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Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

Every year the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival, using National Cancer Institute (NCI) incidence and National Center for Health Statistics (NCHS) mortality data. Incidence and death rates are age adjusted to the 1970 US standard population. It is estimated that 1,284,900 new cases of cancer will be diagnosed and 555,500 people will die from cancer in the United States in the year 2002. From 1992 to 1998, cancer death rates declined in males and females, while cancer incidence rates decreased among males and increased slightly among females. Most notably, African-American men showed the largest decline for both incidence and mortality. Nevertheless, African Americans still carry the highest burden of cancer with later-stage cancer diagnosis and poorer survival compared with whites. Despite the continued decline in cancer death rates, the total number of recorded cancer deaths in the United States continues to increase slightly due to the aging and expanding population.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

At present, cancer remains a major public health problem in the United States and in other developed countries as well. One in four deaths in the United States is caused by cancer. In order to provide an up-to-date perspective on the occurrence of cancer, the American Cancer Society presents this overview of cancer frequency, incidence, mortality, and survival statistics for the year 2002.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

Data Sources

Mortality data were obtained from the National Center for Health Statistics (NCHS).1 Incidence data, including five-year relative survival rate data and data on lifetime probability of developing cancer, were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) covering about 10 percent of the US population.2 Population data were obtained from the US Census Bureau.3 For 1999 mortality data, causes of death were coded and classified according to the Tenth Revision of the International Classification of Diseases (ICD-10),4 replacing ICD-95 used in the United States for deaths occurring during 1979 through 1998. Cancer cases were classified according to the International Classification of Diseases for Oncology.6

Estimated New Cancer Cases

Because the United States has no nationwide cancer registry, precisely how many new cases of cancer are diagnosed each year in the United States and in all individual states is unknown. Consequently, we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 1998 by using age-specific cancer incidence rates collected by NCI's SEER program2 coupled with population data reported by the US Census Bureau.3 We then forecasted the number of cancer cases expected to be diagnosed in the United States in the year 2002 using an autoregressive quadratic model fitted to the annual cancer case estimates.7

The observed trend in prostate cancer incidence was not compatible with the selected forecasting model, as rates increased greatly between 1988 and 1992, declined sharply between 1992 and 1995, and leveled off from 1995 to 1998.8,9 This trend likely reflects extensive use of prostate-specific antigen (PSA) screening in a previously unscreened population and the subsequent increase in cancer diagnoses at an early stage.10,11 We therefore assumed that the number of prostate cancer cases is approaching the pattern in effect prior to widespread use of PSA screening; and then estimated the number of new cases of prostate cancer for 2002 using a linear projection based on data from 1979 to 1989 and 1995 to 1998 only.

We could not use the methods mentioned above to estimate new cancer cases for individual states because complete cancer incidence and case counts are not available for many states. To derive these estimates, we relied on state cancer death statistical data and assumed that the ratio of cancer deaths to cancer cases was the same in each state as in the United States on the whole.

Estimated Cancer Deaths

We estimated the number of cancer deaths expected to occur in the United States and in each state in the year 2002 using underlying cause-of-death data from death certificates as reported to the National Center for Health Statistics.1 The recorded numbers of cancer deaths occurring annually from 1979 to 1999 in the United States and in each state were fitted with autoregressive quadratic models7 in order to forecast the number of cancer deaths expected to occur in 2002.

Other Statistics

We provide mortality statistics for the leading causes of deaths and deaths from cancer for 1999. Causes of death for 1999 mortality data were coded and classified according to ICD-10 rulings, replacing ICD-9 coding used for deaths that occurred from 1979 through 1998. Comparisons between the recorded number of deaths between 1998 and 1999 were adjusted for the change in ICD coding rules using a comparability ratio.12

This report also provides updated statistics on the probability of developing cancer,13 trends in cancer mortality and incidence, and five-year relative survival rates for selected cancer sites based on data from 1973 through 1998.2 Cancer incidence and death rates are standardized to the 1970 US standard population and expressed per 100,000 person-years. Death rates for 1999 are presented using both 1970 and 2000 US standard population for age standardization to illustrate the impact of the 2000 standard population on death rates.

SELECTED FINDINGS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

Expected Numbers of New Cancer Cases

The estimated number of new cancer cases expected in 2002 is indicated for men, women, and for both sexes combined in Table 1. The estimate of about 1,284,900 new cases of invasive cancer does not include carcinoma in situ of any site except urinary bladder, nor does it include basal and squamous cell cancers of the skin. More than one million cases of basal and squamous cell skin cancers, 54,300 cases of breast carcinoma in situ, and 34,300 cases of in situ melanoma are expected to be newly diagnosed in 2002. The estimated number of new cancer cases by state and cancer site are shown in Table 2.

Table TABLE 1. Estimated New Cancer Cases and Deaths by Gender, US, 2002*
 Estimated New CasesEstimated Deaths
 Both SexesMaleFemaleBoth SexesMaleFemale
  1. *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Carcinoma in situ of the breast accounts for about 54,300 new cases annually and melanoma in situ accounts for about 34,300 new cases annually.

  2. Estimates of new cases are based on incidence rates from the NCI Surveillance, Epidemiology, and End Results program, 1979 to 1998.

All Sites1,284,900637,500647,400555,500288,200267,300
Oral cavity and pharynx28,90018,90010,0007,4004,9002,500
    Tongue7,1004,7002,4001,7001,100600
    Mouth9,8005,2004,6002,0001,100900
    Pharynx8,6006,5002,1002,1001,500600
    Other oral cavity3,4002,5009001,6001,200400
Digestive system250,600130,300120,300132,30070,80061,500
    Esophagus13,1009,8003,30012,6009,6003,000
    Stomach21,60013,3008,30012,4007,2005,200
    Small intestine5,3002,5002,8001,100600500
    Colon107,30050,00057,30048,10023,10025,000
    Rectum41,00022,60018,4008,5004,7003,800
    Anus, anal canal, and anorectum3,9001,7002,200500200300
    Liver and intrahepatic bile duct16,60011,0005,60014,1008,9005,200
    Gallbladder and other biliary7,1003,4003,7003,5001,3002,200
    Pancreas30,30014,70015,60029,70014,50015,200
    Other digestive organs4,4001,3003,1001,8007001,100
Respiratory system183,200100,70082,500161,40094,10067,300
    Larynx8,9006,9002,0003,7002,900800
    Lung and bronchus169,40090,20079,200154,90089,20065,700
    Other respiratory organs4,9003,6001,3002,8002,000800
Bones and joints2,4001,3001,1001,300700600
Soft tissue (including heart)8,3004,4003,9003,9002,0001,900
Skin (excluding basal and squamous)58,30032,50025,8009,6006,2003,400
    Melanoma-skin53,60030,10023,5007,4004,7002,700
    Other non-epithelial skin4,7002,4002,3002,2001,500700
Breast205,0001,500203,50040,00040039,600
Genital system279,100197,70081,40057,10030,90026,200
    Uterine cervix13,000 13,0004,100 4,100
    Uterine corpus39,300 39,3006,600 6,600
    Ovary23,300 23,30013,900 13,900
    Vulva3,800 3,800800 800
    Vagina and other genital, female2,000 2,000800 800
    Prostate189,000189,000 30,20030,200 
    Testis7,5007,500 400400 
    Penis and other genital, male1,2001,200 200200 
Urinary system90,70062,20028,50024,90016,2008,700
    Urinary bladder56,50041,50015,00012,6008,6004,000
    Kidney and renal pelvis31,80019,10012,70011,6007,2004,400
    Ureter and other urinary organs2,4001,600800700400300
Eye and orbit2,2001,1001,100200100100
Brain and other nervous system17,0009,6007,40013,1007,2005,900
Endocrine system22,7006,00016,7002,3001,0001,300
    Thyroid20,7004,90015,8001,300500800
    Other endocrine2,0001,1009001,000500500
Lymphoma60,90031,90029,00025,80013,50012,300
    Hodgkin's disease7,0003,7003,3001,400800600
    Non-Hodgkin's lymphoma53,90028,20025,70024,40012,70011,700
Multiple myeloma14,6007,8006,80010,8005,5005,300
Leukemia30,80017,60013,20021,70012,1009,600
    Acute lymphocytic leukemia3,8002,2001,6001,400800600
    Chronic lymphocytic leukemia7,0004,1002,9004,5002,6001,900
    Acute myeloid leukemia10,6005,9004,7007,4004,0003,400
    Chronic myeloid leukemia4,4002,5001,9002,0001,100900
    Other leukemia5,0002,9002,1006,4003,6002,800
Other and unspecified primary sites30,20014,00016,20043,70022,60021,100
Table TABLE 2. Estimated New Cancer Cases for Selected Cancer Sites by State, US, 2002*
STATEAll SitesFemale BreastUterine CervixColon and RectumUterine CorpusLeukemiaLung and BronchusMelanoma of the SkinNon-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 2002 by state. State estimates may not add to US total due to rounding.

AL22,6003,1002002,2006005003,2009008003,900800
AK1,60030010200200100100100100
AZ22,1003,5002002,4006005002,9001,2001,0003,3001,000
AR14,2002,0002001,5004003002,2005006002,300500
CA119,90019,9001,40012,9003,7003,00014,3005,3005,10017,3005,600
CO14,5002,4001001,6004004001,6008007002,200600
CT16,1002,6001001,8005004002,0006007002,400800
DE4,100600100400100100600200100600300
DC2,70060040300100300500100
FL92,20013,10090010,4002,6002,20013,0004,1003,90013,6004,300
GA31,6005,2004003,2001,0007004,4001,3001,1004,8001,100
HI4,70070030500100100600100200700100
ID5,20090040600100100600300200900300
IL57,4009,7007006,8001,8001,4007,4002,2002,4008,5002,500
IN30,0004,6003003,6009007004,3001,3001,2004,4001,300
IA14,8002,4001002,0005004001,9006006002,400600
KS12,3001,8001001,4003003001,7006005001,900500
KY21,1003,1003002,3005004003,4009008002,700800
LA21,9003,5002002,6006005002,9007008003,400700
ME7,0001,0001008002001001,000300300800400
MD23,5004,1003002,9007005003,2008009003,4001,100
MA31,7004,7002003,8009007004,0001,4001,4004,6001,700
MI45,8007,3004005,3001,5001,0006,1001,7002,1006,7002,100
MN20,8003,2002002,3007006002,5009001,1003,4001,000
MS14,4002,2002001,5003003002,1005005002,500500
MO28,6004,0003003,3009007004,2001,3001,1003,9001,100
MT4,40060040500100100600200200800200
NE7,7001,2001001,1002002001,0003003001,000300
NV9,5001,3001001,2002002001,4005003001,400400
NH5,80080040700200100800300200700300
NJ41,1006,9004004,9001,6001,1004,9001,8001,9005,7002,100
NM7,1001,2001008002002008004002001,200300
NY83,70014,7001,00010,4003,4002,00010,0002,8003,40011,8004,300
NC38,2005,9004004,2001,2009005,5001,5001,4005,6001,500
ND3,10050030400100100300100100400200
OH58,7009,5006007,2001,9001,4007,9002,3002,6008,1002,700
OK16,9002,7002002,0004004002,5009007002,100700
OR16,8002,6001001,8005004002,2008007002,800800
PA68,90011,0006008,7002,3001,6008,7002,7003,00010,3003,300
RI5,600800100700200100800200200800300
SC19,5003,1002002,2006004002,6007007003,100800
SD3,70050020500100100400200200600100
TN29,1004,4004003,1007007004,4001,4001,2003,9001,000
TX79,70013,1001,0009,5002,5001,90010,8003,6003,40011,7003,000
UT5,9001,100407002002005004003001,300300
VT2,90040040400100100400200100400100
VA31,3005,0003003,5001,0007004,2001,3001,2004,7001,200
WA25,6003,7002002,7007007003,4001,3001,1003,3001,100
WV11,0001,5001001,3004003001,7004004001,400500
WI25,3003,9002002,9008007003,0001,1001,3004,0001,200
WY2,30030020300100100300100100400100
US1,284,900203,50013,000148,30039,30030,800169,40053,60053,900189,00056,500

Figure 1 lists the most common cancers expected to occur in men and women in 2002. Among men, cancers of the prostate, lung and bronchus, and colon and rectum comprise 55 percent of all new cancer cases. Prostate cancer accounts for 30 percent (189,000) of new cancer cases in men. Based on the most current data on stage distributions of prostate cancer cases, however, over 80 percent of these estimated new cases are expected to be diagnosed at local and regional stages with nearly 100 percent five-year relative survival rates.

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Figure FIGURE 1. Ten Leading Cancer Sites for the Estimated New Cancer Cases and Deaths by Gender, US, 2002*

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

Percentages may not total 100% due to rounding.

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Among women, the three most commonly diagnosed cancers are expected to be cancers of the breast, lung and bronchus, and colon and rectum. Cancers occurring at these sites are expected to account for about 55 percent of new cancer cases in women. Breast cancer alone is expected to account for 31 percent (203,500) of all new cancer cases among women in 2002.

Expected Number of Cancer Deaths

Table 1 also shows the expected number of cancer deaths in 2002 for men, women, and both sexes combined. It is estimated that about 555,500 Americans will die from cancer, corresponding to 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colon and rectum in men, and cancers of the lung and bronchus, breast, and colon and rectum in women continue to be the most common causes of cancer deaths. These four cancers account for more than half of the total cancer deaths among men and women (Figure 1). Lung cancer has surpassed breast cancer as the leading cause of cancer death in women since 1987 and is expected to account for about 25 percent of all female cancer deaths in 2002. The estimated number of cancer deaths in 2002 by state appears in Table 3.

Table TABLE 3. Estimated Cancer Deaths for Selected Cancer Sites by State, US, 2002*
StateRecorded‡ Death Rate Per 100,000All SitesBrain/Nervous SystemFemale BreastColon and RectumLeukemiaLiverLung and BronchusNon– Hodgkin's LymphomaOvaryPancreasProstate
  1. *Rounded to nearest 100. Excludes in situ carcinomas except urinary bladder.

  2. †Estimate is 50 or fewer deaths.

  3. ‡Average annual rates for 1994 to 1998 and age adjusted to 1970 US standard population.

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

  5. Source: US Mortality Public Use Data Tapes, 1960 to 1999, National Center for Health Statistics.

AL177.79,8002006008004003002,900400200500600
AK160.1700100100200
AZ150.19,6002007009004002002,700500200500500
AR177.86,2002004006002002002,000300100300400
CA151.751,8001,5003,9004,9002,1001,80013,1002,3001,4002,8002,800
CO139.36,3002005006003001001,500300200400400
CT160.17,0001005007003002001,800300200400400
DE188.51,800100200100500100100100
DC205.51,200100100300100100
FL162.739,9009002,6004,0001,6001,00011,9001,8001,0002,1002,200
GA172.213,7003001,0001,2005003004,000500400700800
HI129.22,000100200100100500100100100
ID145.42,300100200200100600100100100100
IL172.124,8005001,9002,6001,0006006,7001,1006001,3001,400
IN174.813,0003009001,4005003004,000600300600700
IA155.86,4002005008003001001,700300200300400
KS155.45,3001004005002001001,500200100300300
KY189.19,1002006009003002003,100400200400400
LA190.39,5002007001,0003003002,700400200500500
ME180.03,000100200300100100900100100200100
MD179.210,2002008001,1004002002,900400200600500
MA171.413,7003009001,5005003003,600600300800700
MI168.019,8004001,4002,0007005005,5009005001,1001,100
MN153.19,0002006009004002002,300500200500500
MS181.86,2002004006002002001,900200100300400
MO172.712,3003008001,3005003003,800500300600600
MT154.81,900100200100500100100100100
NE151.33,300100200400200100900200100200200
NV178.14,1001003005001001001,300100100200200
NH177.22,500100200300100100700100100100100
NJ174.317,8004001,4001,9008005004,5008005001,000900
NM143.53,000100200300100100700100100200200
NY164.236,2008002,9004,0001,4001,0009,1001,5009002,2001,900
NC171.416,5004001,2001,6006003005,000600400800900
ND150.91,300100100100300100100100
OH175.925,4006001,9002,7001,0005007,3001,2006001,3001,300
OK168.07,3001005007003002002,300300100300300
OR162.77,3002005007003001002,000300200400500
PA172.529,8006002,2003,3001,1007008,0001,4007001,6001,600
RI176.42,400100200300100100700100100100100
SC174.18,4002006008003002002,400300200500500
SD152.71,600100100200100400100100100100
TN181.012,6003009001,2005003004,000500300600600
TX163.834,5009002,6003,6001,3001,2009,9001,5008001,8001,900
UT119.82,500100200300100100400100100100200
VT169.41,300100200400100100100
VA172.813,5003001,0001,4005003003,800600300700800
WA158.211,1003007001,0005003003,100500300600500
WV182.14,7001003005002001001,500200100200200
WI159.311,0003008001,1005002002,800600300600600
WY155.31,000100100200100
US est.166.2555,50013,10040,00056,60021,70014,100154,90024,40013,90029,70030,200

Trends in Cancer Incidence and Mortality

From 1992 through 1998, overall cancer incidence and mortality rates declined by 1.1 percent each year on average (Figure 2). Mortality declined among both males and females, while incidence declined only in males and increased slightly in females. Most notably, African-American men showed the largest decline for both incidence and mortality (data not shown). Recent declines or stabilizations in incidence (Figure 3) and mortality (Figures 4 and 5) have occurred for several leading cancer sites.

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Figure FIGURE 2. Annual Age-adjusted Cancer Incidence and Death Rates* by Gender, US, 1973 to 1998

*Rates are age adjusted to the 1970 US standard population.

Source: Incidence data from Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001. Mortality data from US Mortality Public Use Data Tapes, 1960 to 1999, National Center for Health Statistics.

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Figure FIGURE 3. Annual Age-adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancer Sites, US, 1973 to 1998

*Rates are age adjusted to the 1970 US standard population.

Source: Surveillance, Epidemiology, and End Results program, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

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Figure FIGURE 4. Annual Age-adjusted Cancer Death Rates* Among Males for Selected Cancer Sites, US, 1930 to 1998

*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 cancer of the lung and bronchus, and colon and rectum are affected by these coding changes.

Source: US Mortality Public Use Data Tapes, 1960 to 1998, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics.

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Figure FIGURE 5. Annual Age-adjusted Cancer Death Rates* Among Females for Selected Cancer Sites, US, 1930 to 1998

*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 cancer of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these coding changes.

Source: US Mortality Public Use Data Tapes, 1960 to 1998, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics.

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Female breast cancer incidence for all races combined increased by 3.8 percent per year between 1980 and 1987, and stabilized through 1998 (Figure 3). A significant downturn in the incidence of lung and bronchus cancer in males began in the early 1980s; between 1992 and 1998, incidence rates decreased 2.4 percent per year. Overall incidence rates of female lung and bronchus cancer have been stable since 1991, but rates have begun to decline in women under 65 years of age from 28.3 percent per 100,000 women in 1991 to 22.7 percent per 100,000 women in 1998. In both men and women, colon and rectum cancer incidence declined between the mid-1980s and the mid-1990s and stabilized thereafter. Prostate cancer incidence rates have generally leveled off during the years 1995 to 1998, following large annual increases of 17.5 percent from 1988 to 1992 and a sharp decline of 10.0 percent per year from 1992 to 1995.8,9

Similar to trends in incidence, significant decreases in death rates for lung and bronchus cancer have occurred only among males (on average 1.8 percent per year during 1990 to 1998) (Figure 4); the increase in lung cancer death rates among females has begun to slow recently (Figure 5).

Breast cancer death rates among females declined annually by 1.6 percent from 1989 to 1995, and by 3.4 percent since then. Age-specific analysis revealed that breast cancer mortality declined in every age group except in African-American women, age 75 and older; the decline was more pronounced in females younger than 50 years old in both whites and African Americans.9 Colon and rectum cancer death rates have been decreasing by about 2 percent per year since 1984 in females and 1987 in males.8,9 Prostate cancer deaths peaked in 1991, and have decreased an average of 4.5 percent per year from 1994 through 1998.8,9

The Recorded Number of Deaths from Cancer and Other Causes in 1999

A total of 549,838 cancer deaths were recorded in 1999 in the United States, up by 8,306 deaths compared with 1998. Adjusting for changes in rules for selecting underlying cause of death reduced the increase in the number of cancer deaths to 4,624. Cancer deaths accounted for 23 percent of all deaths, ranking second only to death from heart disease (Table 4). When deaths are categorized by age and sex, cancer is by far the leading cause of death among women aged 40 to 79 and among men aged 60 to 79 (Table 5). In contrast, cancer ranks fifth as a cause of death among men aged 20 to 39.

Table TABLE 4. Fifteen Leading Causes of Death, US, 1999
RankCause of DeathNumber of DeathsPercent Total DeathsAge-adjusted Rate (1970 US Standard Population)Age-adjusted Rate (2000 US Standard Population)
  1. Note: Percentages may not total 100% due to rounding.

  2. Source: US Mortality Public Use Data Tape, 1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

 All Causes2,391,399 647.4882.1
    1Heart Diseases725,19230.3184.7267.9
    2Cancer549,83823.0161.2202.7
    3Cerebrovascular Diseases167,3667.040.461.9
    4Chronic Lower Respiratory Diseases124,1815.233.545.7
    5Accidents (Unintentional Injuries)97,8604.131.235.9
    6Diabetes Mellitus68,3992.919.225.2
    7Influenza and Pneumonia63,7302.714.823.6
    8Alzheimer's Disease44,5361.99.516.5
    9Nephritis, Nephrotic Syndrome, and Nephrosis35,5251.59.213.1
10Septicemia30,6801.38.111.3
11Intentional Self-harm (Suicide)29,1991.29.510.7
12Chronic Liver Disease and Cirrhosis26,2591.18.39.7
13Hypertension and Hypertensive Renal Disease16,9680.74.26.3
14Assault (Homicide)16,8890.76.16.1
15Atherosclerosis14,9790.63.35.5
 All Other and Ill-defined Causes379,798   
Table TABLE 5. Reported Deaths for the Ten Leading Causes of Death by Age and Gender, US, 1999
 All AgesAges 1 to 19Ages 20 to 39Ages 40 to 59Ages 60 to 79Ages 80+
 MaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale
  1. Source: US Mortality Public Use Data Tape, 1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

 All Causes 1,175,460All Causes 1,215,939All Causes 17,247All Causes 9,375All Causes 64,591All Causes 30,157All Causes 192,537All Causes 117,773All Causes 509,056All Causes 415,988All Causes 376,106All Causes 630,276
1Heart Diseases 351,617Heart Diseases 373,575Accidents (Unintentional Injuries) 7,725Accidents (Unintentional Injuries) 3,952Accidents (Unintentional Injuries) 19,924Accidents (Unintentional Injuries) 6,300Heart Diseases 51,247Cancer 46,757Cancer 160,670Cancer 131,972Heart Diseases 134,592Heart Diseases 238,579
2Cancer 285,832Cancer 264,006Assault (Homicide) 2,192Cancer 945Intentional Self-harm49,529 (Suicide) 8,763Cancer 5,747Cancer 49,529Heart Diseases 20,249Heart Diseases 159,306Heart Diseases 111,350Cancer 69,360Cancer 78,550
3Cerebro-vascular Diseases 64,485Cerebro-vascular Diseases 102,881Intentional Self-harm (Suicide) 1,541Assault (Homicide) 709Assault (Homicide) 7,046Heart Diseases 2,768Accidents (Unintentional Injuries) 17,192Accidents (Unintentional Injuries) 6,256Chronic Lower Respiratory Diseases 34,287Chronic Lower Respiratory Diseases 30,453Cerebro-vascular Diseases 30,791Cerebro-vascular Diseases 68,709
4Accidents (Unintentional Injuries) 63,535Chronic Lower Respiratory Diseases 61,766Cancer 1,230Congenital Anomalies 535Heart Diseases 5,607Intentional Self-harm (Suicide) 1,915Chronic Liver Disease & Cirrhosis 8,478Cerebro-vascular Diseases 5,262Cerebro-vascular Diseases 26,618Cerebro-vascular Diseases 27,981Chronic Lower Respiratory Diseases 23,578Chronic Lower Respiratory Diseases 26,912
5Chronic Lower Respiratory Diseases 62,415Diabetes Mellitus 37,249Congenital Anomalies 664Heart Diseases 365Cancer 5,001Assault (Homicide) 1,841Intentional Self-harm (Suicide) 7,567Diabetes Mellitus 4,199Diabetes Mellitus 16,205Diabetes Mellitus 17,204Pneumonia & Influenza 16,114Pneumonia & Influenza 26,531
6Diabetes Mellitus 31,150Influenza & Pneumonia 36,012Heart Diseases 558Intentional Self-harm (Suicide) 318HIV Disease 4,218HIV Disease 1,659HIV Disease 6,262Chronic Lower Respiratory Diseases 3,889Accidents (Unintentional Injuries) 10,350Pneumonia & Influenza 7,400Alzheimer's Disease 9,368Alzheimer's Disease 25,679
7Influenza & Pneumonia 27,718Accidents (Unintentional Injuries) 34,325Chronic Lower Respiratory Diseases 183Pneumonia & Influenza 143Chronic Liver Disease & Cirrhosis 981Cerebro-vascular Diseases 804Cerebro-vascular Diseases 6,111Chronic Liver Disease & Cirrhosis 2,892Pneumonia & Influenza 8,764Accidents (Unintentional Injuries) 6,971Diabetes Mellitus 8,474Diabetes Mellitus 15,192
8Intentional Self-harm (Suicide) 23,458Alzheimer's Disease 31,145Influenza & Pneumonia 153Chronic Lower Respiratory Diseases 117Diabetes Mellitus 811Diabetes Mellitus 605Diabetes Mellitus 5,613Intentional Self-harm (Suicide) 2,372Nephritis, Nephrotic Syndrome, & Nephrosis 7,393Nephritis, Nephrotic Syndrome, & Nephrosis 6,843Accidents (Unintentional Injuries) 7,756Accidents (Unintentional Injuries) 10,483
9Chronic Liver Disease & Cirrhosis 17,115Nephritis, Nephrotic Syndrome, & Nephrosis 18,509Septicemia 101Septicemia 95Cerebro-vascular Diseases 807Chronic Liver Disease & Cirrhosis 546Chronic Lower Respiratory Diseases 3,988HIV Disease 1,673Chronic Liver Disease & Cirrhosis 6,554Septicemia 6,002Nephritis, Nephrotic Syndrome, & Nephrosis 7,473Nephritis, Nephrotic Syndrome, & Nephrosis 9,917
10Nephritis, Nephrotic Syndrome, & Nephrosis 17,016Septicemia 17,285Cerebro-vascular Diseases 92Cerebro-vascular Diseases 86Congenital Anomalies 517Congenital Anomalies 439Assault (Homicide) 2,602Septicemia 1,539Septicemia 5,970Alzheimer's Disease 5,373Septicemia 4,960Septicemia 9,230

Table 6 describes the leading site-specific causes of cancer death by age for males and females. Among men under age 40, leukemia is the most common fatal cancer, while lung and bronchus cancer ranks first for men aged 40 years and older. Colorectal cancer is the second most common site causing death among men 40 to 79 years old. Among women under age 20, leukemia is the leading cause of cancer death; breast cancer ranks first as the cause of cancer death for women between age 20 to 59 years, and lung cancer is the leading cause of cancer death for women aged 60 years and above.

Table TABLE 6. Reported Deaths for the Five Leading Cancer Sites by Gender and Age, US, 1999
All Ages< 2020 to 3940 to 5960 to 79≥ 80
Males
All Sites 285,832All Sites 1,266All Sites 5,001All Sites 49,529All Sites 160,670All Sites 69,360
Lung and Bronchus 89,401Leukemia 379Leukemia 641Lung and Bronchus 15,457Lung and Bronchus 57,263Lung and Bronchus 16,242
Prostate 31,729Brain and ONS* 287Brain and ONS* 606Colon and Rectum 4,615Colon and Rectum 15,470Prostate 15,523
Colon and Rectum 28,313Bones and Joints 117Non-Hodgkin's Lymphoma 443Pancreas 2,948Prostate 15,158Colon and Rectum 7,823
Pancreas 14,176Endocrine System 109Lung and Bronchus 428Non-Hodgkin's Lymphoma 2,268Pancreas 8,145Urinary Bladder 3,041
Non-Hodgkin's Lymphoma 11,794Soft Tissue 92Colon and Rectum 398Esophagus 2,253Non-Hodgkin's Lymphoma 6,224Leukemia 3,005
Females
  1. *ONS = other nervous system.

  2. Note: “All Sites” excludes in situ carcinomas except urinary bladder.

  3. Source: US Mortality Public Use Data Tape, 1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

All Sites 264,006All Sites 977All Sites 5,747All Sites 46,757All Sites 131,972All Sites 78,550
Lung and Bronchus 62,662Leukemia 293Breast 1,426Breast 11,525Lung and Bronchus 38,260Lung and Bronchus 13,786
Breast 41,144Brain and ONS* 259Uterine Cervix 519Lung and Bronchus 10,182Breast 17,773Colon and Rectum 12,044
Colon and Rectum 28,909Bones and Joints 92Leukemia 494Colon and Rectum 3,571Colon and Rectum 12,940Breast 10,415
Pancreas 14,906Endocrine System 84Lung and Bronchus 432Ovary 2,964Pancreas 7,747Pancreas 5,202
Ovary 13,627Soft Tissue 60Brain and ONS* 384Pancreas 1,860Ovary 7,100Non-Hodgkin's Lymphoma 3,983

The number of recorded cancer deaths among men increased by 3,767 from 1998 to 1999 (Table 7). Accounting for the change in ICD coding rules diminished the increase to 1,849. The recorded number of deaths from lung cancer continued to decrease among men. The decrease in lung cancer death was accentuated by the change in ICD code from ICD-9 to ICD-10. The new ICD code more rigorously excluded cancers metastatic to the lung, causing a decline of 1.6 percent of total lung cancer deaths.12 Accounting for this change substantially reduced the decline in the number of lung cancer deaths (from 1,998 deaths to 508 deaths). The number of prostate cancer deaths has continued to decline since 1995. From 1998 to 1999, the recorded number of prostate cancer deaths decreased by 474 and 906 with and without adjustment for the change in ICD codes and coding rules, respectively. Colon and rectum cancer deaths among men increased by about 300 from 1998 to 1999, and were affected very little by the new ICD version.

Table TABLE 7. Trends in the Recorded Number of Cancer Deaths for Selected Cancer Sites by Gender, US, 1989 to 1999
 All SitesLung and BronchusColon and RectumProstateBreast
YearMaleFemaleMaleFemaleMaleFemaleMaleFemale
  1. *Comparability-modified number of cancer deaths, i.e., the total number of cancer deaths that would have been recorded in 1998 if the underlying causes of death for 1998 mortality data were classified according to the Tenth Revision International Classification of Diseases (ICD-10).

  2. Note: Effective with the mortality data for 1999, causes of death are classified by ICD-10, replacing ICD-9 used for 1979 to 1998 data.

  3. Source: US Mortality Public Use Data Tapes, 1989 to 1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

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
1998*283,983261,23189,90962,04728,00428,93032,63541,971
1999285,832264,00689,40162,66228,31328,90931,72941,144

Among women, the total number of cancer deaths recorded increased from 259,467 in 1998 to 264,006 in 1999 (Table 7). Adjusting for changes in ICD coding rules reduced the increase from 4,539 to 2,775 cancer deaths. There were 413 fewer female lung cancer deaths in 1999, compared with the year before, due to a decrease of 1.6 percent of lung cancer deaths resulting from the implementation of ICD-10. Accounting for this change resulted in 615 more lung cancer deaths in 1999 compared with 1998, consistent with the long-term increasing trend. Female breast cancer deaths decreased by 593, and decreased even more (827 deaths) when accounting for changes in ICD coding rules. The number of colorectal cancer deaths among females has remained fairly constant in recent years.

Lifetime Probability of Developing Cancer

The lifetime probability of developing cancer is higher for men (43.39 percent) than for women (38.25 percent) (Table 9). However, because of breast cancer, women have a slightly higher probability of developing cancer before the age of 60.

Table TABLE 8. Average Annual Incidence and Mortality Rates* for Selected Cancer Sites by Race and Ethnicity, US, 1992 to 1998
 WhiteAfrican AmericanAsian/Pacific IslanderAmerican Indian/Alaska NativeHispanic†
Incidence
All Sites     
Males470.4596.8327.7227.7319.7
Females354.4337.6252.1186.3237.7
Total401.4445.3283.4202.7270.0
Breast (female)115.5101.578.150.568.5
Colon and rectum     
Males51.457.747.333.535.2
Females36.344.731.024.623.2
Total42.950.138.228.628.4
Lung and bronchus     
Males69.6107.251.944.336.0
Females43.645.722.720.618.7
Total54.771.635.531.026.0
Prostate144.6234.282.847.8103.4
 WhiteAfrican AmericanAsian/Pacific IslanderAmerican Indian/Alaska NativeHispanic†
Mortality
  1. *Rates are per 100,000 and are age adjusted to the 1970 US standard population.

  2. †Hispanic is not mutually exclusive from White, African American, Asian/Pacific Islander, or American Indian/Alaska Native.

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

  4. Source: Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001. Mortality derived from data originating from the National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

All Sites     
Males203.2297.7125.6125.3128.8
Females138.0166.682.490.884.3
Total164.5218.2101.2105.4102.6
Breast (female)24.331.011.012.414.8
Colon and rectum     
Males20.627.312.911.913.0
Females13.919.68.98.98.0
Total16.822.810.710.310.2
Lung and bronchus     
Males67.896.233.841.830.5
Females34.633.615.120.910.9
Total48.859.123.330.119.3
Prostate22.453.19.814.015.9
Table TABLE 9. Probability of Developing Invasive Cancers within Selected Age Intervals, by Gender, US, 1996 to 1998*
  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 during 1996 to 1998.

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

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

  4. ‡Includes invasive and in situ cancer cases.

  5. Source: DEVCAN Software, Version 4.1, Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

All Sites †Male1.45 (1 in 69)8.33 (1 in 12)33.3 (1 in 3)43.48 (1 in 2)
 Female1.92 (1 in 52)9.09 (1 in 11)20.0 (1 in 5)33.3 (1 in 3)
Bladder ‡Male0.024 (1 in 4,234)0.42 (1 in 236)2.38 (1 in 42)3.45 (1 in 29)
 Female(Less than 1 in 10,000)0.13 (1 in 760)0.64 (1 in 156)1.12 (1 in 89)
BreastFemale0.44 (1 in 229)4.17 (1 in 24)7.14 (1 in 14)12.5 (1 in 8)
Colon andMale0.07 (1 in 1,508)0.87 (1 in 115)4.00 (1 in 25)5.88 (1 in 17)
RectumFemale0.06 (1 in 1,719)0.69 (1 in 145)3.03 (1 in 33)5.55 (1 in 18)
LeukemiaMale0.16 (1 in 627)0.21 (1 in 483)0.81 (1 in 124)1.43 (1 in 70)
 Female0.12 (1 in 810)0.15 (1 in 671)0.47 (1 in 212)1.04 (1 in 96)
Lung andMale0.03 (1 in 3,060)1.12 (1 in 89)5.88 (1 in 17)7.69 (1 in 13)
BronchusFemale0.03 (1 in 3,099)0.86 (1 in 116)4.00 (1 in 25)5.88 (1 in 17)
MelanomaMale0.13 (1 in 769)0.50 (1 in 199)0.97 (1 in 103)1.72 (1 in 58)
of the SkinMale Female0.19 (1 in 508)0.38 (1 in 261)0.49 (1 in 201)1.22 (1 in 82)
Non-Hodgkin'sMale0.17 (1 in 591)0.48 (1 in 208)1.23 (1 in 81)2.08 (1 in 48)
LymphomaFemale0.08 (1 in 1,311)0.32 (1 in 317)0.98 (1 in 102)1.75 (1 in 57)
ProstateMale(Less than 1 in 10,000)2.08 (1 in 48)12.5 (1 in 8)16.67 (1 in 6)
Uterine CervixFemale0.18 (1 in 567)0.35 (1 in 288)0.28 (1 in 354)0.85 (1 in 117)
Uterine CorpusFemale0.05 (1 in 2,097)0.72 (1 in 138)1.64 (1 in 61)2.70 (1 in 37)

CANCER OCCURRENCE BY RACE/ETHNICITY

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

Cancer incidence and mortality rates vary considerably among racial and ethnic groups (Table 8). Overall, African Americans have the highest incidence and mortality rates for cancer. Incidence rate is 60 percent higher in African Americans than in Hispanics and Asian/Pacific Islanders and is more than twice as high as the rate for American Indians. Similarly, the mortality rate from cancer is about 33 percent higher in African Americans than among whites, and more than twice as high as cancer death rates in Asian/Pacific Islanders, American Indians, and Hispanics. Except for female breast cancer incidence and female lung cancer death rates, where rates are highest in whites, race- and sex-specific incidence and death rates for the most common cancer sites are higher for African Americans than for any of the other racial and ethnic groups.

From 1992 through 1998, cancer incidence rates decreased by 2 percent per year among Hispanics, by 1.7 percent for African Americans, and by 1.2 percent for whites, while rates remained relatively stable among American Indians/Alaska Natives and Asian/Pacific Islanders (data not shown). Similarly, the annual mortality rate for all cancer sites combined decreased 1.3 percent in African Americans, 1.2 percent in Asian/Pacific Islanders, 1.1 percent among whites, and 0.9 percent among Hispanics; and it leveled off in American Indians/Alaska Natives. For race- and sex-specific trends, African-American men showed the largest decrease in both incidence and mortality during the same calendar years.

Cancer Survival By Race

A poorer probability of survival once a cancer diagnosis is made contributes to the higher death rates among African-American men and women. African Americans are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated, and are 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 (Figure 6). Furthermore, for nearly every cancer site, African Americans have lower five-year relative survival rates than whites at each stage of diagnosis (Figure 7), suggesting the possible influences of differences in treatment, tumor pathology, and comorbid conditions.

thumbnail image

Figure FIGURE 6. Distribution of Cancer Cases by Race and Stage at Diagnosis, US, 1992 to 1997

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

Note: Staging according to Surveillance, Epidemiology, and End Results (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.

Source: Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

Download figure to PowerPoint

thumbnail image

Figure FIGURE 7. Five-Year Relative Survival Rates by Race and Stage at Diagnosis, US, 1992 to 1997

*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.

Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system.

Source: Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

Download figure to PowerPoint

Importantly, there have been notable improvements over time in the probability of survival from most of the common cancer sites and from all cancers combined (Table 10). This is true for both whites and African Americans. Cancer sites without significant improvements in survival in the past 25 years include uterine cervix, larynx, and oral cavity.

Table TABLE 10. Trends in Five-Year Relative Cancer Survival Rates* (%) by Race and Year of Diagnosis, US, 1974 to 1997
Relative Five–Year Survival Rate (%)
 WhiteAfrican AmericanAll Races
  1. *Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1992 to 1997, followed through 1997.

  2. †The difference in rates between 1974 to 1976 and 1992 to 1997 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.

  5. Source: Surveillance, Epidemiology, and End Results program, 1973 to 1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

SITE1974 to 19761983 to 19851992 to 1997 1974 to 1976 1983 to 1985 1992 to 1997 1974 to 19761983 to 19851992 to 1997 
All Sites51546339 40 52505262
Brain22263127 32 39222732
Breast (female)75798763 63 72757886
Uterine cervix70717264 60 58 696970 
Colon51586246 49 51505861
Uterine corpus89858661 54 59 888384
Esophagus59154 6 95814
Hodgkin's disease72798469 78 78717983
Kidney52566249 55 60525662
Larynx666966 60 55 53 666765 
Leukemia35424631 33 38 344145
Liver4661 4 4 466
Lung and bronchus13141512 11 12 121415
Melanoma of the skin8085896774§61808589
Multiple myeloma24272827 31 31 242829
Non-Hodgkin's lymphoma48545449 45 43475453
Oral cavity55555836 35 34 535356
Ovary37405241 41 51374152
Pancreas3343 5 4 334
Prostate68769758 64 92677596
Rectum49566242 44 52495561
Stomach15162117 19 20 151722
Testis799195768888 799195
Thyroid92939588 92 94 929395
Urinary bladder74788248 59 65737881

CANCER IN CHILDREN

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

Cancer is the second leading cause of death among children between the ages of one and 14 in the United States; accidents are the most frequent cause of death in this age group (Table 11). The most commonly occurring cancers found in children are leukemias (in particular, acute lymphocytic leukemia), tumors of the central and sympathetic nervous systems, lymphomas, soft-tissue sarcomas, and renal tumors.9 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 12). Between the years 1974 to 1976 and 1992 to 1997, the five-year relative survival rate among children for all cancer sites combined improved from 55.7 to 77.1 percent.9 

Table TABLE 11. Fifteen Leading Causes of Death Among Children Ages 1 to 14, US, 1999
RankCause of DeathNumber of DeathsPercent (%) of Total Deaths*Death Rate (1970 US Standard Population)Death Rate (2000 US Standard Population)
  1. *Percentages may not total 100% due to rounding.

  2. Note: Rates are per 100,000 population.

  3. Source: US Mortality Public Use Data Tape, 1999, National Center for Health Statistics, Centers for Disease Control and Prevention, 2001.

 All Causes12,84410023.223.5
1Accidents (Unintentional Injuries)4,98938.89.09.1
2Cancer1,43011.12.62.6
3Congenital Anomalies9777.61.71.8
4Assault (Homicide)8086.31.71.7
5Heart Diseases4603.60.80.8
6Intentional Self-harm (Suicide)2441.90.50.5
7Pneumonia and Influenza2231.70.40.4
8Chronic Lower Respiratory Diseases1931.50.40.4
9Septicemia1641.30.30.3
10Cerebrovascular Diseases1110.90.20.2
11HIV Disease900.70.20.2
12Anemias830.60.20.2
13Meningitis720.60.10.1
14Meningococcal Infection550.40.10.1
15Complications of Medical and Surgical Care480.40.10.1
 All Others2,89722.6  
Table TABLE 12. Trends in Five-Year Relative Cancer Survival Rates* (%) for Children Under Age 15, US, 1974 to 1997
Five-Year Relative Survival Rates (%)
Year of Diagnosis
Site1974 to 19761977 to 19791980 to 19821983 to 19851986 to 19881989 to 19911992 to 1997
  1. *Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 1998.

  2. †The difference in rates between 1974 to 1976 and 1992 to 1997 is statistically significant (p < 0.05).

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

  4. Note: “All Sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.

All Sites56626567707377†
Acute Lymphocytic Leukemia53677169788085†
Acute Myeloid Leukemia1430‡21‡32‡32‡35‡45†
Bones and Joints53‡53‡55‡5763‡6273†
Brain and Other Nervous System55565662636269†
Hodgkin's Disease78839190909492†
Neuroblastoma53545355606871†
Non-Hodgkin's Lymphoma44506271707580†
Soft Tissue61686576677874†
Wilm's Tumor74788787919392†
Table TABLE 13. Cancer Around the World, Death Rates* per 100,000 Population for 45 Countries, 2000
COUNTRYAll SitesOralColon and RectumBreastProstateLung and BronchusUterusStomachLeukemia
 MaleFemaleMaleFemaleMaleFemaleFemaleMaleMaleFemaleCervixOtherMaleFemaleMaleFemale
  1. *Rates are age adjusted to the World Health Organization world standard population.

  2. Note: Figures in parentheses represent order of rank within site and gender.

  3. Source: GLOBOCAN 2000, Cancer Incidence, Mortality, and Prevalence Worldwide, Version 1.0.

United States161.8 (22)116.4 (10)1.8 (34)0.8 (17)15.9 (27)12.0 (20)21.2 (12)17.9 (18)53.2 (13)27.2 (1)3.3 (33)2.0 (32)4.5 (45)2.3 (45)6.6 (4)4.2 (5)
Romania150.0 (30)90.0 (34)4.2 (11)0.9 (14)11.4 (33)8.2 (34)16.2 (34)8.3 (35)45.1 (21)7.3 (31)10.9 (7)2.2 (29)17.6 (21)7.0 (27)4.5 (34)3.0 (38)
Australia150.9 (28)103.2 (25)2.2 (27)0.9 (10)20.1 (12)14.4 (12)19.7 (18)18.0 (17)36.2 (31)14.0 (10)2.4 (41)1.6 (38)6.1 (44)3.0 (44)5.7 (14)3.8 (14)
Austria168.6 (20)113.8 (12)3.7 (15)0.8 (18)23.0 (8)14.9 (10)23.3 (9)18.9 (12)41.8 (25)10.8 (16)4.7 (26)2.8 (19)14.1 (24)8.6 (22)5.0 (25)3.6 (18)
Azerbaijan114.2 (41)61.8 (45)1.3 (41)0.5 (42)6.4 (40)4.8 (42)8.8 (43)4.3 (43)25.5 (37)4.5 (42)1.9 (44)3.9 (10)24.7 (8)10.5 (10)4.0 (38)2.7 (39)
Bulgaria150.3 (29)89.4 (35)2.9 (21)0.5 (43)17.8 (20)12.0 (21)16.7 (31)9.0 (34)43.7 (22)7.1 (32)7.4 (15)3.2 (14)17.8 (20)9.0 (20)5.2 (21)3.3 (24)
Canada160.5 (23)116.7 (9)2.3 (25)0.8 (19)16.4 (26)11.6 (23)22.7 (10)17.1 (21)50.4 (14)25.0 (3)2.8 (39)1.8 (35)6.4 (43)3.2 (43)6.2 (8)3.9 (8)
Chile141.2 (34)108.7 (18)1.1 (45)0.4 (45)7.0 (39)7.1 (37)12.7 (37)19.9 (9)20.3 (40)7.0 (33)10.6 (8)1.4 (40)30.1 (5)12.7 (7)4.0 (39)3.0 (37)
China143.3 (33)76.9 (43)2.2 (28)1.0 (6)7.2 (38)5.3 (41)4.5 (45)1.0 (45)33.2 (32)13.5 (11)3.1 (35)0.4 (44)27.0 (6)13.0 (6)2.8 (44)2.0 (44)
Colombia116.1 (40)106.5 (19)1.4 (39)1.0 (7)5.8 (41)6.1 (39)10.6 (40)15.1 (27)17.0 (43)8.5 (24)13.7 (4)3.5 (13)26.4 (7)16.4 (2)4.7 (31)3.9 (9)
Croatia230.1 (2)105.4 (21)7.2 (3)0.8 (20)24.8 (6)13.0 (16)19.9 (17)15.3 (25)70.3 (3)9.4 (20)5.7 (21)1.9 (34)21.7 (14)9.1 (19)5.8 (12)3.5 (20)
Cuba141.0 (35)104.0 (23)4.0 (12)1.6 (1)11.4 (32)12.4 (18)15.6 (35)22.1 (5)42.8 (23)15.6 (8)10.6 (9)4.0 (9)8.4 (38)4.3 (38)4.8 (30)3.6 (19)
Czech Republic222.2 (3)127.6 (6)4.4 (9)0.8 (21)34.2 (1)18.5 (3)21.0 (13)15.7 (23)65.3 (5)11.5 (14)6.2 (20)4.4 (4)13.5 (25)7.5 (24)6.7 (3)4.4 (3)
Denmark184.9 (14)144.0 (2)3.0 (20)1.2 (3)23.8 (7)18.5 (4)29.2 (1)23.1 (4)50.0 (15)26.7 (2)4.1 (28)2.4 (22)7.5 (40)3.6 (41)5.8 (13)3.9 (10)
Estonia201.5 (9)104.8 (22)5.3 (5)1.0 (8)16.7 (24)12.0 (22)19.3 (19)15.3 (26)64.5 (6)8.6 (23)9.7 (10)2.9 (17)24.2 (11)10.4 (11)5.7 (15)3.9 (11)
Finland145.8 (32)92.5 (32)1.7 (36)0.9 (11)12.5 (30)9.5 (32)17.9 (26)19.1 (11)41.2 (26)7.4 (28)1.3 (45)2.5 (21)10.3 (30)5.6 (31)4.7 (32)3.3 (25)
France201.5 (10)98.0 (30)4.4 (10)0.8 (22)18.3 (17)12.1 (19)21.4 (11)19.2 (10)48.5 (19)6.7 (35)3.5 (32)2.1 (30)8.0 (39)3.6 (42)6.1 (9)3.9 (12)
Germany176.6 (16)116.9 (8)3.2 (19)0.8 (23)21.7 (11)17.0 (6)23.7 (8)18.4 (15)46.2 (20)9.6 (18)4.2 (27)2.1 (31)12.9 (27)7.8 (23)5.7 (16)3.9 (13)
Greece149.5 (31)81.8 (42)1.5 (37)0.5 (44)8.4 (37)6.7 (38)16.7 (32)10.7 (33)50.0 (16)7.4 (29)2.2 (42)1.1 (43)8.5 (37)4.7 (36)6.3 (6)3.8 (15)
Hungary272.3 (1)147.4 (1)10.9 (1)1.6 (2)33.5 (2)20.9 (1)25.3 (7)17.9 (19)86.2 (1)20.0 (5)7.7 (14)4.1 (8)21.0 (16)10.1 (13)7.6 (1)4.9 (1)
Ireland170.2 (19)127.8 (5)3.4 (17)0.8 (24)22.6 (9)15.4 (8)25.8 (6)21.6 (6)38.3 (30)17.3 (7)3.9 (29)1.5 (39)10.1 (31)5.0 (34)5.4 (19)3.3 (26)
Israel135.1 (38)111.4 (15)1.3 (42)0.7 (33)19.7 (13)15.3 (9)26.2 (4)14.2 (30)27.5 (36)9.3 (21)3.1 (36)1.8 (36)9.3 (35)5.6 (32)6.5 (5)4.5 (2)
Japan159.5 (24)83.1 (41)2.0 (33)0.8 (25)17.6 (21)11.0 (28)7.7 (44)5.5 (40)33.1 (33)9.6 (19)3.0 (37)1.2 (42)31.2 (4)13.8 (4)4.1 (36)2.6 (41)
Kazakhstan201.9 (8)102.6 (27)2.5 (22)1.2 (4)12.2 (31)8.6 (33)13.3 (36)5.2 (41)59.5 (9)8.3 (25)8.1 (12)2.4 (23)32.0 (3)13.8 (5)3.3 (43)2.5 (42)
Kyrgyzstan185.6 (13)112.6 (14)2.1 (31)0.7 (34)10.9 (35)7.9 (35)17.0 (29)6.4 (39)40.7 (27)7.3 (30)11.3 (6)4.9 (2)47.0 (1)18.9 (1)4.1 (37)3.2 (30)
Latvia196.7 (11)102.8 (26)4.8 (8)0.7 (35)17.9 (19)13.3 (15)18.1 (24)13.0 (31)59.1 (10)6.3 (37)6.6 (17)4.3 (6)24.4 (10)10.4 (12)6.0 (10)4.0 (6)
Lithuania195.9 (12)97.0 (31)5.0 (7)0.8 (26)18.0 (18)10.7 (29)19.0 (20)15.6 (24)56.5 (11)5.5 (39)8.8 (11)3.9 (11)24.5 (9)9.5 (17)5.7 (17)3.8 (16)
Macedonia140.1 (36)85.5 (38)2.1 (32)0.7 (36)11.2 (34)7.8 (36)17.2 (28)6.8 (37)39.8 (28)6.6 (36)6.3 (18)3.0 (15)21.9 (13)9.5 (18)4.3 (35)2.7 (40)
Mauritius79.6 (45)66.3 (44)2.2 (29)0.7 (37)5.8 (42)3.9 (45)9.2 (41)7.3 (36)16.7 (44)4.2 (44)13.6 (5)0.2 (45)10.6 (29)5.7 (30)3.4 (41)2.0 (45)
Mexico112.5 (42)106.3 (20)1.4 (40)0.7 (38)4.7 (44)4.6 (43)12.2 (38)16.6 (22)22.1 (39)8.2 (26)17.1 (1)4.5 (3)13.2 (26)9.8 (15)4.9 (27)4.0 (7)
Netherlands182.0 (15)120.0 (7)1.5 (38)0.8 (27)19.0 (14)14.0 (13)27.8 (2)20.0 (8)59.7 (8)14.8 (9)2.2 (43)2.2 (26)9.4 (34)4.6 (37)4.9 (28)3.2 (31)
New Zealand167.2 (21)131.1 (3)2.3 (26)0.9 (12)25.7 (4)20.2 (2)25.9 (5)21.2 (7)39.3 (29)18.7 (6)3.9 (30)2.2 (27)6.8 (42)4.0 (39)6.3 (7)4.4 (4)
Norway155.7 (27)113.1 (13)2.4 (24)0.9 (13)22.0 (10)18.0 (5)20.7 (14)26.8 (3)31.7 (34)12.8 (12)3.3 (34)3.0 (16)9.6 (33)5.5 (33)4.6 (33)3.2 (32)
Poland205.2 (6)111.4 (16)3.7 (16)0.8 (28)16.6 (25)11.6 (24)16.8 (30)11.2 (32)71.5 (2)11.3 (15)7.8 (13)2.9 (18)19.2 (19)7.3 (25)5.6 (18)3.5 (21)
Portugal157.1 (26)89.1 (37)3.9 (13)0.6 (41)18.5 (16)11.3 (26)18.4 (22)17.9 (20)29.5 (35)4.8 (40)4.8 (25)2.3 (25)22.2 (12)10.9 (8)5.1 (23)3.4 (22)
Rep. of Moldova157.8 (25)89.4 (36)6.7 (4)0.8 (29)15.8 (28)10.6 (30)18.5 (21)5.0 (42)42.1 (24)6.2 (38)7.0 (16)2.2 (28)20.4 (17)9.0 (21)5.2 (22)3.3 (27)
Romania150.0 (30)90.0 (34)4.2 (11)0.9 (14)11.4 (33)8.2 (34)16.2 (34)8.3 (35)45.1 (21)7.3 (31)10.9 (7)2.2 (29)17.6 (21)7.0 (27)4.5 (34)3.0 (38)
Russian Fed.211.2 (5)100.6 (29)5.3 (6)0.8 (30)17.5 (22)12.7 (17)16.7 (33)6.8 (38)68.2 (4)6.8 (34)5.2 (24)2.6 (20)35.6 (2)15.2 (3)5.0 (26)3.4 (23)
Slovakia217.8 (4)108.8 (17)9.5 (2)1.0 (9)28.0 (3)16.1 (7)18.4 (23)14.3 (29)60.7 (7)7.8 (27)5.4 (23)5.2 (1)16.9 (23)7.3 (26)7.1 (2)3.7 (17)
Slovenia203.1 (7)115.9 (11)3.4 (18)0.7 (39)25.1 (5)14.6 (11)20.3 (16)18.8 (13)55.3 (12)10.1 (17)5.6 (22)4.4 (5)20.2 (18)9.6 (16)5.9 (11)3.2 (33)
Spain176.1 (17)85.0 (40)3.9 (14)0.8 (31)17.3 (23)11.1 (27)18.1 (25)15.0 (28)49.4 (17)4.2 (45)2.7 (40)2.4 (24)12.6 (28)6.2 (29)5.4 (20)3.2 (34)
Sweden137.9 (37)104.0 (24)1.3 (43)0.7 (40)14.4 (29)11.5 (25)17.5 (27)27.3 (2)22.6 (38)12.6 (13)2.9 (38)2.0 (33)7.4 (41)4.0 (40)5.1 (24)3.3 (28)
Trinidad and Tobago103.5 (44)101.9 (28)2.5 (23)1.1 (5)8.5 (36)9.7 (31)20.6 (15)32.3 (1)13.2 (45)4.3 (43)15.0 (3)4.3 (7)8.7 (36)6.9 (28)3.4 (42)3.1 (36)
Turkmenistan117.7 (39)85.2 (39)2.2 (30)0.9 (15)4.7 (45)4.1 (44)9.2 (42)1.8 (44)18.9 (42)4.6 (41)6.3 (19)1.4 (41)21.1 (15)10.8 (9)2.6 (45)2.4 (43)
United Kingdom171.0 (18)128.0 (4)1.8 (35)0.8 (32)18.7 (15)13.8 (14)26.8 (3)18.5 (14)48.6 (18)21.1 (4)3.9 (31)1.7 (37)10.1 (32)4.8 (35)4.9 (29)3.3 (29)
Venezuela104.1 (43)91.8 (33)1.3 (44)0.9 (16)5.8 (43)6.1 (40)11.6 (39)18.2 (16)19.4 (41)9.2 (22)15.2 (2)3.7 (12)17.5 (22)10.0 (14)3.9 (40)3.2 (35)

LIMITATIONS AND FUTURE CHALLENGES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

When tracking trends over time, estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted with caution. These estimates may vary considerably from year to year, particularly for less common cancers and for states with smaller populations. For this reason, 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 NCHS, and SEER cancer incidence rates are generally more informative for tracking cancer trends. For example, breast cancer incidence rates stabilized between 1973 and 1980, increased by 3.8 percent per year between 1980 and 1987, and by 1.1 percent per year between 1992 and 1998, due to increasing utilization of mammography.

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. Unanticipated changes that may have occurred in the three-or four-year interval between 1998 or 1999 and 2002 are not 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 entire United States.

For the 1999 mortality data, the underlying causes of deaths were coded and classified using ICD-10 coding rules, replacing ICD-9 coding designations used for deaths occurring between 1979 and 1998. Several important changes have taken place in selection and coding of primary sites of malignant neoplasm in ICD-10 codes, including the following two changes:

  1. Order of entry in the medical certificate of death is not used to identify neoplasms as primary or secondary. For example, when two or more cancer sites, which are not listed as common sites of metastasis, appear together in Part I of a medical certificate of death, the underlying cause of death is assigned to malignant neoplasms of independent (primary) multiple sites.

  2. Lung cancer has been added to the list of common sites of metastasis and is considered secondary whenever it appears in Part I of the medical death certification with any other cancer site not on the list.

These coding changes will undoubtedly affect the temporal trends of various cancer mortalities. For the changes in the number of deaths from the most common cancer sites between 1998 and 1999, we have accounted for the change in ICD coding rules using a comparability ratio conversion method, and assumed that they are not influenced by sex.12

Despite these limitations, the American Cancer Society estimates do provide evidence of current patterns of cancer incidence and mortality in the United States. Such estimates will assist us in our continuing effort to reduce the public health burden of cancer.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References

The authors thank Cheryll Cardinez, Vilma Cokkinides, PhD, April Harris, and Emmanuel Ntekop for their assistance in preparation of this manuscript.

References

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. SELECTED FINDINGS
  6. CANCER OCCURRENCE BY RACE/ETHNICITY
  7. CANCER IN CHILDREN
  8. LIMITATIONS AND FUTURE CHALLENGES
  9. Acknowledgements
  10. References