The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its annual compilation of estimated cancer incidence, mortality, and survival data for the United States in the year 2000. After 70 years of increases, the recorded number of total cancer deaths among men in the US declined for the first time from 1996 to 1997. This decrease in overall male mortality is the result of recent downturns in lung and bronchus cancer deaths, prostate cancer deaths, and colon and rectum cancer deaths.
Despite decreasing numbers of deaths from female breast cancer and colon and rectum cancer, mortality associated with lung and bronchus cancer among women continues to increase. Lung cancer is expected to account for 25% of all female cancer deaths in 2000.
This report also includes a summary of global cancer mortality rates using data from the World Health Organization.
Cancer is an important public health concern in the United States and around the world. To provide an up-to-date perspective on the occurrence of cancer, the American Cancer Society presents an overview of cancer frequency, incidence, mortality, and survival statistics for the year 2000.
ESTIMATED NEW CANCER CASES
Because the US does not have a nationwide cancer registry, the exact number of new cases of cancer diagnosed each year in the US and in individual states is not known. Consequently, we first estimated the number of new cancer cases occurring annually in the US from 1979 through 1996 using population data reported by the US Bureau of the Census and age-specific cancer incidence rates collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.1 We fitted these annual cancer case estimates to an autoregressive quadratic model to forecast the number of cancer cases expected to be diagnosed in the US in the year 2000 (Table 1, Fig. 1).2
Between 1987 and 1992, the incidence rate of prostate cancer increased 85%, followed by a decline of 29% between 1992 and 1996.3 The sharp increase in incidence followed by the decline in recent years probably reflects extensive use of prostate-specific antigen (PSA) screening in a previously unscreened population and the subsequent increase in diagnoses at an early stage.4 We assumed that the number of prostate cancer cases would approximate the rates observed prior to widespread use of PSA screening, and there-fore, we estimated new cases of prostate cancer for 2000 using a linear projection based on data from 1979 to 1989.
Because cancer incidence rates and case counts for 1979 through 1996 were not available for many states, we could not use the methods mentioned above to estimate new cases for individual states (Table 3). To derive these estimates, we assumed that the ratio of cancer deaths to cancer cases for each state was the same as the ratio for the US.2
ESTIMATED CANCER DEATHS
We estimated the number of cancer deaths expected to occur in the US in the year 2000 using underlying cause-of-death data from death certificates as reported to the National Center for Health Statistics (Table 2, Fig. 2).5 The recorded numbers of cancer deaths occurring annually from 1979 to 1997 were fitted to an autoregressive quadratic model to forecast the number of cancer deaths expected to occur in the US in 2000. The estimated number of cancer deaths for each state was calculated with the same modeling procedure used for the total US (Table 4).2
Mortality statistics for the leading causes of death (Tables 6, 7, and 12), the leading causes of death from cancer (Tables 8, 9), and cancer mortality rates from 1930 to 1996 (Figs. 5, 6) were obtained using data from the National Center for Health Statistics.5 Incidence rates (Table 10, Figs. 3, 4), the probability of developing cancer (Table 5), and five-year relative survival rates (Tables 11, 13; Figs. 7, 8) were obtained from the SEER program.3,6 We computed global cancer mortality rates (Table 14) using data compiled by the World Health Organization.7 We included data from countries that have: 1) submitted data for at least one of the years between 1994 and 1997 using codes from the ninth or tenth revision of the International Classification of Diseases; 2) populations of 500,000 or more; 3) death registration of at least 82%; and 4) a proportion of deaths with medically certified cause of death of at least 95%.8
EXPECTED NUMBERS OF NEW CANCER CASES
In the year 2000, we estimate that about 1,220,100 new cases of invasive cancer will be diagnosed in the US (Table 1). This estimate does not include carcinoma in situ of any site except urinary bladder, and it does not include basal and squamous cell cancers of the skin. Approximately 1.3 million cases of basal and squamous cell skin cancers, 42,600 cases of breast carcinoma in situ, and 28,600 cases of in situ melanoma are expected to be newly diagnosed in 2000.
Among men, the most common cancers in 2000 are expected to be cancers of the prostate, lung and bronchus, and colon and rectum (Fig. 1). The prostate is the leading site for cancer incidence, accounting for 29% of new cancer cases in men. This year, 180,400 new cases of prostate cancer are expected to be diagnosed.
Among women, the three most commonly diagnosed cancers are expected to be cancers of the breast, lung and bronchus, and colon and rectum (Fig. 1). Cancers occurring at these sites are expected to account for over 50% of new cancer cases in women. Breast cancer alone is expected to account for 182,800 new cancer cases (30%) in 2000.
TRENDS IN CANCER INCIDENCE
For all sites combined, SEER cancer incidence rates appeared to peak in 1992 and decreased an average of -2.2% per year from 1992 to 1996.9 Similar declines have been seen recently for specific leading cancer sites (Figs. 3 and 4).
Breast cancer incidence rates have remained approximately level during the 1990s; however, they appear to be decreasing in younger women. Decreases in colon and rectum cancer incidence rates began in the mid-1980s, and have been observed among both males and females in all racial/ethnic groups (with the exception of American Indian women in whom data were not sufficient to make a determination as to the direction of this trend).3 Incidence rates of colon and rectum cancer declined significantly between 1990 and 1996, on average -2.1% per year.9
A downturn in the incidence of lung and bronchus cancer in males began in the late 1980s, and between 1990 and 1996, incidence rates decreased significantly, -2.6% per year. Incidence rates of lung and bronchus cancer among females are stabilizing, and have begun to decline among women aged 40 to 59.9 Prostate cancer incidence rates also declined significantly between 1990 and 1996, on average -2.0% per year.
EXPECTED NUMBERS OF CANCER DEATHS
In 2000, an estimated 552,200 Americans are expected to die of cancer—more than 1,500 people a day (Table 2). Most cancer deaths in men (52%) in the year 2000 are expected to be from cancers of the lung and bronchus, prostate, and colon and rectum (Fig. 2).
Among women, cancers of the lung and bronchus, breast, and colon and rectum are expected to account for more than half of all cancer deaths in 2000 (Fig. 2). In 1987, lung cancer surpassed breast cancer as the leading cause of cancer death in women and is expected to account for 25% of all female cancer deaths in 2000.
TRENDS IN THE RECORDED NUMBER OF CANCER DEATHS
Following more than 70 years of increases, the recorded number of total cancer deaths among men in the US has declined for the first time, from a peak of 281,898 in 1996 to 281,110 in 1997. This promising change results from recent downturns in each of the top three causes of cancer death among men. Lung and bronchus cancer deaths among men declined from a peak of 92,493 in 1993 to 91,278 in 1997. Prostate cancer deaths declined from a peak of 34,902 in 1994 to 32,891 in 1997. Colon and rectum cancer deaths among men were highest in 1990 at 28,635 and have declined to 28,075 in 1997.
Among women, the recorded number of total cancer deaths continues to increase, although the rate of increase has diminished in recent years. The upward trend among females is primarily due to sustained increases in the number of deaths from lung and bronchus cancer. The numbers of deaths from breast and colorectal cancers among females, however, have begun to decline. Breast cancer deaths were highest in 1995 at 43,844 and have declined to 41,943 in 1997. Colorectal cancer deaths among women have declined from a recent peak of 29,237 in 1995 to 28,621 in 1997, although these deaths reached their all-time high in 1984 at 29,522.
TRENDS IN CANCER DEATH RATES
Death rates for all cancers combined peaked in 1991 and decreased an average -0.7% per year from 1991 to 1996 (Figs. 5 and 6).9 Significant decreases have been seen among both males and females, persons younger than 65 years of age, and among whites, blacks, and Hispanics.
Breast cancer death rates in females decreased an average of -1.8% per year between 1990 and 1996; decreases were more pronounced among white women and among younger women. During the period from 1990 to 1996, colon and rectum cancer death rates decreased significantly, on average -1.7% per year.
Similar to trends in incidence, significant decreases in death rates for lung and bronchus cancer have occurred only among males (on average -1.6% per year between 1990 and 1996); rates among females recently have begun to slow and appear to be stabilizing. Prostate cancer death rates decreased on average -1.6% per year during the period between 1990 and 1996.
TRENDS IN CANCER BY RACE/ETHNICITY
Overall rates of cancer incidence vary considerably among racial and ethnic groups (Table 10). Blacks have the highest cancer incidence rates: They are about 60% more likely to develop cancer than are Hispanics and Asian/Pacific Islanders and more than twice as likely to develop cancer as American Indians. Between 1990 and 1996, incidence rates decreased among whites (-1.2% per year), Hispanics (-1.7% per year), and American Indians (-0.7% per year), and remained relatively stable among blacks and Asian/Pacific Islanders.3
White women are more likely to develop breast cancer than are women of other racial and ethnic groups, and black women are more likely to develop cancers of the colon and rectum.3 Black men have the highest incidence rates for cancers of the colon and rectum, lung and bronchus, and prostate. They are also at least 50% more likely to develop prostate cancer than men of other racial and ethnic groups.
Blacks are about 33% more likely to die of cancer than are whites, and more than twice as likely to die of cancer as are Asian/Pacific Islanders, American Indians, and Hispanics. Between 1990 and 1996, mortality rates decreased significantly among whites (-0.5% per year), blacks (-0.9% per year), and Hispanics (-0.6% per year); remained relatively stable among Asian/Pacific Islanders; and may be increasing among American Indians.3
Black women are more likely to die of breast (see article by Dignam in this issue of CA, page 50) and colon and rectum cancers than are women of any other racial or ethnic group, and they have approximately the same lung and bronchus cancer death rate as white women. As was seen with incidence rates, black men have the highest mortality rates of colon and rectum, lung and bronchus, and prostate cancers.3
CANCER IN CHILDREN
Cancer is the second leading cause of death among children between one and 14 years of age in the US; accidents are the most frequent cause of death in this age group (Table 12). The most commonly occurring cancers in children are leukemias (in particular, acute lymphocytic leukemia), tumors of the central and sympathetic nervous systems, lymphomas, soft-tissue sarcomas, and renal tumors.3 Over the past 20 years, there have been significant improvements in the five-year relative survival rate for many childhood cancers, especially acute lymphocytic and acute myeloid leukemia, non-Hodgkin's lymphoma, and Wilms' Tumor (Table 13). Between 1974/1976 and 1989/1995, five-year relative survival rates for childhood cancers at all sites combined improved from 56% to 75%.
Limitations and Future Challenges
Our estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted with caution when tracking trends over time. These estimates may vary considerably from year to year, particularly for rare cancers and for states with smaller populations. We therefore discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. The recorded number of cancer deaths and cancer death rates from the National Center for Health Statistics, and SEER cancer incidence rates are generally more informative statistics for the purpose of tracking cancer trends. For example, breast cancer incidence rates increased about 1% per year between 1979 and 1982, increased 4% per year between 1982 and 1987, and were approximately constant between 1987 and 1996. Despite the stabilization of incidence rates during the latter time period, the estimates of new breast cancer cases increased between 1988 and 1996.
Our estimates are based on the most currently available cancer mortality and incidence data; however, these data are three and four years old, respectively, at the time that the estimates are calculated. As such, the effects of large changes occurring in the three- or four-year interval between 1996 or 1997 and 2000 cannot be captured by our modeling efforts. Finally, our estimates of new cancer cases are based on incidence rates for the geographic locations that participate in the SEER program and, therefore, may not be representative of the total US.
Despite these limitations, our estimates do describe current patterns of cancer incidence and mortality in the US. Such estimates will assist our continuing efforts to reduce the public health burden of cancer as we enter the 21st century.
Table Table 1. Estimated New Cancer Cases by Gender, US, 2000
Table Table 2. Estimated Cancer Deaths by Gender, US, 2000
Table Table 3. Estimated New Cancer Cases by Site and State, US, 2000
Table Table 4. Estimated Cancer Mortality by Site and State, US, 2000
Table Table 5. Probability of Developing Invasive Cancers Over Selected Age Intervals, by Gender, US, 1994–1996*
Table Table 6. Reported Deaths for the 10 Leading Causes of Death by Age and Gender, US, 1997
Table Table 7. Fifteen Leading Causes of Death, US, 1997
Table Table 8. Reported Deaths for the Five Leading Cancer Sites for Males by Age, US, 1997
Table Table 9. Reported Deaths for the Five Leading Cancer Sites for Females by Age, US, 1997
Table Table 10. Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1990–1996
Table Table 11. Trends in Five-Year Relative Cancer Survival Rates* (%) by Race and Year of Diagnosis, US, 1974–1995
Table Table 12. Fifteen Leading Causes of Death Among Children Aged 1–14 Years, US, 1997
Table Table 13. Trends in Five-Year Relative Cancer Survival Rates* (%) for Children Under Age 15, US, 1974–1995
Table Table 14. Cancer Around the World: Age-Adjusted Death Rates* per 100,000 Population for Selected Sites for 45 Countries, 1994–1997