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Keywords:

  • cancer;
  • epidemiology;
  • health disparities;
  • incidence;
  • survival;
  • trends

Abstract

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

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data were collected by the National Center for Health Statistics. A total of 1,665,540 new cancer cases and 585,720 cancer deaths are projected to occur in the United States in 2014. During the most recent 5 years for which there are data (2006-2010), delay-adjusted cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.4% per year in women. The combined cancer death rate (deaths per 100,000 population) has been continuously declining for 2 decades, from a peak of 215.1 in 1991 to 171.8 in 2010. This 20% decline translates to the avoidance of approximately 1,340,400 cancer deaths (952,700 among men and 387,700 among women) during this time period. The magnitude of the decline in cancer death rates from 1991 to 2010 varies substantially by age, race, and sex, ranging from no decline among white women aged 80 years and older to a 55% decline among black men aged 40 years to 49 years. Notably, black men experienced the largest drop within every 10-year age group. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population. CA Cancer J Clin 2014;64:9–29. © 2014 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. Limitations
  8. Conclusions
  9. References

Cancer is a major public health problem in the United States and many other parts of the world. 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 2014 in the United States nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using the most current population-based data available. In addition, we estimate the total number of deaths averted since the early 1990s as a result of 2 decades of declining cancer death rates and present the actual number of deaths reported in 2010 by age for the 10 leading causes of death and the 5 leading causes of cancer death.

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. Limitations
  8. Conclusions
  9. References

Incidence and Mortality Data

Mortality data from 1930 to 2010 were obtained from the National Center for Health Statistics (NCHS).[1] Population-based cancer incidence data in the United States are collected both by the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program and the Centers for Disease Control and Prevention's (CDC's) National Program of Cancer Registries (NPCR). The SEER program reports long-term (beginning in 1973), high-quality incidence, prevalence, and survival data. Long-term incidence and survival trends (1975-2010) were based on data from the 9 oldest SEER areas (Connecticut, Iowa, Hawaii, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound), representing approximately 10% of the US population.[2] As of 1992, SEER data have been available for 4 additional populations (Alaska Natives, Los Angeles County, San Jose-Monterey, and rural Georgia) that increase the coverage of minority groups and allow for stratification by race and ethnicity.[3] Data from these SEER 13 registries were the source for the annual percent change in incidence from 1992 to 2010. The SEER program added 5 additional catchment areas beginning with cases diagnosed in 2000 (greater California, greater Georgia, Kentucky, Louisiana, and New Jersey), achieving 28% population coverage.[4] Data from all 18 SEER areas were the source for cancer stage distribution, stage-specific survival, and the lifetime probability of developing cancer. Much of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review, 1975-2010.[5]

The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for cancer registries that participate in the SEER program or the NPCR. These data approach 100% coverage of the US population and were the source for incidence rates by state and race/ethnicity, as well as the projection of new cancer cases in 2014.[6] Some of the data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2006-2010.[7, 8]

All cancer cases were classified according to the International Classification of Diseases for Oncology.[9] The lifetime probability of cancer was calculated using the NCI's DevCan software (version 6.7.0).[10] All incidence and death rates were age-standardized to the 2000 US standard population and expressed per 100,000 population, as calculated by NCI's SEER*Stat software (version 8.1.2).[11]

Cancer incidence rates in this report were adjusted for delays in reporting whenever possible. This adjustment, which is available only for SEER data, is based on historic patterns of case ascertainment and accounts for anticipated future corrections to registry data primarily due to a lag in case reporting. Delay adjustment has the largest effect on the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate cancer) and provides a more accurate portrayal of the cancer burden in the most recent time period.[12] For example, melanoma incidence rates adjusted for reporting delays are 14% higher than unadjusted rates in the most recent data year. Delay-adjusted rates were obtained from the SEER Canques database (surveillance.cancer.gov/delay/canques.html [accessed August 6, 2013]).

Projected Cancer Cases and Deaths in 2014

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, compilation, quality control, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in the current year in order to provide an estimate of the contemporary cancer burden. These estimates are not useful for tracking cancer occurrence over time because they are model-based and because the calculation methodology changes every few years in order to take advantage of improvements in modeling techniques, increased cancer registration coverage, and updated risk factor surveillance.

A 3-step spatio-temporal model was used to project the number of new invasive cancer cases that will be diagnosed in 2014 based on 1995 through 2010 high-quality incidence data from 49 states and the District of Columbia, representing 89% population coverage. (All states did not meet high quality data standards for all years and Minnesota did not submit incidence data to NAACCR during the 2012 call for data.) 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.[13] First, complete incidence counts were estimated for each county from 1995 through 2010. Then these counts were adjusted to account for delays in cancer reporting. Finally, a temporal projection method (the vector autoregressive model) was applied to the last 15 years of data (1996-2010) to estimate counts for 2014, which were then aggregated to obtain state-level estimates. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are not reported to cancer registries. For the complete details of the case projection methodology, please refer to Zhu et al.[14]

To estimate the number of in situ female breast and melanoma cases diagnosed in 2014, we first estimated the number of cases occurring annually from 2001 through 2010 by applying age-specific SEER 13 incidence rates to the corresponding US population estimates provided in SEER*Stat.[11] (Delay-adjusted rates were available for in situ breast cancer but not for in situ melanoma.) We then projected the total number of cases in 2014 based on the average annual percent change in case counts from 2001 through 2010 generated by the joinpoint regression model.[15]

We estimated the number of cancer deaths expected to occur in 2014 in the United States overall and in each state using the joinpoint regression model based on the actual numbers of cancer deaths from 1995 through 2010 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.[16]

Other Statistics

The estimated number of cancer deaths averted in men and women due to the reduction in overall cancer death rates was calculated by first estimating the number of cancer deaths that would have occurred if death rates had remained at their peak. The expected number of deaths was estimated by applying the 5-year age-specific cancer death rates in the peak year for age-standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age-specific populations in the subsequent years through 2010. Then the difference between the number of expected and recorded cancer deaths in each age group and calendar year was summed for men and women separately.

Selected Findings

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

Expected Numbers of New Cancer Cases

Table 1 presents the estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2014. The overall estimate of 1,665,540 new cases is the equivalent of more than 4,500 new cancer diagnoses each day. About 62,570 cases of breast carcinoma in situ and 63,770 cases of melanoma in situ are expected to be newly diagnosed in 2014. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2014a
 ESTIMATED NEW CASESESTIMATED DEATHS
 BOTH SEXESMALEFEMALEBOTH SEXESMALEFEMALE
  1. a

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

  2. About 62,570 carcinoma in situ of the female breast and 63,770 melanoma in situ will be newly diagnosed in 2014.

  3. b

    Estimated deaths for colon and rectum cancers are combined.

  4. c

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

All sites1,665,540855,220810,320585,720310,010275,710
Oral cavity & pharynx42,44030,22012,2208,3905,7302,660
Tongue13,5909,7203,8702,1501,450700
Mouth11,9207,1504,7702,0701,130940
Pharynx14,41011,5502,8602,5401,900640
Other oral cavity2,5201,8007201,6301,250380
Digestive system289,610162,730126,880147,26084,97062,290
Esophagus18,17014,6603,51015,45012,4503,000
Stomach22,22013,7308,49010,9906,7204,270
Small intestine9,1604,8804,2801,210640570
Colonb96,83048,45048,38050,31026,27024,040
Rectum40,00023,38016,620   
Anus, anal canal, & anorectum7,2102,6604,550950370580
Liver & intrahepatic bile duct33,19024,6008,59023,00015,8707,130
Gallbladder & other biliary10,6504,9605,6903,6301,6102,020
Pancreas46,42023,53022,89039,59020,17019,420
Other digestive organs5,7601,8803,8802,1308701,260
Respiratory system242,550130,000112,550163,66090,28073,380
Larynx12,63010,0002,6303,6102,870740
Lung & bronchus224,210116,000108,210159,26086,93072,330
Other respiratory organs5,7104,0001,710790480310
Bones & joints3,0201,6801,3401,460830630
Soft tissue (including heart)12,0206,5505,4704,7402,5502,190
Skin (excluding basal & squamous)81,22046,63034,59012,9808,8404,140
Melanoma-skin76,10043,89032,2109,7106,4703,240
Other nonepithelial skin5,1202,7402,3803,2702,370900
Breast235,0302,360232,67040,43043040,000
Genital system338,450243,46094,99058,97030,18028,790
Uterine cervix12,360 12,3604,020 4,020
Uterine corpus52,630 52,6308,590 8,590
Ovary21,980 21,98014,270 14,270
Vulva4,850 4,8501,030 1,030
Vagina & other genital, female3,170 3,170880 880
Prostate233,000233,000 29,48029,480 
Testis8,8208,820 380380 
Penis & other genital, male1,6401,640 320320 
Urinary system141,61097,42044,19030,35020,6109,740
Urinary bladder74,69056,39018,30015,58011,1704,410
Kidney & renal pelvis63,92039,14024,78013,8608,9004,960
Ureter & other urinary organs3,0001,8901,110910540370
Eye & orbit2,7301,4401,290310130180
Brain & other nervous system23,38012,82010,56014,3208,0906,230
Endocrine system65,63016,60049,0302,8201,3001,520
Thyroid62,98015,19047,7901,8908301,060
Other endocrine2,6501,4101,240930470460
Lymphoma79,99043,34036,65020,17011,1409,030
Hodgkin lymphoma9,1905,0704,1201,180670510
Non-Hodgkin lymphoma70,80038,27032,53018,99010,4708,520
Myeloma24,05013,50010,55011,0906,1104,980
Leukemia52,38030,10022,28024,09014,04010,050
Acute lymphocytic leukemia6,0203,1402,8801,440810630
Chronic lymphocytic leukemia15,7209,1006,6204,6002,8001,800
Acute myeloid leukemia18,86011,5307,33010,4606,0104,450
Chronic myeloid leukemia5,9803,1302,850810550260
Other leukemiac5,8003,2002,6006,7803,8702,910
Other & unspecified primary sitesc31,43016,37015,06044,68024,78019,900
Table 2. Incidence Rates for All Cancers Combined (2006-2010) and Estimated New Casesa for Selected Cancers (2014) by State
STATEINCIDENCE RATEbALL CASESFEMALE BREASTUTERINE CERVIXCOLON & RECTUMUTERINE CORPUSLEUKEMIALUNG & BRONCHUSMELANOMA OF THE SKINNON-HODGKIN LYMPHOMAPROSTATEURINARY BLADDER
  1. a

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

  2. b

    Rates are per 100,000 and age adjusted to the 2000 US standard population. US rate excludes cases from Arkansas, Minnesota, Nevada, Ohio, and Virginia.

  3. c

    Estimate is fewer than 50 cases.

  4. d

    High-quality incidence data were not available for all 5 years. Arkansas rate is based on cases diagnosed during 2006 to 2008; Nevada and Ohio rates are based on 2006 to 2009.

  5. e

    Incidence data were not available.

  6. Note: These model-based estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding.

Alabama469.626,7703,6602102,3506506904,1601,3209903,760990
Alaska469.33,750450c28010010043090140530150
Arizona401.132,8304,5202102,5609109504,2801,4301,3204,3901,490
Arkansasd460.616,5202,0501401,5004004802,6604906602,240640
California442.2171,73026,1301,55013,9305,6505,65018,7808,4407,77023,0107,210
Colorado432.523,8103,7801601,7207508702,5401,4001,0603,6801,040
Connecticut505.722,0703,1601201,6507906102,7301,0909203,1201,170
Delaware511.75,320760c420180150790290220800260
Dist. of Columbia486.92,840430c250100603208010051080
Florida452.0114,56015,48096010,2303,4103,81017,9605,3205,05016,5905,800
Georgia471.347,3907,0104203,9401,3101,3706,5402,1801,8207,6001,710
Hawaii430.16,6401,09060700270220890410300810250
Idaho455.67,9901,100506102302909604503601,320390
Illinois491.266,8409,2304705,5302,2902,1809,1002,4402,8908,8203,090
Indiana464.035,5604,5902603,0201,0701,0605,5401,5501,4804,3901,600
Iowa485.617,6302,3201001,5806106402,3309808002,340830
Kansas476.814,6302,0901001,1204704901,9007806501,980620
Kentucky523.225,7703,3702002,1707207904,6901,5401,0703,2801,100
Louisiana494.124,3003,1602002,2705407203,4707509603,720940
Maine511.19,2701,220507003403101,4004403801,160540
Maryland462.030,6804,5702302,5001,0208003,9901,4001,2105,0001,280
Massachusetts503.337,9405,5602002,8001,3201,1404,9301,8001,6005,6002,030
Michigan492.358,6107,6603404,5702,0101,8308,0902,8302,5008,7402,930
Minnesotae-29,3403,8201302,2409501,0503,0701,0301,2403,8701,220
Mississippi480.915,7402,1301401,5103604102,4205605602,210540
Missouri467.733,8904,6102402,9701,0901,0405,3701,5101,4304,0101,530
Montana466.35,850860c5001802007602902601,010300
Nebraska464.59,5501,360608803203301,2204604401,250430
Nevadad448.714,4501,8801201,2903504402,0404705501,890680
New Hampshire507.28,4501,150c6003002501,1104003501,160460
New Jersey503.751,1307,2903804,2801,8201,5606,1302,5902,2507,3202,510
New Mexico405.910,2101,450808303003701,0604704001,400400
New York504.1107,20015,2308508,5904,0403,46013,7204,2404,72015,4405,330
North Carolina477.252,5507,5803804,2301,5701,5507,8502,5402,1107,5802,170
North Dakota460.03,730510c350110130400160160460180
Ohiod474.767,0008,7104005,4502,2801,8909,7603,1702,8608,6903,110
Oklahoma475.819,8302,7001601,7605306603,3206508502,570830
Oregon462.222,5303,3201301,5407206402,9501,4409603,2001,080
Pennsylvania502.679,92010,6605006,7902,8402,42010,2903,8203,42010,9304,070
Rhode Island506.56,370870c500230180870260250840340
South Carolina463.826,3903,7502102,2007507904,1301,3501,0304,0001,100
South Dakota439.74,490600c410150160540200200590210
Tennessee475.836,5704,8402903,0309301,0405,9801,9101,4704,6701,510
Texas441.5115,73016,0801,1409,7603,1304,19014,8903,4205,03015,9004,190
Utah418.610,7801,440606503503906507704901,780420
Vermont489.84,130560c290140110550220160580210
Virginia449.040,9706,1702903,2801,3001,0805,5802,1301,6406,3301,700
Washington483.038,2305,6202302,6701,1601,2504,6302,4101,7105,3801,730
West Virginia484.611,7001,350901,0603803302,0905404801,450570
Wisconsin466.032,4804,3301902,5201,1401,1504,0201,4401,4104,6301,580
Wyoming435.02,890420c2409090330150120490140
United States469.61,665,540232,67012,360136,83052,63052,380224,21076,10070,800233,00074,690

Figure 1 indicates the most common cancers expected to occur in men and women in 2014. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about 50% of all newly diagnosed cancers. Prostate cancer alone will account for 27% (233,000) of incident cases in men. The 3 most commonly diagnosed types of cancer among women in 2014 will be breast, lung and bronchus, and colorectum, accounting for one-half of all cases in women. Breast cancer alone is expected to account for 29% (232,670) of all new cancers among women.

image

Figure 1. Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2014.

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

Download figure to PowerPoint

Expected Numbers of Cancer Deaths

Table 1 also shows the expected numbers of deaths from cancer projected for 2014. It is estimated that about 585,720 Americans will die from cancer this year, corresponding to about 1,600 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), with more than one-quarter of all cancer deaths due to lung cancer. Table 3 provides the estimated numbers of cancer deaths in 2014 by state for selected cancer sites.

Table 3. Death Rates for All Cancers Combined (2006-2010) and Estimated Deathsa for Selected Cancers (2014) by State
STATEDEATH RATEbALL SITESBRAIN & OTHER NERVOUS SYSTEMFEMALE BREASTCOLON & RECTUMLEUKEMIALIVER & INTRAHEPATIC BILE DUCTLUNG & BRONCHUSNON-HODGKIN LYMPHOMAOVARYPANCREASPROSTATE
  1. a

    Rounded to the nearest 10.

  2. b

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

  3. c

    Estimate is fewer than 50 deaths.

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

Alabama196.410,5102706909504103503,310310280630540
Alaska182.5990c7090cc270cc6060
Arizona155.211,4003107809905004702,840390310790640
Arkansas198.06,7301504206202702102,200200140400310
California160.357,9501,5904,2705,1502,5103,14012,5902,0001,5604,1503,380
Colorado152.87,4802405306703303001,720240240510450
Connecticut166.46,8801804704602902501,760220180520390
Delaware187.71,980c1201607090600605013090
Dist. of Columbia199.01,010c80100c60230cc8080
Florida168.442,7409202,7703,5601,7601,62012,0501,4309402,8902,170
Georgia179.216,3203801,2201,4806205904,6904604301,040800
Hawaii143.72,450c140230901405808060210120
Idaho162.82,73080180210130806709060210180
Illinois183.924,0205401,6102,1901,0208106,5707805601,6101,190
Indiana192.613,3703108601,0905503804,140440310840580
Iowa174.36,3801903905702801901,780230180410330
Kansas174.75,4601503704802601701,560200140370250
Kentucky209.510,1302105908503702803,570300200570390
Louisiana201.39,0402006408403304002,650260190600400
Maine187.73,3009019025013011097010060200160
Maryland179.010,5002408208903904002,760300270760550
Massachusetts177.612,8103107909905105503,500400320920630
Michigan185.120,8005501,4001,6809107105,9907204801,480890
Minnesota168.99,7502606207804603602,480340240650540
Mississippi203.56,3501404206402502401,990180120380330
Missouri189.212,8703109101,0905404503,950390250860550
Montana166.32,0005013017090505207060130130
Nebraska170.73,48010021034014010090013080240200
Nevada179.04,7901403804801902201,420140100370280
New Hampshire177.32,67070170200100807508060190130
New Jersey175.016,3503501,2901,5106306003,9705104401,220760
New Mexico155.53,6009026035014017079011090240220
New York166.634,4407902,3902,9701,4401,4708,7901,1109102,5401,760
North Carolina182.818,9804101,3101,5007206605,7005604301,190920
North Dakota164.81,270c9013060c310cc8080
Ohio192.425,2606001,7202,1409907907,3708105701,7301,200
Oklahoma193.37,9802005106903202802,440270180470370
Oregon176.37,9402305106603203402,090280220550440
Pennsylvania184.528,6706101,9402,4901,2009807,6001,0107301,9901,370
Rhode Island177.52,1405013016090805806050130100
South Carolina187.69,9502206708403603702,970280230610510
South Dakota168.41,61050110150705044050c11090
Tennessee199.114,2803509101,2205405004,630440290820630
Texas169.737,8309502,7003,4301,5302,0809,6001,2309002,4401,660
Utah131.32,87011027025015010046012080240210
Vermont177.91,340c801005060390cc9070
Virginia179.314,7503501,0901,2405705204,1104603801,010730
Washington175.012,5503808209705405503,270430360880730
West Virginia201.24,6801002704201701201,480160100230190
Wisconsin175.611,3603107108605503903,000400300800630
Wyoming167.8990c609070c250cc8040
United States176.4585,72014,32040,00050,31024,09023,000159,26018,99014,27039,59029,480

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (38%) (Table 4). However, because of the earlier median age at diagnosis for breast cancer (61 years) compared with prostate (66 years) and other major cancers, women have a slightly higher probability of developing cancer than men before age 65 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), medical history, and/or genetic susceptibility.

Table 4. Probability (%) of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2008 to 2010a
  BIRTH TO 4950 TO 5960 TO 6970 AND OLDERBIRTH TO DEATH
  1. a

    For people free of cancer at beginning of age interval.

  2. b

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

  3. c

    Probabilities for whites only.

All sitesbMale3.5 (1 in 29)6.8 (1 in 15)15.4 (1 in 6)36.9 (1 in 3)43.9 (1 in 2)
 Female5.4 (1 in 19)6.0 (1 in 17)10.1 (1 in 10)26.7 (1 in 4)38.0 (1 in 3)
Kidney & renal pelvisMale0.2 (1 in 480)0.3 (1 in 289)0.6 (1 in 154)1.3 (1 in 75)2.1 (1 in 49)
 Female0.1 (1 in 753)0.2 (1 in 586)0.3 (1 in 317)0.7 (1 in 134)1.2 (1 in 83)
BreastFemale1.9 (1 in 53)2.3 (1 in 43)3.5 (1 in 29)6.7 (1 in 15)12.3 (1 in 8)
ColorectumMale0.3 (1 in 305)0.7 (1 in 144)1.3 (1 in 76)4.0 (1 in 25)5.0 (1 in 20)
 Female0.3 (1 in 334)0.5 (1 in 189)0.9 (1 in 109)3.7 (1 in 27)4.6 (1 in 22)
LeukemiaMale0.2 (1 in 421)0.2 (1 in 614)0.4 (1 in 279)1.3 (1 in 76)1.7 (1 in 60)
 Female0.2 (1 in 526)0.1 (1 in 979)0.2 (1 in 475)0.8 (1 in 120)1.2 (1 in 86)
Lung & bronchusMale0.2 (1 in 548)0.7 (1 in 134)2.1 (1 in 47)6.7 (1 in 15)7.6 (1 in 13)
 Female0.2 (1 in 522)0.6 (1 in 171)1.6 (1 in 62)4.9 (1 in 20)6.3 (1 in 16)
Melanoma of the skincMale0.4 (1 in 284)0.4 (1 in 134)0.8 (1 in 129)2.1 (1 in 48)2.9 (1 in 34)
 Female0.5 (1 in 206)0.3 (1 in 313)0.4 (1 in 243)0.9 (1 in 113)1.9 (1 in 53)
Non-Hodgkin lymphomaMale0.3 (1 in 357)0.3 (1 in 338)0.6 (1 in 171)1.8 (1 in 56)2.4 (1 in 42)
 Female0.2 (1 in 537)0.2 (1 in 475)0.4 (1 in 233)1.4 (1 in 71)1.9 (1 in 52)
ProstateMale0.3 (1 in 298)2.3 (1 in 43)6.4 (1 in 16)11.2 (1 in 9)15.3 (1 in 7)
Uterine cervixFemale0.3 (1 in 348)0.1 (1 in 812)0.1 (1 in 824)0.2 (1 in 619)0.7 (1 in 154)
Uterine corpusFemale0.3 (1 in 370)0.6 (1 in 171)0.9 (1 in 111)1.3 (1 in 78)2.7 (1 in 37)

Trends in Cancer Incidence

Figures 2 and 3 illustrate long-term trends in cancer incidence rates for all cancers combined and for selected cancer sites by sex. Trends since 1992 are presented in Table 5 in terms of the annual percent change in rates using joinpoint regression analysis. Joinpoint is a tool used to describe and quantify trends by fitting observed rates to lines connected at “joinpoints” where trends change in direction or magnitude.[15, 17]

image

Figure 2. Trends in Cancer Incidence and Death Rates by Sex, United States, 1975 to 2010.

Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting.

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image

Figure 3. Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2010.

Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Includes intrahepatic bile duct.

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Table 5. Trends in Cancer Incidence (Delay-Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1992 to 2010
 TREND 1TREND 2TREND 3TREND 42006–2010
 YEARSAPCYEARSAPCYEARSAPCYEARSAPCAAPC
  1. APC indicates annual percent change based on incidence (delay-adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change.

  2. a

    The APC or AAPC is significantly different from zero (P < .05).

  3. Note: Trends analyzed by the Joinpoint Regression Program, version 4.0.3, allowing up to 3 joinpoints. Incidence trends based on Surveillance, Epidemiology, and End Results (SEER) 13 areas.

All sites         
Incidence         
Overall1992-1994-3.2a1994-19980.41998-2010-0.4a  -0.4a
Male1992-1994-5.6a1994-2010-0.6a    -0.6a
Female1992-1994-0.41994-19981.21998-2003-0.8a2003-20100.10.1
Death         
Overall1992-2001-1.0a2001-2010-1.5a    -1.5a
Male1992-2001-1.4a2001-2010-1.8a    -1.8a
Female1992-1995-0.21995-1998-1.2a1998-2001-0.42001-2010-1.4a-1.4a
Lung & bronchus         
Incidence         
Male1992-2010-1.9a      -1.9a
Female1992-19980.8a1998-2001-1.32001-20050.72005-2010-1.2a-1.2a
Death         
Male1992-2005-1.9a2005-2010-2.9a    -2.9a
Female1992-19961.1a1996-20040.22004-2010-1.4a  -1.4a
Colorectum         
Incidence         
Male1992-1995-2.6a1995-19981.41998-2008-2.5a2008-2010-4.2a-3.3a
Female1992-1995-1.8a1995-19981.81998-2008-1.9a2008-2010-4.1a-3.0a
Death         
Male1992-2002-2.0a2002-2005-4.0a2005-2010-2.5a  -2.5a
Female1992-2001-1.7a2001-2010-3.0a    -3.0a
Liver & intrahepatic bile duct       
Incidence         
Male1992-20103.7a      3.7a
Female1992-20102.9a      2.9a
Death         
Male1992-20102.3a      2.3a
Female1992-20101.4a      1.4a
Melanoma of skin         
Incidence         
Male1992-20102.4a      2.4a
Female1992-19973.9a1997-20101.7a    1.7a
Death         
Male1992-20100.4a      0.4a
Female1992-2010-0.5a      -0.5a
Thyroid         
Incidence         
Male1992-1996-0.91996-20105.4a    5.4a
Female1992-19983.9a1998-20106.5a    6.5a
Death         
Male1992-20101.6a      1.6a
Female1992-1994-6.41994-20100.9a    0.9a
Female breast         
Incidence1992-19991.3a1999-2004-2.2a2004-20100.2  0.2
Death1992-1995-1.3a1995-1998-3.4a1998-2010-1.9a  -1.9a
Prostate         
Incidence1992-1995-11.2a1995-20002.22000-2010-2.0a  -2.0a
Death1992-1994-1.01994-2004-3.8a2004-2010-3.1a  -3.1a

The overall cancer incidence rate is 23% lower among women compared with men. However, during the past 5 years for which there are data (2006-2010), the incidence rate decreased by 0.6% per year among males but remained stable in females (Table 5). The decrease in men is driven by the rapid declines in colorectal (3.3% per year), prostate (2.0% per year), and lung (1.9% per year) cancers. Among women, although colorectal cancer declines are similar to those in men, the lung cancer rate has been slow to decline and breast cancer incidence rates have remained relatively flat since 2003 (Fig. 3).

Declines in incidence rates for the major cancers reflect improvements in cancer control and prevention. The long-term declines in colorectal cancer incidence rates since the mid-1980s have been attributed to both changes in risk factors and the introduction of screening.[18] However, the rapid declines in recent years (eg, greater than 4.0% per year from 2008-2010) have been attributed to the increased uptake of colonoscopy, which prevents cancer by allowing for the removal of precancerous lesions.[19, 20] Prostate cancer incidence rates have been generally declining since around 2000, although rates have fluctuated widely from year to year (Fig. 3), likely reflecting variation in the prevalence of prostate-specific antigen testing for the detection of prostate cancer. Lung cancer incidence rates began declining in the mid-1980s in men and in the late 1990s in women as a result of reduced smoking prevalence.[5] Differences in lung cancer incidence patterns between men and women (Fig. 3) reflect historical differences in tobacco use; cigarette smoking prevalence peaked about 20 years later in women than in men.[21]

In contrast to the stable or declining trends for most cancer types, incidence rates are increasing for melanoma of the skin; esophageal adenocarcinoma; cancers of the thyroid, liver, kidney, anus, and pancreas; and human papillomavirus-positive oropharyngeal cancers.[5, 22] Among both men and women, the largest annual increases from 2006 to 2010 were for cancers of the thyroid (5.4% and 6.5% in men and women, respectively) and liver (3.7% and 2.9% in men and women, respectively) (Table 5).

Trends in Cancer Mortality

The overall cancer death rate rose for most of the 20th century, peaking at 215.1 deaths per 100,000 population in 1991. This increase was largely driven by rapid increases in lung cancer deaths among men as a consequence of the tobacco epidemic. Over the past 2 decades, however, there has been a steady decline in the cancer death rate (to 171.8 in 2010) as a result of advances in prevention, early detection, and treatment, including the implementation of comprehensive tobacco control. As a result of this 20% decline, an estimated 1,340,400 cancer deaths (952,700 in men and 387,700 in women) that would have occurred had peak rates persisted have been averted (Fig. 4).

image

Figure 4. Total Number of Cancer Deaths Averted From 1991 to 2010 in Men and From 1992 to 2010 in Women.

The blue line represents the actual number of cancer deaths recorded in each year, and the red line represents the number of cancer deaths that would have been expected if cancer death rates had remained at their peak.

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Overall declines in the cancer death rate from 1991 to 2010 occurred among white women (16%), black women (20%), white men (24%), and black men (33%). Figure 5 illustrates the variation in the magnitude of the declines by race, sex, and 10-year age group. Downturns occurred for black and white men and women of all ages with the exception of white women aged 80 years and older. Notably, black males experienced the largest drop in death rates in every age group. The sharpest decrease (44%–55%) occurred among black men aged 30 years to 59 years. In general, middle-aged men and women experienced the largest declines, particularly compared with adults aged 70 years and older. The smaller declines among seniors reflect the lingering effects of the tobacco epidemic on older birth cohorts. Progress is more stunted among women than men in this generation because of the later onset and more protracted decline in smoking prevalence among women.

image

Figure 5. Relative Decline in Cancer Death Rates From 1991 to 2010 by Age, Race, and Sex.

The relative decline is the difference between the 2010 and 1991 rate expressed as a percentage of the 1991 rate.

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Figure 6 depicts long-term trends in cancer death rates among men and women overall and for selected cancer sites. In contrast to male cancer death rates, which rose continuously prior to 1990, female cancer death rates fell from the late 1940s to the mid-1970s (Fig. 6a). It is also interesting to note that prior to 1941, men had a lower risk of dying from cancer than women due to the high death rate for uterine cancer (uterine corpus and uterine cervix combined), which was the leading cause of cancer death among women in the early 20th century. Uterine cancer death rates declined by more than 80% between 1930 and 2010, largely due to the widespread uptake of screening for the prevention and early detection of cervical cancer. A similar dramatic decline occurred for stomach cancer, which accounted for 30% and 20% of male and female cancer deaths, respectively, in the 1930s. By 2010, stomach cancer accounted for just 2% of cancer deaths. Rates of stomach cancer have declined worldwide due to improved hygiene, resulting in a lower prevalence of Helicobacter pylori, and advances in food preservation techniques (eg, refrigeration), which have led to lower salt intake and higher consumption of fresh fruits and vegetables.

image

Figure 6. Trends in Death Rates Overall and for Selected Sites by Sex, United States, 1930 to 2010.

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, colorectum, liver, uterus, and ovary are affected by these changes. *Uterus includes uterine cervix and uterine corpus.

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During the most recent 5 years for which data are available, the average annual decline in cancer death rates was slightly larger among men (1.8%) than women (1.4%) (Fig. 6) (Table 5). These declines are driven by continued decreases in death rates for the 4 major cancer sites (Fig. 6). Due to the reduction in tobacco use over the past 50 years, the lung cancer death rate declined 34% between 1991 and 2010 among males and 9% between 2002 and 2010 among females.[5, 23] Death rates for breast, prostate, and colorectal cancers are down from peak rates by 34%, 45%, and 46%, respectively, as a result of improvements in early detection and treatment.[5, 18, 24, 25]

In contrast, joinpoint trend analysis for 2001 to 2010 indicates that death rates are rising for cancers of the oropharynx, anus, liver, pancreas, and soft tissue (including the heart), and for melanoma in men.[5] The rate of death from thyroid cancer is also increasing according to joinpoint analysis (Table 5), although the observed rates increased only slightly from 0.47 (per 100,000 population) to 0.50 among men and from 0.48 to 0.51 among women.

Recorded Number of Deaths in 2010

A total of 2,468,435 deaths were recorded in the United States in 2010, of which 574,743 (23%) were from cancer. Overall, cancer is the second leading cause of death following heart disease. However, within 20-year age groups, cancer is the leading cause of death among adults aged 40 years to 79 years (Table 6). Among females, cancer is the first or second leading cause of death in every age group.

Table 6. Ten Leading Causes of Death by Age and Sex, United States, 2010
 ALL AGESAGES 1 TO 19AGES 20 TO 39AGES 40 TO 59AGES 60 TO 79AGES ≥80
 MALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALE
 All CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll CausesAll Causes
 1,232,4321,236,00313,3807,10260,73028,205224,613140,576475,230376,110444,690673,087
  1. HIV indicates human immunodeficiency virus.

  2. *Includes primary and secondary hypertension.

  3. 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.

  4. Source: US Final Mortality Data, 2010, National Center for Health Statistics, Centers for Disease Control and Prevention, 2013.

1Heart diseases 307,384Heart diseases 290,305Accidents (unintentional injuries) 5,124Accidents (unintentional injuries) 2,450Accidents (unintentional injuries) 21,504Accidents (unintentional injuries) 7,818Cancer 54,440Cancer 50,509Cancer 156,723Cancer 128,760Heart diseases 131,682Heart diseases 193,291
2Cancer 301,037Cancer 273,706Assault (homicide) 1,978Cancer 824Intentional self-harm (suicide) 9,463Cancer 4,429Heart diseases 52,472Heart diseases 21,458Heart diseases 117,385Heart diseases 72,817Cancer 84,636Cancer 89,153
3Accidents (unintentional injuries) 75,921Cerebro-vascular diseases 77,109Intentional self-harm (suicide) 1,510Congenital anomalies 501Assault (homicide) 7,098Heart diseases 2,339Accidents (unintentional injuries) 23,991Accidents (unintentional injuries) 11,469Chronic lower respiratory diseases 31,964Chronic lower respiratory diseases31,397Chronic lower respiratory diseases 27,899Cerebro-vascular disease 51,984
4ChronicChronicCancerAssaultHeartIntentionalIntentionalChronicCerebro-Cerebro-Cerebro-Alzheimer
 lowerlower1,039(homicide)diseasesself-harmself-harmlowervascularvascularvasculardisease
 respiratoryrespiratory 5005,202(suicide)(suicide)respiratorydiseasediseasedisease50,503
 diseasesdiseases   2,29712,253diseases19,70319,26125,130 
 65,42372,657     5,172    
5Cerebro-AlzheimerCongenitalIntentionalCancerAssaultChronic liverCerebro-DiabetesDiabetesAlzheimerChronic
 vasculardiseaseanomaliesself-harm4,163(homicide)disease &vascularmellitusmellitusdiseaselower
 diseases58,130506(suicide) 1,342cirrhosisdisease16,71813,43119,934respiratory
 52,367  423  10,8995,128   diseases
            35,719
6DiabetesAccidentsHeartHeartHIVPregnancy,DiabetesChronic liverAccidentsNephritis,Influenza &Influenza &
 mellitus(unintentionaldiseasesdiseasesdiseasechildbirth &mellitusdisease &(unintentionalnephroticpneumoniapneumonia
 35,490injuries)4272591,016puerperium7,403cirrhosisinjuries)syndrome &13,26618,344
  44,938   632 4,74613,459nephrosis  
          8,266  
7IntentionalDiabetesChronic lowerInfluenza &Chronic liverDiabetesCerebro-DiabetesNephritis,AccidentsNephritis,Diabetes
 self-harmmellitusrespiratorypneumoniadisease &mellitusvascularmellitusnephrotic(unintentionalnephroticmellitus
 (suicide)33,581diseases96cirrhosis587disease4,445syndrome &injuries)syndrome &15,082
 30,277 154 828 6,675 nephrosis7,937nephrosis 
         9,581 12,217 
8AlzheimerInfluenza &Cerebro-Cerebro-DiabetesCerebro-ChronicIntentionalChronic liverAlzheimerAccidentsNephritis,
 diseasepneumoniavascularvascularmellitusvascularlowerself-harmdisease &disease(unintentionalnephrotic
 25,36426,482diseasedisease779diseaserespiratory(suicide)cirrhosis7,431injuries)syndrome &
   13393  diseases3,7937,734 11,195nephrosis
      5765,027    14,891
9Nephritis,Nephritis,Influenza &ChronicCerebro-HIVHIVSepticemiaInfluenza &SepticemiaDiabetesAccidents
 nephroticnephroticpneumonialowervasculardiseasedisease2,269pneumonia6,715mellitus(unintentional
 syndrome &syndrome &114respiratorydisease5534,054 7,366 10,548injuries)
 nephrosisnephrosis diseases661      14,786
 24,86525,611 90        
10Influenza &SepticemiaIn situ,In situ,CongenitalChronic liverViralNephritis,SepticemiaInfluenza &ParkinsonHypertension
 pneumonia18,743benign,benign,anomaliesdisease &hepatitisnephrotic6,768pneumoniadisease& hypertensive
 23,615 & unknown& unknown477cirrhosis3,306syndrome & 5,9198,291renal disease*
   neoplasmsneoplasms 466 nephrosis   10,756
   9790   2,087    

Table 7 presents the number of deaths from all cancers combined and from the 5 most common sites for each 20-year age group by sex. For all ages combined, men have a higher number of deaths for shared sites with the exception of pancreatic cancer, for which the burden is similar. Among males, leukemia is the leading cause of cancer death in those aged younger than 40 years, while lung cancer ranks first in men aged 40 years and older. Among females, leukemia is the leading cause of cancer death in children and adolescents (aged younger than 20 years), breast cancer ranks first in women aged 20 years to 59 years, and lung cancer causes the most cancer deaths in those aged 60 years and older.

Table 7. Five Leading Types of Cancer Death by Age and Sex, United States, 2010
ALL AGES<2020 TO 3940 TO 5960 TO 79≥80
MALE
ALL SITESALL SITESALL SITESALL SITESALL SITESALL SITES
300,4641,0704,16354,440156,72384,636
Lung & bronchusLeukemiaLeukemiaLung & bronchusLung & bronchusLung & bronchus
87,69929355014,68752,23320,504
ProstateBrain & ONSBrain & ONS*ColorectumColorectumProstate
28,5612725035,64513,27215,188
ColorectumBones & jointsColorectumLiver & bile ductProstateColorectum
27,074924424,45811,9497,708
PancreasSoft tissueNon-HodgkinPancreasPancreasUrinary bladder
18,699(including heart)lymphoma3,74810,3714,766
 83276   
Liver & intrahepaticNon-HodgkinLung & bronchusEsophagusLiver & intrahepaticPancreas
bile ductlymphoma2662,737bile duct4,466
13,65855  6,803 
FEMALE
ALL SITESALL SITESALL SITESALL SITESALL SITESALL SITES
273,7068554,42950,509128,76089,153
  1. ONS indicates other nervous system.

  2. Note: Ranking order excludes category titles that begin with “Other.”

Lung & bronchusLeukemiaBreastBreastLung & bronchusLung & bronchus
70,55023596311,50739,54019,681
BreastBrain & ONS*Uterine cervixLung & bronchusBreastBreast
40,99622643011,08217,37511,151
ColorectumBones & jointsLeukemiaColorectumColorectumColorectum
24,972743954,1859,85510,588
PancreasSoft tissueColorectumOvaryPancreasPancreas
18,189633383,1138,9116,692
OvaryLiver & intrahepaticBrain & ONS*PancreasOvaryNon-Hodgkin
14,572bile duct3092,5067,338lymphoma
 25   4,144

Regional Variations in Cancer Rates

Tables 8 and 9 depict cancer incidence and death rates for selected cancers by state. Lung cancer shows the largest geographic variation in cancer occurrence by far, reflecting the large historical and continuing differences in smoking prevalence among states.[23] For example, lung cancer incidence rates in Kentucky, which has historically had the highest smoking prevalence, are almost 4-fold higher than those in Utah, which has the lowest smoking prevalence (126 vs 34 cases per 100,000 men). There is also a large range for prostate cancer incidence rates, from 112.7 in Arizona to 194.4 in the District of Columbia, which likely reflects state differences in PSA testing prevalence and racial distribution.[27] In contrast, state variations for other cancer sites are smaller in both absolute and relative terms. For example, the breast cancer incidence rate ranges from 140 (per 100,000 population) in the District of Columbia to 109 in New Mexico, a difference of 28%. State variation in incidence rates reflects differences in the use of screening tests or detection practices in addition to differences in disease occurrence.

Table 8. Incidence Rates for Selected Cancers by State, United States, 2006 to 2010
 ALL CANCERSBREASTCOLORECTUMLUNG & BRONCHUSNON-HODGKIN LYMPHOMAPROSTATEURINARYBLADDER
STATEMALEFEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEMALEFEMALE
  1. Rates are per 100,000 and age adjusted to the 2000 US standard population.

  2. a

    This state's data are not included in the US combined rates because it did not meet high-quality standards for one or more years during 2006 to 2010 according to the North American Association of Central Cancer Registries (NAACCR).

  3. b

    Rates are based on incidence data for 2006 to 2008.

  4. c

    This state's registry did not submit cancer incidence data to the NAACCR.

  5. d

    Rates are based on incidence data for 2006 to 2009.

Alabama573.2395.2118.757.240.3103.254.019.513.6157.733.37.5
Alaska521.0430.3127.753.144.583.860.421.816.1137.338.09.8
Arizona441.4371.2110.241.432.061.847.918.013.4112.732.28.4
Arkansasab557.7388.1110.355.640.5108.460.421.215.3156.433.98.1
California505.7397.1122.049.437.360.444.422.915.6140.333.58.0
Colorado483.1396.4125.343.633.656.144.222.515.9142.731.28.2
Connecticut576.2456.9136.351.339.275.559.525.217.3160.046.812.6
Delaware601.7443.3126.553.139.687.165.823.716.7177.343.211.3
Dist. of Columbia574.8427.7139.750.944.877.548.121.813.4194.425.19.0
Florida518.8399.9114.347.836.679.456.721.915.2131.235.38.6
Georgia568.7403.1121.552.138.493.355.021.514.8165.733.97.9
Hawaii484.4393.4123.156.938.064.338.720.713.7119.925.86.3
Idaho513.3410.1119.543.234.861.547.221.317.5152.936.18.9
Illinois566.6440.3126.459.143.486.760.924.016.4153.939.49.9
Indiana527.4422.0117.454.741.896.463.523.317.0122.435.28.8
Iowa555.7437.1123.456.944.384.754.926.818.9137.241.78.8
Kansas552.2422.0123.255.039.980.254.523.416.8152.437.99.3
Kentucky611.2462.4121.363.946.0125.980.325.317.5134.640.59.7
Louisiana603.4413.6119.762.444.099.657.724.516.5169.334.18.1
Maine581.5460.6126.551.441.291.567.325.417.9144.848.013.2
Maryland529.1415.0128.047.636.774.455.821.315.0157.233.49.2
Massachusetts568.1460.4134.249.938.878.364.125.016.5153.643.911.9
Michigan574.1433.5120.051.039.386.161.624.917.7163.741.310.7
Minnesotac------------
Mississippi598.6396.9113.861.344.7112.756.221.614.5166.330.87.2
Missouri530.8423.3121.555.340.895.664.322.316.0126.234.88.4
Montana520.8421.9124.151.139.068.956.322.815.0155.236.49.9
Nebraska526.2420.9122.357.744.474.651.223.517.7143.035.08.6
Nevadaad509.8399.2112.752.038.175.764.720.415.3138.937.310.7
New Hampshire580.3452.1132.046.738.080.162.225.117.1155.449.113.2
New Jersey582.6450.6129.354.741.272.855.325.217.8169.243.611.6
New Mexico461.9362.5108.844.133.652.938.118.213.8134.126.26.2
New York585.4449.2127.753.340.976.356.026.318.1167.342.110.6
North Carolina564.9416.0124.950.837.196.757.222.615.7151.937.58.9
North Dakota528.6410.2123.059.241.868.143.322.018.4156.238.69.2
Ohioad548.1425.4120.555.542.292.660.723.016.1145.238.79.6
Oklahoma552.2422.0121.753.640.896.162.722.417.1148.434.78.6
Oregon508.8429.2129.545.536.870.657.622.815.3139.337.19.5
Pennsylvania573.6454.8126.056.042.884.457.925.217.8149.544.111.0
Rhode Island575.7462.4131.051.341.384.164.522.517.9148.948.713.8
South Carolina551.7401.1122.350.337.994.153.920.513.4152.830.88.4
South Dakota499.4395.9117.955.741.873.848.021.615.9145.533.68.3
Tennessee562.0416.0118.853.440.4103.461.322.616.3144.335.48.2
Texas513.9389.9114.450.935.778.249.022.215.9133.229.56.9
Utah494.8357.7110.839.431.234.123.325.216.3175.931.45.3
Vermont539.8453.8131.444.838.381.265.624.117.7139.940.512.2
Virginiaa521.7397.4124.546.936.782.253.921.714.2150.333.38.3
Washington544.6437.7131.046.136.372.157.326.217.4151.638.99.3
West Virginia557.7434.1110.258.043.8106.470.023.217.5131.838.810.7
Wisconsin530.8419.2122.548.437.573.653.424.317.3142.939.29.7
Wyoming497.1384.2110.847.537.757.346.019.815.0152.238.79.9
United States542.3418.8122.251.739.180.055.123.316.3146.636.99.1
Table 9. Death Rates for Selected Cancers by State, United States, 2006 to 2010
 ALL SITESBREASTCOLORECTUMLUNG & BRONCHUSNON-HODGKIN LYMPHOMAPANCREASPROSTATE
STATEMALEFEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALEFEMALEMALE
  1. Rates are per 100,000 and age adjusted to the 2000 US standard population.

Alabama255.4156.423.322.515.087.440.88.05.313.29.728.9
Alaska210.5161.024.219.615.161.845.87.65.512.99.822.5
Arizona186.0131.720.617.111.949.833.27.64.811.48.320.5
Arkansas250.6160.923.422.715.690.145.48.65.513.29.625.3
California189.8139.821.917.512.747.232.37.84.911.79.422.3
Colorado181.4133.219.616.712.444.231.37.84.410.89.022.9
Connecticut199.5144.721.616.212.152.738.27.54.913.99.922.3
Delaware228.0159.322.820.413.368.247.78.34.813.09.523.7
Dist. of Columbia248.5167.629.822.218.961.935.08.04.016.912.038.8
Florida204.5140.721.318.112.861.438.87.84.912.18.820.1
Georgia228.3147.823.420.213.873.138.77.64.512.59.127.1
Hawaii178.4117.116.417.310.948.825.97.24.312.39.715.7
Idaho192.9140.221.616.112.449.234.57.25.612.09.225.9
Illinois223.3158.523.621.715.465.841.98.55.313.010.124.3
Indiana238.8161.523.921.314.579.446.79.35.413.09.423.2
Iowa212.6148.421.320.015.264.138.38.95.512.28.822.7
Kansas214.4146.522.220.613.166.839.49.15.312.69.120.7
Kentucky262.7173.323.123.416.297.155.89.05.712.79.623.9
Louisiana254.7164.425.424.015.780.943.68.65.214.211.126.6
Maine231.1158.320.920.213.969.946.08.85.111.69.822.9
Maryland216.9154.024.520.514.061.740.87.44.512.910.325.0
Massachusetts216.6152.521.318.713.460.642.17.84.812.710.422.4
Michigan223.0159.524.019.414.268.243.98.95.813.910.221.8
Minnesota203.9145.020.917.612.653.337.09.45.211.99.323.9
Mississippi270.6159.124.724.816.595.442.08.34.714.110.131.2
Missouri231.1160.224.221.214.676.546.28.35.413.09.921.8
Montana195.3145.119.816.714.052.139.67.94.911.88.426.4
Nebraska208.4143.820.121.415.060.335.58.45.712.09.722.9
Nevada211.4153.623.021.014.959.746.57.14.612.69.723.9
New Hampshire211.7154.221.317.913.159.043.37.34.713.210.422.4
New Jersey207.8154.325.221.014.955.837.27.85.213.410.121.6
New Mexico187.4131.620.918.812.743.428.66.64.510.98.424.4
New York199.7145.422.319.213.854.336.17.94.912.89.921.8
North Carolina232.2149.923.119.413.176.640.77.55.012.09.625.8
North Dakota203.6137.221.621.213.954.132.26.75.112.68.323.6
Ohio236.5162.624.821.815.274.844.29.25.613.110.123.8
Oklahoma238.8161.023.922.114.579.646.69.06.012.28.923.5
Oregon208.5153.421.618.113.358.442.78.55.312.39.924.4
Pennsylvania225.6157.023.821.515.065.839.68.95.513.410.022.7
Rhode Island221.8149.620.818.613.264.942.68.34.412.28.920.6
South Carolina240.1151.723.520.214.277.139.97.84.712.79.827.5
South Dakota206.8141.320.319.813.961.934.17.85.311.19.323.4
Tennessee256.4160.423.321.815.389.546.69.25.413.19.425.2
Texas209.3141.821.820.013.160.735.47.94.911.88.821.3
Utah157.1112.321.814.310.727.516.87.74.710.08.425.9
Vermont212.0154.320.417.414.862.345.17.85.012.49.322.1
Virginia221.1151.424.019.214.067.140.08.24.812.79.724.7
Washington207.2152.221.517.112.557.042.18.65.412.710.024.2
West Virginia246.9168.622.123.416.184.350.98.76.611.37.820.9
Wisconsin213.7149.721.318.012.758.438.49.05.512.810.024.5
Wyoming196.0146.821.318.714.749.936.47.65.312.99.022.8
United States215.3149.722.619.613.963.539.28.25.112.59.623.0

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. Limitations
  8. Conclusions
  9. References

Cancer incidence and death rates vary considerably between and within racial and ethnic groups. Of the 5 broadly defined groups in Table 10, black men have the highest cancer incidence and death rates–about double those of Asian Americans, who have the lowest rates. Cancer incidence and death rates are higher among black than white men for every site included in Table 10 except kidney cancer mortality. Factors known to contribute to racial disparities vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer), access to high-quality screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment.[28] It is notable that although white women have the highest breast cancer incidence rate, black women have the highest breast cancer mortality rate. The higher incidence rate among white women is thought to reflect a combination of factors that affect both diagnosis (more prevalent mammography) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy).[29] The high breast cancer mortality rate among black women has been attributed to a higher prevalence of comorbidities, a longer time to follow-up after an abnormal mammogram, less access to high-quality treatment, and a higher prevalence of aggressive tumor characteristics.[30-32]

Table 10. Incidence and Death Rates by Site, Race, and Ethnicity, United States, 2006 to 2010
 NON-HISPANIC WHITEBLACKASIAN AMERICAN/PACIFIC ISLANDERAMERICAN INDIAN/ALASKA NATIVEaHISPANIC
  1. Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite race categories are not mutually exclusive of Hispanic origin.

  2. a

    Data based on Indian Health Service Contract Health Service Delivery Areas.

Incidence
All sites     
Male548.6601.0326.1441.1426.8
Female436.2395.9282.6372.0330.8
Breast (female)127.3118.484.790.391.1
Colorectum     
Male50.962.540.851.747.3
Female38.646.731.042.732.6
Kidney & renal pelvis
Male21.623.010.630.620.5
Female11.212.25.117.511.5
Liver & intrahepatic bile duct
Male8.714.921.317.818.8
Female2.94.48.08.06.9
Lung & bronchus
Male82.994.748.870.245.9
Female59.950.428.052.126.6
Prostate138.6220.075.0104.1124.2
Stomach     
Male7.815.715.613.113.9
Female3.58.19.06.98.2
Uterine cervix7.210.36.79.710.9
Mortality
All sites     
Male217.3276.6132.4191.0152.2
Female153.6171.292.1139.0101.3
Breast (female)22.730.811.515.514.8
Colorectum     
Male19.228.713.118.716.1
Female13.619.09.715.410.2
Kidney & renal pelvis
Male5.95.73.09.55.1
Female2.62.61.24.42.3
Liver & intrahepatic bile duct
Male7.111.814.413.212.3
Female2.94.16.06.15.4
Lung & bronchus
Male65.778.535.549.631.3
Female42.737.218.433.114.1
Prostate21.350.910.120.719.2
Stomach     
Male3.99.88.78.17.6
Female1.94.75.13.84.4
Uterine cervix2.14.21.93.52.9

Cancer incidence and death rates are lower among Asian Americans/Pacific Islanders, American Indians/Alaska Natives, and Hispanics than whites for all cancer sites combined and for the 4 most common cancer sites. However, cancers associated with infectious agents (eg, those of the uterine cervix, stomach, and liver) are generally more common in nonwhite populations. For example, stomach and liver cancer incidence and death rates are twice as high in the Asian American/Pacific Islander population as in whites, reflecting a higher prevalence of chronic infection with Helicobacter pylori and hepatitis B virus, respectively.[33] Kidney cancer incidence and death rates are the highest among American Indians/Alaska Natives, which may be due in part to high rates of obesity and smoking in this population.[34]

Table 11 presents trends in cancer incidence and death rates during the most recent 10 years for which there are data (2001-2010) by race and ethnicity. These trends are based on rates that are not adjusted for reporting delays because the long-term incidence data required for delay adjustment are not available for populations other than whites or blacks. Among men, incidence rates declined between 1.6% and 2.0% per year for all groups except American Indians/Alaska Natives. Declines in death rates among men were of a similar magnitude, and were highest among blacks (2.5% per year). Among women, incidence rate declines were smaller and were confined to non-Hispanic whites (0.5% per year) and Hispanics (0.8% per year), though mortality declines of greater than 1.0% per year were experienced by all racial/ethnic groups except American Indians/Alaska Natives. As in men, black women had the largest annual decline in cancer death rates (1.7%).

Table 11. Average Annual Percent Change in Cancer Incidence and Mortality Rates From 2001 to 2010 by Race/Ethnicity, United States
 INCIDENCEMORTALITY
 MALEFEMALEMALEFEMALE
  1. a

    Average annual percent change is statistically significant (P < .05).

  2. b

    Excludes deaths from Connecticut, District of Columbia, Maine, Maryland, Minnesota, New Hampshire, New York, North Dakota, Oklahoma, South Carolina, and Vermont due to unreliable Hispanic origin data for some years.

  3. c

    Data based on Indian Health Service Contract Health Service Delivery Areas.

  4. Notes: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 2 joinpoints. Incidence trends based on the North American Association of Central Cancer Registries (NAACCR) data. Nonwhite race categories are not mutually exclusive of Hispanic origin.

All race/ethnicities-1.6a-0.3a-1.8a-1.4a
Non-Hispanic whiteb-1.6a-0.5a-1.6a-1.3a
Black-1.8a-0.1-2.5a-1.7a
Asian American/Pacific Islander-1.7a0.0-1.6a-1.0a
American Indian/Alaska Nativec-0.8-0.2-0.10.1
Hispanicb-2.0a-0.8a-1.6a-1.4a

Cancer Survival

The stage-specific 5-year relative survival rate is lower for blacks than for whites for nearly every cancer type (Fig. 7). Studies suggest that racial disparities in survival are primarily due to differences in treatment, stage at diagnosis, and comorbidities, as opposed to differences in cancer biology.[35] As shown in Figure 8, blacks are less likely than whites to be diagnosed with cancer at a localized stage, when treatment is more successful. This disparity is particularly striking for cancers of the breast, cervix, uterine corpus, and oral cavity and pharynx. Lower socioeconomic status among blacks likely explains much of the stage disparity and is also associated with receipt of less aggressive treatment.[36, 37] Even among Medicare-insured patients, blacks are less likely than whites to receive standard cancer therapies for lung, breast, colorectal, and prostate cancers.[26]

image

Figure 7. Five-Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2003 to 2009.

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

The survival rate for carcinoma in situ of the urinary bladder is 96% for All Races, 97% for Whites, and 91% for blacks.

Download figure to PowerPoint

image

Figure 8. Stage Distribution of Selected Cancers by Race, United States, 2003 to 2009.

*The proportions of carcinoma in situ of the urinary bladder are 51% for All Races, 52% for Whites, and 38% for blacks. Stage categories do not sum to 100% because sufficient information is not available to assign a stage to all cancer cases.

Download figure to PowerPoint

There have been notable improvements in survival over the past 3 decades for most cancers among both whites and blacks (Table 12). Between 1975 and 1977 and 2003 and 2009, overall 5-year relative survival rates increased 19 percentage points among whites and 22 percentage points among blacks. The largest improvements in survival have been for leukemia and non-Hodgkin lymphoma, while lung and pancreatic cancers have shown the least improvement.

Table 12. Trends in 5-Year Relative Survival Ratesa (%) by Race and Year of Diagnosis, United States, 1975 to 2009
 ALL RACESWHITEBLACK
 1975 TO 19771987 TO 19892003 TO 20091975 TO 19771987 TO 19892003 TO 20091975 TO 19771987 TO 19892003 TO 2009
  1. a

    Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillance, Epidemiology, and End Results (SEER) 9 areas from 1975 to 1977, 1987 to 1989, and 2003 to 2009, all followed through 2010.

  2. b

    The difference in rates between 1975 to 1977 and 2003 to 2009 is statistically significant (P < .05).

  3. c

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

  4. d

    Survival rate is for 1978 to 1980.

All sites495568b505769b394361b
Brain & other nervous system222935b222833b253241b
Breast (female)758490b768592b627179b
Colon516065b516167b455256b
Esophagus5919b61120b4714b
Hodgkin lymphoma727988b728089b707283b
Kidney & renal pelvis505773b505773b495572b
Larynx666663b676764585652
Leukemia344359b354460b333553b
Liver & intrahepatic bile duct3518b3617b2312b
Lung & bronchus121318b121318b111114b
Melanoma of the skin828893b828893b57c79c77c
Myeloma252745b242745b303044b
Non-Hodgkin lymphoma475171b475172b484664b
Oral cavity535465b545667b363446b
Ovary363844b353844b423436
Pancreas246b337b266b
Prostate6883100b6984100b617198b
Rectum485868b485968b445262b
Stomach152029b141828b161929b
Testis839597b839697b73cd88c90
Thyroid929498b929498b909297b
Urinary bladder727980b738081b506364b
Uterine cervix697069707371645763
Uterine corpus878284b888486b605764

Relative survival rates cannot be calculated for some minority populations because accurate life tables are not available. Comparison of cause-specific survival rates for patients diagnosed from 2003 to 2009 indicates that Asian American/Pacific Islander women have the highest probability of surviving 5 years after a cancer diagnosis (69.5%), while American Indian/Alaska Native men have the lowest probability of surviving (56.8%).[5] For both sexes combined, whites and Hispanics have the highest 5-year cause-specific survival (66.7%), while American Indians/Alaska Natives have the lowest (59.0%).

Limitations

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

The projected numbers of new cancer cases and cancer deaths should be interpreted with caution because they are model-based estimates that may vary considerably from year to year for reasons other than changes in cancer occurrence. For instance, estimates are affected by changes in method, which are implemented regularly as modeling techniques improve and surveillance coverage becomes more complete. In addition, the model is sometimes oversensitive or undersensitive to abrupt or large changes in observed data. For these reasons, the projections are not an accurate measure of year-to-year changes in cancer occurrence and death. The data sources used for tracking cancer trends are age-standardized or age-specific cancer death rates from the NCHS and cancer incidence rates from SEER and/or the National Program of Cancer Registries. Nevertheless, the American Cancer Society projections 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 nonblack populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic groups that are not homogenous, masking important differences in the cancer burden within these groups.

Conclusions

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

Cancer death rates have been continuously declining for the past 2 decades. Overall, the risk of dying from cancer decreased by 20% between 1991 and 2010. Progress has been most rapid for middle-aged black men, among whom death rates have declined by approximately 50%. Despite this substantial progress, 5-year survival rates among blacks continue to lag behind whites by as much as 22 percentage points for uterine cancer, 21 percentage points for cancer of the oral cavity, and 17 percentage points for urinary bladder cancer. 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 and other disadvantaged populations. ▪

References

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  2. Abstract
  3. Introduction
  4. Materials and Methods
  5. Selected Findings
  6. Cancer Occurrence by Race/Ethnicity
  7. Limitations
  8. Conclusions
  9. References
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