome, & nephrosis45,3441.914.5
10Septicemia34,2341.411.0
11Intentional self-harm (suicide)33,3001.410.9
12Chronic liver disease & cirrhosis27,5551.18.8
13Essential hypertension & hypertensive renal disease23,8551.07.5
14Parkinson disease19,5660.86.3
15Assault (homicide)18,5730.86.2
 All other & ill-defined causes447,80518.5
Table 8. Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990–2006
YEARALL SITESLUNG AND BRONCHUSCOLORECTUMPROSTATEBREAST
MALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALE
  1. Note: Effective with the mortality data for 1999, causes of death are classified by ICD-10, replacing ICD-9 used for 1990 to 1998 data.

  2. Source: US Mortality Data, 1990 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

1990268,283237,03991,01450,13628,48428,67432,37843,391
1991272,380242,27791,60352,02228,02628,75333,56443,583
1992274,838245,74091,32254,48528,28028,71434,24043,068
1993279,375250,52992,49356,23428,19929,20634,86543,555
1994280,465253,84591,82557,53528,47128,93634,90243,644
1995281,611256,84491,80059,30428,40929,23734,47543,844
1996281,898257,63591,55960,35127,98928,76634,12343,091
1997281,110258,46791,27861,92228,07528,62132,89141,943
1998282,065259,46791,39963,07528,02428,95032,20341,737
1999285,832264,00689,40162,66228,31328,90931,72941,144
2000286,082267,00990,41565,01628,48428,95031,07841,872
2001287,075266,69390,36765,60628,22928,57930,71941,394
2002288,768268,50390,12167,50928,47228,13230,44641,514
2003287,990268,91289,90868,08427,99127,79329,55441,620
2004286,830267,05889,57568,43126,88126,69929,00240,954
2005290,422268,89090,14169,07926,78326,22428,90541,116
2006290,069269,81989,24369,35726,80326,39628,37240,821
Table 9. Ten Leading Causes of Death by Age and Sex, United States, 2006
 All AgesAges 1 to 19 yAges 20 to 39 yAges 40 to 59 yAges 60 to 79 yAges ≥80 y
MaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
All CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll Causes
1,201,9421,224,32216,0848,43566,47129,128228,564141,064460,006376,145414,666656,954
  • *

    Includes primary and secondary hypertension.

  • Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. In accordance with the National Center for Health Statistics' cause-of-death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked.

  • Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

1HeartHeartAccidentsAccidentsAccidentsAccidentsHeartCancerCancerCancerHeartHeart
 diseasesdiseases(unintentional(unintentional(unintentional(unintentionaldiseases51,449150,835126,619diseasesdiseases
 315,706315,930injuries)injuries)injuries)injuries)54,918   131,920209,723
   7,0093,51824,6207,712      
2CancerCancerAssaultCancerIntentionalCancerCancerHeartHeartHeartCancerCancer
 290,069269,819(homicide)829self-harm4,83554,461diseasesdiseasesdiseases79,41186,047
   2,444 (suicide)  22,130122,65581,157  
     8,738       
3AccidentsCerebro-IntentionalAssaultAssaultHeartAccidents AccidentsChronicChronicCerebro-Cerebro-
 (unintentionalvascular self-harm(homicide)(homicide)diseases(unintentional(unintentionallowerlowervascularvascular
 injuries)disease(suicide)6038,2022,442injuries)injuries)respiratoryrespiratorydiseasedisease
 78,94182,5951,415   25,33310,833diseasesdiseases25,95255,096
         29,47829,204  
4ChronicChronicCancerCongenitalHeartIntentionalIntentionalCerebro-Cerebro-Cerebro-ChronicAlzheimer
 lowerlower1,130anomaliesdiseasesself-harmself-harmvascularvascularvascularlowerdisease
 respiratoryrespiratory 5225,531(suicide)(suicide)diseasediseasediseaserespiratory44,265
 diseasesdiseases   1,99610,3375,64820,60021,069diseases 
 59,26065,323        24,641 
5Cerebro-AlzheimerCongenitalIntentionalCancerAssaultChronicDiabetesDiabetesDiabetesAlzheimerChronic
 vasculardiseaseanomaliesself-harm4,188(homicide)diseasemellitusmellitusmellitusdiseaselower
 disease51,281565(suicide) 1,551& cirrhosis4,89117,19014,96316,111respiratory
 54,524  359  9,707    diseases
            31,198
6DiabetesAccidentsHeartHeartHIV diseaseHIV diseaseDiabetesChronicAccidentsNephritis,Influenza &Influenza &
 mellitus(unintentionaldiseasesdiseases1,9061,033mellituslower(unintentionalnephroticpneumoniapneumonia
 36,006injuries)465309  7,420respiratoryinjuries)syndrome &14,84322,077
  42,658     diseases11,726nephrosis  
        4,566 7,724  
7IntentionalDiabetesChronicInfluenza &DiabetesDiabetesCerebro-Chronic liverNephritis,AccidentsDiabetesDiabetes
 self-harmmellituslowerpneumoniamellitusmellitusvasculardisease &nephrotic(unintentionalmellitusmellitus
 (suicide)36,443respiratory132871633diseasecirrhosissyndrome &injuries)10,48015,917
 26,308 diseases   7,0084,001nephrosis7,379  
   146     8,529   
8Influenza &InfluenzaInfluenza &Cerebro-Cerebro-Cerebro-HIV diseaseIntentionalInfluenza &AlzheimerNephritis,Nephritis,
 pneumonia& pneumoniapneumoniavascularvascularvascular5,927self-harmpneumoniadiseasenephroticnephrotic
 25,65030,676134diseasediseasedisease (suicide)7,7906,841syndrome &syndrome &
    104763618 3,357  nephrosisnephrosis
           10,33413,213
9Nephritis,Nephritis,SepticemiaSepticemiaChronic liverPregnancy,ChronicSepticemiaSepticemiaSepticemiaAccidentsAccidents
 nephroticnephrotic119103disease &childbirth &lower2,0986,4776,621(unintentional(unintentional
 syndrome &syndrome &  cirrhosispuerperiumrespiratory   injuries)injuries)
 nephrosisnephrosis  687610diseases   9,53812,727
 22,09423,250    4,676     
10AlzheimerSepticemiaCerebro-In situ &CongenitalChronic liverViral hepatitisHIV diseaseChronic liverInfluenza &ParkinsonHypertension
 disease18,712vascularbenignanomaliesdisease3,4422,045disease &pneumoniadisease& hypertensive
 21,151 diseaseneoplasms537& cirrhosis  cirrhosis6,3997,085renal disease*
   118100 362  6,272  9,718
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Figure 6. Death Rates for Cancer and Heart Disease for Ages Younger than 85 Years and 85 Years and Older, 1975–2005.

Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

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Table 10 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among males younger than age 40 years, leukemia is the most common fatal cancer, whereas cancer of the lung and bronchus predominates in men aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men aged 40 to 79 years, and prostate cancer among those aged 80 years and older. Among females, leukemia is the leading cause of cancer death before the age of 20 years, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at ages 60 years and older.

Table 10. Reported Deaths for the Five Leading Cancer Sites by Age and Sex, United States, 2006
ALL AGES<20 Y20 TO 39 Y40 TO 59 Y60 TO 79 Y≥80 Y
MALE
ALL SITESALL SITESALL SITESALL SITESALL SITESALL SITES
290,0691,1694,18854,461150,83579,411
  • *

    ONS indicates other nervous system.

  • Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. “Other and unspecified malignant neoplasm” is excluded from cause-of-death ranking order.

  • Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

Lung & bronchusLeukemiaLeukemiaLung & bronchusLung & bronchusLung & bronchus
89,24335960915,81453,53619,579
ProstateBrain & ONS*Brain & ONS*ColorectumColorectumProstate
28,3722874795,14613,34015,120
ColorectumOther endocrineColorectumLiver & bile ductProstateColorectum
26,803system3953,71311,9677,913
 102    
PancreasBones & jointsLung & bronchusPancreasPancreasUrinary bladder
16,559993073,5828,9834,091
LeukemiaSoft tissueNon-Hodgkin lymphomaEsophagusEsophagusPancreas
12,426842972,7695,9183,881
FEMALE
ALL SITESALL SITESALL SITESALL SITESALL SITESALL SITES
269,8198664,83551,449126,61986,047
Lung & bronchusLeukemiaBreastBreastLung & bronchusLung & bronchus
69,3572591,17012,08239,61417,986
BreastBrain & ONS*Uterine cervixLung & bronchusBreastColorectum
40,82123743711,45816,80311,366
ColorectumOther endocrineLeukemiaColorectumColorectumBreast
26,396system4164,06310,59510,763
 83    
PancreasBones & jointsColorectumOvaryPancreasPancreas
16,895753693,3468,1726,330
OvarySoft tissueBrain & ONS*PancreasOvaryNon-Hodgkin lymphoma
14,857563372,3267,3184,153

Figure 7 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. About 650,000 cancer deaths (481,300 in men and 169,100 in women) were averted during the 1991–1992 through 2005 time interval.

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Figure 7. Total Number of Cancer Deaths Avoided from 1991–2005 in Men and from 1992–2005 in Women.

The blue line represents the actual number of cancer deaths recorded in each year, and the bold red line represents the expected number of cancer deaths if cancer mortality rates had remained the same since 1990 and 1991.

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Cancer Occurrence by Race/Ethnicity

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11). For all cancer sites combined, African American men have an 18% higher incidence rate and a 36% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 17% higher death rate than white women. For the specific cancer sites listed in Table 11, incidence and death rates are consistently higher in African Americans than in whites except for cancers of the breast (incidence) and lung (incidence and mortality) among women, and kidney (mortality) among both men and women. Factors known to contribute to racial disparities in mortality vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer among men), access to high-quality regular screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment (for many cancers). The higher breast cancer incidence rates among white women is thought to reflect a combination of factors that affect both diagnosis (more frequent mammography in white women) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy among white than black women).21

Table 11. Incidence and Mortality Rates* by Site, Race, and Ethnicity, United States, 2001–2005
 WHITEAFRICAN AMERICANASIAN AMERICAN AND PACIFIC ISLANDERAMERICAN INDIAN AND ALASKA NATIVEHISPANIC/LATINO§
  • *

    Per 100,000 population, age adjusted to the 2000 US standard population.

  • Data based on Contract Health Service Delivery Areas, 624 counties comprising 54% of the US American Indian/Alaska Native population; for more information please see: Espey DK, Wu XC, Swan J, et al.19

  • Persons of Hispanic/Latino origin may be of any race.

  • §

    Data unavailable from the Alaska Native Registry and Kentucky.

  • ¶Data unavailable from Minnesota, New Hampshire, and North Dakota.

  • Source: Ries LAG, Melbert D, Krapcho M, et al.3

Incidence
All sites     
 Male551.4651.5354.0336.6419.4
 Female423.6398.9287.8296.4317.8
Breast, female130.6117.589.675.090.1
Colon and rectum     
 Male58.971.248.046.047.3
 Female43.254.535.441.232.8
Kidney and renal pelvis     
 Male18.821.39.119.517.4
 Female9.510.14.612.79.6
Liver and bile duct     
 Male8.213.221.714.415.0
 Female2.94.08.36.35.8
Lung and bronchus     
 Male79.3107.653.954.344.2
 Female54.954.628.039.725.4
Prostate156.7248.593.873.3138.0
Stomach     
 Male10.017.418.616.815.5
 Female4.78.910.57.79.5
Uterine cervix8.210.88.06.913.2
Mortality
All sites     
 Male230.7313.0138.8190.0159.0
 Female159.2186.795.9142.0105.2
Breast, female24.433.512.617.115.8
Colon and rectum     
 Male22.131.814.420.516.5
 Female15.322.410.214.210.8
Kidney and renal pelvis     
 Male6.26.12.49.35.3
 Female2.82.71.24.32.4
Liver and bile duct     
 Male6.710.315.210.611.1
 Female2.93.96.66.65.1
Lung and bronchus     
 Male71.393.137.550.235.1
 Female42.039.918.533.814.6
Prostate24.659.411.021.120.6
Stomach     
 Male5.011.510.19.98.7
 Female2.55.55.95.24.9
Uterine cervix2.34.72.23.73.2

Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, incidence and death rates are generally higher in minority populations than in whites for cancers of the uterine cervix, stomach, and liver. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders as they are in whites, reflecting increased prevalence of chronic infection with H pylori and hepatitis B and C viruses.22 Kidney cancer incidence and death rates are highest among American Indians/Alaskan Natives, although obesity is the only factor known to contribute to this disparity.

Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because long-term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1996 to 2005, incidence (unadjusted for delayed reporting) and death rates for all cancer sites combined decreased among whites, African Americans, Asian Americans/Pacific Islanders, and Hispanics in both men and women.15 Among American Indians/Alaska Natives residing in Indian Health Service (IHS) Contract Health Service Delivery Areas, mortality rates during this time period remained stable; trends in incidence rates could not be examined because the linkage of incident cancer cases with IHS was not complete at the time of this report.15

Death Rates by Educational Attainment, Race, and Sex

Table 12 shows trends in death rates from 1993 to 2001 for the four major cancers by educational attainment among white and African American men and women aged 25 to 64 years.23 In general, death rates decreased significantly from 1993 through 2001 for those with 13 or more years of education but increased or remained constant in those with 12 or fewer years of education. For example, lung cancer death rates in white women decreased for those with 13 or more years of education, leveled in those with 12 years of education, and increased in those with fewer than 12 years of education. Similarly, colorectal cancer death rates among black men decreased for those with 16 or more years of education, leveled in those with 12–15 years of education, and increased in those with fewer than 12 years of education. Notably, the rate of decreases in death rates for each race-, sex-, and cancer-specific category followed an educational gradient in that each group of increasing educational level experienced a progressively steeper decrease. As a result, educational disparity in cancer mortality increased from 1993 to 2001 for lung and colorectal cancers (except among black women) and prostate cancer. Factors that may have contributed to this disparity include higher prevalence of risk factors, such as smoking and obesity, and limited access to medical services among less educated individuals. If everyone ages 25 to 64 years experienced the same cancer death rates as the most educated, 17,650 cancer deaths in women and 30,940 cancer deaths in men could have been averted or postponed in 2001, accounting for over 30% of the total number of cancer deaths in this age group.

Table 12. Trends in Cancer Death Rates* by Education, Race, and Sex, United States, 1993–2001
 EDUCATIONWHITE NON-HISPANICBLACK NON-HISPANIC
19932001APC19932001APC
  • *

    Rates are for individuals aged 25–64 years at death, per 100,000 population, and age adjusted to the 2000 US standard population.

  • Annual percentage change.

  • Includes persons with missing data for educational attainment.

  • §

    The APC is significantly different from zero.

  • Rate ratio comparing rate for less than 12 years of education to less than 16 or more years of education for the indicated year.

  • Source: Adapted from Kinsey T, Jemal A, Liff J, et al.23

Lung and bronchus       
 All48.836.4−3.5§88.560.2−4.4§
 <12 y  88.187.3−0.198.390.4−0.2
 12 y  59.553.2−1.5§98.673.7−3.2§
 13–15 y  32.724.2−3.5§45.632.2−4.7§
 ≥16 y  20.713.7−4.9§38.321.0−6.8§
  RR (95% CI)  4.2 (4.1–4.4)  6.4 (6.2–6.6)  2.6 (2.5–2.8)  4.3 (3.9–4.8) 
 Female
 All28.425.1−1.6§30.526.9−1.5§
 <12 y  45.555.42.4§32.730.40.8
 12 y  32.133.10.137.335.7−0.7
 13–15 y  19.816.6−1.7§20.119.3−1.3
 ≥16 y  13.911.6−2.9§14.816.7−2.2
  RR (95% CI)  3.3 (3.1–3.5)  4.8 (4.5–5.0)  2.2 (1.8–2.7)  1.8 (1.6–2.1) 
Colon and rectumMale
 All12.010.7−1.6§19.718.3−0.7
 <12 y  14.116.00.917.420.92.7§
 12 y  14.613.9−0.921.923.91.0
 13–15 y  9.28.1−1.1§15.411.7−2.7
 ≥16 y  9.37.9−2.4§16.311.5−4.8§
  RR (95% CI)  1.5 (1.4–1.6)  2.0 (1.9–2.2)  1.1 (0.9–1.3)  1.8 (1.5–2.2) 
 Female
 All8.57.3−1.8§13.713.3−0.7
 <12 y  9.510.41.411.010.3−0.3
 12 y  9.79.2−1.0§16.117.8−0.3
 13–15 y  6.45.5−1.6§9.410.00.7
 ≥16 y  6.85.4−3.0§15.612.2−2.6§
  RR (95% CI)  1.4 (1.3–1.6)  1.9 (1.7–2.1)  0.7 (0.6–0.9)  0.8 (0.7–1.0) 
BreastFemale
 All28.221.7−3.5§40.135.5−1.5§
 <12 y  27.424.1−1.4§30.028.70.1
 12 y  30.625.4−2.9§45.343.4−1.5
 13–15 y  23.217.3−3.6§35.330.0−0.9
 ≥16 y  27.420.1−4.3§45.735.8−3.8§
  RR (95% CI)  1.0 (1.0–1.1)  1.2 (1.1–1.3)  0.7 (0.6–0.7)  0.8 (0.7–0.9) 
ProstateMale
 All4.02.8−4.7§12.79.1−3.6§
 <12 y  4.03.4−1.610.49.6−1.6
 12 y  4.33.3−3.5§16.212.7−1.6
 13-15 y  3.42.3−5.5§10.35.3−7.4§
 ≥16 y  3.82.3−6.3§7.64.8−5.9
  RR (95% CI)  1.1 (0.9–1.2)  1.5 (1.3–1.7)  1.4 (1.0–1.8)  2.0 (1.5–2.7) 

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (37%) (Table 13). However, because of the earlier median age of diagnosis for breast cancer compared with other major cancers, women have a slightly higher probability of developing cancer before age 60 years. It is noteworthy that these estimates are based on the average experience of the general population and may overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility.

Table 13. Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2003–2005*
  BIRTH TO 39 Y40 TO 59 Y60 TO 69 Y70 Y AND OLDERBIRTH TO DEATH
PERCENTAGEPERCENTAGEPERCENTAGEPERCENTAGEPERCENTAGE
  • *

    For people free of cancer at beginning of age interval.

  • All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder.

  • Includes invasive and in situ cancer cases.

  • §

    Statistics for whites only.

  • Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0. Statistical Research and Applications Branch, National Cancer Institute, 2008. www.srab.cancer.gov/devcan

All sitesMale1.42 (1 in 70)8.44 (1 in 12)15.71 (1 in 6)37.74 (1 in 3)43.89 (1 in 2)
 Female2.07 (1 in 48)8.97 (1 in 11)10.23 (1 in 10)26.17 (1 in 4)37.35 (1 in 3)
Urinary bladderMale0.02 (1 in 4448)0.41 (1 in 246)0.96 (1 in 104)3.57 (1 in 28)3.74 (1 in 27)
 Female0.01 (1 in 10,185)0.12 (1 in 810)0.26 (1 in 378)1.01 (1 in 99)1.18 (1 in 84)
BreastFemale0.48 (1 in 208)3.79 (1 in 26)3.41 (1 in 29)6.44 (1 in 16)12.03 (1 in 8)
Colon & rectumMale0.08 (1 in 1296)0.92 (1 in 109)1.55 (1 in 65)4.63 (1 in 22)5.51 (1 in 18)
 Female0.07 (1 in 1343)0.72 (1 in 138)1.10 (1 in 91)4.16 (1 in 24)5.10 (1 in 20)
LeukemiaMale0.16 (1 in 611)0.22 (1 in 463)0.35 (1 in 289)1.17 (1 in 85)1.50 (1 in 67)
 Female0.12 (1 in 835)0.14 (1 in 693)0.20 (1 in 496)0.77 (1 in 130)1.07 (1 in 94)
Lung & bronchusMale0.03 (1 in 3398)0.99 (1 in 101)2.43 (1 in 41)6.70 (1 in 18)7.78 (1 in 13)
 Female0.03 (1 in 2997)0.81 (1 in 124)1.78 (1 in 56)4.70 (1 in 21)6.22 (1 in 16)
Melanoma of the skin§Male0.16 (1 in 645)0.64 (1 in 157)0.70 (1 in 143)1.67 (1 in 60)2.56 (1 in 39)
 Female0.27 (1 in 370)0.53 (1 in 189)0.35 (1 in 282)0.76 (1 in 131)1.73 (1 in 58)
Non-Hodgkin lymphomaMale0.13 (1 in 763)0.45 (1 in 225)0.58 (1 in 171)1.66 (1 in 60)2.23 (1 in 45)
 Female0.08 (1 in 1191)0.32 (1 in 316)0.45 (1 in 223)1.36 (1 in 73)1.90 (1 in 53)
ProstateMale0.01 (1 in 10,002)2.43 (1 in 41)6.42 (1 in 16)12.49 (1 in 8)15.78 (1 in 6)
Uterine cervixFemale0.15 (1 in 651)0.27 (1 in 368)0.13 (1 in 761)0.19 (1 in 530)0.69 (1 in 145)
Uterine corpusFemale0.07 (1 in 1499)0.72 (1 in 140)0.81 (1 in 123)1.22 (1 in 82)2.48 (1 in 40)

Cancer Survival by Race

Compared with whites, African American men and women have poorer survival once cancer is diagnosed. Five-year relative survival is lower in African Americans than in whites within every stratum of stage of diagnosis for nearly every cancer site (Fig. 8). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. As shown in Figure 9, African Americans areless likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated, and are more likely to be diagnosed with cancer at a regional or distant stage of disease. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear.24 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.25

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Figure 8. Five-year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004.

*The rate for localized stage represents localized and regional stages combined. †The standard error of the mean for the survival rate is between 5 and 10 percentage points. Staging is according to Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. Source: Ries LAG, Melbert D, and Krapcho M, et al.3

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thumbnail image

Figure 9. Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004.

*The rate for localized stage represents localized and regional stages combined. †Staging was performed according to the Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. For each cancer type, stage categories do not total 100% because sufficient information was not available to assign a stage to all cancer cases. Source: Ries LAG, Melbert D, Krapcho M, et al.3

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There have been notable improvements since 1975 in relative 5-year survival rates for many cancer sites and for all cancers combined (Table 14). This is true for both whites and African Americans. Cancers for which survival has not improved substantially during the past 30 years include lung and pancreas. The improvement in survival reflects a combination of earlier diagnoses and improved treatments.

Table 14. Trends in 5-Year Relative Survival Rates* (%) by Race and Year of Diagnosis, United States, 1975–2004
 ALL RACESWHITEAFRICAN AMERICAN
1975–19771984–19861996–20041975–19771984–19861996–20041975–19771984–19861996–2004
  • *

    Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillence, Epidemiology, and End Results 9 areas from 1975–77, 1984–86, and 1996 to 2004 and followed through 2005.

  • The difference in rates between 1975–1977 and 1996–2004 is statistically significant (P<.05).

  • The standard error of the survival rate is between 5 and 10 percentage points.

  • §

    The standard error of the survival rate is greater than 10 percentage points.

  • #

    Includes intrahepatic bile duct.

  • Source: Ries LAG, Melbert D, Krapcho M, et al.3

All sites505466515568404158
Brain242935232834273339
Breast, female757989768091626578
Colon525965526066465055
Esophagus51017611183811
Hodgkin lymphoma747986748087717580
Kidney515667515667505466
Larynx676664676866595350
Leukemia354251364352343442
Liver#46114610258
Lung and bronchus131316131416111113
Melanoma of the skin8287928287926070§78
Myeloma262935252735313233
Non-Hodgkin lymphoma485365485466494858
Oral cavity535560555762363642
Ovary374046373945434138
Pancreas335335255
Prostate697699707799616696
Rectum495767495867454659
Stomach161825151823162025
Testis839396839396828787
Thyroid939497939497919095
Urinary bladder747881757982516166
Uterine cervix706873717074655865
Uterine corpus888484898586615861

Relative survival rates cannot be calculated for racial and ethnic populations other than for whites and African Americans because accurate life expectancies (the average number of years of life remaining for persons who have attained a given age) are not available. However, based on cause-specific survival rates of cancer patients diagnosed from 1992 to 2000 in SEER areas of the United States, compared to non-Hispanic whites, all minority populations except Asian American/Pacific Islander women have a greater probability of dying from cancer within five years of diagnosis after accounting for differences in stage at diagnosis.20, 26 For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely than non-Hispanic whites to be diagnosed at a distant stage.26

Cancer in Children

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, surpassed only by accidents (Table 15). Leukemia (particularly acute lymphocytic leukemia) is the most common cancer in children (aged 0–14 years), followed by cancer of the brain and other nervous system, soft tissue sarcomas, renal (Wilms) tumors, and non-Hodgkin lymphoma.3 During the past 25 years, there have been significant improvements in the 5-year relative survival rate for all of the major childhood cancers (Table 16). The 5-year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975–1977 to 80% for those diagnosed in 1996–2004.3

Table 15. Ten Leading Causes of Death Among Children Aged 1 to 14 Years, United States, 2006
RANKCAUSE OF DEATHNO. OF DEATHS% OF TOTAL DEATHSDEATH RATE*
ALL CAUSES10,780100.019.0
  • *

    Rates are per 100,000 population and age adjusted to the 2000 US standard population.

  • Note: “Symptoms, signs, and abnormal clinical or laboratory findings” and “Other respiratory diseases” were excluded from ranking order.

  • Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

1Accidents (unintentional injuries)3,86835.96.8
2Cancer1,28411.92.3
3Congenital anomalies8598.01.5
4Assault (homicide)7567.01.3
5Heart diseases4143.80.7
6Intentional self-harm (suicide)2192.00.4
7Influenza & pneumonia1931.80.3
8Septicemia1721.60.3
9Chronic lower respiratory diseases1581.50.3
10Cerebrovascular disease1491.40.3
 All other causes2,70825.1
Table 16. Trends in 5-Year Relative Survival Rates* (%) for Children Younger than Age 15 Years, US, 1975–2004
 YEAR OF DIAGNOSIS
SITE1975 TO 19771978 TO 19801981 TO 19831984 TO 19861987 TO 19891990 TO 19921993 TO 19951996 TO 2004
  • Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  • *

    Survival rates are adjusted for normal life expectancy and are based on follow up of patients through 2005.

  • Difference in rates between 1975 to 1977 and 1996 to 2004 is statistically significant (P<.05).

  • Source: Ries LAG, Melbert D, Krapcho M, et al.3

All sites5863676871767780
Acute lymphocytic leukemia5866717378838488
Acute myeloid leukemia192627‡31‡37‡4142‡55
Bone and joint51‡4957‡58‡67‡677471
Brain and other nervous system5758566264647074
Hodgkin lymphoma8188889187979596
Neuroblastoma5257555262766770
Non-Hodgkin lymphoma4353677071768186
Soft tissue6175697365807774
Wilms tumor7379879192929292

Limitations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References

Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously. These estimates may vary considerably from year to year, particularly for less common cancers and in states with smaller populations. Estimates are also affected by changes in method. The introduction of a new method for projecting incident cancer cases beginning with the 2007 estimates substantially affected the estimates for several cancers, particularly leukemia and female breast. (See Pickle et al for more detailed discussion.) Not all changes in cancer trendsare captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. The preferred data sources for tracking cancer trends are the age-standardized or age-specific cancer death rates from the National Center for Health Statistics and cancer incidence rates from SEER or NPCR, although these data are 3 and 4 years old, respectively, by the time that they become available. Nevertheless, the American Cancer Society estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Cancer in Children
  8. Limitations
  9. References
  • 1
    National Center for Health Statistics, Division of Vital Statistics, Centers for Disease Control. Available at: http://www.cdc.gov/nchs/deaths.htm. Accessed April 20, 2009.
  • 2
    Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence — SEER 9 Regs Public Use, Nov 2007 Sub (1973–2005) — Linked to County Attributes — Total US, 1969–2005 Counties. Bethesda, MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2008. Released April 2008 based on the November 2007 submission. Available at: www.seer.cancer.gov.
  • 3
    RiesLAG, MelbertD, KrapchoM, et al, eds. SEER Cancer Statistics Review, 1975–2005. Bethesda, MD: National Cancer Institute; 2008. Available at: http://seer.cancer.gov/csr/1975_2005/.
  • 4
    Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence - SEER 13 Regs Public Use, Nov 2007 Sub (1992–2005) — Linked To County Attributes — Total US, 1969–2005 Counties. Bethesda, MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2008. Released April 2008 based on the November 2007 submission. Available at: www.seer.cancer.gov.
  • 5
    Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence - SEER 17 Regs Public Use, Nov 2007 Sub (2000–2005) — Linked To County Attributes — Total US, 1969–2005 Counties. Bethesda, MD: National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch; 2008. Released April 2008 based on the November 2007 submission. Available at: www.seer.cancer.gov.
  • 6
    Surveillance, Epidemiology and End Results (SEER) Program. SEER*Stat Database: NAACCR Incidence — CiNA+. In: SEER*Stat 2001–2005, All Races, North American Association of Central Cancer Registries. Available at: www.seer.cancer.gov.
  • 7
    US Census Bureau. Available at: http://www.census.gov. Accessed September, 2008.
  • 8
    Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, Vol 1, 10th rev. Geneva: World Health Organization; 1992.
  • 9
    Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death: Vol 1, 9th rev. Geneva: World Health Organization; 1975.
  • 10
    Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death: Vol 1, 8th rev. Geneva: World Health Organization; 1967.
  • 11
    FritzA, PercyC, JackA, et al, eds. International Classification of Diseases for Oncology, 3rd ed. Geneva: World Health Organization; 2000.
  • 12
    Pickle LW, Hao Y, Jemal A, et al. A new method of predicting US and state level cancer incidence counts for the current calendar year. CA Cancer J Clin. 2007; 57: 3042.
  • 13
    Tiwari RC, Ghosh K, Jemal A, et al. A new method of predicting US and state-level cancer mortality counts for the current calendar year. CA Cancer J Clin. 2004; 54: 3040.
  • 14
    Clegg LX, Feuer EJ, Midthune DN, Fay MP, Hankey BF. Impact of reporting delay and reporting error on cancer incidence rates and trends. J Natl Cancer Inst. 2002; 94: 1537.
  • 15
    Jemal A, Thun MJ, Ries LA, et al. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008; 100: 16721694.
  • 16
    Jemal A, Ward E, Thun MJ. Recent trends in breast cancer incidence rates by age and tumor characteristics among US women. Breast Cancer Res. 2007; 9: R28.
  • 17
    Ravdin PM, Cronin KA, Howlader N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007; 356: 16701674. Comments in: N Engl J Med. 2007;357:509–510; author reply 513. N Engl J Med. 2007;357:509; author reply 513. N Engl J Med. 2007;357:509; author reply 513. N Engl J Med. 2007;357:510–511; author reply 513. N Engl J Med. 2007;357:511–512; author reply 513. N Engl J. Med. 2007;357:511; author reply 513. N Engl J Med. 2007;357:512–513; author reply 513.
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