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Cancer Statistics, 2005

Cancer Statistics, 2005 INTRODUCTION Cancer is a major public health problem in the United States and other developed countries. Currently, one in four deaths in the United States is due to cancer. In this article, we provide an overview of cancer statistics, including updated incidence, mortality, and survival rates and expected number of new cancer cases and deaths in 2005. MATERIALS AND METHODS Data Sources Mortality data from 1930 to 2002 were obtained from the National Center for Health Statistics (NCHS). Incidence data (1975 to 2001), 5‐year relative survival rates, 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% to 14% of the US population. , , , Population data were obtained from the US Census Bureau. Causes of death were coded and classified according to the International Classification of Diseases (ICD‐8, ICD‐9, and ICD‐10). , , Cancer cases were classified according to the International Classification of Diseases for Oncology. Estimated New Cancer Cases The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because complete cancer registration has not yet been achieved in many states. Consequently, for the national estimate we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 2001 using age‐specific cancer incidence rates collected by the SEER program and population data reported by the US Census Bureau. We then forecasted the number of cancer cases expected to be diagnosed in the United States in the year 2005 using an autoregressive quadratic time‐trend model fitted to the annual cancer case estimates. For estimates of new cancer cases in individual states, we projected the number of deaths from cancer in each state in 2005 and assumed that the ratio of estimated cancer deaths to cases in each state equaled that in the United States. Estimated Cancer Deaths We used the state‐space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2005. Projections are based on underlying cause of death from death certificates as reported to the NCHS. This model projects the number of cancer deaths expected to occur in 2005 based on the number that occurred each year from 1969 to 2002 in the United States and in each state separately. Other Statistics We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2002. Causes of death for 2002 were coded and classified according to ICD‐10. This report also provides updated statistics on trends in cancer incidence and mortality rates, the probability of developing cancer, and 5‐year relative survival rates for selected cancer sites based on data from 1973 through 2001. All age‐adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population. The long‐term incidence trends (1975 to 2001) presented in Table 4 are adjusted for delays in reporting. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 1999 to 2001), especially for cancers such as melanoma and prostate cancer that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and several specific cancer sites when long‐term incidence trends are analyzed. Delay‐adjusted trends provide a more accurate assessment of trends in the most recent years for which data are available. SELECTED FINDINGS Expected Numbers of New Cancer Cases Table 1 presents the estimated number of new cancer cases expected among men and women in the United States in 2005. The estimate of about 1.4 million 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 1 million cases of basal and squamous cell skin cancer, approximately 58,490 cases of breast carcinoma in situ, and 46,170 cases of in situ melanoma are expected to be newly diagnosed in 2005. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2 . TABLE 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2005* Estimated New Cases Estimated Deaths Both Sexes Male Female Both sexes Male Female All Sites 1,372,910 710,040 662,870 570,280 295,280 275,000 Oral cavity & pharynx 29,370 19,100 10,270 7,320 4,910 2,410 Tongue 7,660 5,050 2,610 1,730 1,120 610 Mouth 10,070 5,370 4,700 1,890 1,100 790 Pharynx 8,590 6,520 2,070 2,130 1,490 640 Other oral cavity 3,050 2,160 890 1,570 1,200 370 Digestive system 253,500 134,370 119,130 136,060 75,020 61,040 Esophagus 14,520 11,220 3,300 13,570 10,530 3,040 Stomach 21,860 13,510 8,350 11,550 6,770 4,780 Small intestine 5,420 2,840 2,580 1,070 580 490 Colon 104,950 48,290 56,660 56,290 † 28,540 27,750 Rectum 40,340 23,530 16,810 Anus, anal canal, & anorectum 3,990 1,750 2,240 620 230 390 Liver & intrahepatic bile duct 17,550 12,130 5,420 15,420 10,330 5,090 Gallbladder & other biliary 7,480 3,330 4,150 3,340 1,270 2,070 Pancreas 32,180 16,100 16,080 31,800 15,820 15,980 Other digestive organs 5,210 1,670 3,540 2,400 950 1,450 Respiratory system 184,800 102,420 82,380 168,140 93,990 74,150 Larynx 9,880 7,920 1,960 3,770 2,960 810 Lung & bronchus 172,570 93,010 79,560 163,510 90,490 73,020 Other respiratory organs 2,350 1,490 860 860 540 320 Bones & joints 2,570 1,480 1,090 1,210 670 540 Soft tissue (including heart) 9,420 5,530 3,890 3,490 1,910 1,580 Skin (excluding basal & squamous) 66,000 37,580 28,420 10,590 6,920 3,670 Melanoma‐skin 59,580 33,580 26,000 7,770 4,910 2,860 Other nonepithelial skin 6,420 4,000 2,420 2,820 2,010 810 Breast 212,930 1,690 211,240 40,870 460 40,410 Genital system 321,050 241,570 79,480 59,920 31,010 28,910 Uterine cervix 10,370 10,370 3,710 3,710 Uterine corpus 40,880 40,880 7,310 7,310 Ovary 22,220 22,220 16,210 16,210 Vulva 3,870 3,870 870 870 Vagina & other genital, female 2,140 2,140 810 810 Prostate 232,090 232,090 30,350 30,350 Testis 8,010 8,010 390 390 Penis & other genital, male 1,470 1,470 270 270 Urinary system 101,880 71,090 30,790 26,590 17,420 9,170 Urinary bladder 63,210 47,010 16,200 13,180 8,970 4,210 Kidney & renal pelvis 36,160 22,490 13,670 12,660 8,020 4,640 Ureter & other urinary organs 2,510 1,590 920 750 430 320 Eye & orbit 2,120 1,090 1,030 230 110 120 Brain & other nervous system 18,500 10,620 7,880 12,760 7,280 5,480 Endocrine system 27,650 7,550 20,100 2,370 1,080 1,290 Thyroid 25,690 6,500 19,190 1,490 630 860 Other endocrine 1,960 1,050 910 880 450 430 Lymphoma 63,740 33,050 30,690 20,610 10,930 9,680 Hodgkin disease 7,350 3,980 3,370 1,410 780 630 Non‐Hodgkin lymphoma 56,390 29,070 27,320 19,200 10,150 9,050 Multiple myeloma 15,980 8,600 7,380 11,300 5,660 5,640 Leukemia 34,810 19,640 15,170 22,570 12,540 10,030 Acute lymphocytic leukemia 3,970 2,180 1,790 1,490 850 640 Chronic lymphocytic leukemia 9,730 5,780 3,950 4,600 2,520 2,080 Acute myeloid leukemia 11,960 6,530 5,430 9,000 5,040 3,960 Chronic myeloid leukemia 4,600 2,640 1,960 850 430 420 Other leukemia ‡ 4,550 2,510 2,040 6,630 3,700 2,930 Other & unspecified primary sites ‡ 28,590 14,660 13,930 46,250 25,370 20,880 *Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 58,490 carcinoma in situ of the breast and 46,170 melanoma in situ will be newly diagnosed in 2005. †Estimated deaths for colon and rectum cancers are combined. ‡More deaths than cases suggests lack of specificity in recording underlying causes of death on death certificates. Source: Estimates of new cases are based on incidence rates from 1979 to 2001, National Cancer Institute's Surveillance, Epidemiology and End Results program, nine oldest registries. Estimates of deaths are based on data from US Mortality Public Use Data Tapes, 1969 to 2002, National Center for Health Statistics, Center for Disease Control and Prevention, 2004. TABLE 2 Estimated New Cancer Cases for Selected Cancers by State, United States, 2005* State All Cases Female Breast Uterine Cervix Colon & Rectum Uterine Corpus Leukemia Lung & Bronchus Melanoma of the Skin Non‐Hodgkin Lymphoma Prostate Urinary Bladder AL 24,320 3,820 200 2,300 670 560 3,340 920 940 4,360 860 AK 1,930 260 † 210 60 50 220 80 90 310 100 AZ 23,880 3,760 200 2,500 500 620 2,870 1,300 1,060 3,900 1,200 AR 14,950 2,090 170 1,630 340 400 2,530 540 650 2,060 620 CA 135,030 21,170 1,090 14,070 4,250 3,380 15,150 5,440 5,700 25,010 6,380 CO 16,080 2,560 80 1,650 450 460 1,750 920 880 2,680 720 CT 16,920 2,720 220 1,680 500 400 1,950 690 730 3,360 860 DE 3,800 630 † 410 110 120 490 230 210 610 190 DC 2,820 520 † 340 170 50 310 80 90 610 190 FL 96,200 13,430 730 9,860 2,520 2,620 13,130 4,600 3,470 19,650 4,890 GA 35,650 5,850 360 3,480 890 820 4,800 1,610 1,380 5,660 1,530 HI 4,790 680 60 540 170 120 510 150 260 920 190 ID 5,490 940 60 540 170 150 630 380 210 1,150 340 IL 59,730 9,300 500 6,610 2,010 1,620 7,220 2,300 2,200 9,410 2,640 IN 31,900 4,600 170 3,410 1,010 820 4,410 1,460 1,410 4,890 1,390 IA 15,910 2,300 110 1,700 500 480 1,790 540 760 3,060 670 KS 12,930 1,990 80 1,570 390 350 1,630 540 650 2,060 720 KY 23,020 3,290 220 2,350 500 480 3,680 1,150 970 2,520 910 LA 23,280 3,870 220 2,580 500 540 3,090 770 1,060 3,440 770 ME 7,750 890 † 800 220 150 990 380 260 1,300 430 MD 25,450 4,390 220 2,760 780 680 3,210 1,070 1,030 4,210 1,150 MA 33,030 4,910 110 3,560 1,010 770 4,010 1,530 1,260 5,350 1,870 MI 50,220 7,210 340 4,830 1,450 1,250 6,110 1,840 2,140 7,650 2,350 MN 22,890 3,240 110 2,220 670 660 2,620 1,000 1,380 4,360 1,150 MS 14,970 2,350 140 1,630 340 370 2,180 460 530 3,210 480 MO 30,210 4,550 170 3,230 840 830 4,070 1,460 1,530 3,060 1,150 MT 4,910 680 † 460 170 140 620 230 210 990 240 NE 8,330 1,200 60 1,030 280 250 1,000 380 380 1,380 340 NV 11,120 1,620 80 1,240 220 260 1,530 540 440 1,990 530 NH 6,310 890 † 620 170 170 790 310 320 1,150 380 NJ 43,000 7,740 340 4,670 1,790 1,100 4,830 1,920 1,760 6,420 2,060 NM 7,780 990 60 880 280 170 760 310 320 1,680 340 NY 87,050 14,430 840 9,700 3,240 2,170 9,870 3,220 2,940 14,220 4,320 NC 40,520 6,330 310 4,100 1,170 990 5,520 1,920 1,760 6,810 1,580 ND 3,080 520 † 360 110 110 330 80 180 610 140 OH 59,680 9,670 390 6,500 1,850 1,510 7,790 2,450 1,970 10,860 3,070 OK 18,460 2,820 140 2,010 450 460 2,580 1,000 680 2,450 820 OR 17,720 2,610 140 1,760 450 420 2,160 1,000 1,000 2,980 1,010 PA 71,840 11,340 390 8,130 2,570 1,630 8,470 2,990 2,880 13,150 3,600 RI 5,870 780 60 650 110 120 720 310 290 840 340 SC 21,860 3,290 170 2,300 500 510 2,880 770 940 4,210 860 SD 3,900 520 † 460 110 110 430 150 230 920 190 TN 31,080 4,230 280 3,150 730 760 4,630 1,300 1,350 4,280 1,150 TX 86,880 12,860 1,030 9,270 2,400 2,250 11,210 3,830 3,050 13,380 3,410 UT 6,380 1,150 † 670 220 220 460 460 380 1,150 290 VT 3,030 470 † 340 110 90 390 150 180 460 190 VA 33,680 6,010 200 3,560 1,010 830 4,400 1,610 1,170 5,740 1,390 WA 27,350 3,920 110 2,660 890 720 3,440 1,380 1,410 5,510 1,250 WV 11,190 1,410 110 1,260 280 220 1,700 460 500 1,450 580 WI 26,340 4,130 80 2,760 840 770 3,060 1,230 1,120 4,050 1,340 WY 2,380 260 † 280 60 60 280 150 90 610 100 US 1,372,910 211,240 10,370 145,290 40,880 34,810 172,570 59,580 56,390 232,090 63,210 *Rounded to the nearest 10. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Estimate is fewer than 50 cases. Note: These estimates are offered as a rough guide and should be interpreted with caution. State estimates are calculated according to the distribution of estimated cancer deaths in 2005 by state. State estimates may not add to US total due to rounding and exclusion of state estimates fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2005. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account formore than 56% of all newly diagnosed cancers. Prostate cancer alone accounts for approximately 33% (232,090) of incident cases in men. Based on cases diagnosed between 1995 and 2000, about 90% of these estimated new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which 5‐year relative survival approaches 100%. FIGURE 1 The three most commonly diagnosed cancers among women in 2005 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for approximately 55% of estimated cancer cases in women. Breast cancer alone is expected to account for 32% (211,240) of all new cancer cases among women. Expected Number of New Cancer Deaths Table 1 also shows the expected number of cancer deaths in 2005 for men, women, and both sexes combined. It is estimated that approximately 570,280 Americans will die from cancer, corresponding to more than 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 fatal cancers. These four cancers account for one‐half of the total cancer deaths among men and women ( Figure 1 ). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 27% of all female cancer deaths in 2005. Table 3 provides the estimated number of cancer deaths in 2005 by state for selected cancer sites. TABLE 3 Age‐standardized Death Rates from All Cancers Combined and Estimated Cancer Deaths from All Causes and Selected Sites by State, United States, 2005* STATE Death Rate † per 100,000 All Sites Brain/Other Nervous System Female Breast Colon & Rectum Leukemia Liver Lung & Bronchus Non‐Hodgkin Lymphoma Ovary Pancreas Prostate AL 214.4 10,100 210 730 890 360 290 3,160 320 300 530 570 AK 199.2 800 ‡ 50 80 ‡ ‡ 210 ‡ ‡ 50 ‡ AZ 176.5 9,920 240 720 970 400 290 2,720 360 290 550 510 AR 211.5 6,210 160 400 630 260 200 2,400 220 160 310 270 CA 183.7 56,090 1,460 4,050 5,450 2,190 2,070 14,350 1,940 1,720 3,150 3,270 CO 172.2 6,680 180 490 640 300 170 1,660 300 220 400 350 CT 191.5 7,030 140 520 650 260 170 1,850 250 200 430 440 DE 217.4 1,580 ‡ 120 160 80 ‡ 460 70 50 100 80 DC 241.2 1,170 ‡ 100 130 ‡ ‡ 290 ‡ ‡ 60 80 FL 191.0 39,960 930 2,570 3,820 1,700 1,110 12,440 1,180 1,120 2,250 2,570 GA 205.1 14,810 300 1,120 1,350 530 340 4,550 470 420 770 740 HI 158.0 1,990 ‡ 130 210 80 100 480 90 50 150 120 ID 179.8 2,280 70 180 210 100 50 600 70 80 130 150 IL 208.9 24,810 480 1,780 2,560 1,050 680 6,840 750 650 1,470 1,230 IN 214.1 13,250 320 880 1,320 530 250 4,180 480 380 690 640 IA 189.7 6,610 160 440 660 310 120 1,700 260 210 390 400 KS 189.4 5,370 130 380 610 230 120 1,540 220 160 290 270 KY 227.0 9,560 160 630 910 320 200 3,490 330 230 420 330 LA 230.4 9,670 190 740 1,000 350 310 2,930 360 220 520 450 ME 212.2 3,220 80 170 310 100 70 940 90 100 180 170 MD 211.1 10,570 200 840 1,070 440 260 3,040 350 310 590 550 MA 205.4 13,720 280 940 1,380 500 370 3,800 430 380 850 700 MI 203.9 20,860 450 1,380 1,870 810 530 5,790 730 590 1,140 1,000 MN 187.5 9,510 250 620 860 430 210 2,480 470 270 550 570 MS 222.3 6,220 170 450 630 240 150 2,070 180 160 330 420 MO 207.9 12,550 260 870 1,250 540 290 3,860 520 340 670 400 MT 195.0 2,040 50 130 180 90 50 590 70 70 100 130 NE 184.8 3,460 90 230 400 160 60 950 130 100 180 180 NV 209.5 4,620 90 310 480 170 120 1,450 150 120 230 260 NH 205.2 2,620 70 170 240 110 70 750 110 60 140 150 NJ 208.3 17,860 320 1,480 1,810 710 410 4,580 600 540 1,050 840 NM 171.9 3,230 70 190 340 110 130 720 110 90 180 220 NY 194.1 36,160 720 2,760 3,760 1,410 1,010 9,350 1,000 1,080 2,270 1,860 NC 204.9 16,830 340 1,210 1,590 640 380 5,230 600 470 910 890 ND 184.7 1,280 ‡ 100 140 70 ‡ 310 60 ‡ 80 80 OH 212.4 24,790 530 1,850 2,520 980 570 7,380 670 660 1,300 1,420 OK 206.2 7,670 170 540 780 300 170 2,440 230 180 360 320 OR 198.9 7,360 190 500 680 270 160 2,050 340 240 410 390 PA 207.1 29,840 520 2,170 3,150 1,060 730 8,030 980 880 1,670 1,720 RI 208.4 2,440 50 150 250 80 60 680 100 60 140 110 SC 209.5 9,080 180 630 890 330 220 2,730 320 190 510 550 SD 191.0 1,620 50 100 180 70 ‡ 410 80 60 90 120 TN 216.3 12,910 320 810 1,220 490 300 4,390 460 350 680 560 TX 196.8 36,090 910 2,460 3,590 1,460 1,280 10,620 1,040 960 1,950 1,750 UT 151.0 2,650 90 220 260 140 60 440 130 90 170 150 VT 200.8 1,260 ‡ 90 130 60 ‡ 370 60 ‡ 70 60 VA 207.1 13,990 270 1,150 1,380 540 340 4,170 400 400 750 750 WA 195.3 11,360 350 750 1,030 470 340 3,260 480 390 690 720 WV 223.3 4,650 90 270 490 140 110 1,610 170 140 200 190 WI 194.3 10,940 260 790 1,070 500 290 2,900 380 320 650 530 WY 190.8 990 ‡ 50 110 ‡ ‡ 270 ‡ ‡ 50 80 US 199.8 570,280 12,760 40,410 56,290 22,570 15,420 163,510 19,200 16,210 31,800 30,350 *Rounded to the nearest 10; excludes in situ carcinomas except urinary bladder. †Average annual rates for 1997‐2001 and age‐adjusted to the 2000 US standard population. ‡Estimate is fewer than 50 deaths. Note: State estimates may not add to US total due to rounding and exclusion of state estimates for fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. Trends in Cancer Incidence and Mortality Figures 2 through 5 , depict long‐term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 4 shows incidence and mortality patterns for all cancer sites and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting in the table (joinpoint analysis) but not in the figures ( Figures 2 and 3 ). Death rates from all cancers combined decreased by 1.5% per year from 1993 to 2001 in males and by 0.8% per year in females from1992 to 2001 ( Table 4 ). Delay‐adjusted cancer incidence rates stabilized in men from 1995 to 2001 and increased by 0.3% per year from 1987 to 2001 in women ( Table 4 ). TABLE 4 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, All Races, 1975 to 2001 Line Segment 1 Line Segment 2 Line Segment 3 Line Segment 4 Year APC* Year APC* Year APC* Year APC* All Cancers Incidence Male and female 1975–1989 1.2 † 1989–1992 2.8 1992–1995 −2.1 1995–2001 0.4 Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.7 † 1995–2001 0.2 Female 1975–1979 −0.2 1979–1987 1.5 † 1987–2001 0.3 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2001 −1.1 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.4 1993–2001 −1.5 † Female 1975–1992 0.5 † 1992–2001 −0.8 † Lung & bronchus Incidence Male and female 1975–1982 2.5 † 1982–1991 1.0 † 1991–2001 −0.8 † Male 1975–1982 1.4 † 1982–1991 −0.4 1991–2001 −1.9 † Female 1975–1982 5.5 † 1982–1990 3.5 † 1990–1998 1.1 † 1998–2001 −1.3 Death Male and female 1975–1980 3.0 † 1980–1990 1.8 † 1990–1995 −0.2 1995–2001 −1.0 † Male 1975–1982 1.8 † 1982–1991 0.4 † 1991–2001 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2001 0.2 Colon & rectum Incidence Male and female 1975–1985 0.8 † 1985–1995 −1.8 † 1995–1998 1.3 1998–2001 −2.4 † Male 1975–1986 1.1 † 1986–1995 −2.1 † 1995–1998 1.1 1998–2001 −2.9 † Female 1975–1985 0.3 † 1985–1995 −1.9 † 1995–1998 1.8 1998–2001 −2.3 † Death Male and female 1975–1984 −0.5 † 1984–2001 −1.8 † Male 1975–1984 −0.1 1984–1990 −1.4 † 1990–2001 −2.0 † Female 1975–1984 −1.0 † 1984–2001 −1.8 † Female breast Incidence 1975–1980 −0.4 1980–1987 3.7 † 1987–2001 0.5 † Death 1975–1990 0.4 † 1990–2001 −2.3 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.5 † 1995–2001 2.0 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2001 −4.1 † *APC, annual percent change based on rates age‐adjusted to the 2000 standard population. †The APC is significantly different from zero. Note: Trends were analyzed by Joinpoint Regression Program, version 2.7, with a maximum of three joinpoints (ie, four line segments). Trends in incidence are based on rates adjusted for delay in reporting. Source: Ries LAG, Eisner MP, Kosary CL, et al. FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 Mortality rates have continued to decrease across all four major cancer sites in men and in women except for female lung cancer in which rates have leveled off for the first time after increasing for many decades ( Table 4 ). The incidence trends are mixed, however. Lung cancer incidence rates are declining in men and leveled off for the first time in women after increasing for many decades. Colorectal cancer incidence rates have decreased from 1998 through 2001 both in males and in females. The incidence rates of prostate cancer and female breast cancer have continued to increase, although at a slower rate than in previous years. The continuing increase may be attributable to increased screening through prostate‐specific antigen testing (for prostate cancer) and mammography (for breast cancer). The increase in female breast cancer incidence may also reflect increased use of hormone replacement therapy and/or increased prevalence of obesity. Changes in the Recorded Number of Deaths From Cancer From 2001 to 2002 A total of 557,271 cancer deaths were recorded in the United States in 2002, the most recent year for which actual data are available. More than 3,500 additional cancer deaths were recorded in 2002 than in 2001, predominantly because of growth and aging of the population. Cancer accounted for approximately 23% of all deaths, ranking second only to heart disease ( Table 5 ). When age‐adjusted death rates are considered ( Figure 6 ), cancer is the leading cause of death among men and women under age 85. A total of 476,009 people under age 85 died from cancer in the United States in 2002 compared with 450,637 deaths from heart disease. When cause of death is ranked within each age group, categorized in 20‐year age intervals, cancer is one of the five leading causes of death in each age group among both males and females. Cancer is the leading cause of death among women aged 40 to 79 and among men aged 60 to 79 ( Table 6 ). TABLE 5 Fifteen Leading Causes of Death, United States, 2002 Rank Causes of Death Number of Deaths Percent (%) of Total Deaths Death Rate* All causes 2,443,387 843.6 1 Heart diseases 696,947 28.5 240.1 2 Cancer 557,271 22.8 193.4 3 Cerebrovascular diseases 162,672 6.7 56.0 4 Chronic lower respiratory diseases 124,816 5.1 43.4 5 Accidents (unintentional injuries) 106,742 4.4 36.8 6 Diabetes mellitus 73,249 3.0 25.4 7 Influenza & pneumonia 65,681 2.7 22.5 8 Alzheimer disease 58,866 2.4 20.1 9 Nephritis, nephrotic syndrome, & nephrosis 40,974 1.7 14.2 10 Septicemia 33,865 1.4 11.7 11 Intentional self‐harm (suicide) 31,655 1.3 10.9 12 Chronic liver disease & cirrhosis 27,257 1.1 9.4 13 Hypertension and hypertensive renal disease 20,261 0.8 7.0 14 Assault (homicide) 17,638 0.7 6.1 15 Parkinson disease 16,959 0.7 5.9 All other & ill‐defined causes 408,534 *Rates are per 100,000 population and age‐adjusted to the 2000 US standard population. Note: Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities and pneumonitis due to solids and liquids were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tape, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. FIGURE 6 TABLE 6 Ten Leading Causes of Death, by Age and Sex, United States, 2002 All Ages Ages 1 to 19 Ages 20 to 39 Ages 40 to 59 Ages 60 to 79 Ages 80+ Male Female Male Female Male Female Male Female Male Female Male Female All Causes 1,199,264 All Causes 1,244,123 All Causes 16,848 All Causes 8,972 All Causes 65,934 All Causes 30,002 All Causes 212,519 All Causes 131,100 All Causes 488,179 All Causes 402,852 All Causes 399,785 All Causes 658,805 1 Heart diseases 340,933 Heart diseases 356,014 Accidents (unintentional injuries) 7,718 Accidents (unintentional injuries) 3,778 Accidents (unintentional injuries) 21,627 Accidents (unintentional injuries) 6,859 Heart diseases 54,028 Cancer 49,570 Cancer 156,527 Cancer 129,699 Heart diseases 136,941 Heart diseases 231,969 2 Cancer 288,768 Cancer 268,503 Assault (homicide) 2,035 Cancer 957 Intentional self‐harm (suicide) 8,771 Cancer 5,403 Cancer 52,489 Heart diseases 21,677 Heart diseases 143,570 Heart diseases 99,160 Cancer 73,839 Cancer 82,840 3 Accidents (unintentional injuries) 69,257 Cerebro‐vascular disease 100,050 Intentional self‐harm (suicide) 1,479 Assault (homicide) 636 Assault (homicide) 7,827 Heart diseases 2,640 Accidents (unintentional injuries) 20,224 Accidents (unintentional injuries) 8,076 Chronic lower respiratory diseases 31,438 Chronic lower respiratory diseases 29,905 Cerebro‐vascular diseases 30,688 Cerebro‐vascular diseases 67,702 4 Cerebro‐vascular disease 62,622 Chronic lower respiratory diseases 64,103 Cancer 1,240 Congenital anomalies 552 Heart diseases 5,590 Intentional self‐harm (suicide) 1,913 Intentional self‐harm (suicide) 9,325 Cerebro‐vascular diseases 5,536 Cerebro‐vascular disease 24,573 Cerebro‐vascular diseases 25,934 Chronic lower respiratory diseases 24,411 Alzheimer disease 35,225 5 Chronic lower respiratory diseases 60,713 Alzheimer disease 41,877 Congenital anomalies 643 Heart diseases 322 Cancer 4,626 Assault (homicide) 1,723 Chronic liver disease & cirrhosis 9,082 Diabetes mellitus 4,675 Diabetes mellitus 16,886 Diabetes mellitus 17,038 Influenza & pneumonia 16,980 Chronic lower respiratory diseases 29,619 6 Diabetes mellitus 34,301 Diabetes mellitus 38,948 Heart disease 503 Intentional self‐harm (suicide) 298 HIV disease 3,206 HIV disease 1,391 Diabetes mellitus 6,719 Chronic lower respiratory diseases 4,089 Accidents (unintentional injuries) 10,825 Influenza & pneumonia 7,508 Alzheimer disease 12,384 Influenza & pneumonia 27,094 7 Influenza & pneumonia 28,918 Accidents (unintentional injuries) 37,485 Chronic lower respiratory diseases 186 Influenza & pneumonia 134 Diabetes mellitus 905 Cerebro‐vascular disease 740 HIV disease6,450 Chronic liver disease & cirrhosis 3,617 Influenza & pneumonia8,960 Nephritis, nephrotic syndrome & nephrosis 7,375 Diabetes mellitus 9,737 Diabetes mellitus 16,566 8 Intentional self‐harm (suicide) 25,409 Influenza & pneumonia 36,763 Influenza & pneumonia 142 Chronic lower respiratory diseases 108 Chronic liver disease & cirrhosis 852 Diabetes mellitus 629 Cerebro‐vascular diseases 6,440 Intentional self‐harm (suicide) 2,879 Nephritis, nephrotic syndrome & nephrosis 8,077 Accidents (unintentional injuries) 6,987 Nephritis, nephrotic syndrome & nephrosis 9,030 Nephritis, nephrotic syndrome & nephrosis 11,784 9 Nephritis, nephrotic syndrome & nephrosis 19,695 Nephritis, nephrotic syndrome & nephrosis 21,279 Septecemia 115 Septicemia 108 Cerebro‐vascular disease 742 Chronic liver disease & cirrhosis 475 Chronic lower respiratory diseases 4,274 HIV disease 1,998 Septicemia 6,611 Septicemia 6,781 Accidents (unintentional injuries) 8,236 Accidents (unintentional injuries) 11,381 10 Chronic liver disease & cirrhosis 17,401 Septicemia 18,918 Cerebro‐vascular disease 111 In Situ/Benign unknown neoplasms 90 Congenital anomalies 552 Congenital anomalies 431 Assault (homicide) 2,875 Septicemia 1,938 Chronic Liver disease & cirrhosis 6,313 Alzheimer disease 6,542 Parkinson disease 5,805 Septicemia 9,614 Note: Symptoms, signs, and abnormalities and events of undetermined intent were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. Table 7 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among men under age 40, leukemia is the most common fatal cancer, while cancer of the lung and bronchus predominates in men aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men 40 to 79 years old, and prostate cancer is the second most common among men aged 80 and older. Among women, leukemia is the leading cause of cancer death before age 20, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at age 60 years and older. TABLE 7 Reported Deaths for the Five Leading Cancer Sites, by Age and Sex, United States, 2002 All Ages <20 20 to 39 40 to 59 60 to 79 ≥80 Male All Sites 288,768 All Sites 1,282 All Sites 4,626 All Sites 52,489 All Sites 156,527 All Sites 73,839 Lung & bronchus 90,121 Leukemia 382 Leukemia 599 Lung & bronchus 16,044 Lung & bronchus 55,996 Lung & bronchus 17,681 Prostate 30,446 Brain & ONS* 327 Brain & ONS* 516 Colon & rectum 5,257 Colon & rectum 14,973 Prostate 15,795 Colon & rectum 28,472 Other endocrine system 104 Colon & rectum 413 Pancreas 3,195 Prostate 13,539 Colon & rectum 7,820 Pancreas 14,877 Bones & joints 96 Non‐Hodgkin lymphoma 401 Liver & bile duct 2,733 Pancreas 8,312 Leukemia 3,409 Leukemia 12,058 Soft tissue 82 Lung & bronchus 394 Esophagus 2,470 Leukemia 5,919 Urinary bladder 3,331 Female All Sites 268,503 All Sites 989 All Sites 5,403 All Sites 49,570 All Sites 129,699 All Sites 82,840 Lung & bronchus 67,509 Leukemia 296 Breast 1,331 Breast 12,115 Lung & bronchus 39,943 Lung & bronchus 16,064 Breast 41,514 Brain & ONS* 244 Uterine cervix 499 Lung & bronchus 11,129 Breast 17,218 Colon & rectum 12,030 Colon & rectum 28,132 Other endocrine system 88 Leukemia 433 Colon & rectum 3,857 Colon & rectum 11,904 Breast 10,849 Pancreas 15,387 Bones & joints 83 Lung & bronchus 370 Ovary 3,285 Pancreas 7,869 Pancreas 5,436 Ovary 14,682 Soft tissue 71 Brain & ONS* 349 Pancreas 1,999 Ovary 7,349 Non‐Hodgkin lymphoma 4,029 *ONS, other nervous system. Note: Others and Unspecified Primary are excluded from cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. From 2001 to 2002, the number of recorded cancer deaths increased by 1,693 in men and by 1,810 in women ( Table 8 ). The total number of deaths for the major cancers in men and women did not change substantially except for lung cancer (increased by 1,903) and colorectal cancer (decreased by 447) among women. TABLE 8 Trends in the Recorded Number of Cancer Deaths for Selected Cancers, by Sex, United States, 1989 to 2002 Year All Sites Lung and Bronchus Colon and Rectum Prostate Breast Male Female Male Female Male Female Male Female 1989 263,309 232,843 88,975 48,042 28,123 28,903 30,520 42,837 1990 268,283 237,039 91,014 50,136 28,484 28,674 32,378 43,391 1991 272,380 242,277 91,603 52,022 28,026 28,753 33,564 43,583 1992 274,838 245,740 91,322 54,485 28,280 28,714 34,240 43,068 1993 279,375 250,529 92,493 56,234 28,199 29,206 34,865 43,555 1994 280,465 253,845 91,825 57,535 28,471 28,936 34,902 43,644 1995 281,611 256,844 91,800 59,304 28,409 29,237 34,475 43,844 1996 281,898 257,635 91,559 60,351 27,989 28,766 34,123 43,091 1997 281,110 258,467 91,278 61,922 28,075 28,621 32,891 41,943 1998 282,065 259,467 91,399 63,075 28,024 28,950 32,203 41,737 1999 285,832 264,006 89,401 62,662 28,313 28,909 31,729 41,144 2000 286,082 267,009 90,415 65,016 28,484 28,950 31,078 41,872 2001 287,075 266,693 90,367 65,606 28,229 28,579 30,719 41,394 2002 288,768 268,503 90,121 67,509 28,472 28,132 30,446 41,514 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. Source: US Mortality Public Use Data Tapes, 1989 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. CANCER OCCURRENCE BY RACE AND ETHNICITY Cancer incidence and death rates vary considerably among racial and ethnic groups ( Table 9 ). For all cancer sites combined, African American men have a 24% higher incidence rate and 40% higher death rate than Whites. African American women have a lower incidence rate but nearly 20% higher death rate than Whites for all cancer sites combined. For the specific cancer sites listed in Table 9 , incidence and death rates are consistently higher in African Americans than in Whites, except for breast cancer (incidence) and lung cancer (mortality) among women. Death rates from prostate, stomach, and cervical cancers among African Americans are more than twice the rates in Whites. Factors that contribute to these mortality differences include differences in exposure (eg, Helicobacter pylori for stomach cancer), access to regular screening (breast, cervical, and colorectal cancers), and timely, high quality treatments (many cancers). The higher breast cancer incidence rates among Whites are thought to reflect a combination of more frequent mammography, which makes diagnosis more likely, delayed age at first birth, and historically greater use of hormone replacement therapy. TABLE 9 Age‐standardized Incidence and Death Rates* for Selected Cancer Sites by Race and Ethnicity, United States, 1997 to 2001 All Races White African American Asian American/Pacific Islander American Indian/Alaskan Native Hispanic‐Latino † Incidence Rates All sites Male 554.3 556.5 689.2 385.9 263.2 419.8 Female 414.4 429.8 400.1 302.8 222.5 309.9 Breast (Female) 135.2 141.7 119.9 96.8 54.2 89.6 Colon & rectum Male 63.4 63.1 72.9 56.3 38.3 49.6 Female 46.4 45.9 56.5 38.6 32.7 32.5 Lung & bronchus Male 79.1 77.9 117.2 60.5 46.0 45.2 Female 49.1 51.3 54.5 28.5 23.4 23.9 Prostate 172.3 167.4 271.3 100.7 51.2 140.0 Stomach Male 12.6 10.8 18.8 21.9 15.7 17.8 Female 6.1 5.0 9.9 12.4 8.9 10.0 Liver & bile duct Male 9.1 7.2 11.8 21.1 8.3 13.5 Female 3.5 2.9 3.9 7.7 4.8 5.8 Uterine cervix 9.3 8.9 11.8 9.5 6.0 16.2 Death Rates All sites Male 251.1 245.5 347.3 151.2 167.0 174.0 Female 166.7 165.5 196.5 100.5 113.4 111.6 Breast (female) 27.0 26.4 35.4 12.6 13.6 17.3 Colon & rectum Male 25.3 24.8 34.3 15.8 17.1 18.0 Female 17.7 17.1 24.5 10.8 11.7 11.6 Lung & bronchus Male 77.9 76.6 104.1 40.2 49.8 39.6 Female 40.8 41.6 39.9 19.2 26.6 14.9 Prostate 31.5 28.8 70.4 13.0 20.2 23.5 Stomach Male 6.6 5.8 13.3 11.9 7.3 9.7 Female 3.3 2.8 6.3 7.0 4.1 5.3 Liver & bile duct Male 6.7 6.1 9.3 15.6 8.3 10.6 Female 2.9 2.7 3.8 6.6 4.3 5.1 Uterine cervix 2.9 2.6 5.6 2.8 2.8 3.6 *Rates are per 100,000 and age‐adjusted to the 2000 US standard population. †Hispanics‐Latinos are not mutually exclusive from Whites, African Americans, Asian Americans/Pacific Islanders, and American Indians/Alaskan Natives. Source: Ries LAG, Eisner MP, Kosary CL, et al. Among other racial and ethnic groups, cancer incidence and death rates are lower for all cancer sites combined and for the four most common cancer sites than those for Whites and African Americans. However, incidence and death rates for cancers of the uterine cervix, stomach, and liver are generally higher in minority population than in Whites. Stomach and liver cancer incidence and death rates are more than twice as high in Asian/Pacific Islanders than in Whites, reflecting increased exposure to infectious agents such as H pylori and hepatitis C virus. Historical information to adjust for delays in reporting is not available for all racial and ethnic groups. From 1992 to 2001, incidence rates for all cancer sites combined, not adjusted for delayed reporting, decreased by 2.8% per year among American Indians/Alaskan Natives, by 1.2% per year in African Americans, by 0.7% among Asian/Pacific Islanders, by 0.6% among Hispanic‐Latinos, and by 0.5% among Whites (data not shown). Similarly, the death rate from all cancers combined decreased from 1992 through 2001 by 1.6% per year in Asian/Pacific Islanders, by 1.4% among African Americans, by 0.9% among Whites, and by 0.5% among Hispanic‐Latinos. The death rate from all cancers combined stabilized during this time period among American Indians/Alaskan Natives. Lifetime Probability of Developing Cancer The lifetime probability of developing cancer is higher for men (46%) than for women (38%) ( Table 10 ). However, because of the relatively early age of onset of breast cancer, women have a slightly higher probability of developing cancer before the age of 60. It is noteworthy that these estimates are based on the average experience of the general population and may overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility. TABLE 10 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, United States, 1999 to 2001* Birth to 39 (%) 40 to 59 (%) 60 to 79 (%) Birth to Death (%) All sites † Male 1.41 (1 in 71) 8.52 (1 in 12) 34.63 (1 in 3) 45.59 (1 in 2) Female 1.97 (1 in 51) 9.10 (1 in 11) 22.51 (1 in 4) 38.18 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4264) 0.41 (1 in 243) 2.42 (1 in 41) 3.56 (1 in 28) Female 0.01 (1 in 8876) 0.12 (1 in 804) 0.65 (1 in 153) 1.13 (1 in 88) Breast Female 0.48 (1 in 207) 4.18 (1 in 24) 7.49 (1 in 13) 13.39 (1 in 7) Colon & rectum Male 0.07 (1 in 1484) 0.90 (1 in 111) 3.96 (1 in 25) 5.90 (1 in 17) Female 0.06 (1 in 1586) 0.69 (1 in 145) 3.04 (1 in 33) 5.54 (1 in 18) Leukemia Male 0.15 (1 in 659) 0.22 (1 in 461) 0.85 (1 in 118) 1.47 (1 in 68) Female 0.13 (1 in 799) 0.14 (1 in 697) 0.48 (1 in 206) 1.04 (1 in 96) Lung & bronchus Male 0.03 (1 in 3164) 1.06 (1 in 95) 5.75 (1 in 17) 7.63 (1 in 13) Female 0.03 (1 in 2977) 0.81 (1 in 123) 3.91 (1 in 26) 5.71 (1 in 18) Melanoma of the skin Male 0.13 (1 in 795) 0.51 (1 in 195) 1.08 (1 in 93) 1.89 (1 in 53) Female 0.21 (1 in 484) 0.40 (1 in 248) 0.53 (1 in 190) 1.28 (1 in 78) Non‐Hodgkin lymphoma Male 0.14 (1 in 724) 0.46 (1 in 217) 1.32 (1 in 76) 2.18 (1 in 46) Female 0.09 (1 in 1147) 0.31 (1 in 328) 1.00 (1 in 100) 1.80 (1 in 56) Prostate Male 0.01 (1 in 9879) 2.58 (1 in 39) 14.76 (1 in 7) 17.81 (1 in 6) Uterine cervix Female 0.16 (1 in 636) 0.29 (1 in 340) 0.27 (1 in 368) 0.77 (1 in 130) Uterine corpus Female 0.06 (1 in 1632) 0.72 (1 in 139) 1.57 (1 in 64) 2.62 (1 in 38) *For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 1999 to 2001. †The “1 in” statistic and the inverse of the percentage may not be equivalent due to rounding. ‡All sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Source: DEVCAN Software, Probability of Developing or Dying of Cancer Software, Version 5.2. Statistical Research and Applications Branch, National Cancer Institute, 2005. http://srab.cancer.gov/devcan . Cancer Survival by Race African American men and women have poorer probability of survival once a cancer diagnosis is made. As shown in Figure 7 , 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. Five‐year relative survival is lower in African Americans than in Whites at each stage of diagnosis for nearly every cancer site ( Figure 8 ). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. The extent to which these factors, individually or collectively, contribute to the overall differential survival is unclear. However, recent findings suggest that when African Americans receive similar cancer treatment and medical care as Whites they tend to have similar disease outcomes. FIGURE 7 FIGURE 8 There have been notable improvements over time in the relative 5‐year survival rates for the common cancer sites and all cancers combined ( Table 11 ). This is true for both Whites and African Americans. Cancer sites for which survival has not improved substantially over the past 25 years include uterine corpus, uterine cervix, larynx, liver, lung, pancreas, stomach, and esophagus. TABLE 11 Trends in Five‐year Relative Survival Rates* (%) for Selected Cancer Sites, by Race and Year of Diagnosis, United States, 1974 to 2000 Site Relative Five‐year Survival Rate (%) White African American All Races 1974 to 1976 1983 to 1985 1995 to 2000 1974 to 1976 1983 to 1985 1995 to 2000 1974 to 1976 1983 to 1985 1995 to 2000 All Cancers 51 54 66 † 39 40 55 † 50 53 64 † Brain & ONS ‡ 22 26 32 † 27 32 38 † 22 27 33 † Breast (female) 75 79 89 † 63 64 75 † 75 78 88 † Colon 51 59 64 † 46 50 54 † 50 58 63 † Esophagus 5 9 16 † 4 6 9 † 5 8 14 † Hodgkin disease 72 79 86 † 69 77 80 † 71 79 85 † Kidney & renal pelvis 52 56 64 † 49 55 64 † 52 56 64 † Larynx 66 69 67 60 55 51 66 67 65 Leukemia 35 42 48 † 31 34 39 34 41 46 † Liver & bile duct 4 6 8 † 1 4 5 † 4 6 8 † Lung & bronchus 13 14 15 † 12 11 13 † 13 14 15 † Melanoma of the skin 81 85 91 † 67 § 75 ¶ 74 § 80 85 91 † Myeloma 24 27 32 † 28 31 32 25 28 32 † Non‐Hodgkin lymphoma 48 55 60 † 49 45 51 47 54 59 † Oral cavity & pharynx 55 55 61 † 36 35 39 54 53 59 † Ovary** 37 40 44 † 41 42 38 37 41 44 † Pancreas 3 3 4 † 3 5 4 † 3 3 4 † Prostate 68 76 100 † 58 64 96 † 67 75 99 † Rectum 49 56 65 † 42 44 55 † 49 55 64 † Stomach 15 16 22 † 16 19 24 † 15 17 23 † Testis 79 91 96 † 76 § 88 § 87 79 91 96 † Thyroid 92 93 97 † 88 92 95 92 94 97 † Urinary bladder 74 78 83 † 48 60 62 † 73 78 82 † Uterine cervix 70 71 74 † 64 61 66 69 69 73 † Uterine corpus 89 85 86 † 62 54 63 88 83 84 † *Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1974 to 1976, 1983 to 1985, and 1995 to 2000, and followed through 2001. †The difference in rates between 1974 to 1976 and 1995 to 2000 is statistically significant ( P < 0.05). ‡ONS, other nervous system. §The standard error of the survival rate is between 5 and 10 percentage points. ¶The standard error of the survival rate is greater than 10 percentage points. **Recent changes in classification of ovarian cancer, namely excluding borderline ovarian tumors, have affected 1995‐2000 survival rates. Source: Ries LAG, Eisner MP, Kosary CL, et al. Relative survival rate cannot be calculated for other racial and ethnic groups because accurate life expectancies are not available. However, based on cause‐specific survival rates of cancer patients diagnosed from 1992 to 2000 in SEER areas of the United States, all minority populations except Asian/Pacific Islander women have an elevated probability of dying from all cancers combined within 5 years of diagnosis compared with non‐Hispanic Whites after accounting for differences in age at diagnosis. , For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely to be diagnosed at distant stage compared with non‐Hispanic Whites. CANCER IN CHILDREN Cancer is the second leading cause of death among children between the ages of 1 and 14 in the United States; accidents are the most frequent cause of death in this age group ( Table 12 ). The most commonly occurring cancers in children (0 to 14 years) are leukemia (particularly acute lymphocytic leukemia), brain and other nervous system cancers, soft tissue sarcomas, non‐Hodgkin lymphoma, and renal (Wilms) tumor. Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for many childhood cancers, including non‐Hodgkin lymphoma, acute lymphocytic leukemia, acute myeloid leukemia, and Wilms tumor ( Table 13 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 56% for patients diagnosed in 1974 to 1976 to 79% for those diagnosed in 1995 to 2000. TABLE 12 Fifteen Leading Causes of Death Among Children Aged 1 to 14, United States, 2002 Rank Cause of Death Number of Deaths Percent (%) of Total Deaths* Death Rate † All Causes 12,008 100.0 21.2 1 Accidents (unintentional injuries) 4,359 36.3 7.7 2 Cancer 1,474 12.3 2.6 3 Congenital anomalies 947 7.9 1.7 4 Assault (homicide) 779 6.5 1.4 5 Heart diseases 420 3.5 0.7 6 Intentional self‐harm (suicide) 264 2.2 0.5 7 Chronic lower respiratory disease 201 1.7 0.4 8 Influenza & pneumonia 201 1.7 0.4 9 Septicemia 174 1.4 0.3 10 In situ & benign neoplasms 149 1.2 0.3 11 Cerebrovascular disease 144 1.2 0.3 12 Anemias 74 0.6 0.1 13 Meningitis 50 0.4 0.1 14 Diabetes mellitus 37 0.3 0.1 15 Nephritis, nephrotic syndrome, & nephrosis 35 0.3 0.1 All other causes 2,700 22.5 *Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities, events of undetermined intent, certain perinatal conditions, and complications from treatment were excluded from ranking order. †Rates are per 100,000 population and age‐adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. TABLE 13 Trends in Five‐year Relative Cancer Survival Rates* (%) for Children Under Age 15, United States, 1974 to 2000 Site Five‐year Relative Survival Rates (%) Year of Diagnosis 1974 to 1976 1977 to 1979 1980 to 1982 1983 to 1985 1986 to 1988 1989 to 1991 1995 to 2000 All sites 56 62 65 68 71 73 79 † Acute lymphocytic leukemia 53 67 71 69 78 80 85 † Acute myeloidleukemia 14 26 ‡ 25 ‡ 30 ‡ 33 ‡ 36 ‡ 53 † Bones & joints 55 ‡ 52 ‡ 54 ‡ 57 ‡ 63 ‡ 62 73 † Brain & other nervous system 55 56 56 62 63 62 73 † Hodgkin disease 78 84 91 90 90 94 96 † Neuroblastoma 53 53 53 55 60 68 66 † Non‐Hodgkin lymphoma 45 50 61 71 70 75 85 † Soft tissue 60 68 65 70 67 78 75 † Wilms tumor 74 78 86 87 91 93 92 † *Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2001. †The difference in rates between 1974 to 1976 and 1995 to 2000 is statistically significant ( P < 0.05). ‡The standard error of the survival rate is between 5 and 10 percentage points. Note: “All sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Ries LAG, Eisner MP, Kosary CL, et al. LIMITATIONS AND FUTURE CHALLENGES Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously. These estimates may vary considerably from year to year, particularly for less common cancers and in states with smaller populations. Unanticipated changes may occur that are not captured by our modeling efforts. The 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 these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and mortality. The recorded number of cancer deaths and cancer death rates from the NCHS and cancer incidence rates from SEER are generally the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, at the time that the estimates are calculated. 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 in continuing efforts to reduce the public health burden of cancer. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CA: A Cancer Journal for Clinicians Wiley

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References (19)

Publisher
Wiley
Copyright
Copyright © 2005 American Cancer Society
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/canjclin.55.1.10
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTION Cancer is a major public health problem in the United States and other developed countries. Currently, one in four deaths in the United States is due to cancer. In this article, we provide an overview of cancer statistics, including updated incidence, mortality, and survival rates and expected number of new cancer cases and deaths in 2005. MATERIALS AND METHODS Data Sources Mortality data from 1930 to 2002 were obtained from the National Center for Health Statistics (NCHS). Incidence data (1975 to 2001), 5‐year relative survival rates, 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% to 14% of the US population. , , , Population data were obtained from the US Census Bureau. Causes of death were coded and classified according to the International Classification of Diseases (ICD‐8, ICD‐9, and ICD‐10). , , Cancer cases were classified according to the International Classification of Diseases for Oncology. Estimated New Cancer Cases The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because complete cancer registration has not yet been achieved in many states. Consequently, for the national estimate we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 2001 using age‐specific cancer incidence rates collected by the SEER program and population data reported by the US Census Bureau. We then forecasted the number of cancer cases expected to be diagnosed in the United States in the year 2005 using an autoregressive quadratic time‐trend model fitted to the annual cancer case estimates. For estimates of new cancer cases in individual states, we projected the number of deaths from cancer in each state in 2005 and assumed that the ratio of estimated cancer deaths to cases in each state equaled that in the United States. Estimated Cancer Deaths We used the state‐space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2005. Projections are based on underlying cause of death from death certificates as reported to the NCHS. This model projects the number of cancer deaths expected to occur in 2005 based on the number that occurred each year from 1969 to 2002 in the United States and in each state separately. Other Statistics We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2002. Causes of death for 2002 were coded and classified according to ICD‐10. This report also provides updated statistics on trends in cancer incidence and mortality rates, the probability of developing cancer, and 5‐year relative survival rates for selected cancer sites based on data from 1973 through 2001. All age‐adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population. The long‐term incidence trends (1975 to 2001) presented in Table 4 are adjusted for delays in reporting. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 1999 to 2001), especially for cancers such as melanoma and prostate cancer that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and several specific cancer sites when long‐term incidence trends are analyzed. Delay‐adjusted trends provide a more accurate assessment of trends in the most recent years for which data are available. SELECTED FINDINGS Expected Numbers of New Cancer Cases Table 1 presents the estimated number of new cancer cases expected among men and women in the United States in 2005. The estimate of about 1.4 million 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 1 million cases of basal and squamous cell skin cancer, approximately 58,490 cases of breast carcinoma in situ, and 46,170 cases of in situ melanoma are expected to be newly diagnosed in 2005. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2 . TABLE 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2005* Estimated New Cases Estimated Deaths Both Sexes Male Female Both sexes Male Female All Sites 1,372,910 710,040 662,870 570,280 295,280 275,000 Oral cavity & pharynx 29,370 19,100 10,270 7,320 4,910 2,410 Tongue 7,660 5,050 2,610 1,730 1,120 610 Mouth 10,070 5,370 4,700 1,890 1,100 790 Pharynx 8,590 6,520 2,070 2,130 1,490 640 Other oral cavity 3,050 2,160 890 1,570 1,200 370 Digestive system 253,500 134,370 119,130 136,060 75,020 61,040 Esophagus 14,520 11,220 3,300 13,570 10,530 3,040 Stomach 21,860 13,510 8,350 11,550 6,770 4,780 Small intestine 5,420 2,840 2,580 1,070 580 490 Colon 104,950 48,290 56,660 56,290 † 28,540 27,750 Rectum 40,340 23,530 16,810 Anus, anal canal, & anorectum 3,990 1,750 2,240 620 230 390 Liver & intrahepatic bile duct 17,550 12,130 5,420 15,420 10,330 5,090 Gallbladder & other biliary 7,480 3,330 4,150 3,340 1,270 2,070 Pancreas 32,180 16,100 16,080 31,800 15,820 15,980 Other digestive organs 5,210 1,670 3,540 2,400 950 1,450 Respiratory system 184,800 102,420 82,380 168,140 93,990 74,150 Larynx 9,880 7,920 1,960 3,770 2,960 810 Lung & bronchus 172,570 93,010 79,560 163,510 90,490 73,020 Other respiratory organs 2,350 1,490 860 860 540 320 Bones & joints 2,570 1,480 1,090 1,210 670 540 Soft tissue (including heart) 9,420 5,530 3,890 3,490 1,910 1,580 Skin (excluding basal & squamous) 66,000 37,580 28,420 10,590 6,920 3,670 Melanoma‐skin 59,580 33,580 26,000 7,770 4,910 2,860 Other nonepithelial skin 6,420 4,000 2,420 2,820 2,010 810 Breast 212,930 1,690 211,240 40,870 460 40,410 Genital system 321,050 241,570 79,480 59,920 31,010 28,910 Uterine cervix 10,370 10,370 3,710 3,710 Uterine corpus 40,880 40,880 7,310 7,310 Ovary 22,220 22,220 16,210 16,210 Vulva 3,870 3,870 870 870 Vagina & other genital, female 2,140 2,140 810 810 Prostate 232,090 232,090 30,350 30,350 Testis 8,010 8,010 390 390 Penis & other genital, male 1,470 1,470 270 270 Urinary system 101,880 71,090 30,790 26,590 17,420 9,170 Urinary bladder 63,210 47,010 16,200 13,180 8,970 4,210 Kidney & renal pelvis 36,160 22,490 13,670 12,660 8,020 4,640 Ureter & other urinary organs 2,510 1,590 920 750 430 320 Eye & orbit 2,120 1,090 1,030 230 110 120 Brain & other nervous system 18,500 10,620 7,880 12,760 7,280 5,480 Endocrine system 27,650 7,550 20,100 2,370 1,080 1,290 Thyroid 25,690 6,500 19,190 1,490 630 860 Other endocrine 1,960 1,050 910 880 450 430 Lymphoma 63,740 33,050 30,690 20,610 10,930 9,680 Hodgkin disease 7,350 3,980 3,370 1,410 780 630 Non‐Hodgkin lymphoma 56,390 29,070 27,320 19,200 10,150 9,050 Multiple myeloma 15,980 8,600 7,380 11,300 5,660 5,640 Leukemia 34,810 19,640 15,170 22,570 12,540 10,030 Acute lymphocytic leukemia 3,970 2,180 1,790 1,490 850 640 Chronic lymphocytic leukemia 9,730 5,780 3,950 4,600 2,520 2,080 Acute myeloid leukemia 11,960 6,530 5,430 9,000 5,040 3,960 Chronic myeloid leukemia 4,600 2,640 1,960 850 430 420 Other leukemia ‡ 4,550 2,510 2,040 6,630 3,700 2,930 Other & unspecified primary sites ‡ 28,590 14,660 13,930 46,250 25,370 20,880 *Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 58,490 carcinoma in situ of the breast and 46,170 melanoma in situ will be newly diagnosed in 2005. †Estimated deaths for colon and rectum cancers are combined. ‡More deaths than cases suggests lack of specificity in recording underlying causes of death on death certificates. Source: Estimates of new cases are based on incidence rates from 1979 to 2001, National Cancer Institute's Surveillance, Epidemiology and End Results program, nine oldest registries. Estimates of deaths are based on data from US Mortality Public Use Data Tapes, 1969 to 2002, National Center for Health Statistics, Center for Disease Control and Prevention, 2004. TABLE 2 Estimated New Cancer Cases for Selected Cancers by State, United States, 2005* State All Cases Female Breast Uterine Cervix Colon & Rectum Uterine Corpus Leukemia Lung & Bronchus Melanoma of the Skin Non‐Hodgkin Lymphoma Prostate Urinary Bladder AL 24,320 3,820 200 2,300 670 560 3,340 920 940 4,360 860 AK 1,930 260 † 210 60 50 220 80 90 310 100 AZ 23,880 3,760 200 2,500 500 620 2,870 1,300 1,060 3,900 1,200 AR 14,950 2,090 170 1,630 340 400 2,530 540 650 2,060 620 CA 135,030 21,170 1,090 14,070 4,250 3,380 15,150 5,440 5,700 25,010 6,380 CO 16,080 2,560 80 1,650 450 460 1,750 920 880 2,680 720 CT 16,920 2,720 220 1,680 500 400 1,950 690 730 3,360 860 DE 3,800 630 † 410 110 120 490 230 210 610 190 DC 2,820 520 † 340 170 50 310 80 90 610 190 FL 96,200 13,430 730 9,860 2,520 2,620 13,130 4,600 3,470 19,650 4,890 GA 35,650 5,850 360 3,480 890 820 4,800 1,610 1,380 5,660 1,530 HI 4,790 680 60 540 170 120 510 150 260 920 190 ID 5,490 940 60 540 170 150 630 380 210 1,150 340 IL 59,730 9,300 500 6,610 2,010 1,620 7,220 2,300 2,200 9,410 2,640 IN 31,900 4,600 170 3,410 1,010 820 4,410 1,460 1,410 4,890 1,390 IA 15,910 2,300 110 1,700 500 480 1,790 540 760 3,060 670 KS 12,930 1,990 80 1,570 390 350 1,630 540 650 2,060 720 KY 23,020 3,290 220 2,350 500 480 3,680 1,150 970 2,520 910 LA 23,280 3,870 220 2,580 500 540 3,090 770 1,060 3,440 770 ME 7,750 890 † 800 220 150 990 380 260 1,300 430 MD 25,450 4,390 220 2,760 780 680 3,210 1,070 1,030 4,210 1,150 MA 33,030 4,910 110 3,560 1,010 770 4,010 1,530 1,260 5,350 1,870 MI 50,220 7,210 340 4,830 1,450 1,250 6,110 1,840 2,140 7,650 2,350 MN 22,890 3,240 110 2,220 670 660 2,620 1,000 1,380 4,360 1,150 MS 14,970 2,350 140 1,630 340 370 2,180 460 530 3,210 480 MO 30,210 4,550 170 3,230 840 830 4,070 1,460 1,530 3,060 1,150 MT 4,910 680 † 460 170 140 620 230 210 990 240 NE 8,330 1,200 60 1,030 280 250 1,000 380 380 1,380 340 NV 11,120 1,620 80 1,240 220 260 1,530 540 440 1,990 530 NH 6,310 890 † 620 170 170 790 310 320 1,150 380 NJ 43,000 7,740 340 4,670 1,790 1,100 4,830 1,920 1,760 6,420 2,060 NM 7,780 990 60 880 280 170 760 310 320 1,680 340 NY 87,050 14,430 840 9,700 3,240 2,170 9,870 3,220 2,940 14,220 4,320 NC 40,520 6,330 310 4,100 1,170 990 5,520 1,920 1,760 6,810 1,580 ND 3,080 520 † 360 110 110 330 80 180 610 140 OH 59,680 9,670 390 6,500 1,850 1,510 7,790 2,450 1,970 10,860 3,070 OK 18,460 2,820 140 2,010 450 460 2,580 1,000 680 2,450 820 OR 17,720 2,610 140 1,760 450 420 2,160 1,000 1,000 2,980 1,010 PA 71,840 11,340 390 8,130 2,570 1,630 8,470 2,990 2,880 13,150 3,600 RI 5,870 780 60 650 110 120 720 310 290 840 340 SC 21,860 3,290 170 2,300 500 510 2,880 770 940 4,210 860 SD 3,900 520 † 460 110 110 430 150 230 920 190 TN 31,080 4,230 280 3,150 730 760 4,630 1,300 1,350 4,280 1,150 TX 86,880 12,860 1,030 9,270 2,400 2,250 11,210 3,830 3,050 13,380 3,410 UT 6,380 1,150 † 670 220 220 460 460 380 1,150 290 VT 3,030 470 † 340 110 90 390 150 180 460 190 VA 33,680 6,010 200 3,560 1,010 830 4,400 1,610 1,170 5,740 1,390 WA 27,350 3,920 110 2,660 890 720 3,440 1,380 1,410 5,510 1,250 WV 11,190 1,410 110 1,260 280 220 1,700 460 500 1,450 580 WI 26,340 4,130 80 2,760 840 770 3,060 1,230 1,120 4,050 1,340 WY 2,380 260 † 280 60 60 280 150 90 610 100 US 1,372,910 211,240 10,370 145,290 40,880 34,810 172,570 59,580 56,390 232,090 63,210 *Rounded to the nearest 10. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Estimate is fewer than 50 cases. Note: These estimates are offered as a rough guide and should be interpreted with caution. State estimates are calculated according to the distribution of estimated cancer deaths in 2005 by state. State estimates may not add to US total due to rounding and exclusion of state estimates fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2005. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account formore than 56% of all newly diagnosed cancers. Prostate cancer alone accounts for approximately 33% (232,090) of incident cases in men. Based on cases diagnosed between 1995 and 2000, about 90% of these estimated new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which 5‐year relative survival approaches 100%. FIGURE 1 The three most commonly diagnosed cancers among women in 2005 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for approximately 55% of estimated cancer cases in women. Breast cancer alone is expected to account for 32% (211,240) of all new cancer cases among women. Expected Number of New Cancer Deaths Table 1 also shows the expected number of cancer deaths in 2005 for men, women, and both sexes combined. It is estimated that approximately 570,280 Americans will die from cancer, corresponding to more than 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 fatal cancers. These four cancers account for one‐half of the total cancer deaths among men and women ( Figure 1 ). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 27% of all female cancer deaths in 2005. Table 3 provides the estimated number of cancer deaths in 2005 by state for selected cancer sites. TABLE 3 Age‐standardized Death Rates from All Cancers Combined and Estimated Cancer Deaths from All Causes and Selected Sites by State, United States, 2005* STATE Death Rate † per 100,000 All Sites Brain/Other Nervous System Female Breast Colon & Rectum Leukemia Liver Lung & Bronchus Non‐Hodgkin Lymphoma Ovary Pancreas Prostate AL 214.4 10,100 210 730 890 360 290 3,160 320 300 530 570 AK 199.2 800 ‡ 50 80 ‡ ‡ 210 ‡ ‡ 50 ‡ AZ 176.5 9,920 240 720 970 400 290 2,720 360 290 550 510 AR 211.5 6,210 160 400 630 260 200 2,400 220 160 310 270 CA 183.7 56,090 1,460 4,050 5,450 2,190 2,070 14,350 1,940 1,720 3,150 3,270 CO 172.2 6,680 180 490 640 300 170 1,660 300 220 400 350 CT 191.5 7,030 140 520 650 260 170 1,850 250 200 430 440 DE 217.4 1,580 ‡ 120 160 80 ‡ 460 70 50 100 80 DC 241.2 1,170 ‡ 100 130 ‡ ‡ 290 ‡ ‡ 60 80 FL 191.0 39,960 930 2,570 3,820 1,700 1,110 12,440 1,180 1,120 2,250 2,570 GA 205.1 14,810 300 1,120 1,350 530 340 4,550 470 420 770 740 HI 158.0 1,990 ‡ 130 210 80 100 480 90 50 150 120 ID 179.8 2,280 70 180 210 100 50 600 70 80 130 150 IL 208.9 24,810 480 1,780 2,560 1,050 680 6,840 750 650 1,470 1,230 IN 214.1 13,250 320 880 1,320 530 250 4,180 480 380 690 640 IA 189.7 6,610 160 440 660 310 120 1,700 260 210 390 400 KS 189.4 5,370 130 380 610 230 120 1,540 220 160 290 270 KY 227.0 9,560 160 630 910 320 200 3,490 330 230 420 330 LA 230.4 9,670 190 740 1,000 350 310 2,930 360 220 520 450 ME 212.2 3,220 80 170 310 100 70 940 90 100 180 170 MD 211.1 10,570 200 840 1,070 440 260 3,040 350 310 590 550 MA 205.4 13,720 280 940 1,380 500 370 3,800 430 380 850 700 MI 203.9 20,860 450 1,380 1,870 810 530 5,790 730 590 1,140 1,000 MN 187.5 9,510 250 620 860 430 210 2,480 470 270 550 570 MS 222.3 6,220 170 450 630 240 150 2,070 180 160 330 420 MO 207.9 12,550 260 870 1,250 540 290 3,860 520 340 670 400 MT 195.0 2,040 50 130 180 90 50 590 70 70 100 130 NE 184.8 3,460 90 230 400 160 60 950 130 100 180 180 NV 209.5 4,620 90 310 480 170 120 1,450 150 120 230 260 NH 205.2 2,620 70 170 240 110 70 750 110 60 140 150 NJ 208.3 17,860 320 1,480 1,810 710 410 4,580 600 540 1,050 840 NM 171.9 3,230 70 190 340 110 130 720 110 90 180 220 NY 194.1 36,160 720 2,760 3,760 1,410 1,010 9,350 1,000 1,080 2,270 1,860 NC 204.9 16,830 340 1,210 1,590 640 380 5,230 600 470 910 890 ND 184.7 1,280 ‡ 100 140 70 ‡ 310 60 ‡ 80 80 OH 212.4 24,790 530 1,850 2,520 980 570 7,380 670 660 1,300 1,420 OK 206.2 7,670 170 540 780 300 170 2,440 230 180 360 320 OR 198.9 7,360 190 500 680 270 160 2,050 340 240 410 390 PA 207.1 29,840 520 2,170 3,150 1,060 730 8,030 980 880 1,670 1,720 RI 208.4 2,440 50 150 250 80 60 680 100 60 140 110 SC 209.5 9,080 180 630 890 330 220 2,730 320 190 510 550 SD 191.0 1,620 50 100 180 70 ‡ 410 80 60 90 120 TN 216.3 12,910 320 810 1,220 490 300 4,390 460 350 680 560 TX 196.8 36,090 910 2,460 3,590 1,460 1,280 10,620 1,040 960 1,950 1,750 UT 151.0 2,650 90 220 260 140 60 440 130 90 170 150 VT 200.8 1,260 ‡ 90 130 60 ‡ 370 60 ‡ 70 60 VA 207.1 13,990 270 1,150 1,380 540 340 4,170 400 400 750 750 WA 195.3 11,360 350 750 1,030 470 340 3,260 480 390 690 720 WV 223.3 4,650 90 270 490 140 110 1,610 170 140 200 190 WI 194.3 10,940 260 790 1,070 500 290 2,900 380 320 650 530 WY 190.8 990 ‡ 50 110 ‡ ‡ 270 ‡ ‡ 50 80 US 199.8 570,280 12,760 40,410 56,290 22,570 15,420 163,510 19,200 16,210 31,800 30,350 *Rounded to the nearest 10; excludes in situ carcinomas except urinary bladder. †Average annual rates for 1997‐2001 and age‐adjusted to the 2000 US standard population. ‡Estimate is fewer than 50 deaths. Note: State estimates may not add to US total due to rounding and exclusion of state estimates for fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. Trends in Cancer Incidence and Mortality Figures 2 through 5 , depict long‐term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 4 shows incidence and mortality patterns for all cancer sites and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting in the table (joinpoint analysis) but not in the figures ( Figures 2 and 3 ). Death rates from all cancers combined decreased by 1.5% per year from 1993 to 2001 in males and by 0.8% per year in females from1992 to 2001 ( Table 4 ). Delay‐adjusted cancer incidence rates stabilized in men from 1995 to 2001 and increased by 0.3% per year from 1987 to 2001 in women ( Table 4 ). TABLE 4 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, All Races, 1975 to 2001 Line Segment 1 Line Segment 2 Line Segment 3 Line Segment 4 Year APC* Year APC* Year APC* Year APC* All Cancers Incidence Male and female 1975–1989 1.2 † 1989–1992 2.8 1992–1995 −2.1 1995–2001 0.4 Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.7 † 1995–2001 0.2 Female 1975–1979 −0.2 1979–1987 1.5 † 1987–2001 0.3 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2001 −1.1 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.4 1993–2001 −1.5 † Female 1975–1992 0.5 † 1992–2001 −0.8 † Lung & bronchus Incidence Male and female 1975–1982 2.5 † 1982–1991 1.0 † 1991–2001 −0.8 † Male 1975–1982 1.4 † 1982–1991 −0.4 1991–2001 −1.9 † Female 1975–1982 5.5 † 1982–1990 3.5 † 1990–1998 1.1 † 1998–2001 −1.3 Death Male and female 1975–1980 3.0 † 1980–1990 1.8 † 1990–1995 −0.2 1995–2001 −1.0 † Male 1975–1982 1.8 † 1982–1991 0.4 † 1991–2001 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2001 0.2 Colon & rectum Incidence Male and female 1975–1985 0.8 † 1985–1995 −1.8 † 1995–1998 1.3 1998–2001 −2.4 † Male 1975–1986 1.1 † 1986–1995 −2.1 † 1995–1998 1.1 1998–2001 −2.9 † Female 1975–1985 0.3 † 1985–1995 −1.9 † 1995–1998 1.8 1998–2001 −2.3 † Death Male and female 1975–1984 −0.5 † 1984–2001 −1.8 † Male 1975–1984 −0.1 1984–1990 −1.4 † 1990–2001 −2.0 † Female 1975–1984 −1.0 † 1984–2001 −1.8 † Female breast Incidence 1975–1980 −0.4 1980–1987 3.7 † 1987–2001 0.5 † Death 1975–1990 0.4 † 1990–2001 −2.3 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.5 † 1995–2001 2.0 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2001 −4.1 † *APC, annual percent change based on rates age‐adjusted to the 2000 standard population. †The APC is significantly different from zero. Note: Trends were analyzed by Joinpoint Regression Program, version 2.7, with a maximum of three joinpoints (ie, four line segments). Trends in incidence are based on rates adjusted for delay in reporting. Source: Ries LAG, Eisner MP, Kosary CL, et al. FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 Mortality rates have continued to decrease across all four major cancer sites in men and in women except for female lung cancer in which rates have leveled off for the first time after increasing for many decades ( Table 4 ). The incidence trends are mixed, however. Lung cancer incidence rates are declining in men and leveled off for the first time in women after increasing for many decades. Colorectal cancer incidence rates have decreased from 1998 through 2001 both in males and in females. The incidence rates of prostate cancer and female breast cancer have continued to increase, although at a slower rate than in previous years. The continuing increase may be attributable to increased screening through prostate‐specific antigen testing (for prostate cancer) and mammography (for breast cancer). The increase in female breast cancer incidence may also reflect increased use of hormone replacement therapy and/or increased prevalence of obesity. Changes in the Recorded Number of Deaths From Cancer From 2001 to 2002 A total of 557,271 cancer deaths were recorded in the United States in 2002, the most recent year for which actual data are available. More than 3,500 additional cancer deaths were recorded in 2002 than in 2001, predominantly because of growth and aging of the population. Cancer accounted for approximately 23% of all deaths, ranking second only to heart disease ( Table 5 ). When age‐adjusted death rates are considered ( Figure 6 ), cancer is the leading cause of death among men and women under age 85. A total of 476,009 people under age 85 died from cancer in the United States in 2002 compared with 450,637 deaths from heart disease. When cause of death is ranked within each age group, categorized in 20‐year age intervals, cancer is one of the five leading causes of death in each age group among both males and females. Cancer is the leading cause of death among women aged 40 to 79 and among men aged 60 to 79 ( Table 6 ). TABLE 5 Fifteen Leading Causes of Death, United States, 2002 Rank Causes of Death Number of Deaths Percent (%) of Total Deaths Death Rate* All causes 2,443,387 843.6 1 Heart diseases 696,947 28.5 240.1 2 Cancer 557,271 22.8 193.4 3 Cerebrovascular diseases 162,672 6.7 56.0 4 Chronic lower respiratory diseases 124,816 5.1 43.4 5 Accidents (unintentional injuries) 106,742 4.4 36.8 6 Diabetes mellitus 73,249 3.0 25.4 7 Influenza & pneumonia 65,681 2.7 22.5 8 Alzheimer disease 58,866 2.4 20.1 9 Nephritis, nephrotic syndrome, & nephrosis 40,974 1.7 14.2 10 Septicemia 33,865 1.4 11.7 11 Intentional self‐harm (suicide) 31,655 1.3 10.9 12 Chronic liver disease & cirrhosis 27,257 1.1 9.4 13 Hypertension and hypertensive renal disease 20,261 0.8 7.0 14 Assault (homicide) 17,638 0.7 6.1 15 Parkinson disease 16,959 0.7 5.9 All other & ill‐defined causes 408,534 *Rates are per 100,000 population and age‐adjusted to the 2000 US standard population. Note: Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities and pneumonitis due to solids and liquids were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tape, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. FIGURE 6 TABLE 6 Ten Leading Causes of Death, by Age and Sex, United States, 2002 All Ages Ages 1 to 19 Ages 20 to 39 Ages 40 to 59 Ages 60 to 79 Ages 80+ Male Female Male Female Male Female Male Female Male Female Male Female All Causes 1,199,264 All Causes 1,244,123 All Causes 16,848 All Causes 8,972 All Causes 65,934 All Causes 30,002 All Causes 212,519 All Causes 131,100 All Causes 488,179 All Causes 402,852 All Causes 399,785 All Causes 658,805 1 Heart diseases 340,933 Heart diseases 356,014 Accidents (unintentional injuries) 7,718 Accidents (unintentional injuries) 3,778 Accidents (unintentional injuries) 21,627 Accidents (unintentional injuries) 6,859 Heart diseases 54,028 Cancer 49,570 Cancer 156,527 Cancer 129,699 Heart diseases 136,941 Heart diseases 231,969 2 Cancer 288,768 Cancer 268,503 Assault (homicide) 2,035 Cancer 957 Intentional self‐harm (suicide) 8,771 Cancer 5,403 Cancer 52,489 Heart diseases 21,677 Heart diseases 143,570 Heart diseases 99,160 Cancer 73,839 Cancer 82,840 3 Accidents (unintentional injuries) 69,257 Cerebro‐vascular disease 100,050 Intentional self‐harm (suicide) 1,479 Assault (homicide) 636 Assault (homicide) 7,827 Heart diseases 2,640 Accidents (unintentional injuries) 20,224 Accidents (unintentional injuries) 8,076 Chronic lower respiratory diseases 31,438 Chronic lower respiratory diseases 29,905 Cerebro‐vascular diseases 30,688 Cerebro‐vascular diseases 67,702 4 Cerebro‐vascular disease 62,622 Chronic lower respiratory diseases 64,103 Cancer 1,240 Congenital anomalies 552 Heart diseases 5,590 Intentional self‐harm (suicide) 1,913 Intentional self‐harm (suicide) 9,325 Cerebro‐vascular diseases 5,536 Cerebro‐vascular disease 24,573 Cerebro‐vascular diseases 25,934 Chronic lower respiratory diseases 24,411 Alzheimer disease 35,225 5 Chronic lower respiratory diseases 60,713 Alzheimer disease 41,877 Congenital anomalies 643 Heart diseases 322 Cancer 4,626 Assault (homicide) 1,723 Chronic liver disease & cirrhosis 9,082 Diabetes mellitus 4,675 Diabetes mellitus 16,886 Diabetes mellitus 17,038 Influenza & pneumonia 16,980 Chronic lower respiratory diseases 29,619 6 Diabetes mellitus 34,301 Diabetes mellitus 38,948 Heart disease 503 Intentional self‐harm (suicide) 298 HIV disease 3,206 HIV disease 1,391 Diabetes mellitus 6,719 Chronic lower respiratory diseases 4,089 Accidents (unintentional injuries) 10,825 Influenza & pneumonia 7,508 Alzheimer disease 12,384 Influenza & pneumonia 27,094 7 Influenza & pneumonia 28,918 Accidents (unintentional injuries) 37,485 Chronic lower respiratory diseases 186 Influenza & pneumonia 134 Diabetes mellitus 905 Cerebro‐vascular disease 740 HIV disease6,450 Chronic liver disease & cirrhosis 3,617 Influenza & pneumonia8,960 Nephritis, nephrotic syndrome & nephrosis 7,375 Diabetes mellitus 9,737 Diabetes mellitus 16,566 8 Intentional self‐harm (suicide) 25,409 Influenza & pneumonia 36,763 Influenza & pneumonia 142 Chronic lower respiratory diseases 108 Chronic liver disease & cirrhosis 852 Diabetes mellitus 629 Cerebro‐vascular diseases 6,440 Intentional self‐harm (suicide) 2,879 Nephritis, nephrotic syndrome & nephrosis 8,077 Accidents (unintentional injuries) 6,987 Nephritis, nephrotic syndrome & nephrosis 9,030 Nephritis, nephrotic syndrome & nephrosis 11,784 9 Nephritis, nephrotic syndrome & nephrosis 19,695 Nephritis, nephrotic syndrome & nephrosis 21,279 Septecemia 115 Septicemia 108 Cerebro‐vascular disease 742 Chronic liver disease & cirrhosis 475 Chronic lower respiratory diseases 4,274 HIV disease 1,998 Septicemia 6,611 Septicemia 6,781 Accidents (unintentional injuries) 8,236 Accidents (unintentional injuries) 11,381 10 Chronic liver disease & cirrhosis 17,401 Septicemia 18,918 Cerebro‐vascular disease 111 In Situ/Benign unknown neoplasms 90 Congenital anomalies 552 Congenital anomalies 431 Assault (homicide) 2,875 Septicemia 1,938 Chronic Liver disease & cirrhosis 6,313 Alzheimer disease 6,542 Parkinson disease 5,805 Septicemia 9,614 Note: Symptoms, signs, and abnormalities and events of undetermined intent were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. Table 7 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among men under age 40, leukemia is the most common fatal cancer, while cancer of the lung and bronchus predominates in men aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men 40 to 79 years old, and prostate cancer is the second most common among men aged 80 and older. Among women, leukemia is the leading cause of cancer death before age 20, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at age 60 years and older. TABLE 7 Reported Deaths for the Five Leading Cancer Sites, by Age and Sex, United States, 2002 All Ages <20 20 to 39 40 to 59 60 to 79 ≥80 Male All Sites 288,768 All Sites 1,282 All Sites 4,626 All Sites 52,489 All Sites 156,527 All Sites 73,839 Lung & bronchus 90,121 Leukemia 382 Leukemia 599 Lung & bronchus 16,044 Lung & bronchus 55,996 Lung & bronchus 17,681 Prostate 30,446 Brain & ONS* 327 Brain & ONS* 516 Colon & rectum 5,257 Colon & rectum 14,973 Prostate 15,795 Colon & rectum 28,472 Other endocrine system 104 Colon & rectum 413 Pancreas 3,195 Prostate 13,539 Colon & rectum 7,820 Pancreas 14,877 Bones & joints 96 Non‐Hodgkin lymphoma 401 Liver & bile duct 2,733 Pancreas 8,312 Leukemia 3,409 Leukemia 12,058 Soft tissue 82 Lung & bronchus 394 Esophagus 2,470 Leukemia 5,919 Urinary bladder 3,331 Female All Sites 268,503 All Sites 989 All Sites 5,403 All Sites 49,570 All Sites 129,699 All Sites 82,840 Lung & bronchus 67,509 Leukemia 296 Breast 1,331 Breast 12,115 Lung & bronchus 39,943 Lung & bronchus 16,064 Breast 41,514 Brain & ONS* 244 Uterine cervix 499 Lung & bronchus 11,129 Breast 17,218 Colon & rectum 12,030 Colon & rectum 28,132 Other endocrine system 88 Leukemia 433 Colon & rectum 3,857 Colon & rectum 11,904 Breast 10,849 Pancreas 15,387 Bones & joints 83 Lung & bronchus 370 Ovary 3,285 Pancreas 7,869 Pancreas 5,436 Ovary 14,682 Soft tissue 71 Brain & ONS* 349 Pancreas 1,999 Ovary 7,349 Non‐Hodgkin lymphoma 4,029 *ONS, other nervous system. Note: Others and Unspecified Primary are excluded from cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. From 2001 to 2002, the number of recorded cancer deaths increased by 1,693 in men and by 1,810 in women ( Table 8 ). The total number of deaths for the major cancers in men and women did not change substantially except for lung cancer (increased by 1,903) and colorectal cancer (decreased by 447) among women. TABLE 8 Trends in the Recorded Number of Cancer Deaths for Selected Cancers, by Sex, United States, 1989 to 2002 Year All Sites Lung and Bronchus Colon and Rectum Prostate Breast Male Female Male Female Male Female Male Female 1989 263,309 232,843 88,975 48,042 28,123 28,903 30,520 42,837 1990 268,283 237,039 91,014 50,136 28,484 28,674 32,378 43,391 1991 272,380 242,277 91,603 52,022 28,026 28,753 33,564 43,583 1992 274,838 245,740 91,322 54,485 28,280 28,714 34,240 43,068 1993 279,375 250,529 92,493 56,234 28,199 29,206 34,865 43,555 1994 280,465 253,845 91,825 57,535 28,471 28,936 34,902 43,644 1995 281,611 256,844 91,800 59,304 28,409 29,237 34,475 43,844 1996 281,898 257,635 91,559 60,351 27,989 28,766 34,123 43,091 1997 281,110 258,467 91,278 61,922 28,075 28,621 32,891 41,943 1998 282,065 259,467 91,399 63,075 28,024 28,950 32,203 41,737 1999 285,832 264,006 89,401 62,662 28,313 28,909 31,729 41,144 2000 286,082 267,009 90,415 65,016 28,484 28,950 31,078 41,872 2001 287,075 266,693 90,367 65,606 28,229 28,579 30,719 41,394 2002 288,768 268,503 90,121 67,509 28,472 28,132 30,446 41,514 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. Source: US Mortality Public Use Data Tapes, 1989 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. CANCER OCCURRENCE BY RACE AND ETHNICITY Cancer incidence and death rates vary considerably among racial and ethnic groups ( Table 9 ). For all cancer sites combined, African American men have a 24% higher incidence rate and 40% higher death rate than Whites. African American women have a lower incidence rate but nearly 20% higher death rate than Whites for all cancer sites combined. For the specific cancer sites listed in Table 9 , incidence and death rates are consistently higher in African Americans than in Whites, except for breast cancer (incidence) and lung cancer (mortality) among women. Death rates from prostate, stomach, and cervical cancers among African Americans are more than twice the rates in Whites. Factors that contribute to these mortality differences include differences in exposure (eg, Helicobacter pylori for stomach cancer), access to regular screening (breast, cervical, and colorectal cancers), and timely, high quality treatments (many cancers). The higher breast cancer incidence rates among Whites are thought to reflect a combination of more frequent mammography, which makes diagnosis more likely, delayed age at first birth, and historically greater use of hormone replacement therapy. TABLE 9 Age‐standardized Incidence and Death Rates* for Selected Cancer Sites by Race and Ethnicity, United States, 1997 to 2001 All Races White African American Asian American/Pacific Islander American Indian/Alaskan Native Hispanic‐Latino † Incidence Rates All sites Male 554.3 556.5 689.2 385.9 263.2 419.8 Female 414.4 429.8 400.1 302.8 222.5 309.9 Breast (Female) 135.2 141.7 119.9 96.8 54.2 89.6 Colon & rectum Male 63.4 63.1 72.9 56.3 38.3 49.6 Female 46.4 45.9 56.5 38.6 32.7 32.5 Lung & bronchus Male 79.1 77.9 117.2 60.5 46.0 45.2 Female 49.1 51.3 54.5 28.5 23.4 23.9 Prostate 172.3 167.4 271.3 100.7 51.2 140.0 Stomach Male 12.6 10.8 18.8 21.9 15.7 17.8 Female 6.1 5.0 9.9 12.4 8.9 10.0 Liver & bile duct Male 9.1 7.2 11.8 21.1 8.3 13.5 Female 3.5 2.9 3.9 7.7 4.8 5.8 Uterine cervix 9.3 8.9 11.8 9.5 6.0 16.2 Death Rates All sites Male 251.1 245.5 347.3 151.2 167.0 174.0 Female 166.7 165.5 196.5 100.5 113.4 111.6 Breast (female) 27.0 26.4 35.4 12.6 13.6 17.3 Colon & rectum Male 25.3 24.8 34.3 15.8 17.1 18.0 Female 17.7 17.1 24.5 10.8 11.7 11.6 Lung & bronchus Male 77.9 76.6 104.1 40.2 49.8 39.6 Female 40.8 41.6 39.9 19.2 26.6 14.9 Prostate 31.5 28.8 70.4 13.0 20.2 23.5 Stomach Male 6.6 5.8 13.3 11.9 7.3 9.7 Female 3.3 2.8 6.3 7.0 4.1 5.3 Liver & bile duct Male 6.7 6.1 9.3 15.6 8.3 10.6 Female 2.9 2.7 3.8 6.6 4.3 5.1 Uterine cervix 2.9 2.6 5.6 2.8 2.8 3.6 *Rates are per 100,000 and age‐adjusted to the 2000 US standard population. †Hispanics‐Latinos are not mutually exclusive from Whites, African Americans, Asian Americans/Pacific Islanders, and American Indians/Alaskan Natives. Source: Ries LAG, Eisner MP, Kosary CL, et al. Among other racial and ethnic groups, cancer incidence and death rates are lower for all cancer sites combined and for the four most common cancer sites than those for Whites and African Americans. However, incidence and death rates for cancers of the uterine cervix, stomach, and liver are generally higher in minority population than in Whites. Stomach and liver cancer incidence and death rates are more than twice as high in Asian/Pacific Islanders than in Whites, reflecting increased exposure to infectious agents such as H pylori and hepatitis C virus. Historical information to adjust for delays in reporting is not available for all racial and ethnic groups. From 1992 to 2001, incidence rates for all cancer sites combined, not adjusted for delayed reporting, decreased by 2.8% per year among American Indians/Alaskan Natives, by 1.2% per year in African Americans, by 0.7% among Asian/Pacific Islanders, by 0.6% among Hispanic‐Latinos, and by 0.5% among Whites (data not shown). Similarly, the death rate from all cancers combined decreased from 1992 through 2001 by 1.6% per year in Asian/Pacific Islanders, by 1.4% among African Americans, by 0.9% among Whites, and by 0.5% among Hispanic‐Latinos. The death rate from all cancers combined stabilized during this time period among American Indians/Alaskan Natives. Lifetime Probability of Developing Cancer The lifetime probability of developing cancer is higher for men (46%) than for women (38%) ( Table 10 ). However, because of the relatively early age of onset of breast cancer, women have a slightly higher probability of developing cancer before the age of 60. It is noteworthy that these estimates are based on the average experience of the general population and may overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility. TABLE 10 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, United States, 1999 to 2001* Birth to 39 (%) 40 to 59 (%) 60 to 79 (%) Birth to Death (%) All sites † Male 1.41 (1 in 71) 8.52 (1 in 12) 34.63 (1 in 3) 45.59 (1 in 2) Female 1.97 (1 in 51) 9.10 (1 in 11) 22.51 (1 in 4) 38.18 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4264) 0.41 (1 in 243) 2.42 (1 in 41) 3.56 (1 in 28) Female 0.01 (1 in 8876) 0.12 (1 in 804) 0.65 (1 in 153) 1.13 (1 in 88) Breast Female 0.48 (1 in 207) 4.18 (1 in 24) 7.49 (1 in 13) 13.39 (1 in 7) Colon & rectum Male 0.07 (1 in 1484) 0.90 (1 in 111) 3.96 (1 in 25) 5.90 (1 in 17) Female 0.06 (1 in 1586) 0.69 (1 in 145) 3.04 (1 in 33) 5.54 (1 in 18) Leukemia Male 0.15 (1 in 659) 0.22 (1 in 461) 0.85 (1 in 118) 1.47 (1 in 68) Female 0.13 (1 in 799) 0.14 (1 in 697) 0.48 (1 in 206) 1.04 (1 in 96) Lung & bronchus Male 0.03 (1 in 3164) 1.06 (1 in 95) 5.75 (1 in 17) 7.63 (1 in 13) Female 0.03 (1 in 2977) 0.81 (1 in 123) 3.91 (1 in 26) 5.71 (1 in 18) Melanoma of the skin Male 0.13 (1 in 795) 0.51 (1 in 195) 1.08 (1 in 93) 1.89 (1 in 53) Female 0.21 (1 in 484) 0.40 (1 in 248) 0.53 (1 in 190) 1.28 (1 in 78) Non‐Hodgkin lymphoma Male 0.14 (1 in 724) 0.46 (1 in 217) 1.32 (1 in 76) 2.18 (1 in 46) Female 0.09 (1 in 1147) 0.31 (1 in 328) 1.00 (1 in 100) 1.80 (1 in 56) Prostate Male 0.01 (1 in 9879) 2.58 (1 in 39) 14.76 (1 in 7) 17.81 (1 in 6) Uterine cervix Female 0.16 (1 in 636) 0.29 (1 in 340) 0.27 (1 in 368) 0.77 (1 in 130) Uterine corpus Female 0.06 (1 in 1632) 0.72 (1 in 139) 1.57 (1 in 64) 2.62 (1 in 38) *For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 1999 to 2001. †The “1 in” statistic and the inverse of the percentage may not be equivalent due to rounding. ‡All sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. Source: DEVCAN Software, Probability of Developing or Dying of Cancer Software, Version 5.2. Statistical Research and Applications Branch, National Cancer Institute, 2005. http://srab.cancer.gov/devcan . Cancer Survival by Race African American men and women have poorer probability of survival once a cancer diagnosis is made. As shown in Figure 7 , 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. Five‐year relative survival is lower in African Americans than in Whites at each stage of diagnosis for nearly every cancer site ( Figure 8 ). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. The extent to which these factors, individually or collectively, contribute to the overall differential survival is unclear. However, recent findings suggest that when African Americans receive similar cancer treatment and medical care as Whites they tend to have similar disease outcomes. FIGURE 7 FIGURE 8 There have been notable improvements over time in the relative 5‐year survival rates for the common cancer sites and all cancers combined ( Table 11 ). This is true for both Whites and African Americans. Cancer sites for which survival has not improved substantially over the past 25 years include uterine corpus, uterine cervix, larynx, liver, lung, pancreas, stomach, and esophagus. TABLE 11 Trends in Five‐year Relative Survival Rates* (%) for Selected Cancer Sites, by Race and Year of Diagnosis, United States, 1974 to 2000 Site Relative Five‐year Survival Rate (%) White African American All Races 1974 to 1976 1983 to 1985 1995 to 2000 1974 to 1976 1983 to 1985 1995 to 2000 1974 to 1976 1983 to 1985 1995 to 2000 All Cancers 51 54 66 † 39 40 55 † 50 53 64 † Brain & ONS ‡ 22 26 32 † 27 32 38 † 22 27 33 † Breast (female) 75 79 89 † 63 64 75 † 75 78 88 † Colon 51 59 64 † 46 50 54 † 50 58 63 † Esophagus 5 9 16 † 4 6 9 † 5 8 14 † Hodgkin disease 72 79 86 † 69 77 80 † 71 79 85 † Kidney & renal pelvis 52 56 64 † 49 55 64 † 52 56 64 † Larynx 66 69 67 60 55 51 66 67 65 Leukemia 35 42 48 † 31 34 39 34 41 46 † Liver & bile duct 4 6 8 † 1 4 5 † 4 6 8 † Lung & bronchus 13 14 15 † 12 11 13 † 13 14 15 † Melanoma of the skin 81 85 91 † 67 § 75 ¶ 74 § 80 85 91 † Myeloma 24 27 32 † 28 31 32 25 28 32 † Non‐Hodgkin lymphoma 48 55 60 † 49 45 51 47 54 59 † Oral cavity & pharynx 55 55 61 † 36 35 39 54 53 59 † Ovary** 37 40 44 † 41 42 38 37 41 44 † Pancreas 3 3 4 † 3 5 4 † 3 3 4 † Prostate 68 76 100 † 58 64 96 † 67 75 99 † Rectum 49 56 65 † 42 44 55 † 49 55 64 † Stomach 15 16 22 † 16 19 24 † 15 17 23 † Testis 79 91 96 † 76 § 88 § 87 79 91 96 † Thyroid 92 93 97 † 88 92 95 92 94 97 † Urinary bladder 74 78 83 † 48 60 62 † 73 78 82 † Uterine cervix 70 71 74 † 64 61 66 69 69 73 † Uterine corpus 89 85 86 † 62 54 63 88 83 84 † *Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1974 to 1976, 1983 to 1985, and 1995 to 2000, and followed through 2001. †The difference in rates between 1974 to 1976 and 1995 to 2000 is statistically significant ( P < 0.05). ‡ONS, other nervous system. §The standard error of the survival rate is between 5 and 10 percentage points. ¶The standard error of the survival rate is greater than 10 percentage points. **Recent changes in classification of ovarian cancer, namely excluding borderline ovarian tumors, have affected 1995‐2000 survival rates. Source: Ries LAG, Eisner MP, Kosary CL, et al. Relative survival rate cannot be calculated for other racial and ethnic groups because accurate life expectancies are not available. However, based on cause‐specific survival rates of cancer patients diagnosed from 1992 to 2000 in SEER areas of the United States, all minority populations except Asian/Pacific Islander women have an elevated probability of dying from all cancers combined within 5 years of diagnosis compared with non‐Hispanic Whites after accounting for differences in age at diagnosis. , For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely to be diagnosed at distant stage compared with non‐Hispanic Whites. CANCER IN CHILDREN Cancer is the second leading cause of death among children between the ages of 1 and 14 in the United States; accidents are the most frequent cause of death in this age group ( Table 12 ). The most commonly occurring cancers in children (0 to 14 years) are leukemia (particularly acute lymphocytic leukemia), brain and other nervous system cancers, soft tissue sarcomas, non‐Hodgkin lymphoma, and renal (Wilms) tumor. Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for many childhood cancers, including non‐Hodgkin lymphoma, acute lymphocytic leukemia, acute myeloid leukemia, and Wilms tumor ( Table 13 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 56% for patients diagnosed in 1974 to 1976 to 79% for those diagnosed in 1995 to 2000. TABLE 12 Fifteen Leading Causes of Death Among Children Aged 1 to 14, United States, 2002 Rank Cause of Death Number of Deaths Percent (%) of Total Deaths* Death Rate † All Causes 12,008 100.0 21.2 1 Accidents (unintentional injuries) 4,359 36.3 7.7 2 Cancer 1,474 12.3 2.6 3 Congenital anomalies 947 7.9 1.7 4 Assault (homicide) 779 6.5 1.4 5 Heart diseases 420 3.5 0.7 6 Intentional self‐harm (suicide) 264 2.2 0.5 7 Chronic lower respiratory disease 201 1.7 0.4 8 Influenza & pneumonia 201 1.7 0.4 9 Septicemia 174 1.4 0.3 10 In situ & benign neoplasms 149 1.2 0.3 11 Cerebrovascular disease 144 1.2 0.3 12 Anemias 74 0.6 0.1 13 Meningitis 50 0.4 0.1 14 Diabetes mellitus 37 0.3 0.1 15 Nephritis, nephrotic syndrome, & nephrosis 35 0.3 0.1 All other causes 2,700 22.5 *Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities, events of undetermined intent, certain perinatal conditions, and complications from treatment were excluded from ranking order. †Rates are per 100,000 population and age‐adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004. TABLE 13 Trends in Five‐year Relative Cancer Survival Rates* (%) for Children Under Age 15, United States, 1974 to 2000 Site Five‐year Relative Survival Rates (%) Year of Diagnosis 1974 to 1976 1977 to 1979 1980 to 1982 1983 to 1985 1986 to 1988 1989 to 1991 1995 to 2000 All sites 56 62 65 68 71 73 79 † Acute lymphocytic leukemia 53 67 71 69 78 80 85 † Acute myeloidleukemia 14 26 ‡ 25 ‡ 30 ‡ 33 ‡ 36 ‡ 53 † Bones & joints 55 ‡ 52 ‡ 54 ‡ 57 ‡ 63 ‡ 62 73 † Brain & other nervous system 55 56 56 62 63 62 73 † Hodgkin disease 78 84 91 90 90 94 96 † Neuroblastoma 53 53 53 55 60 68 66 † Non‐Hodgkin lymphoma 45 50 61 71 70 75 85 † Soft tissue 60 68 65 70 67 78 75 † Wilms tumor 74 78 86 87 91 93 92 † *Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2001. †The difference in rates between 1974 to 1976 and 1995 to 2000 is statistically significant ( P < 0.05). ‡The standard error of the survival rate is between 5 and 10 percentage points. Note: “All sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Ries LAG, Eisner MP, Kosary CL, et al. LIMITATIONS AND FUTURE CHALLENGES Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously. These estimates may vary considerably from year to year, particularly for less common cancers and in states with smaller populations. Unanticipated changes may occur that are not captured by our modeling efforts. The 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 these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and mortality. The recorded number of cancer deaths and cancer death rates from the NCHS and cancer incidence rates from SEER are generally the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, at the time that the estimates are calculated. 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 in continuing efforts to reduce the public health burden of cancer.

Journal

CA: A Cancer Journal for CliniciansWiley

Published: Jan 1, 2005

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