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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 numbers 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, 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. A total of 1,596,670 new cancer cases and 571,950 deaths from cancer are projected to occur in the United States in 2011. Overall cancer incidence rates were stable in men in the most recent time period after decreasing by 1.9% per year from 2001 to 2005; in women, incidence rates have been declining by 0.6% annually since 1998. Overall cancer death rates decreased in all racial/ethnic groups in both men and women from 1998 through 2007, with the exception of American Indian/Alaska Native women, in whom rates were stable. African American and Hispanic men showed the largest annual decreases in cancer death rates during this time period (2.6% and 2.5%, respectively). Lung cancer death rates showed a significant decline in women after continuously increasing since the 1930s. The reduction in the overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 898,000 deaths from cancer. However, this progress has not benefitted all segments of the population equally; cancer death rates for individuals with the least education are more than twice those of the most educated. The elimination of educational and racial disparities could potentially have avoided about 37% (60,370) of the premature cancer deaths among individuals aged 25 to 64 years in 2007 alone. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population with an emphasis on those groups in the lowest socioeconomic bracket. CA Cancer J Clin 2011. © 2011 American Cancer Society.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 4 deaths in the United States is due to cancer. In this article, we provide the expected numbers of new cancer cases and deaths in 2011, as well as an overview of cancer statistics, including updated incidence, mortality, and survival rates and trends. We also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s and quantify the impact of eliminating racial and socioeconomic disparities on premature deaths from cancer in 2007.

Material and Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 (1975-2007), 5-year relative survival rates, and the lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI).2-4 State-specific incidence rates for the years 2003 through 2007 and incidence data (1995-2007) 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), as reported by the North American Association of Central Cancer Registries (NAACCR).5 Population data were obtained from the US Census Bureau.6 Cancer cases were classified according to the International Classification of Diseases for Oncology.7 All incidence and death rates are age-standardized to the 2000 US standard population and expressed per 100,000 population.

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 registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 4 years behind the current year due to the time required for data collection, compilation, and dissemination. Therefore, we project the expected number of new cancer cases and deaths in the United States in 2011 in order to provide an estimate of the current cancer burden. We projected the estimated number of new malignant cancer cases diagnosed in 2011 using a spatiotemporal model8 based on incidence data from 1995 through 2007 from 46 states and the District of Columbia that met the NAACCR's high-quality data standard for incidence, covering about 95% of the US population.5 This method accounts for expected delays in case reporting and considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. To estimate the numbers of new breast carcinoma in situ and melanoma in situ cases in 2011, we first estimated the number of in situ cases occurring annually from 2000 through 2007 by applying the age-specific incidence rates in the 17 SEER areas to the corresponding US population estimates.3, 6 We then projected the total number of cases in 2011 based on the annual percent change generated by the joinpoint regression model.9

We estimated the number of cancer deaths expected to occur in the United States and in each state in the year 2011 using the state-space prediction method.10 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 2011 based on the number that occurred each year from 1969 to 2007 in the United States and in each state separately.

Other Statistics

Incidence rates and trends are adjusted for delays in reporting whenever possible. Delayed adjustment accounts for anticipated future corrections to reported cancer case counts and primarily affects the most recent years of incidence data, especially for cancers such as melanoma, leukemia, and prostate that are frequently diagnosed in outpatient settings; thus, delay-adjusted rates provide the most accurate assessment of trends in the most recent time period. 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.11 Long-term incidence and mortality trends for selected cancer sites were previously published in the “Annual Report to the Nation on the Status of Cancer.”2, 12

The contribution of individual cancer sites to the decrease in cancer death rates was calculated as the proportion of the absolute difference in rates between the peak year (1990 in men and 1991 in women) and 2007 to the total difference in rates for all declining sites combined for each sex. Sites with differences of less than 0.2 per 100,000 were collapsed. The estimated total numbers of cancer deaths avoided in men and women due to the reduction in overall age-standardized cancer death rates through 2007 were calculated by applying the 5-year 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 2007 to obtain the number of expected deaths in each calendar year if 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 17-year interval.

Cancer death rates by educational attainment (≤ 12 years of schooling, 13-15 years, and ≥ 16 years) for individuals aged 25 to 64 years in 2007 were calculated using educational attainment information recorded on death certificates and population estimates from the US Census Bureau. Deaths were restricted to those occurring in individuals aged 25 to 64 years because educational attainment is a more reliable index of socioeconomic status in this age group than in older ages13; moreover, deaths in younger adults have a larger economic and social impact and are considered premature. Rates were age-standardized to the US 2000 standard population. Rate ratios with corresponding 95% confidence intervals were calculated to compare the least with the most educated groups.14 The potential number of premature cancer deaths that could have been avoided among individuals aged 25 to 64 years in 2007 by eliminating educational and racial disparities was calculated by applying the age-specific cancer death rates of the most educated non-Hispanic whites in 2007 to all populations. Similarly, we applied the age- and sex-specific death rates of the most educated African Americans to all African Americans and the age-, sex-, and educational attainment-specific death rates of non-Hispanic whites to the corresponding African American population to estimate the numbers of avoidable deaths among the African American population by eliminating educational or racial disparities, respectively.

Selected Findings

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 2011. The overall estimate of about 1.6 million new cases does not include carcinoma in situ of any site except the urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. More than 3.5 million unreported cases of basal cell and squamous cell skin cancer (in more than 2 million people), about 57,650 cases of breast carcinoma in situ, and 53,360 cases of melanoma in situ are expected to be newly diagnosed in 2011.15 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, 2011*
 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 57,650 carcinoma in situ of the female breast and 53,360 melanoma in situ will be newly diagnosed in 2011.

  • 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 1995-2007 incidence rates from 46 states and the District of Columbia, as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 95% 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 Sites1,596,670822,300774,370571,950300,430271,520
Oral cavity & pharynx39,40027,71011,6907,9005,4602,440
 Tongue12,0608,5603,5002,0301,320710
 Mouth11,5106,9504,5601,7901,130660
 Pharynx13,58010,6002,9802,4301,740690
 Other oral cavity2,2501,6006501,6501,270380
Digestive system277,570151,540126,030139,25079,02060,230
 Esophagus16,98013,4503,53014,71011,9102,800
 Stomach21,52013,1208,40010,3406,2604,080
 Small intestine7,5703,9903,5801,100610490
 Colon101,34048,94052,40049,38025,25024,130
 Rectum39,87022,91016,960   
 Anus, anal canal, & anorectum5,8202,1403,680770300470
 Liver & intrahepatic bile duct26,19019,2606,93019,59013,2606,330
 Gallbladder & other biliary9,2503,9905,2603,3001,2302,070
 Pancreas44,03022,05021,98037,66019,36018,300
 Other digestive organs5,0001,6903,3102,4008401,560
Respiratory system239,320128,890110,430161,25088,89072,360
 Larynx12,74010,1602,5803,5602,840720
 Lung & bronchus221,130115,060106,070156,94085,60071,340
 Other respiratory organs5,4503,6701,780750450300
Bones & joints2,8101,6201,1901,490850640
Soft tissue (including heart)10,9806,0504,9303,9202,0601,860
Skin (excluding basal & squamous)76,33043,89032,44011,9808,0803,900
 Melanoma-skin70,23040,01030,2208,7905,7503,040
 Other nonepithelial skin6,1003,8802,2203,1902,330860
Breast232,6202,140230,48039,97045039,520
Genital system338,620250,54088,08063,98034,39029,590
 Uterine cervix12,710 12,7104,290 4,290
 Uterine corpus46,470 46,4708,120 8,120
 Ovary21,990 21,99015,460 15,460
 Vulva4,340 4,340940 940
 Vagina & other genital, female2,570 2,570780 780
 Prostate240,890240,890 33,72033,720 
 Testis8,2908,290 350350 
 Penis & other genital, male1,3601,360 320320 
Urinary system132,90090,75042,15028,97019,4609,510
 Urinary bladder69,25052,02017,23014,99010,6704,320
 Kidney & renal pelvis60,92037,12023,80013,1208,2704,850
 Ureter & other urinary organs2,7301,6101,120860520340
Eye & orbit2,5701,2701,300240130110
Brain & other nervous system22,34012,26010,08013,1107,4405,670
Endocrine system50,40012,82037,5802,6201,1601,460
 Thyroid48,02011,47036,5501,740760980
 Other endocrine2,3801,3501,030880400480
Lymphoma75,19040,88034,31020,62010,51010,110
 Hodgkin lymphoma8,8304,8204,0101,300760540
 Non-Hodgkin lymphoma66,36036,06030,30019,3209,7509,570
Myeloma20,52011,4009,12010,6105,7704,840
Leukemia44,60025,32019,28021,78012,7409,040
 Acute lymphocytic leukemia5,7303,3202,4101,420780640
 Chronic lymphocytic leukemia14,5708,5206,0504,3802,6601,720
 Acute myeloid leukemia12,9506,8306,1209,0505,4403,610
 Chronic myeloid leukemia5,1503,0002,150270100170
 Other leukemia6,2003,6502,5506,6603,7602,900
Other & unspecified primary sites30,50015,22015,28044,26024,02020,240
Table 2. Age-standardized Incidence Rates for All Cancers Combined, 2003-2007, and Estimated New Cases* for Selected Cancers by State, United States, 2011
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.

  • §

    This state is not included in the overall US rate because its registry did not achieve high-quality data standards for one or more years during 2003-2007 as determined by the North American Association of Central Cancer Registries (NAACCR).

  • Combined incidence rate is not available.

  • Source: NAACCR, 2010. Data are 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, MS, and TX from July 2005 - December 2005.

  • Note: These model-based estimates are calculated using incidence rates from 46 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 US total due to rounding and exclusion of states with fewer than 50 cases.

Alabama457.825,5303,7002102,3105505904,2401,2609603,680930
Alaska463.23,090460260808038090130490130
Arizona397.531,5504,2402202,6208007803,8201,3301,2204,6601,530
Arkansas462.716,0702,1001301,5503704202,6605006502,400650
California440.1163,48025,5101,52013,8804,7304,76017,6608,2507,07025,0306,810
Colorado439.422,3903,3901601,7806007102,2501,1309703,920960
Connecticut509.421,4403,2801101,6807005202,6801,0608803,3001,050
Delaware516.05,130810430150120780240200840230
Dist. of Columbia§479.52,83050024080703607010058090
Florida458.5113,40015,33090010,1802,9603,44017,1505,2604,72016,7805,490
Georgia461.344,5807,0304103,9401,1201,1306,4102,1201,6707,3601,460
Hawaii431.06,7101,04050670230170780340230850230
Idaho462.67,5201,030506202102408703403101,320350
Illinois488.565,6109,5105706,2402,0501,8709,2102,3402,6409,3402,910
Indiana470.734,0504,7602603,2901,0109705,5201,4101,3904,5801,440
Iowa480.717,5002,1201001,6705605802,4808907702,590810
Kansas§476.014,0701,890901,3004404301,9907106201,870580
Kentucky516.225,0103,4702102,4206906504,8601,5101,0403,2201,020
Louisiana495.122,7802,9402202,2204706203,6306309303,640870
Maine530.18,8201,280507703002601,4004003701,240500
Maryland28,8904,8502302,4709007003,9601,3301,1305,0601,150
Massachusetts511.137,4705,6402003,0001,2109704,9701,7401,5505,4701,870
Michigan500.657,0107,8903604,8001,8101,6308,1402,4702,3308,9402,680
Minnesota480.527,6003,3801302,1108208203,3408801,1404,3701,100
Mississippi§471.414,9902,1701501,5203203702,4305005502,150520
Missouri471.832,7404,1002303,1509608805,4701,3101,3004,2301,370
Montana459.55,6907604801501707501902401,020280
Nebraska478.19,4301,240509303102901,2704304301,290410
Nevada12,8001,4201101,0802902901,5104104401,850540
New Hampshire505.88,2101,1906502602101,1104103301,200410
New Jersey509.549,0807,3604304,2901,6301,3606,2102,4302,1407,8402,390
New Mexico413.19,6301,310808202403209804003701,420360
New York491.7107,26015,7109609,4803,6703,07014,2003,7504,65015,9505,150
North Carolina469.548,8707,3903804,2001,2801,2307,3002,3001,9307,5801,900
North Dakota470.43,560430340100100420130150600170
Ohio470.065,0608,9704805,8502,0801,69010,0602,6202,6609,1902,890
Oklahoma486.918,9802,6801701,8004805903,2706908502,730760
Oregon469.821,1803,3601301,7306305602,8601,2309403,2501,020
Pennsylvania504.378,03010,5705407,3602,6202,09010,9003,2403,34011,5003,920
Rhode Island517.36,090930510200160880270250880320
South Carolina472.925,5103,7102002,1006506403,9001,2009604,230950
South Dakota446.64,430590460130140580180190670220
Tennessee§465.834,7505,0202803,1708509305,8701,8101,4104,8501,350
Texas451.5105,00015,0701,2309,5602,6703,28013,8803,9704,52015,6303,670
Utah404.910,5301,380707603003206306004401,890400
Vermont500.03,950590320130100530210160610190
Virginia452.438,7206,4803003,4201,1509405,6701,9201,5206,4201,500
Washington488.435,3605,6302302,7201,0601,0604,5402,0001,6105,4701,640
West Virginia497.811,0801,510801,1403603002,0804804801,510510
Wisconsin474.730,5304,4301902,6901,0609604,0201,1601,3904,9001,450
Wyoming444.52,6803602307070310110120490130
United States471.51,596,670230,48012,710141,21046,47044,600221,13070,23066,360240,89069,250

Figure 1 indicates the most common cancers expected to occur in men and women in 2011. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about 52% of all newly diagnosed cancers; prostate cancer alone will account for 29% (240,890) of incident cases. The 3 most commonly diagnosed types of cancer among women in 2011 will be breast, lung and bronchus, and colorectum, accounting for about 53% of estimated cancer cases in women. Breast cancer alone is expected to account for 30% (230,480) of all new cancer cases among women.

thumbnail image

Figure 1. Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths By Sex, United States, 2011.

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

Download figure to PowerPoint

Expected Number of Cancer Deaths

Table 1 also shows the expected number of deaths from cancer projected for 2011 for men, women, and both sexes combined. It is estimated that about 571,950 Americans will die from cancer, corresponding to more 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 causes of cancer death. These 4 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 and is expected to account for 26% of all female cancer deaths in 2011. Table 3 provides the estimated number of cancer deaths in 2011 by state for selected cancer sites.

Table 3. Age-standardized Death Rates for All Cancers Combined, 2003-2007, and Estimated Deaths* for Selected Cancers by State, United States, 2011
STATEDEATH RATEALL SITESBRAIN & OTHER NERVOUS SYSTEMFEMALE BREASTCOLON & RECTUMLEUKEMIALIVERLUNG & BRONCHUSNON- HODGKIN LYMPHOMAOVARYPANCREASPROSTATE
  • *

    Rounded to the nearest 10.

  • b

    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.

Alabama201.510,2102107009303503203,210310290600710
Alaska180.9910708025060
Arizona159.610,8202907601,0204204002,660340330690640
Arkansas202.66,4601404405802402102,030190150440330
California166.956,0301,4803,9804,7802,2002,70012,4502,0501,6304,0104,330
Colorado159.86,9802105006503002401,690290240480430
Connecticut179.36,8001504805002602201,750220190550460
Delaware198.41,93012016060605905050120110
Dist. of Columbia198.792080902107080
Florida174.140,9807902,6903,3701,5701,41011,4601,3101,0202,6102,160
Georgia187.115,8603301,1201,4205604504,6705004409801,080
Hawaii150.82,370140220801205809060180140
Idaho170.42,57090160210120706309070200210
Illinois191.323,1404701,8302,1909007106,4206806401,6101,310
Indiana199.412,9603408701,0905203504,020420350810690
Iowa182.16,3901603806003001701,770290190390410
Kansas182.75,3701403704803001501,600190150340290
Kentucky216.59,7501905908503202503,420300220550410
Louisiana211.58,3602106109003003602,480270220540480
Maine199.73,18080170260110909608080200170
Maryland188.810,2402108009203903802,720300270710770
Massachusetts186.612,9102707609804704603,490360370940640
Michigan191.020,7705101,3201,6708206105,8306605601,3601,150
Minnesota173.79,2402306107503902902,470310250610460
Mississippi207.76,0601504006202202002,010190150360360
Missouri197.512,7002808701,0605103903,970450300830540
Montana179.32,0006011017090505708060120140
Nebraska176.53,510902003501409090014090200280
Nevada189.14,7401203305401001901,290150120320310
New Hampshire187.82,69070190200100807706060200160
New Jersey186.116,3703301,2601,5106104704,1606304701,1401,100
New Mexico162.23,4608024034012016080012090230270
New York171.934,3508102,4502,8901,3501,3108,5801,4701,0002,4701,770
North Carolina192.319,7603401,3901,4806605205,7705504601,200990
North Dakota173.31,280801105031010080
Ohio200.224,9005401,7302,1709107007,2108306001,5501,260
Oklahoma196.97,7801705306902902302,390280180400350
Oregon185.87,5502104907002802402,110320240540470
Pennsylvania193.828,5605401,9702,4401,0808707,9601,0908002,0701,920
Rhode Island187.52,150501201409080590506014080
South Carolina194.29,3102006607403302802,910300260570550
South Dakota176.71,68010015070504508050110120
Tennessee206.013,7903408901,1704903904,570470330770750
Texas177.536,7708302,6203,2301,4101,7309,5601,0609502,2602,060
Utah135.72,8801002602501408049010090200230
Vermont179.71,290100110603608060
Virginia188.614,3403001,1401,2705004304,100440410950780
Washington181.211,7403808009604904603,090430370790760
West Virginia209.84,6801002704201401201,480190120220120
Wisconsin182.011,4402606908604803402,940390330730600
Wyoming176.31,02060110260507060
United States183.8571,95013,11039,52049,38021,78019,590156,94019,32015,46037,66033,720

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (38%) (Table 4). 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 over- or underestimate individual risk because of differences in exposure (eg, smoking history) and/or genetic susceptibility.

Table 4. Probability (%) of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2005-2007*
  BIRTH TO 3940 TO 5960 TO 6970 AND OLDERBIRTH 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 6.5.0. Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; 2010.

All sitesMale1.44 (1 in 69)8.50 (1 in 12)15.71 (1 in 6)37.95 (1 in 3)44.29 (1 in 2)
 Female2.12 (1 in 47)9.01 (1 in 11)10.22 (1 in 10)26.49 (1 in 4)37.76 (1 in 3)
UrinarybladderMale0.02 (1 in 4,693)0.38 (1 in 262)0.93 (1 in 107)3.67 (1 in 27)3.80 (1 in 26)
 Female0.01 (1 in 12,116)0.12 (1 in 836)0.26 (1 in 390)0.98 (1 in 102)1.16 (1 in 87)
BreastFemale0.48 (1 in 207)3.75 (1 in 27)3.45 (1 in 29)6.53 (1 in 15)12.15 (1 in 8)
ColorectumMale0.08 (1 in 1,270)0.91 (1 in 110)1.46 (1 in 69)4.38 (1 in 23)5.30 (1 in 19)
 Female0.08 (1 in 1,272)0.72 (1 in 138)1.05 (1 in 95)4.00 (1 in 25)4.97 (1 in 20)
LeukemiaMale0.17 (1 in 598)0.22 (1 in 462)0.33 (1 in 302)1.20 (1 in 83)1.52 (1 in 66)
 Female0.13 (1 in 759)0.15 (1 in 688)0.20 (1 in 494)0.78 (1 in 128)1.10 (1 in 91)
Lung &bronchusMale0.03 (1 in 3,646)0.93 (1 in 108)2.29 (1 in 44)6.70 (1 in 15)7.67 (1 in 13)
 Female0.03 (1 in 3,185)0.77 (1 in 130)1.74 (1 in 57)4.90 (1 in 20)6.35 (1 in 16)
Melanomaof the skin§Male0.15 (1 in 656)0.64 (1 in 157)0.74 (1 in 136)1.85 (1 in 54)2.73 (1 in 37)
 Female0.28 (1 in 353)0.55 (1 in 181)0.37 (1 in 267)0.81 (1 in 123)1.82 (1 in 55)
Non-HodgkinlymphomaMale0.13 (1 in 782)0.44 (1 in 226)0.60 (1 in 168)1.73 (1 in 58)2.30 (1 in 43)
 Female0.08 (1 in 1,179)0.31 (1 in 318)0.44 (1 in 229)1.39 (1 in 72)1.92 (1 in 52)
ProstateMale0.01 (1 in 8,517)2.52 (1 in 40)6.62 (1 in 15)12.60 (1 in 8)16.22 (1 in 6)
Uterine cervixFemale0.15 (1 in 656)0.27 (1 in 377)0.13 (1 in 762)0.18 (1 in 544)0.68 (1 in 147)
Uterine corpusFemale0.07 (1 in 1,423)0.75 (1 in 134)0.85 (1 in 117)1.24 (1 in 81)2.58 (1 in 39)

Trends in Cancer Incidence

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 long-term incidence (delay-adjusted) and mortality patterns for all cancer sites combined and for the 4 most common cancer sites based on joinpoint regression analysis, which describes trends by fitting annual rates to lines connected at “joinpoints” where trends change in direction or magnitude.2, 16 Although Table 5 shows a decrease of 1.1% per year from 2000 through 2007 in overall male cancer incidence, the most recent 3 years of delay-adjusted rates indicate a slight increase, which is likely a reflection of an uptick in prostate cancer incidence. Trend analysis based on a larger data set indicates stable incidence rates among men from 2005 to 2007.12 Overall cancer incidence rates in females decreased by about 0.5% per year from 1998 through 2007. Incidence trends are decreasing for the 4 major cancer sites except for lung cancer in women, in whom rates are still increasing at a slow rate from 1991 through 2007. However, analysis based on a larger geographic area showed that lung cancer incidence rates are decreasing in the most recent 5 years,12 which is consistent with the most recent mortality trend based on national-level data. 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. Recent rapid declines in colorectal cancer incidence rates largely reflect increases in screening that can detect and remove precancerous polyps.17, 18 Although long-term incidence data indicate a decrease in prostate cancer since 2000, delay-adjusted rates in the most recent time period have increased from 155 (per 100,000) in 2005 to 171 in 2007.2 The decrease in the breast cancer incidence rate since 1998 likely reflects the large decline in the use of menopausal hormone therapy among postmenopausal women beginning in 2001, and it may also reflect delayed diagnosis due to decreased mammography utilization from 2003 to 2005.19, 20 However, close inspection of incidence data by individual year shows that after dramatically decreasing from 2002 to 2003, incidence rates from 2003 to 2007 remained relatively unchanged.21 This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer.20

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Figure 2. Annual Age-Adjusted Cancer Incidence and Death Rates* by Sex, United States, 1975 to 2007.

*Rates are age adjusted to the 2000 US standard population. Incidence 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, 1975-2007. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; released April 2010, based on the November 2009 SEER data submission. Mortality: US Mortality Data, 1975 to 2007, National Center for Health Statistics, Centers for Disease Control and Prevention.

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Figure 3. Annual Age-Adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2007.

*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, 1975-2007. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; released April 2010, based on the November 2009 SEER data submission.

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Figure 4. Annual Age-Adjusted Cancer Death Rates* Among Males for Selected Cancers, United States, 1930 to 2007.

*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 Volumes 1930 to 1959, US Mortality Data, 1960 to 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

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Figure 5. Annual Age-Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2007.

*Rates are age adjusted to the 2000 US standard population.

†Uterus indicates 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 Volumes 1930 to 1959, US Mortality Data, 1960 to 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

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Table 5. Trends in Cancer Incidence (Delay-Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1975 to 2007
 Trend 1Trend 2Trend 3Trend 4Trend 5
YearsAPC*YearsAPC*YearsAPC*YearsAPC*YearsAPC*
  • *

    Annual percent change (APC) based on incidence (SEER 9 areas) and mortality rates age adjusted to the 2000 US standard population.

  • The APC is significantly different from zero.

  • Analysis of the SEER 13 areas published in Kohler et al12 shows a significant decrease of 0.3% per year from 2003–2007.

  • Note: Trends were analyzed by Joinpoint Regression Program, version 3.4.3, with a maximum of four joinpoints (ie, five line segments).

  • Source: Altekruse, et al.2

All sites          
 Incidence          
  Male and female1975-19891.21989-19922.81992-1995-2.41995-19990.91999-2007-0.7
  Male1975-19891.31989-19925.21992-1995-4.81995-20000.42000-2007-1.1
  Female1975-1979-0.31979-19871.61987-19950.11995-19981.41998-2007-0.5
 Death          
  Male and female1975-19900.51990-1993-0.31993-2001-1.12001-2007-1.6  
  Male1975-19791.01979-19900.31990-1993-0.41993-2001-1.52001-2007-1.9
  Female1975-19900.61990-1994-0.11994-2002-0.82002-2007-1.5  
Lung & bronchus          
 Incidence          
  Male1975-19821.41982-1991-0.41991-2007-1.8    
  Female1975-19825.51982-19913.51991-20070.4†,    
 Death          
  Male1975-19782.41978-19841.21984-19910.31991-2005-1.92005-2007-3.0
  Female1975-19826.01982-19904.21990-19951.71995-20030.32003-2007-0.9
Colorectum          
 Incidence          
  Male1975-19851.11985-1991-1.21991-1995-3.21995-19982.11998-2007-3.1
  Female1975-19850.31985-1995-1.91995-19981.91998-2007-2.2  
 Death          
  Male1975-1984-0.11984-1990-1.41990-2002-2.02002-2005-4.32005-2007-2.1
  Female1975-1984-1.01984-2001-1.82001-2007-3.2    
Female breast          
 Incidence1975-1980-0.51980-19873.91987-1995-0.11995-19982.71998-2007-1.6
 Death1975-19900.41990-2007-2.2      
Prostate          
 Incidence1975-19882.61988-199216.51992-1995-11.51995-20002.12000-2007-1.7
 Death1975-19870.91987-19913.01991-1994-0.51994-2005-4.12005-2007-2.6

Trends in Cancer Mortality

Cancer replaced heart disease as the leading cause of death among men and women aged younger than 85 years in 1999 (Fig. 6). The overall cancer death rate decreased by 1.9% per year from 2001 through 2007 in males and by 1.5% in females from 2002 through 2007, compared with smaller declines of 1.5% per year in males from 1993 through 2001 and 0.8% per year in females from 1994 through 2002 (Table 5). Notably, the lung cancer mortality rate in women has begun to decline for the first time in recorded history and more than a decade later than the decline began in men. Mortality rates have continued to decrease for colorectal, female breast, and prostate cancers. Table 6 shows the contribution of individual cancer sites to the total decrease in overall cancer death rates by comparing rates in the current year with those in the peak year—1990 for men and 1991 for women—for all sites combined. Between 1990/1991 and 2007, cancer death rates decreased by 22.2% in men and by 13.9% in women. Among men, the reduction in death rates for lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in the cancer death rate, while among women, the reduction in death rates for breast and colorectal cancers accounted for almost 60% of the decrease. Lung cancer in men and breast cancer in women each account for more than one-third of the sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men since 1990 is due to the reduction in tobacco use over 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.

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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 to 2007.

*Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1975 to 2007. National Center for Health Statistics, Centers for Disease Control and Prevention.

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Table 6. The Contribution of Indvidual Cancer Sites to the Decrease in Cancer Death Rates, 1990 to 2007
MaleDeath Rate (per 100,000)Change% Contribution
1990*2007Absolute%
  • *

    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.

  • Lung cancer death rates in women are decreasing in the most recent time period.

All malignant cancers279.82217.79-62.03-22.17 
Decreasing     
  Lung & bronchus90.5665.23-25.33-27.9738.5
  Prostate38.5623.50-15.06-39.0622.9
  Colorectum30.7720.05-10.72-34.8416.3
  Stomach8.865.01-3.85-43.455.9
  Oral cavity & pharynx5.613.85-1.76-31.372.7
  Non-Hodgkin lymphoma9.978.29-1.68-16.852.6
  Leukemia10.719.44-1.27-11.861.9
  Larynx2.972.05-0.92-30.981.4
  Brain & other nervous system5.975.10-0.87-14.571.3
  Myeloma4.834.39-0.44-9.110.7
  Urinary bladder7.977.56-0.41-5.140.6
  Kidney & renal pelvis6.165.79-0.37-6.010.6
  Hodgkin lymphoma0.850.50-0.35-41.180.5
  Other decreasing38.6635.89-2.77-7.174.2
  Total262.45196.65-65.80 100.0
Increasing     
  Liver & intrahepatic bile duct5.277.922.6550.28 
  Esophagus7.167.670.517.12 
  Melanoma of the skin3.803.980.184.74 
  Other increasing0.841.290.4553.57 
  Total17.0720.863.79  
No change     
  Bones & joints0.550.550.000.00 
FemaleDeath Rate (per 100,000)Change% Contribution
1991*2007Absolute%
All malignant cancers175.30150.87-24.43-13.93 
Decreasing     
  Breast32.6922.84-9.85-30.1335.2
  Colorectum20.314.15-6.15-30.3022.0
  Non-Hodgkin lymphoma6.745.19-1.55-23.005.5
  Stomach4.012.57-1.44-35.915.1
  Ovary9.518.22-1.29-13.564.6
  Cervix uteri3.492.42-1.07-30.663.8
  Leukemia6.325.27-1.05-16.613.8
  Brain & other nervous system4.113.47-0.64-15.572.3
  Oral cavity & pharynx2.031.42-0.61-30.052.2
  Myeloma3.262.81-0.45-13.801.6
  Gallbladder1.090.73-0.36-33.031.3
  Kidney & renal pelvis2.952.63-0.32-10.851.1
  Esophagus1.811.58-0.23-12.710.8
  Larynx0.630.42-0.21-33.330.8
  Other decreasing21.0018.25-2.75-13.109.8
  Total119.9491.97-27.97-23.32100.0
Increasing     
  Lung & bronchus37.6139.982.376.31 
  Liver & intrahepatic bile duct2.523.240.7328.83 
  Pancreas9.289.370.090.97 
  Total49.4052.593.19  
No change     
  Uterine corpus4.184.180.000.00 

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 898,000 cancer deaths (649,300 in men and 248,600 in women) were averted during the time interval from 1991/1992 through 2007.

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Figure 7. Total Number of Cancer Deaths Avoided From 1991 to 2007 in Men and From 1992 to 2007 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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Regional Variations in Cancer Rates

Tables 7 and 8 depict cancer incidence and death rates for selected cancer sites by state. Lung cancer shows by far the largest geographic variation in cancer occurrence; lung cancer incidence and death rates in men and women are 3-fold higher in Kentucky (the state with the highest rates) than in Utah (the state with the lowest rates). This variation reflects the large historical and continuing differences in smoking prevalence among states. Utah ranks lowest in adult smoking prevalence and Kentucky among the highest. In contrast, state variations in rates for other cancer sites are smaller in both absolute and proportionate terms. For cancers that can be detected by screening or other testing practices, such as those of the prostate, female breast, and colorectum, state variation in incidence rates reflects differences in the use of screening tests or detection practices in addition to differences in disease occurrence.

Table 7. Cancer Incidence Rates* by Site and State, United States, 2003-2007
StateAll SitesBreastColorectumLung & BronchusNon-Hodgkin LymphomaProstateUrinary Bladder
MaleFemaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleMaleFemale
  • *

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

  • Due to the effect of large migrations of populations on this state as a result of Hurricane Katrina in September 2005, statistics exclude cases diagnosed in 2005 from July-December.

  • This state is not included in the overall US rates because its registry did not achieve high quality data standards for one or more years during 2003-2007 as determined by the North American Association of Central Cancer Registries (NAACCR).

  • §

    This state's registry did not submit incidence data to NAACCR for 2003-2007.

  • Source: NAACCR, 2010. Data are collected by cancer registries participating in NCI's SEER program and CDC's National Program of Cancer Registries.

Alabama567.5381.2114.561.441.6106.353.220.013.9158.432.07.7
Alaska512.0423.5128.656.844.384.263.522.116.7133.437.57.8
Arizona452.0355.0103.644.733.165.448.518.013.1123.433.08.4
Arkansas565.2386.5111.357.541.9110.960.222.115.2161.333.38.6
California508.9392.4121.051.438.863.946.322.515.5147.134.08.1
Colorado503.6393.8122.449.838.658.845.321.716.0158.933.38.5
Connecticut589.3456.3134.559.444.480.560.326.018.1163.546.312.5
Delaware612.6443.6125.761.444.098.070.723.916.6182.243.611.8
Dist. of Columbia569.5421.9139.458.147.979.446.322.913.4185.424.88.6
Florida532.0401.0112.553.140.486.759.421.515.2137.236.49.4
Georgia562.7393.2118.556.941.298.853.921.114.3162.032.77.9
Hawaii493.8386.8120.659.540.169.240.519.412.4131.625.86.5
Idaho536.2404.9116.348.238.468.349.121.817.1165.836.09.0
Illinois576.7430.3122.665.647.391.259.424.216.2157.040.210.5
Indiana552.7416.1113.861.345.2102.463.922.917.0137.237.29.4
Iowa557.2429.2122.461.948.089.354.225.218.1141.841.49.3
Kansas559.3419.3124.660.742.487.653.724.318.1158.536.28.9
Kentucky610.0452.8120.167.648.9131.378.223.517.1141.739.210.1
Louisiana616.4409.0118.866.746.0107.858.923.516.6174.535.48.5
Maine618.9466.2128.861.647.299.166.624.618.8166.249.813.9
Maryland537.8414.7123.854.441.481.557.920.914.5159.432.89.8
Massachusetts594.0456.8131.760.543.982.263.124.516.9164.645.912.7
Michigan591.8437.2122.257.143.491.962.525.718.7173.041.910.7
Minnesota567.2418.4125.954.841.669.049.726.317.8183.440.010.1
Mississippi589.5383.7109.764.146.3114.554.920.613.8170.829.47.3
Missouri549.3417.8119.861.144.0104.163.921.815.8132.535.78.6
Montana527.8405.3120.250.339.674.558.322.514.5168.538.39.3
Nebraska562.4419.2122.866.647.484.251.224.417.7159.037.19.5
Nevada§
New Hampshire578.8454.6130.156.043.182.562.423.518.1155.746.813.3
New Jersey598.2451.2128.462.646.078.356.325.617.7172.446.712.1
New Mexico474.8365.1109.348.235.955.738.718.314.3144.426.27.3
New York576.8435.6124.358.444.378.254.325.017.5165.842.211.1
North Carolina561.6406.3121.456.040.9101.057.621.915.4153.935.79.0
North Dakota552.3410.0123.468.543.573.648.023.116.8165.840.310.4
Ohio548.4418.6119.960.044.596.159.723.116.4145.538.89.5
Oklahoma572.3428.9126.858.643.7105.364.923.217.8154.035.98.8
Oregon527.1428.4130.251.839.977.160.124.016.6146.838.79.9
Pennsylvania590.0447.4123.963.947.490.057.125.017.5158.144.911.3
Rhode Island607.1460.0130.061.845.792.661.924.917.4153.552.913.0
South Carolina576.5398.6119.858.542.8100.253.720.814.4166.531.68.0
South Dakota526.0387.4116.856.642.777.446.321.016.5165.035.77.9
Tennessee543.8399.1116.557.843.0109.860.121.515.5135.633.48.1
Texas539.1389.6113.356.339.186.050.922.516.0145.230.27.3
Utah483.4342.4108.144.431.636.223.222.616.1178.828.85.9
Vermont562.1456.4130.449.442.984.561.123.818.3155.545.112.6
Virginia539.1391.9122.154.241.088.553.820.813.9159.133.88.5
Washington559.5436.8130.351.238.676.159.327.018.2161.740.39.8
West Virginia582.5439.9115.368.048.7116.371.324.017.3140.139.711.0
Wisconsin543.8426.3122.054.642.276.853.825.518.7148.339.711.1
Wyoming512.0389.9114.851.041.659.948.321.315.7167.940.89.3
United States552.5414.7120.757.142.484.955.623.216.3153.537.79.6
Table 8. Cancer Death Rates* by Site and State, United States, 2003-2007
StateAll SitesBreastColorectumLung & BronchusNon-Hodgkin LymphomaPancreasProstate
MaleFemaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMale
  • *

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

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

Alabama263.8159.924.823.615.192.241.78.65.712.79.230.1
Alaska213.0156.022.721.013.864.844.47.44.811.79.320.6
Arizona190.6135.421.318.512.554.134.97.74.911.07.721.0
Arkansas255.5164.924.423.415.793.247.58.95.312.69.427.1
California198.7145.222.818.813.551.434.58.35.211.69.323.6
Colorado190.6139.421.318.713.947.832.98.45.010.98.824.5
Connecticut218.2154.723.718.814.259.640.18.85.514.210.025.5
Delaware241.4168.424.622.316.076.450.49.25.011.29.526.1
Dist. of Columbia258.1162.228.324.417.669.134.98.84.115.510.441.7
Florida211.0145.322.118.913.466.240.68.35.111.78.520.5
Georgia241.1153.023.921.314.781.639.78.25.012.59.128.9
Hawaii187.3122.617.919.911.451.227.77.54.312.29.317.1
Idaho202.3146.621.617.213.753.435.48.46.211.510.327.5
Illinois235.4163.425.223.916.571.142.29.25.713.09.926.2
Indiana249.4166.724.524.015.783.947.610.06.013.19.425.6
Iowa225.4153.322.022.115.870.839.19.55.911.78.925.9
Kansas225.2154.124.021.615.072.341.29.76.012.59.422.6
Kentucky275.0177.624.225.217.6105.256.09.66.012.59.425.8
Louisiana270.7171.527.726.316.989.745.69.45.813.610.728.8
Maine245.0169.522.620.816.376.948.79.45.612.99.925.4
Maryland230.8161.725.822.815.669.142.98.15.112.810.527.5
Massachusetts230.5159.422.921.114.865.543.88.95.713.410.224.6
Michigan232.8163.124.521.115.472.544.19.66.313.49.723.9
Minnesota211.9149.121.818.813.758.337.09.55.511.79.125.3
Mississippi276.3162.025.824.916.999.443.08.34.913.59.832.1
Missouri245.7164.925.822.515.684.346.68.95.612.99.523.6
Montana211.2156.521.418.114.360.743.38.76.112.18.827.8
Nebraska218.8148.022.423.115.765.635.69.16.212.18.424.5
Nevada217.9165.223.922.016.565.050.97.05.311.99.524.5
New Hampshire227.2162.223.121.014.865.544.78.75.512.411.226.2
New Jersey222.5163.227.023.316.761.539.78.95.813.19.823.9
New Mexico194.8138.022.119.213.346.129.97.44.911.29.125.4
New York206.0150.523.920.815.057.736.78.05.212.49.623.5
North Carolina244.8157.724.821.214.582.542.08.35.412.89.627.7
North Dakota210.8147.922.421.314.858.635.18.45.211.69.526.4
Ohio249.1168.326.623.616.880.345.39.65.912.99.626.3
Oklahoma246.0162.624.723.115.085.047.19.35.911.88.523.6
Oregon219.9161.723.219.314.864.245.59.56.212.410.026.0
Pennsylvania239.6164.025.623.616.171.440.49.66.213.49.925.0
Rhode Island234.9158.622.821.014.669.842.08.85.211.59.324.2
South Carolina249.0156.724.421.415.283.940.68.05.212.49.328.9
South Dakota220.3145.722.321.415.165.536.58.85.411.29.526.0
Tennessee264.0167.125.423.115.995.747.59.55.912.79.227.6
Texas221.3147.323.021.013.968.337.58.35.311.68.623.1
Utah161.7116.322.815.110.931.417.68.15.29.88.125.7
Vermont215.3156.723.520.515.461.842.58.55.110.88.925.2
Virginia235.7158.025.621.714.774.542.18.25.313.09.827.3
Washington214.0158.523.018.313.461.544.39.05.812.29.625.4
West Virginia259.4175.824.325.317.991.050.510.06.411.47.522.3
Wisconsin223.5154.522.619.914.062.338.59.36.012.69.427.1
Wyoming204.6155.223.420.116.055.638.48.36.812.310.721.8
United States225.4155.424.021.214.968.840.68.75.512.39.424.7

Cancer Occurrence by Race/Ethnicity

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 9). For all cancer sites combined, African American men have a 14% higher incidence rate and a 33% 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 9, 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 screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment for many cancers. The higher breast cancer incidence rates noted among white women are thought to reflect a combination of factors that affect both diagnosis (historically more prevalent mammography use in white women) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy among white women).22

Table 9. Incidence and Death Rates* by Site, Race, and Ethnicity, United States, 2003-2007
 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, comprising about 55% of the US American Indian/Alaska Native population; for more information please see: Espey et al.23

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

  • Source: Kohler, et al.12

Incidence
All sites     
 Male544.9623.1332.3424.6426.1
 Female418.8392.9278.1359.2331.2
Breast (female)121.9114.682.388.291.0
Colorectum     
 Male56.167.242.851.949.2
 Female41.450.732.542.234.9
Kidney & renal pelvis     
 Male20.221.69.626.918.9
 Female10.611.04.716.511.0
Liver & bile duct     
 Male8.213.521.614.316.4
 Female2.83.98.17.26.2
Lung & bronchus     
 Male84.3103.549.970.248.0
 Female57.051.827.750.627.1
Prostate143.8230.081.0101.5128.0
Stomach     
 Male8.716.417.214.514.1
 Female4.18.49.77.38.6
Uterine cervix7.710.77.49.712.5
Mortality
All sites     
 Male222.5296.5134.2183.7150.6
 Female155.0180.694.1138.0102.3
Breast (female)23.432.412.217.615.3
Colorectum     
 Male20.630.513.219.215.6
 Female14.421.09.912.910.5
Kidney & renal pelvis     
 Male6.06.02.68.85.2
 Female2.72.71.23.82.4
Liver & bile duct     
 Male7.011.114.710.911.3
 Female3.03.96.46.65.2
Lung & bronchus     
 Male68.387.536.748.132.5
 Female41.639.618.533.314.4
Prostate22.854.210.620.018.8
Stomach     
 Male4.610.79.49.28.0
 Female2.45.05.64.24.6
Uterine cervix2.24.42.13.43.1

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 at least twice as high in Asian Americans/Pacific Islanders compared with whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses in this population. Kidney cancer incidence and death rates are the highest among American Indians/Alaska Natives; the higher prevalence of obesity and smoking in this population are factors that may contribute to this disparity.23

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 1998 to 2007, both incidence (unadjusted for delayed reporting) and death rates for all cancer sites combined decreased among men of all racial/ethnic groups; the largest declines in death rates occurred among men of African American (2.6% per year) and Hispanic heritage (2.5% per year) (Table 10).12 It is important to note, however, that cancer death rates in African American men remain substantially higher than those among white men and twice those of Hispanic men. Among women during this time period, incidence rates decreased in whites, Asian Americans/Pacific Islanders, and Hispanics, and were stable in African Americans and American Indians/Alaska Natives; cancer death rates decreased among women of all racial/ethnic groups except American Indians/Alaska Natives, in whom they were stable.

Table 10. Fixed-Interval Trends in Overall Cancer Incidence and Death Rates by Race/Ethnicity, United States, 1998 to 2007
 1998 - 2007 AAPC
IncidenceMortality
MaleFemaleMaleFemale
  • AAPC indicates average annual percent change. Race and ethnicity categories are not mutually exclusive of Hispanic origin.

  • *

    AAPC is statistically significantly different from zero (two-sided Z test, P < 0.05).

  • Data based on Contract Health Service Delivery Areas.

  • Excludes deaths from the District of Columbia, Maine, Minnesota, New Hampshire, and North Dakota.

  • Source: Kohler, et al.12

All race/ethnicities combined-0.8*-0.5*-1.8*-1.1*
White-0.9*-0.5*-1.7*-1.0*
African American-1.4*-0.5-2.6*-1.4*
Asian American/Pacific Islander-1.4*-0.3*-2.0*-1.2*
American Indian/Alaska Native-1.3*-0.2-1.0*-0.2
Hispanic-1.4*-0.6*-2.5*-1.3*

The Impact of Eliminating Disparities on Premature Death From Cancer

Level of education is often used as a marker of socioeconomic status. In 2007, cancer death rates in the least educated segment of the population were 2.6 times higher than those in the most educated segment (Table 11). The racial patterns in educational disparities were generally similar across the 4 major cancer sites, although the magnitude of the association was generally weaker for Hispanics. The largest socioeconomic disparity was seen for lung cancer; the death rate in men was 5 times higher for the least educated than for the most educated. Differences in lung cancer death rates reflect the striking gradient in smoking prevalence by level of education; 31% of men with 12 or fewer years of education are current smokers, compared with 12% of college graduates and 5% of men with graduate degrees.24

Table 11. Cancer Death Rates* by Educational Attainment, Race, and Sex, United States, 2007
 MenWomen
All RacesNon-Hispanic African AmericanNon-Hispanic whiteHispanicAll RacesNon-Hispanic African AmericanNon-Hispanic whiteHispanic
  • RR indicates relative risk of cancer death among those with the lowest level of education compared to those with the highest level; CI, confidence interval; NA, not applicable. Absolute difference is between the lowest and highest education levels.

  • Education categories are defined based on 1989 death certificates.

  • *

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

  • Source: National Center for Health Statistics

All sites        
< = 12 years of education147.85216.48148.7952.80119.38145.38123.9655.99
13-15 years of education72.67101.6771.3345.7169.07105.8866.2435.84
>= 16 years of education55.9276.9056.4837.0559.1386.1857.7958.68
RR (95% CI)2.64 (2.53 - 2.76)2.82 (2.40 - 3.30)2.63 (2.52 - 2.76)1.43 (1.06 - 1.92)2.02 (1.94 - 2.10)1.69 (1.49 - 1.90)2.15 (2.05 - 2.25)0.95 (0.69 - 1.32)
Absolute difference91.94139.5892.3215.7560.2559.2066.17-2.68
Lung        
< = 12 years of education51.6373.0153.499.4033.8633.2037.715.43
13-15 years of education20.5428.2620.486.8515.2820.2215.294.42
>= 16 years of education10.3517.6410.188.618.7711.968.626.48
RR (95% CI)4.99 (4.65 - 5.34)4.14 (3.27 - 5.24)5.26 (4.88 - 5.67)1.09 (0.66 - 1.82)3.86 (3.58 - 4.17)2.78 (2.22 - 3.48)4.38 (4.02 - 4.76)0.84 (0.38 - 1.83)
Absolute difference41.2855.3743.310.7925.0921.2429.09-1.05
Colorectum        
< = 12 years of education13.5922.4513.185.349.7513.979.745.11
13-15 years of education7.4113.466.746.305.659.875.233.26
>= 16 years of education6.2210.376.053.804.739.814.434.60
RR (95% CI)2.18 (2.00 - 2.39)2.17 (1.66 - 2.87)2.18 (1.97 - 2.41)1.41 (0.67 - 2.96)2.06 (1.86 - 2.29)1.42 (1.11 - 1.83)2.20 (1.95 - 2.48)1.11 (0.47 - 2.60)
Absolute difference7.3712.087.131.545.024.165.310.51
Prostate     NA
< = 12 years of education3.619.033.041.33
13-15 years of education2.165.511.811.85
>= 16 years of education2.175.992.050.82
RR (95% CI)1.66 (1.44 - 1.93)1.51 (1.03 - 2.22)1.48 (1.25 - 1.75)1.61 (0.36 - 7.20)
Absolute difference1.443.040.990.51
BreastNA    
< = 12 years of education22.1233.5321.4111.93
13-15 years of education16.2331.1714.607.97
>= 16 years of education16.5127.4415.7618.46
RR (95% CI)1.34 (1.26 - 1.43)1.22 (1.03 - 1.44)1.36 (1.26 - 1.46)0.65 (0.41 - 1.03)
Absolute difference5.606.095.64-6.52

Figure 8 shows the numbers of potential premature cancer deaths that could have been avoided in 2007 among adults aged 25 to 64 years in the absence of socioeconomic and/or racial disparities. If everyone in the United States experienced the same overall cancer death rates as the most educated non-Hispanic whites, 37% (60,370 of 164,190) of the premature cancer deaths could potentially have been avoided. This analysis suggests that eliminating socioeconomic disparities in African Americans could potentially avert twice as many premature cancer deaths as eliminating racial disparities, underscoring the dominant role of poverty in cancer disparities.

thumbnail image

Figure 8. Potential US* Cancer Deaths That Could Have Been Avoided by Eliminating Educational and/or Racial Disparities, Aged 25 to 64 Years, 2007.

*Excludes Rhode Island and Georgia. aAge-specific cancer death rates of the most educated non-Hispanic whites in 2007 were applied to all races.

bAge-specific cancer death rates of the most educated African Americans in 2007 were applied to all African Americans.

cAge- and educational attainment-specific cancer death rates of non-Hispanic whites in 2007 were applied to the corresponding population of African Americans.

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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. 9). 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 10, 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 survival differential is unclear.25 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.26

thumbnail image

Figure 9. Five-Year Relative Survival Rates Among Patients Diagnosed With Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2006.

*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 and Whites and 94% for 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: Altekruse, et al.2

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thumbnail image

Figure 10. Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2006.

*The proportion of in situ urinary bladder cancer cases is 50%, 51%, and 37% in All Races, 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: Altekruse, et al.2

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There have been notable improvements since 1975 in the relative 5-year survival rates for many cancer sites and for all cancers combined for both whites and African Americans (Table 12). The improvement in survival reflects a combination of earlier diagnosis and improved treatments. Cancers for which survival has shown the least improvement over the past 30 years include lung and pancreas.

Table 12. Trends in 5-Year Relative Survival Rates* (%) by Race and Year of Diagnosis, United States, 1975 to 2006
 All RacesWhiteAfrican American
1975 to 19771984 to 19861999 to 20061975 to 19771984 to 19861999 to 20061975 to 19771984 to 19861999 to 2006
  • *

    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 1999-2006 and followed through 2007.

  • The difference in rates between 1975-1977 and 1999-2006 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: Altekruse, et al.2

All sites505468515569404159
Brain242936232835273241
Breast (female)757990768191626578
Colon525966526067475055
Esophagus51019611203913
Hodgkin lymphoma748087748088717582
Kidney515670515670505467
Larynx676663686865†595349
Leukemia364255364356343447
Liver & bile duct461446142510
Lung & bronchus131316131417121113
Melanoma of the skin8387938387936070§74
Myeloma262939262739313238
Non-Hodgkin lymphoma485369495471494860
Oral cavity535563555765363645
Ovary374045373945434137†
Pancreas336336255
Prostate69761007078100616697
Rectum495769505870454660
Stomach161827151826162026
Testis83939683939773#8787†
Thyroid939497939498919095†
Urinary bladder747881757982516166
Uterine cervix706871†717073†655964†
Uterine corpus888484898586615861†

Relative survival rates cannot be calculated for all racial and ethnic subpopulations because accurate life expectancies are not available. However, based on cause-specific survival rates of cancer patients diagnosed from 1999 to 2006 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 (56.0%), followed by American Indians/Alaska Natives (60.6%), Hispanics (65.5%), whites (65.6%), and Asian Americans/Pacific Islanders (68.2%).2 For the 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely than non-Hispanic whites to be diagnosed at a distant stage of disease.27

Cancer in Children

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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. About one-third of the invasive cancers diagnosed in children aged birth to 14 years are leukemias (particularly acute lymphocytic leukemia), followed by cancer of the brain and other nervous system (27%), soft tissue sarcomas (7%, half of which are rhabdomyosarcoma), neuroblastoma (7%), renal (Wilms) tumors (5%), and Hodgkin and non-Hodgkin lymphomas (4% each).2 Between 1998 and 2007, the overall incidence rate for cancer in children aged 14 years and younger increased by 0.6% per year while the death rate decreased by 1.0% per year.12 Over the past 25 years, there have been significant improvements in the 5-year relative survival rate for all of the major childhood cancers due to new and improved treatments (Table 13). The 5-year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed between 1975 and 1977 to 82% for those diagnosed between 1999 and 2006.2

Table 13. Trends in Five-Year Relative Survival Rates* (%) for Children Under Age 15, United States, 1975 to 2006
SiteYear of Diagnosis
1975 to 19771978 to 19801981 to 19831984 to 19861987 to 19891990 to 19921993 to 19951996 to 19981999 to 2006
  • *

    Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2007.

  • The difference in rates between 1975 to 1977 and 1999 to 2006 is statistically significant (p < 0.05).

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

  • Source: Altekruse, et al.2

All sites586367687276777982
Acute lymphocytic leukemia586671737883848789
Acute myeloid leukemia192627313742424961
Bone & joint504857586767747073
Brain & other nervous system575856626465707574
Hodgkin lymphoma818888918797959696
Neuroblastoma535755526376676672
Non-Hodgkin lymphoma445367707177818387
Soft tissue617569736680777081
Wilms tumor737987919292929292

Limitations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 model-based and may vary considerably from year to year for reasons other than changes in cancer occurrence. For instance, estimates are invariably affected by changes in method, which occur regularly as modeling techniques improve over time. For example, the introduction of a new method for projecting incident cancer cases in 2007 substantially affected the estimates for a number of cancers, particularly leukemia and female breast.8 In addition, not all changes in cancer trends can be 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 age-standardized or age-specific cancer death rates from the NCHS and cancer incidence rates from SEER or NPCR, even though these data are 3 and 4 years old, respectively, by the time that they become available. Nevertheless, the American Cancer Society projections of the number of new cancer cases and deaths provide a reasonably accurate estimate of the current cancer burden in the United States.

Errors in reporting race/ethnicity in medical records and on death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and non-African American 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 important difference in the cancer burden within racial/ethnic subgroups are often masked.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Material 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 Conrol and Prevention, 2010.
  • 2
    AltekruseSF, KosaryCL, KrapchoM, et al, eds. Surveillance, Epidemiology, and End Results Cancer Statistics Review, 1975-2007. Bethesda, MD: National Cancer Institute; 2010.
  • 3
    Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 17 Regs Public Use, Nov. 2009 Sub (2000-2007)-Linked to County Attributes-Total US, 1969-2007 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2010. Released April 2010 based on the November 2009 submission.
  • 4
    Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 9 Regs Public Use, Nov. 2009 Sub (1973-2007)-Linked to County Attributes-Total US, 1969-2007 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2010. Released April 2010 based on the November 2009 submission.
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    Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: NAACCR Incidence-CiNA Analytic File, 1995-2007, 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; 2010.
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    Day JC. Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, U.S. Bureau of the Census, Current Population Reports, P25-1130, U.S. Government Printing Office, Washington, DC, 1996.
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    FritzA, PercyC, JackA, et al, eds. International Classification of Diseases for Oncology. 3rd ed. Geneva: World Health Organization; 2000.
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    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: 30-42.
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    Joinpoint Regression Program, Version 3.4.3. Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; 2010.
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    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: 30-40.
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    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: 1537-1545.
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    Kohler BA, Ward E, McCarthy BJ, et al. Annual Report to the Nation on the Status of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous System. J Natl Cancer Inst. 2011; 103: 1-23.
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    Sorlie PD, Rogot E, Johnson NJ. Validity of demographic characteristics on the death certificate. Epidemiology. 1992; 3: 181-184.
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    Rothman K, Greenland S. Modern Epidemiology. 2nd ed. Philadelphia: Lippincott-Raven; 1998.
  • 15
    Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010; 146: 283-287.
  • 16
    Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000; 19: 335-351.
  • 17
    Cress RD, Morris C, Ellison GL, Goodman MT. Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992-2001. Cancer. 2006; 107( 5 suppl): 1142-1152.
  • 18
    Phillips KA, Liang SY, Ladabaum U, et al. Trends in colonoscopy for colorectal cancer screening. Med Care. 2007; 45: 160-167.
  • 19
    Breen N, Gentleman JF, Schiller JS. Update on mammography trends: comparisons of rates in 2000, 2005, and 2008. Cancer. 2011; 117: 2209-2218.
  • 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: 1670-1674.
  • 21
    Desantis C, Howlader N, Cronin KA, Jemal A. Breast cancer incidence rates in US women are no longer declining [published online ahead of print February 28, 2011]. Cancer Epidemiol Biomarkers Prev.
  • 22
    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: 342-355.
  • 23
    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: 2119-2152.
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    American Cancer Society. Cancer Facts & Figures 2011. Atlanta, GA: American Cancer Society; 2011.
  • 25
    Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin. 2002; 52: 326-341.
  • 26
    Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002; 287: 2106-2113.
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    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.