SEARCH

SEARCH BY CITATION

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 regarding cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the 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 age-standardized to the 2000 US standard million population. A total of 1,529,560 new cancer cases and 569,490 deaths from cancer are projected to occur in the United States in 2010. Overall cancer incidence rates decreased in the most recent time period in both men (1.3% per year from 2000 to 2006) and women (0.5% per year from 1998 to 2006), largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and 2 major cancer sites in women (breast and colorectum). This decrease occurred in all racial/ethnic groups in both men and women with the exception of American Indian/Alaska Native women, in whom rates were stable. Among men, death rates for all races combined decreased by 21.0% between 1990 and 2006, with decreases in lung, prostate, and colorectal cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2006 decreased by 12.3%, with decreases in breast and colorectal cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, 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. 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 2010. © 2010 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, 1 in 4 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 2010.

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 2007 in the United States were obtained from the National Center for Health Statistics (NCHS).1 Incidence data for long-term trends (1975–2006), 5-year relative survival rates, and lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), covering approximately 26% of the US population.2–5 Incidence data (1995–2006) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR) covering approximately 89% of the US population. State-specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and the NPCR.6 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).8–10 Cancer cases were classified according to the International Classification of Diseases for Oncology.11

Estimated New Cancer Cases and Deaths

The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer case reporting is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection and compilation. Therefore, we project the expected number of new cancer cases and deaths in the United States in 2010 to provide an estimate of the current cancer burden. Estimated new cancer cases in the current year (2010) were projected using a spatiotemporal model based on incidence data from 1995 through 2006 from 44 states and the District of Columbia that met the NAACCR's high-quality data standard for incidence, covering approximately 89% of the US population.12 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.

We used the state-space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2010.13 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 2010 based on the number that occurred each year from 1969 to 2007 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 2007. Causes of death for 2007 were coded and classified according to ICD-10.10 This report also provides updated statistics regarding 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 2006.2, 6 All age-adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population.

The incidence rates (2002–2006) and long-term trends (1975–2006) are adjusted for delays in reporting when possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 2004–2006), 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 for selected cancer sites were previously published in the 2010 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 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age-standardized cancer death rates through 2006. 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 2006 to obtain the number of expected deaths in each calendar year if the death rates had 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 15-year (women) or 16-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 in 2010

Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the US in 2010. The overall estimate of approximately 1.53 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. Greater than 2 million unreported cases of basal cell and squamous cell skin cancer, approximately 54,010 cases of breast carcinoma in situ, and 46,770 cases of melanoma in situ are expected to be newly diagnosed in 2010. 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, 2010*
 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 54,010 female carcinoma in situ of the breast and 46,770 melanoma in situ will be newly diagnosed in 2010.

  • †, ‡

    Estimated deaths for colon and rectum cancers are combined.

  • More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates or an undercount in the case estimate.

  • Source: Estimated new cases are based on 1995–2006 incidence rates from 41 states and the District of Columbia as reported by the 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, representing about 89% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2007, National Center for Health Statistics, Centers for Disease Control and Prevention.

All Sites1,529,560789,620739,940569,490299,200270,290
Oral cavity & pharynx36,54025,42011,1207,8805,4302,450
 Tongue10,9907,6903,3001,9901,300690
 Mouth10,8406,4304,4101,8301,140690
 Pharynx12,6609,8802,7802,4101,730680
 Other oral cavity2,0501,4206301,6501,260390
Digestive system274,330148,540125,790139,58079,01060,570
 Esophagus16,64013,1303,51014,50011,6502,850
 Stomach21,00012,7308,27010,5706,3504,220
 Small intestine6,9603,6803,2801,100610490
 Colon102,90049,47053,43051,37026,58024,790
 Rectum39,67022,62017,050   
 Anus, anal canal, & anorectum5,2602,0003,260720280440
 Liver & intrahepatic bile duct24,12017,4306,69018,91012,7206,190
 Gallbladder & other biliary9,7604,4505,3103,3201,2402,080
 Pancreas43,14021,37021,77036,80018,77018,030
 Other digestive organs4,8801,6603,2202,2908101,480
Respiratory system240,610130,600110,010161,67089,55072,120
 Larynx12,72010,1102,6103,6002,870730
 Lung & bronchus222,520116,750105,770157,30086,22071,080
 Other respiratory organs5,3703,7401,630770460310
Bones & joints2,6501,5301,1201,460830630
Soft tissue (including heart)10,5205,6804,8403,9202,0201,900
Skin (excluding basal & squamous)74,01042,61031,40011,7907,9103,880
 Melanoma-skin68,13038,87029,2608,7005,6703,030
 Other nonepithelial skin5,8803,7402,1403,0902,240850
Breast209,0601,970207,09040,23039039,840
Genital system311,210227,46083,75060,42032,71027,710
 Uterine cervix12,200 12,2004,210 4,210
 Uterine corpus43,470 43,4707,950 7,950
 Ovary21,880 21,88013,850 13,850
 Vulva3,900 3,900920 920
 Vagina & other genital, female2,300 2,300780 780
 Prostate217,730217,730 32,05032,050 
 Testis8,4808,480 350350 
 Penis & other genital, male1,2501,250 310310 
Urinary system131,26089,62041,64028,55019,1109,440
 Urinary bladder70,53052,76017,77014,68010,4104,270
 Kidney & renal pelvis58,24035,37022,87013,0408,2104,830
 Ureter & other urinary organs2,4901,4901,000830490340
Eye & orbit2,4801,2401,240230120110
Brain & other nervous system22,02011,98010,04013,1407,4205,720
Endocrine system46,93011,89035,0402,5701,1401,430
 Thyroid44,67010,74033,9301,690730960
 Other endocrine2,2601,1501,110880410470
Lymphoma74,03040,05033,98021,53011,45010,080
 Hodgkin lymphoma8,4904,6703,8201,320740580
 Non-Hodgkin lymphoma65,54035,38030,16020,21010,7109,500
Myeloma20,18011,1709,01010,6505,7604,890
Leukemia43,05024,69018,36021,84012,6609,180
 Acute lymphocytic leukemia5,3303,1502,1801,420790630
 Chronic lymphocytic leukemia14,9908,8706,1204,3902,6501,740
 Acute myeloid leukemia12,3306,5905,7408,9505,2803,670
 Chronic myeloid leukemia4,8702,8002,070440190250
 Other leukemia5,5303,2802,2506,6403,7502,890
Other & unspecified primary sites30,68015,17015,51044,03023,69020,340
Table 2. Age-standardized Incidence Rates for All Cancers Combined, 2002–2006, and Estimated New Cases* for Selected Cancers by State, United States, 2010
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.

  • Source: Data as of June 2009 reported by the North American Association of Central Cancer Registries (NAACCR) as meeting high quality standards for 2002–2006 and include data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. To account for population anomalies caused by Hurricane Katrina in 2005, statistics exclude data for AL, LA, and TX from July 2005-December 2005.

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

Alabama453.623,6403,4502002,3005205604,1601,2109403,300920
Alaska468.32,860410260707036080130440140
Arizona§29,7803,9502102,6207107604,0301,4301,2103,8501,530
Arkansas459.315,3201,7701401,5003304202,6204606402,330610
California441.0157,32021,1301,54013,9504,4704,46018,4908,0307,01022,6406,620
Colorado438.121,3403,1001501,7705706502,2701,1809203,430960
Connecticut509.420,7502,9601201,7706505102,6401,0908602,9401,110
Delaware511.94,890690440140120800210200710250
Dist. of Columbia§2,76039026080603607010045090
Florida462.4107,00014,08094010,5002,7103,33018,3904,9804,66014,6105,600
Georgia462.240,4806,1303903,8409501,0406,2802,0201,6006,3801,470
Hawaii425.76,670910506802201607703102301,060200
Idaho461.77,220910606002002308603603101,300380
Illinois488.863,8908,7704906,3401,9601,8609,1902,0602,6908,7303,050
Indiana469.433,0204,3502303,3309608905,4301,2001,3704,1601,510
Iowa481.017,2602,0201001,7605505602,4509007502,420840
Kansas§13,5501,780901,2704104001,9906505901,630550
Kentucky511.224,2403,2902102,3706106304,7801,4401,0303,1801,030
Louisiana496.020,9502,5301802,0604405903,3206009203,410850
Maine530.38,6501,160508002802601,3704103601,410530
Maryland§27,7004,1502002,6308106204,1701,2901,1104,0101,180
Massachusetts507.836,0405,3202003,1201,1509105,0201,7701,4604,8202,000
Michigan503.455,6607,3403305,1701,7001,6008,1502,2402,4008,4902,790
Minnesota479.325,0803,3301402,4108508303,1509701,1003,8701,160
Mississippi§14,3301,9701301,4803003402,3604705402,260510
Missouri468.931,1603,8802103,0809108705,3601,3201,2603,6001,360
Montana466.25,570680490150160740200240960280
Nebraska476.89,2301,160609102902901,2004504101,470420
Nevada466.212,2301,3501301,0902903201,9204104801,750620
New Hampshire508.17,8109907202402001,0703903101,100430
New Jersey511.048,1006,8204204,4301,5801,3306,2602,6502,1306,7902,510
New Mexico416.09,2101,180907902302809204203701,610350
New York491.0103,34014,6109309,7803,4302,98013,7204,0504,68014,8405,230
North Carolina460.945,1206,5003604,2201,1901,1507,5202,1301,8006,9101,890
North Dakota465.13,300400340100100410120150580180
Ohio§64,4508,2804105,9602,0101,81010,7102,2002,7208,0102,970
Oklahoma478.318,6702,3001501,7304605603,2506408102,440770
Oregon471.220,7502,9101301,7106005302,8101,2009303,0101,040
Pennsylvania503.775,26010,0005407,4402,4502,07010,5203,5503,4309,8004,050
Rhode Island515.55,970790540190160840290240740350
South Carolina476.423,2403,2601702,1405605903,9701,0609503,600950
South Dakota460.24,220530450130130540170180760230
Tennessee§33,0704,7002703,1307508505,9801,7201,3604,6001,350
Texas451.5101,12012,9201,0709,1902,4203,24014,0303,5704,41013,7403,650
Utah408.59,9701,260807402803106206104301,730390
Vermont§3,72052032011090490190150600210
Virginia444.536,4105,4702803,3701,0408805,5101,8101,4705,5501,520
Washington494.934,5004,9002202,7401,0101,0004,3201,9301,6005,2201,720
West Virginia494.210,6101,310801,0603302802,0704404501,440530
Wisconsin§29,6104,1202002,7601,0409403,9901,0501,3404,6701,510
Wyoming447.62,5403302207070320110110420130
United States472.91,529,560207,09012,200142,57043,47043,050222,52068,13065,540217,73070,530

Figure 1 indicates the most common cancers expected to occur in men and women in 2010. Among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,730) of incident cases in men. Based on cases diagnosed between 1999 and 2005, an estimated 92% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which the 5-year relative survival approaches 100%.

thumbnail image

Figure 1. Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, 2010.

*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 3 most commonly diagnosed types of cancer among women in 2010 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (207,090) of all new cancer cases among women.

Expected Number of Cancer Deaths in 2010

Table 1 also shows the expected number of deaths from cancer projected for 2010 for men, women, and both sexes combined. It is estimated that approximately 569,490 Americans will die from cancer, corresponding to greater than 1500 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 4 cancers account for approximately 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 and is expected to account for 26% of all female cancer deaths in 2010. Table 3 provides the estimated number of cancer deaths in 2010 by state for selected cancer sites.

Table 3. Age-standardized Death Rates for All Cancers Combined, 2002–2006, and Estimated Deaths* for Selected Cancers by State, United States, 2010
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 2007, National Center for Health Statistics, Centers for Disease Control and Prevention.

Alabama203.710,1502106909503503103,190320260590600
Alaska182.0880708025060
Arizona163.910,6302807401,0204203802,670360290740650
Arkansas205.06,4601504306002402001,900200140430460
California169.755,7101,4904,2304,9702,2202,60012,6302,1101,5003,9003,710
Colorado163.56,8802105006602702301,670280210460390
Connecticut182.66,8501504905402302001,760230180540410
Delaware198.71,900120160705058060120100
Dist. of Columbia204.9960801002307070
Florida177.340,8808002,6503,5401,5601,36011,6201,4809302,5602,590
Georgia190.315,5703401,1001,4305604304,620500390940930
Hawaii150.32,330140220801205709050180120
Idaho171.62,53080160220120706409060190180
Illinois194.523,3604701,7902,3109007006,4907405701,5801,420
Indiana202.712,9003408601,1305203404,000440300790620
Iowa184.36,3701703806203001601,770290170380370
Kansas184.75,3701403705302601401,590200140330300
Kentucky219.39,6701805808803202503,410310200540470
Louisiana217.08,4802106209203103402,550280200540440
Maine204.13,17080170270110809609070200150
Maryland193.310,2502108009503903602,760310250710650
Massachusetts190.912,9902807801,0504704403,530400330920600
Michigan193.420,7405001,3201,7408106005,8307005001,3301,010
Minnesota176.69,2002406107803902802,450330220600440
Mississippi211.36,0601304006302301902,010190130360330
Missouri200.112,6202808601,1205403803,950450250790710
Montana182.71,9806011017090505808050120130
Nebraska178.23,500902103601408090015080200240
Nevada193.04,6401203305301101801,300150110300270
New Hampshire190.62,6607019021090807507060190140
New Jersey189.416,5203401,4301,6006004704,2206404301,130940
New Mexico165.23,4008023034012015078012080230240
New York176.134,5408002,4903,1201,3801,2708,7201,4809102,4401,690
North Carolina194.319,1003501,3401,5206505005,6505703901,160980
North Dakota175.51,28080120603209070
Ohio202.324,9805401,7302,2809306807,2608405401,5301,440
Oklahoma198.17,6601705207002902202,390280160400320
Oregon189.27,5102104906902802302,100310210490430
Pennsylvania196.428,6905501,9802,6101,1008407,9601,1007302,0101,660
Rhode Island191.42,170501301509070600606012080
South Carolina197.79,1802006407703302702,870300220560490
South Dakota178.81,670100160704506050100100
Tennessee208.813,6003408901,1904903804,520470250750690
Texas181.736,5408402,7803,3401,4101,6609,6001,2808402,2001,820
Utah139.22,8201002502501408048010080200200
Vermont179.41,28090120503708050
Virginia191.914,2303001,1201,3005104104,050450370930710
Washington183.411,6403707909804804403,110440330760770
West Virginia211.44,6701002704401501201,480190110220130
Wisconsin184.311,3102706909004903302,940410290720600
Wyoming176.71,000601102605070
United States186.9569,49013,14039,84051,37021,84018,910157,30020,21013,85036,80032,050

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 for lung cancer, for which rates (cases per 100,000 population) range from 37.8 in men and 23.0 in women in Utah to 133.1 in men and 76.9 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 is smaller in both absolute and proportionate terms. For screenable cancers, such as those of the prostate and female breast, variation in incidence rates 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, 2002 to 2006
STATEALL SITESBREASTCOLORECTUMLUNG & BRONCHUSNON-HODGKIN LYMPHOMAPROSTATEURINARY BLADDER
MALEFEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEMALEFEMALE
  • *

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

  • Due to the displacement of populations after Hurricane Katrina in September 2005, 2005 statistics are based on cases diagnosed in January to June.

  • This state's registry did not achieve high quality data standards for one or more years during 2002–2006 according to the North American Association of Central Cancer Registry (NAACCR) data quality indicators.

  • §

    This state's registry did not submit incidence data to NAACCR for 2002–2006.

  • Case assertainment for this state's registry is incomplete for the years 2002–2006.

  • Source: NAACCR, 2009. Data are collected by cancer registries participating in the National Cancer Institute's SEER program and the Centers for Disease Control and Prevention's National Program of Cancer Registries.

Alabama561.2379.6114.661.742.0107.852.920.513.8154.231.87.6
Alaska529.4417.7126.460.045.684.664.322.617.6141.441.67.3
Arizona465.9364.0108.848.936.069.649.118.913.5118.935.38.9
Arkansas562.8383.5113.158.842.7111.359.521.815.6161.333.08.6
California510.1393.3122.352.239.265.147.022.415.5149.034.08.2
Colorado501.5394.1123.150.039.560.545.221.016.2156.433.68.8
Connecticut591.0455.5135.062.846.581.860.125.818.1164.645.412.6
Delaware607.7440.8123.962.044.897.670.023.516.1179.942.811.1
Dist. of Columbia556.0412.1132.757.446.381.446.622.813.7175.224.08.3
Florida537.3404.2114.155.241.789.260.321.615.4138.437.49.7
Georgia566.4392.4118.558.742.3101.753.320.814.1162.432.78.0
Hawaii486.7383.0121.461.341.568.840.119.012.6128.626.26.2
Idaho538.4401.7117.549.938.068.748.321.417.2165.837.08.8
Illinois579.8429.1123.167.248.392.358.824.116.2157.940.710.5
Indiana551.3415.1115.362.846.4103.663.322.816.4135.937.49.4
Iowa558.9429.2124.064.449.689.953.124.417.6144.940.79.6
Kansas557.2417.2126.161.343.687.653.224.118.0159.636.28.5
Kentucky608.4446.4119.868.049.8133.176.923.116.9142.539.09.9
Louisiana619.2409.6119.668.547.3109.557.923.216.7176.835.28.6
Maine620.9465.8128.665.948.899.266.024.519.2164.849.413.4
Maryland§
Massachusetts591.8452.9132.263.945.783.762.423.416.5164.646.712.9
Michigan597.5437.9124.258.844.693.061.525.218.7179.441.910.5
Minnesota567.2416.4126.456.442.369.849.526.417.7184.640.110.3
Mississippi574.7382.1108.264.546.3111.754.520.913.5166.729.67.5
Missouri544.3417.2121.962.344.9105.263.421.815.5129.335.88.9
Montana541.9406.3119.652.540.375.357.422.814.9174.540.89.1
Nebraska561.8418.2126.467.647.584.649.324.717.4157.637.29.5
Nevada531.2412.0112.155.243.483.369.022.215.3144.240.711.0
New Hampshire584.3455.3131.259.044.582.162.723.518.2159.548.013.4
New Jersey603.9449.5128.065.448.079.656.025.617.7177.946.212.2
New Mexico480.5366.1109.649.435.857.539.017.914.3146.126.77.0
New York577.5434.4124.560.845.879.454.124.717.3166.342.311.1
North Carolina553.4398.1120.357.241.6101.356.021.215.1153.234.98.8
North Dakota549.3402.7122.866.643.174.648.022.715.8169.539.610.0
Ohio§
Oklahoma561.4422.2127.260.143.7105.665.122.917.5150.034.98.6
Oregon529.3429.7131.952.841.179.460.424.417.0148.039.210.0
Pennsylvania592.7444.6124.566.148.391.056.425.117.5159.744.811.2
Rhode Island608.9455.3128.365.746.292.262.224.817.5152.253.113.0
South Carolina587.4397.5119.261.244.1102.253.020.714.6171.532.47.8
South Dakota547.8395.3119.660.244.578.746.322.117.0171.039.18.1
Tennessee548.3400.6116.458.443.2113.660.621.615.8132.734.08.3
Texas539.6389.9114.957.539.788.351.222.316.1144.030.27.3
Utah486.8346.6110.045.333.737.823.022.416.3182.228.36.1
Vermont§
Virginia529.5385.8120.755.541.888.553.620.613.4155.033.38.4
Washington566.9443.3134.852.640.178.759.527.218.3165.341.310.2
West Virginia578.6437.1114.769.550.7117.770.122.916.8138.639.811.4
Wisconsin§
Wyoming516.5392.9117.852.043.062.147.721.415.8168.042.110.0
United States556.5414.8121.859.043.686.455.523.116.3155.537.99.6

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 4 most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates decreased by 1.3% per year from 2000 through 2006 in males and by 0.5% per year from 1998 through 2006 in females.15 Incidence trends decreased for all 4 major cancer sites except for lung cancer in women, in whom rates are still increasing, though at a much slower rate than in 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 approximately 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2006 largely reflects increases in screening that can detect and remove precancerous polyps.15 The decrease in prostate cancer incidence rates (by 2.4% per year from 2000–2006) may reflect recent stabilization of prostate-specific antigen testing, resulting in decreased detection or a reduced number of undiagnosed cases.16–18 The decrease in the breast cancer incidence rate since 1999 likely reflects the large discontinuity in the use of menopausal hormone therapy among postmenopausal women beginning in 2001, and it may also reflect delayed diagnosis due to decreased mammography use.19–20 However, close inspection of incidence data by individual year (Fig. 3) shows that after a 6% decrease from 2002 to 2003, incidence rates from 2003 to 2006 remained relatively unchanged. This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer.20

thumbnail image

Figure 2. Annual Age-Adjusted Cancer Incidence and Death Rates* by Sex, United States, 1975 to 2006.

*Rates are age adjusted to the 2000 US standard population. Incidences rates are adjusted for delays in reporting. Sources: Incidence: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov). Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. Mortality: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention.

Download figure to PowerPoint

thumbnail image

Figure 3. Annual Age-Adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2006.

*Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov). Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission.

Download figure to PowerPoint

thumbnail image

Figure 4. Annual Age-Adjusted Cancer Death Rates*Among Males for Selected Cancers, United States, 1930 to 2006.

*Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (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 2006, US Mortality Vol. 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention.

Download figure to PowerPoint

thumbnail image

Figure 5. Annual Age-Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2006.

*Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Due to changes in International Classification of Diseases (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 2006, US Mortality Volumes 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention.

Download figure to PowerPoint

Table 5. Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975 to 2006
 TREND 1TREND 2TREND 3TREND 4TREND 5
YEARSAPC*YEARSAPC*YEARSAPC*YEARSAPC*YEARSAPC*
  • *

    Annual percent 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 (P < 0.05).

  • Note: Trends were analyzed by Joinpoint Regression Program, version 3.3.1, with a maximum of four joinpoints (ie, five line segments).

  • Source: Edwards, et al.15

All sites          
 Incidence          
  Male and female1975–19891.21989–19922.81992–1995−2.41995–19990.91999–2006−0.7
  Male1975–19891.31989–19925.21992–1995−4.91995–20000.52000–2006−1.3
  Female1975–1979−0.31979–19871.61987–19950.11995–19981.41998–2006−0.5
 Death          
  Male and female1975–19900.51990–1993−0.31993–2001−1.12001–2006−1.6  
  Male1975–19791.01979–19900.31990–1993−0.51993–2001−1.52001–2006−2.0
  Female1975–19900.61990–1994−0.11994–2002−0.82002–2006−1.5  
Lung & bronchus          
 Incidence          
  Male1975–19821.41982–1991−0.41991–2006−1.8    
  Female1975–19825.61982–19913.41991–20060.4    
 Death          
  Male1975–19782.51978–19841.21984–19900.41990–1994−1.31994–2006−2.0
  Female1975–19826.01982–19904.21990–19951.71995–20030.32003–2006−0.9
Colorectum          
 Incidence          
  Male1975–19851.11985–1991−1.21991–1995−3.21995–19982.11998–2006−3.0
  Female1975–19850.31985–1995−1.81995–19981.91998–2006−2.2  
 Death          
  Male1975–1984−0.11984–1990−1.41990–2002−2.02002–2006−3.9  
  Female1975–1984−1.01984–2001−1.82001–2006−3.4    
Female breast          
 Incidence1975–1980−0.51980–19874.01987–1994−0.11994–19991.61999–2006−2.0
 Death1975–19900.41990–1995−1.81995–1998−3.31998–2006−1.9  
Prostate          
 Incidence1975–19882.61988–199216.51992–1995−11.71995–20002.42000–2006−2.4
 Death1975–19870.91987–19913.01991–1994−0.61994–2006−4.1  

Death rates for all cancer sites combined decreased by 2.0% per year in men from 2001 through 2006 and by 1.5% per year in women from 2002 to 2006, compared with declines of 1.5% per year in men from 1993 to 2001 and 0.8% per year in women from 1994 through 2002 (Table 5). Mortality rates have continued to decrease across all 4 major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2006 after increasing for many decades. Table 6 shows the contribution of individual cancer sites to the decreasing portion of the total cancer death rate for each sex. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2006, death rates for cancer decreased by 21.0% among men and by 12.3% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in the cancer death rate, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease noted among women. Lung cancer in men and breast cancer in women each account for nearly 40% of the sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to a reduction in tobacco use over the past 50 years, whereas 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 2006, death rates increased for liver cancer in both men and women, esophageal cancer and melanoma in men, and lung and pancreatic cancer in women. 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. Approximately 767,000 cancer deaths (561,400 in men and 205,700 in women) were averted between 1991–1992 and 2006.

Table 6. The Contribution of Individual Cancer Sites to the Decrease in Cancer Death Rates, 1990–2006
MALEDEATH RATE (PER 100,000)CHANGE% CONTRIBUTION
1990*2006ABSOLUTE%
  • *

    Death rates for cancer peaked in 1990 in men and in 1991 in 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 cancers279.82221.11−58.71−20.98 
Decreasing     
 Lung & bronchus90.5667.45−23.11−25.5237.2
 Prostate38.5623.56.15.01−38.9124.2
 Colorectum30.7720.51−10.27−33.3616.5
 Stomach8.865.04−3.82−43.126.1
 Oral cavity & pharynx5.613.78−1.83−32.612.9
 Non-Hodgkin lymphoma9.978.41−1.56−15.632.5
 Leukemia10.719.61−1.10−10.311.8
 Brain & other nervous system5.975.13−0.84−14.101.4
 Larynx2.972.19−0.78−26.221.3
 Myeloma4.834.36−0.47−9.700.8
 Kidney & renal pelvis6.165.74−0.42−6.860.7
 Urinary bladder7.977.57−0.40−5.000.6
 Hodgkin lymphoma0.850.56−0.30−34.700.5
 Other39.7937.56−2.23−5.613.6
 Total263.59201.46−62.13 100.0
Increasing     
 Esophagus7.167.8520.699.70 
 Liver & Intrahepatic Bile Duct5.277.732.4546.54 
 Melanoma of the Skin3.804.070.277.07 
 Total16.2319.653.42  
FEMALEDEATH RATE (per 100,000)CHANGE% CONTRIBUTION
1991*2006ABSOLUTE%
All malignant cancers175.30153.66−21.64−12.34 
Decreasing     
 Breast32.69 −9.24−28.2636.7
 Colorectum20.30 −5.77−28.4022.9
 Non-Hodgkin Lymphoma6.74 −1.37−20.305.4
 Stomach4.01 −1.36−33.985.4
 Cervix Uteri3.49 −1.07−30.654.3
 Ovary9.51 −0.97−10.243.9
 Leukemia6.32 −0.92−14.613.7
 Brain & Other Nervous System4.11 −0.72−17.632.9
 Oral Cavity & Pharynx2.03 −0.64−31.562.5
 Other36.69 −3.08−8.4012.3
 Total125.90 −25.15−19.98100.0
Increasing     
 Lung & bronchus37.6140.172.566.82 
 Liver & intrahepatic bile duct2.523.270.7529.98 
 Pancreas9.289.480.202.10 
 Total49.4052.923.51  

Recorded Number of Deaths from Cancer in 2007

A total of 562,875 cancer deaths were recorded in the United States in 2007, the most recent year for which actual data are available, accounting for approximately 23% of all deaths (Table 7). Despite a decrease in age-standardized death rates, from 180.7 in 2006 to 178.4 in 2007, there were 2987 more cancer deaths reported in 2007 than in 2006 due to the influence of the aging and growth of the population (Table 8). When causes of death are ranked within 20-year age groups, cancer is one of the 5 leading causes of death in all age groups among both males and females; it is the leading cause of death among men and women ages 40 to 79 years (Table 9). Cancer is the leading cause of death among men and women aged younger than 85 years (Fig. 6). A total of 475,211 persons aged younger than 85 years died from cancer in the United States in 2007, compared with 380,791 deaths from heart disease, which is the leading cause of death overall in the United States.1

Table 7. Fifteen Leading Causes of Death, United States, 2007
RANKCAUSE OF DEATHNUMBER OF DEATHSPERCENT (%) 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 due to 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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

 All Causes2,423,712100.0760.2
1Heart diseases616,06725.4190.9
2Cancer562,87523.2178.4
3Cerebrovascular diseases135,9525.642.2
4Chronic lower respiratory diseases127,9245.340.8
5Accidents (unintentional injuries)123,7065.140.0
6Alzheimer disease74,6323.122.7
7Diabetes mellitus71,3822.922.5
8Influenza & pneumonia52,7172.216.2
9Nephritis, nephrotic syndrome, & nephrosis46,4481.914.5
10Septicemia34,8281.411.0
11Intentional self-harm (suicide)34,5981.411.3
12Chronic liver disease & cirrhosis29,1651.29.1
13Essential hypertension & hypertensive renal disease23,9651.07.4
14Parkinson disease20,0580.86.4
15Assault (homicide)18,3610.86.1
 All other & ill-defined causes451,03418.6 
Table 8. Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990 to 2007
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 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

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
2007292,857270,01888,33170,35527,00526,21629,09340,599
Table 9. Ten Leading Causes of Death by Age and Sex, United States, 2007
 ALL AGESAGES 1 TO 19AGES 20 TO 39AGES 40 TO 59AGES 60 TO 79AGES 80+
MALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALE
All Causes 1,203,968All Causes 1,219,744All Causes 15,777All Causes 8,372All Causes 65,305All Causes 28,831All Causes 226,396All Causes 139,473All Causes 460,041All Causes 372,878All Causes 420,000All Causes 657,300
  • *

    Includes primary and secondary hypertension.

  • Note: Deaths within each age group do not sum to all ages combined due to 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, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention.

1Heart diseases 309,821Heart diseases 306,246Accidents (unintentional injuries) 6,875Accidents (unintentional injuries) 3,400Accidents (unintentional injuries) 24,329Accidents (unintentional injuries) 7,789Cancer 54,054Cancer 50,640Cancer 152,231Cancer 126,918Heart diseases 130,779Heart diseases 204,138
2Cancer 292,857Cancer 270,018Assault (homicide) 2,355Cancer 911Intentional self-harm (suicide) 8,901Cancer 4,639Heart diseases 53,779Heart diseases 21,389Heart diseases 119,209Heart diseases 77,703Cancer 81,403Cancer 86,873
3Accidents (unintentional injuries) 79,827Cerebro-vascular disease 81,841Intentional self-harm (suicide) 1,352Assault (homicide) 613Assault (homicide) 8,170Heart diseases 2,508Accidents (unintentional injuries) 25,401Accidents (unintentional injuries) 11,208Chronic lower respiratory diseases 30,237Chronic lower respiratory diseases 29,321Cerebro-vascular disease 25,747Cerebro-vascular disease 55,234
4Chronic lower respiratory diseases 61,235Chronic lower respiratory diseases 66,689Cancer 1,085Congenital anomalies 518Heart diseases 5,351Intentional self-harm (suicide) 2,058Intentional self-harm (suicide) 10,828Cerebro-vascular disease 5,524Cerebro-vascular disease 20,454Cerebro-vascular disease 20,281Chronic lower respiratory diseases 25,616Alzheimer disease 45,458
5Cerebro-vascular disease 54,111Alzheimer disease 52,832Congenital anomalies 593Heart diseases 315Cancer 4,041Assault (homicide) 1,534Chronic liver disease & cirrhosis 10,296Diabetes mellitus 4,769Diabetes mellitus 16,722Diabetes mellitus 14,621Alzheimer disease 16,780Chronic lower respiratory diseases 32,524
6Diabetes mellitus 35,478Accidents (unintentional injuries) 43,879Heart diseases 445Intentional self-harm (suicide) 313HIV disease 1,650HIV disease 950Diabetes mellitus 7,304Chronic lower respiratory diseases 4,475Accidents (unintentional injuries) 12,311Nephritis, nephrotic syndrome & nephrosis 7,935Influenza & pneumonia 14,099Influenza & pneumonia 20,555
7Intentional self-harm (suicide) 27,269Diabetes mellitus 35,904Chronic lower respiratory diseases 151Influenza & pneumonia 134Diabetes mellitus 905Cerebro- vascular disease 636Cerebro-vascular disease 7,006Chronic liver disease & cirrhosis 4,229Nephritis, nephrotic syndrome & nephrosis 8,665Accidents (unintentional injuries) 7,457Nephritis, nephrotic syndrome & nephrosis 10,868Diabetes mellitus 15,909
8Influenza & pneumonia 24,071Influenza & pneumonia 28,646Influenza & pneumonia 130Cerebro-vascular disease 109Chronic liver disease & cirrhosis 765Pregnancy, childbirth & puerperium 598HIV disease 5,451Intentional self-harm (suicide) 3,612Influenza & pneumonia 7,046Alzheimer disease 7,191Diabetes mellitus 10,495Nephritis, nephrotic syndrome & nephrosis 13,479
9Nephritis, nephrotic syndrome & nephrosis 22,616Nephritis, nephrotic syndrome & nephrosis 23,832Septecemia 113Chronic lower respiratory diseases 95Cerebro- vascular disease 726Diabetes mellitus 567Chronic lower respiratory diseases 4,887Septicemia 2,321Chronic liver disease & cirrhosis 6,859Septicemia 6,639Accidents (unintentional injuries) 10,164Accidents (unintentional injuries) 13,453
10Alzheimer disease 21,800Septicemia 18,989Cerebro- vascular disease 97Septecemia 92Congenital anomalies 490Chronic liver disease & cirrhosis 388Viral hepatitis 3,463Nephritis, nephrotic syndrome & nephrosis 2,036Septicemia 6,608Influenza & pneumonia 5,997Parkinson disease 7,422Hypertension & hypertensive renal disease* 10,126
thumbnail image

Figure 6. Death Rates* For Cancer and Heart Disease for Ages Younger Than 85 Years and 85 Years and Older, 1975 to 2006.

*Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention.

Download figure to PowerPoint

thumbnail image

Figure 7. Total Number of Cancer Deaths Avoided From 1991 to 2006 in Males and From 1992 to 2006 in Females.

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.

Download figure to PowerPoint

Table 10 presents the number of deaths from all cancers combined and from the 5 most common cancer sites for each 20-year age group. Among males aged younger than 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 ages 40 to 79 years, and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 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, 2007
ALL AGES<2020 TO 3940 TO 5960 TO 79≥ 80
MALE
ALL SITES 292,857ALL SITES 1,124ALL SITES 4,041ALL SITES 54,054ALL SITES 152,231ALL SITES 81,403
  • *

    ONS = Other nervous system.

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

  • Source: US Mortality Data, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention.

Lung & bronchus 88,331Leukemia 365Leukemia 522Lung & bronchus 15,174Lung & bronchus 53,125Lung & bronchus 19,751
Prostate 29,093Brain & ONS* 260Brain & ONS* 502Colorectum 5,434Colorectum 13,370Prostate 15,670
Colorectum 27,005Bones & joints 92Colorectum 395Liver & bile duct 3,944Prostate 12,187Colorectum 7,795
Pancreas 17,132Other endocrine system 92Non-Hodgkin lymphoma 301Pancreas 3,638Pancreas 9,293Urinary bladder 4,216
Leukemia 12,435Soft tissue 72Lung & bronchus 268Esophagus 2,695Esophagus 5,958Pancreas 4,084
FEMALE
ALL SITES 270,018ALL SITES 944ALL SITES 4,639ALL SITES 50,640ALL SITES 126,918ALL SITES 86,873
Lung & bronchus 70,355Leukemia 278Breast 1,094Breast 11,630Lung & bronchus 40,187Lung & bronchus 18,519
Breast 40,599Brain & ONS* 261Uterine cervix 468Lung & bronchus 11,412Breast 16,900Colorectum 11,298
Colorectum 26,216Other endocrine system 81Leukemia 393Colorectum 4,150Colorectum 10,459Breast 10,973
Pancreas 16,985Bones & joints 80Colorectum 304Ovary 3,151Pancreas 8,211Pancreas 6,283
Ovary 14,621Soft tissue 68Brain & ONS* 300Pancreas 2,417Ovary 7,195Non-Hodgkin lymphoma 4,171

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), although the extent of variation may be affected by misclassification of race and ethnicity on medical records, including death certificates.26 For all cancer sites combined, African American men have a 14% higher incidence rate and a 34% higher death rate than white men, whereas African American women have a 7% 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 compared with 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 screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. The higher breast cancer incidence rates observed among white women are believed to reflect a combination of factors that affect both diagnosis (eg, more frequent mammography in white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white compared with black women).21

Table 11. Incidence and Death Rates* by Site, Race, and Ethnicity, United States, 2002–2006
 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, compromising about 55% of the US American Indian/Alaska Native population; for more information please see: Espey DK, et al.16

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

  • Source: Edwards, et al.15

Incidence
All sites     
 Male550.1626.0334.5318.4430.3
 Female420.0389.5276.3265.1326.8
Breast (female)123.5113.081.667.290.2
Colorectum     
 Male58.268.444.138.150.0
 Female42.651.733.130.735.1
Kidney & renal pelvis     
 Male19.720.69.016.618.2
 Female10.310.64.510.610.3
Liver & bile duct     
 Male8.012.521.48.915.9
 Female2.83.88.14.66.2
Lung & bronchus     
 Male85.9104.850.657.949.2
 Female57.150.727.641.326.5
Prostate146.3231.982.382.7131.1
Stomach     
 Male8.916.717.59.414.3
 Female4.28.59.84.78.6
Uterine cervix7.911.17.66.612.7
Mortality
All sites     
 Male226.7304.2135.4183.3154.8
 Female157.3183.795.1140.1103.9
Breast (female)23.933.012.517.615.5
Colorectum     
 Male21.431.413.820.016.1
 Female14.921.610.013.710.7
Kidney & renal pelvis     
 Male6.16.02.49.05.2
 Female2.82.71.24.22.4
Liver & bile duct     
 Male6.810.815.010.311.3
 Female2.93.96.66.55.1
Lung & bronchus     
 Male69.990.136.948.033.9
 Female41.940.018.233.514.4
Prostate23.656.310.620.019.6
Stomach     
 Male4.811.09.69.88.3
 Female2.45.35.84.64.8
Uterine cervix2.24.62.23.43.1

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 4 most common cancer sites. However, incidence and death rates for cancer sites related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders compared with whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses, respectively, in this population.22 Kidney cancer death rates are the highest among American Indians/Alaskan Natives; the higher prevalence of obesity and smoking in this population may contribute to this disparity.16

Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because the long-term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1997 through 2006, 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 males and females. Among American Indians/Alska Natives residing in Indian Health Service Contract Health Service Delivery Areas, incidence and mortality rates decreased in men but remained stable in women during this time period.15

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (38%) (Table 12). 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. 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 12. Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2004–2006*
  BIRTH TO 39 (%)40 TO 59 (%)60 TO 69 (%)70 AND OLDER (%)BIRTH TO DEATH (%)
  • *

    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 6.4.0. Statistical Research and Applications Branch, National Cancer Institute, 2009. www.srab.cancer.gov/devcan

All sitesMale1.43 (1 in 70)8.42 (1 in 12)15.61 (1 in 6)37.84 (1 in 3)44.05 (1 in 2)
Female2.10 (1 in 48)8.97 (1 in 11)10.18 (1 in 10)26.47 (1 in 4)37.63 (1 in 3)
Urinary bladderMale0.02 (1 in 4,741)0.39 (1 in 257)0.95 (1 in 106)3.66 (1 in 27)3.81 (1 in 26)
Female0.01 (1 in 10,613)0.12 (1 in 815)0.26 (1 in 385)1.01 (1 in 99)1.18 (1 in 84)
BreastFemale0.49 (1 in 206)3.75 (1 in 27)3.40 (1 in 29)6.50 (1 in 15)12.08 (1 in 8)
ColorectumMale0.08 (1 in 1,269)0.91 (1 in 110)1.48 (1 in 67)4.50 (1 in 22)5.39 (1 in 19)
Female0.08 (1 in 1,300)0.72 (1 in 139)1.07 (1 in 94)4.09 (1 in 24)5.03 (1 in 20)
LeukemiaMale0.17 (1 in 603)0.21 (1 in 475)0.33 (1 in 299)1.19 (1 in 84)1.51 (1 in 66)
Female0.13 (1 in 798)0.15 (1 in 690)0.20 (1 in 504)0.78 (1 in 128)1.08 (1 in 92)
Lung & bronchusMale0.03 (1 in 3,461)0.95 (1 in 105)2.35 (1 in 43)6.71 (1 in 15)7.73 (1 in 13)
 Female0.03 (1 in 3,066)0.79 (1 in 126)1.75 (1 in 57)4.83 (1 in 21)6.31 (1 in 16)
Melanoma of the skin§Male0.16 (1 in 638)0.64 (1 in 155)0.72 (1 in 138)1.77 (1 in 56)2.67 (1 in 37)
 Female0.28 (1 in 360)0.55 (1 in 183)0.36 (1 in 274)0.79 (1 in 126)1.79 (1 in 56)
Non-Hodgkin lymphonaMale0.13 (1 in 782)0.44 (1 in 225)0.59 (1 in 171)1.71 (1 in 58)2.28 (1 in 44)
 Female0.09 (1 in 1,172)0.32 (1 in 315)0.44 (1 in 227)1.39 (1 in 72)1.92 (1 in 52)
ProstateMale0.01 (1 in 9,422)2.44 (1 in 41)6.45 (1 in 16)12.48 (1 in 8)15.90 (1 in 6)
Uterine cervixFemale0.15 (1 in 648)0.27 (1 in 374)0.13 (1 in 755)0.19 (1 in 552)0.69 (1 in 145)
Uterine corpusFemale0.07 (1 in 1,453)0.73 (1 in 136)0.83 (1 in 121)1.23 (1 in 81)2.53 (1 in 40)

Cancer Survival By Race

Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5-year relative survival is lower in African Americans than in whites for every 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 are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear.23 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.24

thumbnail image

Figure 8. Five-Year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005.

*The standard error of the survival rate is between 5 and 10 percentage points. †The survival rate for in situ urinary bladder cancer is 97% for all races combined, whites, and African Americans. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Source: Horner MJ, Ries LAG, Krapcho M, et al.2

Download figure to PowerPoint

thumbnail image

Figure 9. Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005.

*The proportion of in situ urinary bladder cancer cases is 50%, 51%, and 36% in all races combined, whites, and African Americans, respectively. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Source: Horner MJ, Ries LAG, Krapcho M, et al.2

Download figure to PowerPoint

There have been notable improvements since 1975 in the relative 5-year survival rates for many cancer sites for both whites and African Americans (Table 13). Cancers for which survival has not improved substantially over the past 30 years include those of the lung and pancreas. The improvement in survival reflects a combination of earlier diagnosis and improved treatments.

Table 13. Trends in 5-Year Relative Survival Rates* (%) by Race and Year of Diagnosis, United States, 1975–2005
 ALL RACESWHITEAFRICAN AMERICAN
1975 TO 19771984 TO 19861999 TO 20051975 TO 19771984 TO 19861999 TO 20051975 TO 19771984 TO 19861999 TO 2005
  • *

    Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 9 areas from 1975–77, 1984–86, and 1999–2005 and followed through 2006.

  • The difference in rates between 1975–1977 and 1999–2005 is statistically significant (P < 0.05).

  • 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.

  • #

    Survival rate is for 1978–1980.

  • Source: Horner MJ, Ries LAG, Krapcho M, et al.2

All sites505468515569404159
Brain242936232835273241
Breast (female)757990768091626579
Colon525966526067465056
Esophagus51019611203813
Hodgkin lymphoma747986748087717581
Kidney515669515669505466
Larynx676663676866595350
Leukemia354254364355343446
Liver & bile duct461446132510
Lung & bronchus131316131417121113
Melanoma of the skin8287938287936070§78
Myeloma262937252738313236
Non-Hodgkin lymphoma485369485470494860
Oral cavity535563555764363646
Ovary374046373946434137
Pancreas336336255
Prostate69761007077100616698
Rectum495769495869454661
Stomach161827151825162026
Testis83939683939773#8787
Thyroid939497939498919096
Urinary bladder747882757983516168
Uterine cervix706872717073655865
Uterine corpus888484898587615862

Relative survival rates cannot be calculated for racial and ethnic populations other than 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 between 1999 and 2005 in SEER areas of the United States, all minority male populations have a greater probability of dying from cancer within 5 years of diagnosis than whites. Among women, African Americans have the lowest 5-year, cancer-specific survival (55.8%), followed by American Indians/Alaska Natives (60.0%), whites (65.5%), Hispanics (66.4%), and Asians/Pacific Islanders (68.0%).2 For all 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely to be diagnosed at distant stage, compared with whites (Fig. 9).25

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

Cancer is the second most common cause of death among children between the ages of 1 and 14 years in the United States, surpassed only by accidents (Table 14). Nearly one-third of the cancers diagnosed in children ages birth to 14 years are leukemias (particularly acute lymphocytic leukemia), followed by cancer of the brain and other nervous system (21%), soft tissue sarcomas (including neuroblastoma [7%] and rhabdomyosarcoma [3%]), renal (Wilms) tumors (5%), and non-Hodgkin lymphoma (4%). Over the past 25 years, there have been significant improvements in the 5-year relative survival rate for all of the major childhood cancers (Table 15). The 5-year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed between 1975 and 1977 to 81% for those diagnosed between 1999 and 2005.2

Table 14. Ten Leading Causes of Death Among Children Ages 1 to 14, United States, 2007
RANKCAUSE OF DEATHNUMBER OF DEATHS% OF TOTAL DEATHSDEATH RATE*
ALL CAUSES10,850100.018.9
  • *

    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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

1Accidents (unintentional injuries)3,78234.96.6
2Cancer1,32312.22.3
3Congenital anomalies9208.51.6
4Assault (homicide)7446.91.3
5Heart diseases4143.80.7
6Influenza & pneumonia2122.00.4
7Intentional self-harm (suicide)1841.70.3
8Chronic lower respiratory diseases1751.60.3
9Septicemia1521.40.3
10In situ, benign, & unknown neoplasms1431.30.3
 All other causes2,80125.8 
Table 15. Trends in Five-year Relative Survival Rates* (%) for Children Under Age 15, US, 1975 to 2005
SITEYEAR OF DIAGNOSIS
1975 TO 19771978 TO 19801981 TO 19831984 TO 19861987 TO 19891990 TO 19921993 TO 19951996 TO 19981999 TO 2005
  • *

    Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2006.

  • The difference in rates between 1975 to 1977 and 1999 to 2005 is statistically significant (P < 0.05).

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

  • Note: Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  • Source: Horner MJ, Ries LAG, Krapcho M, et al.2

All sites586367687276777981
Acute lymphocytic leukemia586671737883848789
Acute myeloid leukemia192627313741424960
Bone & joint504857586767747072
Brain & other nervous system575856626464707574
Hodgkin lymphoma818888918797959695
Neuroblastoma525755526276676674
Non-Hodgkin lymphoma445367707176818386
Soft tissue617569736680777081
Wilms tumor737987919292929291

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 because these estimates are based on models and may vary considerably from year to year. 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.12 Not all changes in cancer trends are captured by modeling techniques and sometimes the model may be too sensitive to recent trends, resulting in over- or underestimates. 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 age-standardized or age-specific cancer incidence rates from SEER or NPCR and cancer death rates from the NCHS. 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.

Errors in reporting race/ethnicity in medical records and death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and nonblack populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic minority groups that are not homogenous, and thus significant differences in the cancer burden within racial/ethnic subgroups may be masked.26

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, Center for Disease Control 1930–2004, public-use data file; 2005–2007, special-use data file.
  • 2
    HornerM, RiesL, KrapchoM, et al, eds. SEER Cancer Statistics Review, 1975–2006. Bethesda, MD: National Cancer Institute; 2009.
  • 3
    Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 17 Regs Public Use, Nov. 2008 Sub (2000–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
  • 4
    Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 13 Regs Public Use, Nov. 2008 Sub (1992–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
  • 5
    Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 9 Regs Public Use, Nov. 2008 Sub (1973–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
  • 6
    Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: NAACCR Incidence-CiNA Analytic File, 1995–2006, for Expanded Races, Custom File with County, ACS Facts & Figures Projection Project, North American Association of Central Cancer Registries. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009.
  • 7
    US Census Bureau. Available at: http://www.census.gov. Accessed 2010.
  • 8
    World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol 1. 8th rev. Geneva: World Health Organization; 1967.
  • 9
    World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol 1. 9th rev. Geneva: World Health Organization; 1975.
  • 10
    World Health Organization. Manual of International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol 1. 10th rev. Geneva: World Health Organization; 1992.
  • 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 estimating United States 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: 15371545.
  • 15
    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010; 116: 544573.
  • 16
    Espey DK, Wu XC, Swan J, et al. Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives. Cancer. 2007; 110: 21192152.
  • 17
    Farwell WR, Linder JA, Jha AK. Trends in prostate-specific antigen testing from 1995 through 2004. Arch Intern Med. 2007; 167: 24972502.
  • 18
    Jemal A, Clegg LX, Ward E, et al. Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer. 2004; 101: 327.
  • 19
    Jemal A, Ward E, Thun MJ. Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women. Breast Cancer Res. 2007; 9: R28.
  • 20
    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.
  • 21
    Ghafoor A, Jemal A, Ward E, Cokkinides V, Smith R, Thun M. Trends in breast cancer by race and ethnicity. CA Cancer J Clin. 2003; 53: 342355.
  • 22
    Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004; 54: 7893.
  • 23
    Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin. 2002; 52: 326341.
  • 24
    Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002; 287: 21062113.
  • 25
    Singh GK, Miller BA, Hankey BF, Edwards BK. Area Socioeconomic Variations in U.S. Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999. NCI Cancer Surveillance Monograph Series, No. 4. Bethesda, MD: National Cancer Institute; 2003.
  • 26
    Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. National Center for Health Statistics. Vital Health Stat 2(148). 2008.