Cancer Statistics, 2001

Authors

  • Dr. Robert T. Greenlee PhD, MPH,

    1. Greenlee was Program Director for Cancer Surveillance in the Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. He is currently a lead scientist with the Marshfield Medical Research Foundation, Marshfield, WI
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  • Ms. Mary Beth Hill-Harmon MSPH,

    1. Hill-Harmon is an Epidemiologist in the Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA
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  • Mr. Taylor Murray,

    1. Murray is Manager, Surveillance Data Systems, in the Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA
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  • Dr. Michael Thun MD, MS

    1. Thun is Vice-President of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA
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    • The authors thank Cheryll Cardinez, Vilma Cokkinides, PhD, April Harris, Elyse Luke, and Kate O'Brien for their assistance in preparation of this manuscript.


Abstract

Each year the American Cancer Society compiles estimates of the number of new cancer cases and deaths expected in the US in the current year and the most recent data on cancer incidence, mortality, and survival. An estimated 1,268,000 new cases of cancer will be diagnosed in the year 2001 and an estimated 553,400 Americans will die from cancer. Overall cancer incidence and death rates have continued to decrease in men and women since the early 1990s, and the decline in overall cancer mortality has been greater in recent years. Despite reductions in age-adjusted rates of cancer death, the total number of recorded cancer deaths in the US continues to increase, due to an aging and expanding population. Large disparities in cancer incidence and mortality across racial/ethnic groups continue. Black men and women experience higher incidence of cancer and poorer survival than white men and women. The disparity in survival reflects both diagnosis of cancer at later disease stages, and poorer survival within each stage of diagnosis.

INTRODUCTION

Despite the decrease in overall cancer incidence and mortality rates in the US since the early 1990s, cancer remains a major public health problem. 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 2001.

METHODS

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 all individual states is not known. Consequently, we first estimated the number of new cancer cases occurring annually in the US from 1979 through 1997 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 fit these annual cancer case estimates with an autoregressive quadratic model to forecast the number of cancer cases expected to be diagnosed in the US in the year 2001.2

The observed trend in prostate cancer incidence was not compatible with the selected forecasting model, as rates increased markedly between 1988 and 1992, declined sharply between 1992 and 1995, and leveled off from 1995 to 1997.3 This trend likely 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 therefore assumed that the number of prostate cancer cases is approaching the pattern in effect prior to widespread use of PSA screening, and estimated new cases of prostate cancer for 2001 using a linear projection based on data from 1979 to 1989 and 1995 to 1997 only.

Because cancer incidence rates and case counts for 1979 through 1997 were not available for many states, we could not use the methods mentioned earlier to estimate new cases for individual states. To derive these estimates, we relied on state cancer death data and 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 and in each state in the year 2001 using underlying cause-of-death data from death certificates, as reported to the National Center for Health Statistics.5 The recorded numbers of cancer deaths occurring annually from 1979 to 1998 in the US and in each state were fit with autoregressive quadratic models to forecast the number of cancer deaths expected to occur in 2001.

Other Statistics

Mortality statistics for the leading causes of death, the leading causes of death from cancer, and age-adjusted cancer mortality rates for 1930 to 1997 were obtained using data from the National Center for Health Statistics.5 Age-adjusted cancer incidence rates, the probability of developing cancer, and five-year relative survival rates were obtained from the SEER program.3,6

SELECTED FINDINGS

Expected Numbers of New Cancer Cases

In the year 2001, we estimate that about 1,268,000 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. More than a million cases of basal and squamous cell skin cancers, 46,400 cases of breast carcinoma in situ, and 31,400 cases of in situ melanoma are expected to be newly diagnosed in 2001. Estimated numbers of new cancer cases by state are shown in Table 2.

Table TABLE 1. Estimated New Cancer Cases by Gender, US, 2001*
 TotalMaleFemale
All Sites1,268,000643,000625,000
  1. *Rounded to the nearest 100. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

Oral Cavity & Pharynx30,10020,2009,900
    Tongue7,1004,8002,300
    Mouth10,5006,0004,500
    Pharynx8,4006,3002,100
    Other oral cavity4,1003,1001,000
Digestive System235,700124,000111,700
    Esophagus13,2009,9003,300
    Stomach21,70013,4008,300
    Small intestine5,3002,6002,700
    Colon98,20046,20052,000
    Rectum37,20021,10016,100
    Anus, anal canal, & anorectum3,5001,5002,000
    Liver & intrahepatic bile duct16,20010,7005,500
    Gallbladder & other biliary6,9003,2003,700
    Pancreas29,20014,20015,000
    Other digestive organs4,3001,2003,100
Respiratory System184,600102,40082,200
    Larynx10,0008,0002,000
    Lung & bronchus169,50090,70078,800
    Other respiratory organs5,1003,7001,400
Bones & Joints2,9001,6001,300
Soft Tissue (Including Heart)8,7004,6004,100
Skin (Excluding Basal & Squamous)56,40031,70024,700
    Melanoma-skin51,40029,00022,400
    Other non-epithelial skin5,0002,7002,300
    Breast193,7001,500192,200
Genital System286,800206,50080,300
    Uterine cervix12,900 12,900
    Uterine corpus38,300 38,300
    Ovary23,400 23,400
    Vulva3,600 3,600
    Vagina & other genital, female2,100 2,100
    Prostate198,100198,100 
    Testis7,2007,200 
    Penis & other genital, male1,2001,200 
Urinary System87,50059,40028,100
    Urinary bladder54,30039,20015,100
    Kidney & renal pelvis30,80018,70012,100
    Ureter & other urinary organs2,4001,500900
Eye & Orbit2,1001,1001,000
Brain & Other Nervous System17,2009,8007,400
Endocrine System21,4005,60015,800
    Thyroid19,5004,60014,900
    Other endocrine1,9001,000900
Lymphoma63,60035,00028,600
    Hodgkin's disease7,4003,9003,500
    Non-Hodgkin's lymphoma56,20031,10025,100
Multiple Myeloma14,4007,5006,900
Leukemia31,50017,70013,800
    Acute lymphocytic leukemia3,5002,1001,400
    Chronic lymphocytic leukemia8,1004,6003,500
    Acute myeloid leukemia10,0005,2004,800
    Chronic myeloid leukemia4,7002,8001,900
    Other leukemia5,2003,0002,200
Other & Unspecified Primary Sites31,40014,40017,000
Table TABLE 2. Estimated New Cancer Cases by Site and State, US, 2001*
STATEAll SitesFemale BreastUterine CervixColon & RectumUterine CorpusLeukemiaLung & BronchusMelanomaNon-Hodgkin's LymphomaProstateUrinary Bladder
  1. *Rounded to nearest 100. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  2. — Estimate is 50 or fewer cases.

  3. Note: These estimates are offered as a rough guide and should be interpreted with caution. They are calculated according to the distribution of estimated cancer deaths in 2001 by state. State estimates may not add to US total due to rounding.

AL22,6002,9002002,0005005003,1009008004,100800
AK1,600200100200100100200100
AZ21,3003,2002002,2005005002,8001,1001,0003,600900
AR14,1001,9002001,3004004002,2005006002,400500
CA117,40018,8001,40011,7003,4003,00014,2005,3005,30017,5005,300
CO14,3002,1001001,5004004001,6008007002,100600
CT16,0002,5001001,6005004002,0007008002,500800
DE4,000600100400100100600200200600300
DC2,800600300200300100500100
FL91,60012,5009009,4002,6002,30012,9003,8004,20015,0004,400
GA31,1005,0004002,9001,0007004,4001,2001,1004,9001,100
HI4,700600500100100600100300700100
ID5,000800500100100600300200900300
IL56,8009,1006006,2001,8001,5007,4002,1002,5009,0002,400
IN29,3004,4003003,2009007004,2001,1001,3004,4001,200
IA14,8002,3001001,9006005001,9005007002,500700
KS12,1001,7001001,2003003001,6006005002,000500
KY21,1002,9002002,2005005003,4009009002,800700
LA21,7003,3003002,4005005002,9007009003,500800
ME6,9001,0001007002001001,000300300900400
MD23,5004,0003002,7006005003,2008009003,7001,000
MA31,3004,6003003,6008007004,0001,4001,4004,6001,600
MI45,3006,8004004,9001,5001,1006,2001,6002,2007,1002,000
MN20,6003,2001002,1006006002,4008001,2003,600900
MS13,9002,0002001,3002003002,0005005002,500400
MO28,4003,8003003,1009007004,3001,2001,2004,0001,100
MT4,300600400100100600200200800200
NE7,5001,2001001,0002002009003003001,200300
NV9,2001,2001001,0002002001,3004004001,300400
NH5,800800600200100800200300800300
NJ41,2006,7004004,5001,6001,1005,0001,8002,0006,2002,000
NM6,9001,1001007002002008003003001,300200
NY83,20014,2009009,7003,4002,00010,0002,8003,70012,7004,200
NC37,3005,5004004,0001,2009005,4001,4001,4006,0001,300
ND3,100500300100400100100500100
OH58,2008,9006006,4002,0001,4008,1002,1002,7008,7002,500
OK16,6002,5002001,8003004002,6008007002,200600
OR16,7002,4001001,6005004002,3008008003,000700
PA68,40010,3006008,0002,2001,7008,9002,7003,00010,9003,200
RI5,600800100600100100800200300800200
SC18,8002,8002002,0005005002,6006007003,200700
SD3,600500400100100400200200600100
TN28,8004,2003002,9007007004,3001,4001,2003,900800
TX78,90012,3001,0008,7002,3002,00011,0003,4003,60012,5002,900
UT5,6001,0007002002004004003001,400300
VT2,900400400100100400200100300100
VA30,5004,6003003,2001,0007004,2001,3001,2004,9001,100
WA24,8003,6002002,4007007003,3001,2001,1003,4001,100
WV10,9001,5001001,1003003001,7004005001,400500
WI25,0003,6002002,6007007003,0001,1001,3004,3001,100
WY2,200300300100100300100100400100
US1,268,000192,20012,900135,40038,30031,500169,50051,40056,200198,10054,300

Among men, the most common cancers in 2001 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 31% of new cancer cases in men. This year 198,100 new cases of prostate cancer are expected to be diagnosed.

Figure FIGURE 1.

Estimated New Cancer Cases*

10 Leading Sites by Gender, US, 2001

*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

Percentages may not total 100% due to rounding.

Among women, the three mostly 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 192,200 new cancer cases (31%) in 2001.

Lifetime Probability of Developing Cancer

The lifetime probability of developing cancer is higher in men (43.48%) than in women (38.34%) (Table 3), but women have a higher probability than men of developing any cancer before age 60. In general, however, the probability of developing specific cancers is higher in men than women at all ages, with the exception of breast cancer and cancers specific to women.

Table TABLE 3. Probability of Developing Invasive Cancers within Selected Age Intervals, by Gender, US, 1995-1997*
  Birth to 39%40 to 59%60 to 79%Birth to Death%
  1. * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed between 1995 and 1997.

  2. The “1 in” statistic and the inverse of the percentage may not be equivalent due to rounding.

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

  4. ‡ Includes invasive and in situ cancer cases.

  5. Data Source: DEVCAN Software, Version 4.0, Surveillance, Epidemiology, and End Results Program, 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

All sites Male1.56 (1 in 64)8.25 (1 in 12)33.13 (1 in 3)43.48 (1 in 2)
 Female1.97 (1 in 51)9.37 (1 in 11)22.39 (1 in 4)38.34 (1 in 3)
Bladder Male0.03 (1 in 3,437)0.44 (1 in 226)2.39 (1 in 42)3.40 (1 in 29)
 Female(Less than 1 in 10,000)0.14 (1 in 699)0.68 (1 in 146)1.18 (1 in 85)
BreastFemale0.44 (1 in 225)4.15 (1 in 24)7.02 (1 in 14)12.83 (1 in 8)
Colon & RectumMale0.07 (1 in 1,531)0.87 (1 in 115)4.00 (1 in 25)5.78 (1 in 17)
 Female0.05 (1 in 1,855)0.69 (1 in 146)3.04 (1 in 33)5.55 (1 in 18)
LeukemiaMale0.15 (1 in 654)0.21 (1 in 467)0.84 (1 in 119)1.42 (1 in 70)
 Female0.11 (1 in 900)0.15 (1 in 671)0.50 (1 in 199)1.05 (1 in 95)
Lung & BronchusMale0.04 (1 in 2,499)1.24 (1 in 80)6.29 (1 in 16)8.09 (1 in 12)
 Female0.03 (1 in 2,997)0.92 (1 in 108)4.04 (1 in 25)5.78 (1 in 17)
MelanomaMale0.13 (1 in 744)0.53 (1 in 190)0.94 (1 in 106)1.68 (1 in 60)
 Female0.22 (1 in 453)0.40 (1 in 249)0.48 (1 in 207)1.25 (1 in 80)
Non-Hodgkin's LymphomaMale0.19 (1 in 513)0.50 (1 in 198)1.21 (1 in 83)2.11 (1 in 47)
 Female0.08 (1 in 1,296)0.32 (1 in 312)0.97 (1 in 103)1.74 (1 in 57)
ProstateMale(Less than 1 in 10,000)2.06 (1 in 49)13.42 (1 in 7)15.89 (1 in 6)
Uterine CervixFemale0.17 (1 in 576)0.30 (1 in 332)0.26 (1 in 387)0.78 (1 in 129)
Uterine CorpusFemale0.05 (1 in 2,142)0.74 (1 in 136)1.67 (1 in 60)2.73 (1 in 37)

Trends in Cancer Incidence

For all sites combined, age-adjusted cancer incidence rates declined an average of 1.3% per year from 1992 to 1997, reversing increasing trends in earlier years (Fig. 2).7 However, the overall decline has been limited to incidence rates among men, which were heavily influenced by trends in prostate cancer incidence. Declines have also been seen recently for several other leading cancer sites (Figs. 3 and 4).

Figure FIGURE 2.

Cancer Incidence Rates, * by Gender, US, 1973-1997

*Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

Data Source: Surveillance, Epidemiology, and End Results, 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

Figure FIGURE 3.

Age-Adjusted Cancer Incidence Rates* for Females by Site, US, 1973-1997

*Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

Data Source: Surveillance, Epidemiology, and End Results, 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

Figure FIGURE 4.

Age-Adjusted Cancer Incidence Rates* for Males by Site, US, 1973-1997

*Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

Data Source: Surveillance, Epidemiology, and End Results, 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

Breast cancer incidence remained approximately level during the 1990s, but may appear to be decreasing in younger women.3 Colon and rectum cancer incidence began to decline in 1985, on average 1.6% per year through 1997. Decreases in colon and rectum cancer incidence rates have been observed among males and females in all racial/ethnic groups, (with the exception of American Indian women for whom data were not sufficient to make a determination as to the direction of the trend.)3

A significant downturn in the incidence of lung and bronchus cancer in males began in the 1980s; between 1992 and 1997, incidence rates decreased 3.2% per year. Overall incidence rates of female lung and bronchus cancer have been stable since 1991, but rates have begun to decline among women aged 40 to 59.8

Prostate cancer incidence was essentially level from 1995 to 1997, following large annual increases of 17.5% from 1988 to 1992 and a sharp decline of 10.3% per year from 1992 to 1995.3

Expected Numbers of Cancer Deaths

In 2001, an estimated 553,400 Americans are expected to die of cancer—more than 1,500 people a day (Table 4). The estimated numbers of cancer deaths in 2001 by state are shown in Table 5.

Table TABLE 4. Estimated Cancer Deaths by Gender, US, 2001*
 TotalMaleFemale
All Sites553,400286,100267,300
  1. *Rounded to the nearest 100.

  2. Excludes in situ carcinomas except urinary bladder.

Oral Cavity & Pharynx7,8005,1002,700
    Tongue1,7001,100600
    Mouth2,3001,3001,000
    Pharynx2,1001,500600
    Other oral cavity1,7001,200500
Digestive System131,30070,10061,200
    Esophagus12,5009,5003,000
    Stomach12,8007,4005,400
    Small intestine1,100600500
    Colon48,10023,00025,100
    Rectum8,6004,7003,900
    Anus, anal canal, & anorectum500200300
    Liver & intrahepatic bile duct14,1008,9005,200
    Gallbladder & other biliary3,3001,2002,100
    Pancreas28,90014,10014,800
    Other digestive organs1,400500900
Respiratory System162,50093,90068,600
    Larynx4,0003,100900
    Lung & bronchus157,40090,10067,300
    Other respiratory organs1,100700400
Bones & Joints1,400800600
Soft Tissue (Including Heart)4,4002,1002,300
Skin (Excluding Basal & Squamous)9,8006,3003,500
    Melanoma-skin7,8005,0002,800
    Other non-epithelial skin2,0001,300700
Breast40,60040040,200
Genital System58,50032,20026,300
    Uterine cervix4,400 4,400
    Uterine corpus6,600 6,600
    Ovary13,900 13,900
    Vulva800800 
    Vagina & other genital, female600 600
    Prostate31,50031,500 
    Testis400400 
    Penis & other genital, male300300 
Urinary System25,00016,1008,900
    Urinary bladder12,4008,3004,100
    Kidney & renal pelvis12,1007,5004,600
    Ureter & other urinary organs500300200
Eye & Orbit200100100
Brain & Other Nervous System13,1007,2005,900
Endocrine System2,3001,0001,300
    Thyroid1,300500800
    Other endocrine1,000500500
Lymphoma27,60014,50013,100
    Hodgkin's disease1,300700600
    Non-Hodgkin's lymphoma26,30013,80012,500
Multiple Myeloma11,2005,8005,400
Leukemia21,50012,0009,500
    Acute lymphocytic leukemia1,400800600
    Chronic lymphocytic leukemia4,6002,7001,900
    Acute myeloid leukemia7,2003,9003,300
    Chronic myeloid leukemia2,3001,3001,000
    Other leukemia6,0003,3002,700
Other & Unspecified Primary Sites36,20018,50017,700
Table TABLE 5. Estimated Cancer Deaths by Site and State, US, 2001*
STATEReported Death Rate per 100,000All SitesBrain/ Nervous SystemFemale BreastColon & RectumLeukemiaLiverLung & BronchusNon-Hodgkin's LymphomaOvaryPancreasProstate
  1. *Rounded to nearest 100. Excludes in situ carcinomas except urinary bladder.

  2. — Estimate is 50 or fewer deaths.

  3. Data Source: State and US Death Rates, 1993-1997—Surveillance, Epidemiology, and End Results Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000, derived by SEER from data from the National Center for Health Statistics, Centers for Disease Control and Prevention 2000.

  4. Note: State estimates may not add to US total due to rounding.

AL1789,9002006008004003002,900400300500600
AK164700100100200
AZ1539,3002007009003002002,600500200500600
AR1806,1002004006002002002,000300200300400
CA15551,2001,5003,9004,9002,1001,80013,2002,5001,4002,8002,800
CO1416,2002004006003001001,500300200400300
CT1617,0001005007003002001,900400200400400
DE1921,800100200100500100100100
DC2081,200100100300100100
FL16540,0001,0002,6004,0001,5001,00012,0002,0001,0002,1002,400
GA17413,6003001,0001,2005003004,100500300600800
HI1302,000100200100100600100100100
ID1462,200100200200100600100100100100
IL17524,8005001,9002,6001,0007006,9001,2006001,3001,400
IN17612,8003009001,4005003003,900600300600700
IA1576,5002005008003001001,800300200300400
KS1585,3001004005002001001,500200100300300
KY1919,2002006009003002003,200400200400400
LA1929,5002007001,0003003002,700400200500600
ME1843,000100200300100100900200100200100
MD18110,3002008001,1004002003,000400300600600
MA17413,7003001,0001,5005003003,700700300700700
MI17019,8005001,4002,1007005005,7001,0005001,1001,100
MN1549,0002007009004002002,300500200500600
MS1826,1002004006002002001,900200100300400
MO17412,4003008001,3005003004,000600300600600
MT1571,900100200100500100100100100
NE1533,300100200400200100900200100200200
NV1794,0001002004001001001,200200100200200
NH1802,500100200300100100700100100100100
NJ17718,0003001,4001,9008005004,6009005001,0001,000
NM1453,000100200300100100700100100200200
NY16736,3008003,0004,1001,4001,0009,3001,7009002,2002,000
NC17316,3004001,1001,7006003005,000700400800900
ND1521,300100100100100300100100100
OH17825,4006001,9002,7001,0005007,5001,3006001,3001,400
OK1697,3001005007003002002,400300200300300
OR1647,3002005007003001002,100400200400500
PA17529,8006002,2003,3001,1007008,2001,4007001,5001,700
RI1772,400100200300100100700100100100100
SC1768,2002006008003002002,400300200500500
SD1521,600100200100400100100100
TN18112,6003009001,2005003004,000600300600600
TX16634,4009002,6003,6001,4001,20010,2001,7008001,7002,000
UT1192,500100200300100100400200100100200
VT1711,200100200400100100100
VA17513,3003001,0001,4005003003,900600300700800
WA16010,8003008001,0004003003,100500300600500
WV1834,8001003005002001001,500200100200200
WI16010,9003007001,1005002002,800600300600700
WY1561,000100100200100
US168553,40013,10040,20056,70021,50014,100157,40026,30013,90028,90031,500

Also shown in Table 5 is the reported death rate by state for the years 1993 to 1997 for all cancers combined. The rate varied considerably by state, with the lowest rate in Utah (119 per 100,000 per year) and the highest rate in Washington, DC (208 per 100,000 per year). The average age-adjusted cancer death rate across the entire US was 168 per 100,000 per year.

Cancers of the lung and bronchus, prostate, and colon and rectum combined are expected to contribute 52% of cancer deaths among men in the year 2001 (Fig. 5). Among women, cancers of the lung and bronchus, breast, and colon and rectum are expected to account for 51% of all cancer deaths in 2001 (Fig. 5). Lung cancer has surpassed breast cancer as the leading cause of cancer death in women since 1987 and is expected to account for 25% of all female cancer deaths in 2001.

Figure FIGURE 5.

Estimated Cancer Deaths*

10 Leading Sites by Gender, US, 2001

*Excludes in situ carcinomas except urinary bladder.

Percentages may not total 100% due to rounding.

Trends in Cancer Death Rates

The death rate for all cancers combined peaked in 1991 and then decreased on average 0.6% per year until 1995. The decline was even more marked between 1995 and 1997, at 1.7% per year (Fig. 6).3 Significant decreases in cancer death rates have occurred among males of all ages, and among females younger than 75 years old.7

Figure FIGURE 6.

Cancer Death Rates, * by Gender, US, 1973-1997

*Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

Data Source: Surveillance, Epidemiology, and End Results Program 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000. Mortality derived by SEER using data originating from the National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

The death rates associated with many of the common cancer sites have also been decreasing (Figs. 7 and 8). The breast cancer death rate among females decreased an average of 2.2% per year between 1990 to 1997; decreases were more pronounced among white women and among younger women. Colon and rectum cancer death rates have been decreasing 1.8% per year on average since 1984, with equally strong declines among men and women.3 Similar to trends in incidence, significant decreases in death rates for lung and bronchus cancer have occurred only among males (on average, 1.7% per year between 1990 and 1997); however, the increase in lung cancer death rates among females has begun to slow recently. Prostate cancer death rates stopped increasing in 1991, and decreased an average of 4.4% annually from 1994 through 1997.3

Figure FIGURE 7.

Age-Adjusted Cancer Death Rates, * for Females by Site, US, 1930-1997

*Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

† Uterus cancer death rates are for uterine cervix and uterine corpus combined.

Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung & bronchus, and colon & rectum are affected by these coding changes.

Data Source: US Mortality Public Use Data Tapes 1960-1997, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000

Figure FIGURE 8.

Age-Adjusted Cancer Death Rates, * for Males by Site, US, 1930-1997

* Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung & bronchus, and colon & rectum are affected by these coding changes.

Data Source: US Mortality Public Use Data Tapes 1960-1997, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers

Recorded Numbers of Deaths from Cancer and Other Causes

Among fatal conditions in the US, all cancers combined rank second highest, following only heart disease (Table 6). Cancer accounted for 23.2% of all deaths in 1998. Upon examination of causes of death by age and gender, cancer is by far the leading cause of death among women aged 40 to 59 and also ranks first among women aged 60 to 79 (Table 7). The lowest that cancer ranks as a cause of death for any age-gender group is fifth, among men ages 20 to 39.

Table TABLE 6. Fifteen Leading Causes of Death, US, 1998
RankCause of DeathNumber of DeathsDeath Rate per 100,000 Population*Percent (%) of Total Deaths
 All Causes2,337,256645.5100.00
  1. *Age-adjusted to the 1970 US standard population.

  2. Percentages may not total 100% due to rounding.

  3. Data Source: US Mortality Public Use Data Tape 1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

1Heart Diseases724,859189.031.0
2Cancer541,532161.523.2
3Cerebrovascular Diseases158,44839.46.8
4Chronic Obstructive Pulmonary Disease112,58431.04.8
5Accidents97,83531.54.2
6Pneumonia & Influenza91,87121.93.9
7Diabetes Mellitus64,75118.52.8
8Suicide30,57510.01.3
9Nephritis26,1826.71.1
10Cirrhosis of Liver25,1928.11.1
11Septicemia23,7316.31.0
12Alzheimer's Disease22,7255.01.0
13Homicide18,2726.60.8
14Atherosclerosis15,2793.50.7
15HIV Infection13,4264.00.6
 Other & Ill-defined369,994 15.8
Table TABLE 7. Reported Deaths for the 10 Leading Causes of Death by Age and Gender, US, 1998
 All AgesAges 1-19Ages 20-39Ages 40-59Ages 60-79Ages 80+
 MaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
  1. Data Source: US Mortality Public Use Data Tape 1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

 All Causes 1,157,260All Causes 1,179,996All Causes 17,519All Causes 9,311All Causes 66,053All Causes 30,538All Causes 185,727All Causes 113,027All Causes 510,008All Causes 411,516All Causes 361,843All Causes 602,932
1Heart Diseases 353,897Heart Diseases 370,962Accidents 7,808Accidents 3,971Accidents 19,987Accidents 6,351Heart Diseases 51,215Cancer 45,892Heart Diseases 164,290Cancer 131,017Heart Diseases 131,720Heart Diseases 233,478
2Cancer 282,065Cancer 259,467Homicide 2,451Cancer 885Suicide 9,136Cancer 6,107Cancer 48,282Heart Diseases 20,006Cancer 160,881Heart Diseases 113,981Cancer 66,421Cancer 75,526
3Accidents 63,042Cerebro-vascular Diseases 97,303Suicide 1,704Homicide 719Homicide 7,762Heart Diseases 2,804Accidents 16,222Accidents 6,174Chronic Obstructive Pulmonary Diseases 31,953Chronic Obstructive Pulmonary Diseases 28,423Cerebro-vascular Diseases 27,883Cerebro-vascular Diseases 63,641
4Cerebro-vascular Diseases 61,145Chronic Obstructive Pulmonary Diseases 55,566Cancer 1,213Congenital Anomalies 543Heart Diseases 5,745Suicide 2,066Suicide 7,847Cerebro-vascular Diseases 5,197Cerebro-vascular Diseases 25,844Cerebro-vascular Diseases 27,366Pneumonia & Influenza 23,120Pneumonia & Influenza 37,147
5Chronic Obstructive Pulmonary Diseases 57,018Pneumonia & Influenza 50,892Congenital Anomalies 608Heart Diseases 377Cancer 5,217Homicide 1,930Cirrhosis of Liver 7,818Diabetes Mellitus 4,024Diabetes Mellitus 15,646Diabetes Mellitus 16,506Chronic Obstructive Pulmonary Diseases 20,955Chronic Obstructive Pulmonary Diseases 23,217
6Pneumonia & Influenza 40,979Diabetes Mellitus 35,167Heart Diseases 578Suicide 357HIV Infection 4,369HIV Infection 1,626Cerebro-vascular Diseases 6,246Chronic Obstructive Pulmonary Diseases 3,421Pneumonia & Influenza 14,016Pneumonia & Influenza 11,010Diabetes Mellitus 7,860Diabetes Mellitus 13,980
7Diabetes Mellitus 29,584Accidents 34,793Cerebral Palsy 237Pneumonia & Influenza 174Cirrhosis of Liver 1,059Cerebro-vascular Diseases 886HIV Infection 5,296Cirrhosis of Liver 2,829Accidents 10,810Accidents 7,561Accidents 7,680Alzheimer's Diseases 12,551
8Suicide 24,538Alzheimer's Diseases 15,671Chronic Obstructive Pulmonary Diseases 177Cerebral Palsy 166Cerebro-vascular Diseases 876Diabetes Mellitus 620Diabetes Mellitus 5,227Suicide 2,389Cirrhosis of Liver 6,389Nephritis 4,780Nephritis 5,929Accidents 10,407
9Cirrhosis of Liver 16,343Nephritis 13,621Pneumonia & Influenza 168Chronic Obstructive Pulmonary Diseases 122Diabetes Mellitus 817Cirrhosis of Liver 576Chronic Obstructive Pulmonary Diseases 3,466Pneumonia & Influenza 1,835Nephritis 5,178Septicemia 4,622Alzheimer's Diseases 4,754Nephritis 7,820
10Homicide 14,023Septicemia 13,506Peripheral Nervous Nervous Diseases 138Cerebro-vascular Diseases 86Pneumonia & Influenza 686Pneumonia & Influenza 523Homicide 2,852HIV Infection 1,299Septicemia 4,508Cirrhosis of Liver 4,184Parkinson's Diseases 4,298Athero-sclerosis 7,680

Tables 8 and 9 present the leading site-specific causes of cancer death for males and females according to age. Leukemia is the most common cause of cancer death among men under age 40, while lung and bronchus cancer is the leading cause of cancer death for men 40 years and older. Prostate cancer is the second most common cause of cancer death among men 60 years and older. Among women, leukemia is the leading cause of cancer death before age 20, but breast cancer and uterine cervical cancer each cause more deaths among women between 20 and 39 years old. Breast cancer is the leading cause of cancer death among women aged 40 to 59. Lung cancer causes the most cancer deaths among women 60 years and older.

Table TABLE 8. Reported Deaths for the Five Leading Cancer Sites for Males by Age, US, 1998
All Ages< 2020-3940-5960-79≥ 80
  1. Note: “All Sites” excludes in situ carcinomas except urinary bladder.

  2. ONS = other nervous system

  3. Data Source: US Mortality Public Use Data Tape 1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

All Sites 282,065All Sites 1,256All Sites 5,217All Sites 48,282All Sites 160,881All Sites 66,421
Lung & Bronchus 91,399Leukemia 392Leukemia 663Lung & Bronchus 15,521Lung & Bronchus 59,377Lung & Bronchus 16,011
Prostate 32,203Brain & ONS 307Brain & ONS 627Colon & Rectum 4,539Prostate 15,742Prostate 15,373
Colon & Rectum 28,024Bones & Joints 116Non-Hodgkin's Lymphoma, 612Pancreas 2,671Colon & Rectum 15,615Colon & Rectum 7,455
Pancreas 13,806Endocrine System 102Lung & Bronchus 484Non-Hodgkin's Lymphoma, 2399Pancreas 8,070Urinary Bladder 3,034
Non-Hodgkin's Lymphoma 12,205Non-Hodgkin's Lymphoma 87Colon & Rectum 404Esophagus 2,141Non-Hodgkin's Lymphoma 6,341Pancreas 2,945
Table TABLE 9. Reported Deaths for the Five Leading Cancer Sites for Females by Age, US, 1998
All Ages< 2020-3940-5960-79≥ 80
  1. Note: “All Sites” excludes in situ carcinomas except urinary bladder.

  2. ONS = other nervous system

  3. Data Source: US Mortality Public Use Data Tape 1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

All SitesAll SitesAll SitesAll SitesAll SitesAll Sites
259,4679206,10745,892131,01775,526
Lung & BronchusLeukemiaBreastBreastLung & BronchusLung & Bronchus
63,0752801,60411,88939,07713,392
BreastBrain & ONSUterine CervixLung & BronchusBreastColon & Rectum
41,73723363410,15518,29212,174
Colon & RectumSoft TissueLeukemiaColon & RectumColon & RectumBreast
28,950734563,47212,9509,949
PancreasEndocrine SystemLung & BronchusOvaryPancreasPancreas
14,529684422,8417,4545,193
OvaryBones & JointsBrain & ONSPancreasOvaryNon-Hodgkin's Lymphoma
13,391624011,7757,0383,881

The decrease in the total number of cancer deaths that occurred between 1996 and 1997 among men in the US was not sustained. The 282,065 deaths recorded in 1998 represented an increase of 955 deaths from the previous year (Table 10). The number of prostate cancer deaths continued to decline, however, from a peak of 34,902 in 1994 to 32,203 in 1998. The 91,399 lung and bronchus cancer deaths among men in 1998 remain lower than in the peak year of 1993. Colon and rectum cancer deaths among men were highest in 1990, and were slightly lower in 1998 at 28,024.

Table TABLE 10. Trends in the Recorded Number of Deaths from Cancer, by Site and Gender, US, 1989-1998
 All SitesLung & BronchusColon & RectumProstateBreast
YearMFMFMFMF
  1. Data Source: US Mortality Public Use Data Tapes 1989-1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

1989263,309232,84388,97548,04228,12328,90330,52042,837
1990268,283237,03991,01450,13628,48428,67432,37843,391
1991272,380242,27791,60352,02228,02628,75333,56443,583
1992274,838245,74091,32254,48528,28028,71434,24043,068
1993279,375250,52992,49356,23428,19929,20634,86543,555
1994280,465253,84591,82557,53528,47128,93634,90243,644
1995281,611256,84491,80059,30428,40929,23734,47543,844
1996281,898257,63591,55960,35127,98928,76634,12343,091
1997281,110258,46791,27861,92228,07528,62132,89141,943
1998282,065259,46791,39963,07528,02428,95032,20341,737

Among women, the recorded number of total cancer deaths continues to increase, with 259,467 deaths recorded in 1998, although the rate of increase has diminished recently (Table 10). The upward trend among females is primarily due to sustained increases in the number of deaths from lung and bronchus cancer. The numbers of female deaths from breast cancer, however, have begun to decline. Breast cancer deaths were highest in 1995 at 43,844 and have declined to 41,737 in 1998. The number of colorectal cancer deaths among females has remained fairly constant in recent years.

CANCER OCCURRENCE BY RACE/ETHNICITY

Overall rates of cancer incidence vary considerably among racial and ethnic groups (Table 11). African Americans have the highest incidence rates of cancer. They are about 60% more likely to develop cancer than Hispanics and Asian/Pacific Islanders and more than twice as likely to develop cancer than American Indians. Between 1990 and 1997, incidence rates for all cancers combined decreased among Caucasians (1.0% per year), Hispanics (1.6% per year), American Indians (0.6% per year), and blacks (0.5% per year), but remained relatively stable among Asian/Pacific Islanders.3

Table TABLE 11. Incidence and Mortality Rates* by Site, Race, and Ethnicity, US, 1990-1997
 WhiteBlackAsian/Pacific IslanderAmerican IndianHispanic
  1. *Rates are per 100,000 and are age-adjusted to the 1970 US standard population.

  2. Hispanic is not mutually exclusive from white, black, Asian/Pacific Islander, or American Indian.

  3. Note: Incidence data are from the 11 SEER areas; mortality data are from all states except data for Hispanics exclude deaths from Connecticut, Louisiana, New Hampshire, and Oklahoma.

  4. Data Source: Surveillance, Epidemiology, and End Results Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000. Mortality derived by SEER from data originating from the National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

Incidence
All Sites     
Total402.1444.6279.3152.8272.9
Males476.3597.9323.5175.9323.2
Females352.4337.4246.9137.3240.9
Breast (Female)114.0100.274.633.468.9
Colon & Rectum     
Total43.650.738.116.328.8
Males52.758.347.220.435.7
Females36.645.230.913.123.6
Lung & Bronchus     
Total55.473.335.518.427.1
Males71.9111.151.925.138.0
Females43.345.822.513.319.4
Prostate145.8225.080.445.8101.6
Mortality
All Sites     
Total166.5221.9102.3104.5104.0
Males207.0305.5127.2124.6130.6
Females139.1167.783.090.085.6
Breast (Female)25.331.411.212.115.1
Colon & Rectum     
Total17.223.010.810.110.3
Males21.327.713.111.613.1
Females14.319.98.98.98.3
Lung & Bronchus     
Total49.160.123.429.019.8
Males69.599.534.240.931.6
Females34.033.014.919.811.0
Prostate23.354.110.414.216.2

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 Incidence rates for lung and bronchus cancer are similar among white and black women. Black men have the highest incidence rates for cancers of the colon and rectum and lung and bronchus, and incidence rates of prostate cancer among black men are at least 50% higher than rates for men of other racial and ethnic groups.

African Americans are about 33% more likely to die of cancer than are whites, and more than twice as likely to die from cancer as are Asian/Pacific Islanders, American Indians, and Hispanics. Between 1990 and 1997, mortality rates decreased significantly among whites (0.7% per year), blacks (1.0% per year), Hispanics (0.9% per year), and Asian/Pacific Islanders (0.8% per year), but may be increasing among American Indians.3

Black women are more likely to die of breast and colon and rectum cancers than are women of any other racial or ethnic group, and lung and bronchus cancer death rates are particularly high for both black and white women compared with other racial or ethnic groups. As was seen with incidence rates, black men have the highest death rates of colon and rectum, lung and bronchus, and prostate cancer.3

Cancer Survival

Contributing to the higher death rates among black men and women is a poorer probability of survival once diagnosed with cancer. Blacks are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated, and more likely to be diagnosed with cancer at a regional or distant stage of disease. This is true for most of the common cancer sites (Fig. 9). Furthermore, for nearly every cancer site, blacks have lower five-year relative survival rates than whites at each stage of diagnosis, suggesting possible influences of differences in treatment, tumor pathology, and comorbid conditions (Fig. 10).

Figure FIGURE 9.

Distribution of Cancer Cases by Race and Stage at Diagnosis, US, 1989-1996

*The rate for local stage represents local and regional stages combined.

Note: Staging according to SEER historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each site and race, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases.

Data Source: Surveillance, Epidemiology, and End Results Program 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

Figure FIGURE 10.

Five-Year Relative Survival Rates by Race and Stage at Diagnosis, US, 1989-1996

*The standard error is between five and 10 percentage points.

† The standard error is greater than 10 percentage points.

‡ The rate for local stage represents local and regional stages combined.

§ Statistic could not be calculated.

Note: Staging according to SEER historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system.

Data Source: Surveillance, Epidemiology, and End Results Program 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

There have been notable improvements over time in the probability of survival from most common cancers and from all cancers combined (Table 12). This is true for both whites and blacks. Survival has not significant-ly improved for cancers of the uterine cervix, larynx, and oral cavity in the past 25 years.

Table TABLE 12. Trends in Five-Year Relative Cancer Survival Rates* (%) by Race and Year of Diagnosis, US, 1974-1996
 1974-761980-821989-961974-761980-821989-961974-761980-821989-96
SITE White  Black  All Races 
  1. *Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1989 to 1996, followed through 1997.

  2. †The difference in rates between 1974-76 and 1989-96 is statistically significant (p < 0.05).

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

  4. §The standard error of the survival rate is greater than 10 percentage points.Data Source: Surveillance, Epidemiology and End Results Program 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Insititute, 2000.

All Sites515262 †394049 †505160 †
Brain222530 †273138 †232531 †
Breast (Female)757786 †636671 †757685 †
Uterine Cervix706872 †646159696770
Colon515663 †464952 †515562 †
Uterine Corpus898386 †615557888284 †
Esophagus5813 †459 †5712 †
Hodgkin's Disease727583 †697277717582 †
Kidney525162 †495658 †525261 †
Larynx676966595854666865
Leukemia354045 †323334353944 †
Liver546 †223445
Lung & Bronchus131414 †121211121314
Melanoma808389 †67 ‡61 §70 ‡808388 †
Multiple Myeloma242828 †283031252829
Non-Hodgkin's Lymphoma485253 †495042 †475152 †
Oral Cavity555656363135545354
Ovary373950 †413848 †373950 †
Pancreas334 †354 †334 †
Prostate687594 †596587 †677393 †
Rectum495361 †423852 †495260 †
Stomach151620 †171922151821 †
Testis799296 †76 ‡90 ‡88799295 †
Thyroid929496 †889591929595 †
Urinary Bladder747982 †485964 †737881 †

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 13). 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 25 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 14). Between 1974/1976 and 1989/1996, five-year relative survival rates among children for all cancer sites combined improved from 56% to 75%.3

Table TABLE 13. Fifteen Leading Causes of Death Among Children Aged 1-14, US, 1998
RankCause of DeathNumber of DeathsDeath Rate per 100,000 Population*Percent(%) of Total Deaths
 All Causes13,04223.6100.0
  1. *Age-adjusted to the 1970 US standard population.

  2. †Percentages may not total 100% due to rounding.

  3. Data Source: US Mortality Public Use Data Tape 1998, National Center for Health Statistics, Centers for Disease Control and Prevention, 2000.

1Accidents5,1899.439.8
2Cancer1,3782.510.6
3Congenital Anomalies9351.67.2
4Homicide8591.56.6
5Heart Diseases5401.04.1
6Suicide3240.62.5
7Cerebral Palsy2820.52.2
8Pneumonia & Influenza2670.52.0
9Chronic Obstructive Pulmonary Disease2010.41.5
10Septicemia1450.31.1
11Cerebrovascular Diseases1390.31.1
12Benign Neoplasms1370.21.1
13Viral Diseases890.20.7
14HIV Infection860.20.7
15Meningitis820.10.6
 All Others2,389 18.3
Table TABLE 14. Trends in Five-Year Relative Cancer Survival Rates* (%) for Children Under Age 15, US, 1974-1996
Five-Year Relative Survival Rates (%)
Year of Diagnosis
  1. Note: “All Sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

  2. * Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 1996.

  3. † The difference in rates between 1974-1976 and 1989-1996 is statistically significant (p < 0.05).

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

  5. Data Source: Surveillance, Epidemiology, and End Results Program 1973-1997, Division of Cancer Control and Population Sciences, National Cancer Institute, 2000.

Site1974-19761977-19791980-19821983-19851986-19881989-1996
All Sites566265687075†
Acute Lymphocytic Leukemia536771697882 †
Acute Myeloid Leukemia1530 ‡21 ‡32 ‡32 ‡44 †
Bones & Joints53 ‡53 ‡55 ‡57 ‡63 ‡69 †
Brain & Other Nervous System555655626365 †
Hodgkin's Disease788491909094 †
Neuroblastoma535453555970 †
Non-Hodgkin's Lymphoma445062717078 †
Soft Tissue616965766676 †
Wilms' Tumor747887879193 †

LIMITATIONS AND FUTURE CHALLENGES

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 less common cancers and for states with smaller populations. We 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 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 continued to increase between 1988 and 1996, partly due to the residual effects of the strong rate increases through 1987.

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 effect of large changes occurring in the three or four-year interval between 1997 or 1998 and 2001 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, the American Cancer Society estimates do provide evidence of the 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 in 21st century.

Ancillary