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Cancer Statistics, 2007

Cancer Statistics, 2007 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 2007. MATERIALS AND METHODS Data Sources Mortality data from 1930 to 2004 in the United States were obtained from the National Center for Health Statistics (NCHS). Incidence data for long‐term trends (1975 to 2003), 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, covering about 26% of the US population. , , , Incidence data (1995 to 2003) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR), through the North American Associations of Central Cancer Registries (NAACCR). State‐specific incidence rates were abstracted from Cancer in North America (1999–2003) Volume One , based on data collected by cancer registries participating in the SEER program and NPCR. 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 some states. Since the American Cancer Society (ACS) began producing estimates of new cancer cases in the current year, the method has been refined several times to take advantage of improvements in data and statistical methods. Beginning with 2007, we are using a new projection method described by Pickle et al in an accompanying article inthis issue of CA . The new method is a spatio‐temporal model based on incidence data from 1995 through 2003 from 41 states that met NAACCR's high‐quality data standard for incidence, covering about 86% of the US population. This contrasts with the previous quadratic autoregressive model based on incidence data from the nine oldest SEER registries, covering about 10% of the US population. Furthermore, the new method considers geographic variations in socio‐demographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence, and accounts for expected delays in case reporting. 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 2007. 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 2007 based on the number that occurred each year from 1969 to 2004 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 2004. Causes of death for 2004 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 1975 through 2003. 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 rates and trends (1975 to 2003) are adjusted for delays in reporting where possible. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 2001 to 2003), especially for cancers such as melanoma and prostate that are frequently diagnosed in outpatient settings. The National Cancer Institute (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 estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2007. The overall estimate of about 1.44 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. More than 1 million additional cases of basal cell and squamous cell skin cancer, about 62,030 cases of breast carcinoma in situ, and 48,290 cases of in situ melanoma are expected to be newly diagnosed in 2007. Because of the introduction of a new projection method, estimates have been affected for many individual cancer sites, particularly for leukemia, female breast, lung, and prostate cancers. 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, US, 2007* Estimated New Cases Estimated Deaths Both Sexes Male Female Both sexes Male Female All Sites 1,444,920 766,860 678,060 559,650 289,550 270,100 Oral cavity & pharynx 34,360 24,180 10,180 7,550 5,180 2,370 Tongue 9,800 6,930 2,870 1,830 1,180 650 Mouth 10,660 6,480 4,180 1,860 1,110 750 Pharynx 11,800 9,310 2,490 2,180 1,620 560 Other oral cavity 2,100 1,460 640 1,680 1,270 410 Digestive system 271,250 147,390 123,860 134,710 74,500 60,210 Esophagus 15,560 12,130 3,430 13,940 10,900 3,040 Stomach 21,260 13,000 8,260 11,210 6,610 4,600 Small intestine 5,640 2,940 2,700 1,090 570 520 Colon † 112,340 55,290 57,050 52,180 26,000 26,180 Rectum 41,420 23,840 17,580 Anus, anal canal, & anorectum 4,650 1,900 2,750 690 260 430 Liver & intrahepatic bile duct 19,160 13,650 5,510 16,780 11,280 5,500 Gallbladder & other biliary 9,250 4,380 4,870 3,250 1,260 1,990 Pancreas 37,170 18,830 18,340 33,370 16,840 16,530 Other digestive organs 4,800 1,430 3,370 2,200 780 1,420 Respiratory system 229,400 127,090 102,310 164,840 92,910 71,930 Larynx 11,300 8,960 2,340 3,660 2,900 760 Lung & bronchus 213,380 114,760 98,620 160,390 89,510 70,880 Other respiratory organs 4,720 3,370 1,350 790 500 290 Bones & joints 2,370 1,330 1,040 1,330 740 590 Soft tissue (including heart) 9,220 5,050 4,170 3,560 1,840 1,720 Skin (excluding basal & squamous) 65,050 37,070 27,980 10,850 7,140 3,710 Melanoma‐skin 59,940 33,910 26,030 8,110 5,220 2,890 Other nonepithelial skin 5,110 3,160 1,950 2,740 1,920 820 Breast 180,510 2,030 178,480 40,910 450 40,460 Genital system 306,380 228,090 78,290 55,740 27,720 28,020 Uterine cervix 11,150 11,150 3,670 3,670 Uterine corpus 39,080 39,080 7,400 7,400 Ovary 22,430 22,430 15,280 15,280 Vulva 3,490 3,490 880 880 Vagina & other genital, female 2,140 2,140 790 790 Prostate 218,890 218,890 27,050 27,050 Testis 7,920 7,920 380 380 Penis & other genital, male 1,280 1,280 290 290 Urinary system 120,400 82,960 37,440 27,340 18,100 9,240 Urinary bladder 67,160 50,040 17,120 13,750 9,630 4,120 Kidney & renal pelvis 51,190 31,590 19,600 12,890 8,080 4,810 Ureter & other urinary organs 2,050 1,330 720 700 390 310 Eye & orbit 2,340 1,310 1,030 220 110 110 Brain & other nervous system 20,500 11,170 9,330 12,740 7,150 5,590 Endocrine system 35,520 9,040 26,480 2,320 1,030 1,290 Thyroid 33,550 8,070 25,480 1,530 650 880 Other endocrine 1,970 970 1,000 790 380 410 Lymphoma 71,380 38,670 32,710 19,730 10,370 9,360 Hodgkin lymphoma 8,190 4,470 3,720 1,070 770 300 Non‐Hodgkin lymphoma 63,190 34,200 28,990 18,660 9,600 9,060 Multiple myeloma 19,900 10,960 8,940 10,790 5,550 5,240 Leukemia 44,240 24,800 19,440 21,790 12,320 9,470 Acute lymphocytic leukemia 5,200 3,060 2,140 1,420 820 600 Chronic lymphocytic leukemia 15,340 8,960 6,380 4,500 2,560 1,940 Acute myeloid leukemia 13,410 7,060 6,350 8,990 5,020 3,970 Chronic myeloid leukemia 4,570 2,570 2,000 490 240 250 Other leukemia ‡ 5,720 3,150 2,570 6,390 3,680 2,710 Other & unspecified primary sites ‡ 32,100 15,720 16,380 45,230 24,440 20,790 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 62,030 female carcinoma in situ of the breast and 48,290 melanoma in situ will be newly diagnosed in 2007. †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: Estimated new cases are based on 1995‐2003 incidence rates from 41 states as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 86% of the US population. Estimated deaths are based on data from US Mortality Public Use Data Tapes, 1969 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 2 Age‐standardized Incidence Rates for All Cancers Combined, 1999‐2003, and Estimated New Cases* for Selected Cancers by State, US, 2007 State Incidence Rate † All Cases Female Breast Uterine Cervix Colon & Rectum Uterine Corpus Leukemia Lung & Bronchus Melanoma of the Skin Non‐Hodgkin Lymphoma Prostate Urinary Bladder AL 429.0 20,590 2,750 170 2,350 460 550 3,850 740 860 3,010 850 AK 480.7 2,500 340 ‡ 270 60 70 330 80 110 420 110 AZ § 26,270 3,220 190 2,750 550 740 3,740 1,300 1,080 3,400 1,360 AR § 14,130 1,830 130 1,640 320 510 2,420 550 600 1,960 560 CA 448.2 151,250 19,790 1,350 15,000 3,870 4,610 17,920 6,860 7,190 24,590 6,590 CO 446.8 19,190 2,660 150 1,790 490 670 2,100 1,210 880 3,160 880 CT 508.0 19,780 2,510 100 2,190 650 610 2,720 1,120 870 2,890 1,090 DE 497.4 4,530 560 ‡ 480 130 110 770 190 170 800 220 DC 507.2 2,540 320 ‡ 270 70 60 380 60 100 540 90 FL 478.6 106,560 11,710 850 11,420 2,490 3,360 17,490 4,380 4,530 15,710 5,460 GA 460.3 35,440 4,520 330 3,690 810 960 5,780 1,460 1,370 5,850 1,360 HI 418.5 6,020 820 50 790 170 170 690 270 250 780 200 ID 453.2 6,140 780 ‡ 600 150 220 760 350 280 1,080 310 IL 486.4 62,010 7,030 530 6,890 1,730 2,030 9,550 2,050 2,670 8,060 2,880 IN 465.4 30,040 3,560 240 3,390 880 910 5,210 1,220 1,310 3,710 1,390 IA 476.5 16,540 2,000 100 1,930 500 620 2,290 690 800 2,140 820 KS § 12,760 1,750 100 1,360 360 420 1,870 430 600 1,490 570 KY 509.7 22,850 2,590 200 2,570 560 680 4,450 1,050 900 2,880 970 LA 487.8 22,540 2,820 200 2,520 420 680 3,510 670 920 3,640 850 ME 513.5 8,340 980 ‡ 880 270 250 1,360 410 330 1,210 470 MD 490.5 26,390 3,560 190 2,870 810 630 4,130 1,150 1,160 4,690 1,150 MA 507.2 34,920 4,260 180 3,850 1,110 1,010 5,060 1,820 1,550 5,180 1,950 MI 502.6 54,410 5,900 370 5,570 1,610 1,680 8,210 2,080 2,250 8,200 2,700 MN 472.7 25,420 3,240 150 2,650 750 920 3,160 1,130 1,170 4,800 1,250 MS § 12,470 1,620 120 1,440 230 340 2,190 320 480 2,010 480 MO 460.8 29,930 3,730 240 3,380 830 890 5,350 870 1,260 3,910 1,350 MT 475.3 4,920 630 ‡ 520 120 170 690 190 220 940 260 NE 469.0 8,720 1,160 60 920 260 290 1,190 340 400 1,260 430 NV 470.3 11,030 1,180 80 1,120 230 330 1,750 390 420 1,550 570 NH 492.1 7,140 890 ‡ 800 230 190 1,010 370 290 1,050 390 NJ 518.3 49,370 6,080 350 5,160 1,550 1,520 6,310 2,210 2,200 8,070 2,450 NM § 8,030 1,080 70 790 200 310 940 420 350 1,410 350 NY 479.7 100,960 12,580 790 10,710 3,240 3,080 13,390 3,070 4,540 15,770 4,980 NC § 38,210 4,870 280 4,290 1,020 1,070 6,290 1,630 1,610 6,040 1,690 ND § 3,340 440 ‡ 410 100 110 390 120 150 520 200 OH § 59,220 6,710 390 6,410 1,800 1,710 9,790 2,390 2,560 8,260 2,940 OK 458.7 17,170 2,200 160 1,880 400 570 3,180 720 770 2,510 710 OR 481.0 18,630 2,460 110 1,830 470 500 2,520 990 890 2,870 970 PA 499.0 75,130 8,860 420 8,220 2,400 2,240 10,500 3,120 3,330 12,230 4,030 RI 519.2 6,360 730 ‡ 690 190 170 920 300 260 920 370 SC 471.0 21,370 2,600 190 2,230 480 550 3,460 870 780 3,380 840 SD § 3,990 510 ‡ 470 120 130 490 160 180 710 220 TN § 28,440 3,690 250 3,100 660 800 5,110 980 1,180 3,000 1,230 TX 443.3 91,020 12,120 940 9,510 2,040 3,130 13,520 3,860 4,140 13,280 3,300 UT 408.4 7,660 920 50 740 220 300 600 500 380 1,510 340 VT § 3,500 420 ‡ 390 110 80 440 150 140 550 170 VA § 35,090 4,570 280 3,530 970 900 5,360 1,510 1,390 5,330 1,380 WA 499.5 31,080 4,090 150 2,920 800 960 3,970 1,630 1,500 5,000 1,490 WV 485.4 10,490 1,180 80 1,210 310 300 2,110 410 430 1,430 500 WI 480.2 28,130 3,340 170 3,090 860 1,040 3,930 1,070 1,300 4,770 1,350 WY § 2,340 310 ‡ 260 60 70 290 100 110 410 110 US 474.8 1,444,920 178,480 11,150 153,760 39,080 44,240 213,380 59,940 63,190 218,890 67,160 * Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Rates are per 100,000 and age‐adjusted to the 2000 US standard population; source: CINA+ Online, NAACCR, based on data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. ‡Estimate is fewer than 50 cases. §Combined incidence rate is not available. Note: These model‐based estimates are calculated using incidence rates from 41 states as reported by NAACCR; they are offered as a rough guide and should be interpreted with caution. 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 2007. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 54% of all newly diagnosed cancers. Prostate cancer alone accounts for about 29% (218,890) of incident cases in men. Based on cases diagnosed between 1996 and 2002, an estimated 91% of these 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 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths, by Sex, US, 2007. * Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimates are rounded to the nearest 10. The three most commonly diagnosed types of cancer among women in 2007 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for about 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 26% (178,480) of all new cancer cases among women. Expected Number of New Cancer Deaths Table 1 also shows the expected number of deaths from cancer projected for 2007 for men, women, and both sexes combined. It is estimated that about 559,650 Americans will die from cancer, corresponding to over 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 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 26% of all female cancer deaths in 2007. Table 3 provides the estimated number of cancer deaths in 2007 by state for selected cancer sites. TABLE 3 Age‐standardized Death Rates for All Cancers Combined, 1999‐2003, and Estimated Deaths* From All Cancers Combined and Selected Sites by State, US, 2007 State Death Rate † All Sites Brain & Other Nervous System Female Breast Colon & Rectum Leukemia Liver Lung & Bronchus Non‐Hodgkin Lymphoma Ovary Pancreas Prostate AL 210.7 9,740 210 680 880 350 300 3,240 330 290 530 480 AK 195.3 810 ‡ 50 70 ‡ ‡ 230 ‡ ‡ 50 ‡ AZ 174.9 10,120 250 710 970 400 330 2,850 320 300 590 520 AR 210.2 6,240 140 410 610 240 200 2,220 200 140 310 300 CA 178.7 54,890 1,460 4,130 5,230 2,150 2,270 13,220 1,830 1,680 3,480 3,040 CO 171.2 6,660 190 520 630 290 200 1,650 240 220 410 330 CT 186.5 6,990 150 490 590 270 190 1,860 230 190 480 390 DE 207.7 1,810 ‡ 120 160 70 ‡ 580 60 50 100 90 DC 230.3 1,020 ‡ 80 100 ‡ ‡ 260 ‡ ‡ 60 60 FL 186.2 40,430 790 2,700 3,530 1,630 1,190 12,360 1,300 1,040 2,350 2,180 GA 202.3 14,950 280 1,120 1,340 540 360 4,500 470 420 820 630 HI 152.9 2,260 ‡ 130 210 80 110 530 90 50 170 130 ID 178.1 2,370 80 180 200 120 50 570 100 50 140 150 IL 204.8 23,870 490 1,740 2,380 990 650 6,690 750 620 1,480 990 IN 211.9 12,730 280 860 1,180 510 290 3,800 430 350 740 600 IA 188.5 6,510 160 410 600 310 140 1,750 300 190 390 350 KS 189.0 5,290 140 380 520 230 120 1,530 220 150 310 220 KY 226.8 9,390 150 600 860 320 220 3,450 290 220 460 310 LA 226.3 9,550 200 730 960 330 330 3,020 310 220 530 400 ME 210.5 3,190 80 190 280 100 70 970 110 80 190 180 MD 203.7 10,210 230 830 970 390 250 2,900 320 270 640 540 MA 200.8 13,240 270 890 1,180 490 380 3,630 420 360 860 560 MI 199.6 19,180 450 1,320 1,750 770 560 5,840 660 540 1,180 850 MN 185.2 9,380 240 600 810 400 240 2,460 350 250 550 490 MS 219.5 5,990 160 450 610 210 180 2,040 170 150 340 290 MO 205.0 12,610 270 870 1,170 460 330 4,120 500 320 690 510 MT 191.6 1,920 50 130 160 80 ‡ 520 80 60 110 110 NE 184.6 3,320 90 220 350 150 70 900 110 90 180 170 NV 206.2 4,660 100 330 490 160 140 1,330 130 130 260 230 NH 198.4 2,630 70 180 220 100 70 740 90 60 150 140 NJ 201.6 17,140 320 1,350 1,680 680 530 4,380 600 490 1,070 750 NM 171.1 3,270 80 240 320 120 140 720 120 90 190 200 NY 187.3 35,270 720 2,670 3,350 1,360 1,090 9,500 1,030 1,020 2,330 1,630 NC 202.0 16,880 360 1,240 1,480 610 420 5,150 570 450 980 800 ND 181.8 1,220 ‡ 90 120 ‡ ‡ 350 ‡ ‡ 80 110 OH 209.0 24,600 540 1,820 2,350 950 600 7,310 610 650 1,370 1,350 OK 205.2 7,380 170 510 720 290 180 2,390 210 170 370 280 OR 196.1 7,370 200 530 640 260 190 2,140 360 230 440 340 PA 202.8 29,140 560 2,470 2,730 1,070 790 7,780 1,140 790 1,780 1,310 RI 200.2 2,370 50 140 210 80 70 640 60 60 140 110 SC 208.1 8,940 190 570 790 330 230 2,750 260 220 510 420 SD 189.0 1,600 50 100 160 70 ‡ 420 80 50 100 110 TN 214.7 12,920 350 890 1,160 480 330 4,340 410 320 700 550 TX 192.8 34,170 840 2,480 3,220 1,410 1,490 9,920 1,160 860 2,010 1,620 UT 148.0 2,690 90 240 240 130 70 470 140 90 170 140 VT 192.6 1,160 ‡ 100 120 50 ‡ 350 50 ‡ 70 80 VA 202.9 13,740 280 1,100 1,320 500 370 4,290 360 390 800 600 WA 193.2 11,370 370 770 990 490 380 3,170 440 370 740 630 WV 218.5 4,610 90 280 480 130 110 1,450 170 140 220 160 WI 189.6 10,870 260 770 960 490 310 2,890 320 290 680 540 WY 187.8 980 ‡ 60 110 ‡ ‡ 260 ‡ ‡ 60 60 US 195.7 559,650 12,740 40,460 52,180 21,790 16,780 160,390 18,660 15,280 33,370 27,050 * Rounded to the nearest 10. †Rates are per 100,000 population 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 fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Regional Variations in Cancer Rates Table 4 depicts cancer incidence for select cancers by state. Rates vary widely across states. For example, among the cancers listed in Table 4 , the largest variations in the incidence rates, in proportionate terms, occurred in lung cancer, in which rates (cases per 100,000 population) ranged from 41.8 in men and 21.5 in women in Utah to 137.9 in men and 73.5 in women in Kentucky. In contrast, the variation in female breast cancer incidence rates was small, ranging from 115 cases per 100,000 population in New Mexico to 146.7 cases in Washington. Factors that contribute to the state variations in the incidence rates include differences in the prevalence of risk factors, access to and utilization of early detection services, and completeness of reporting. For example, the state variation in lung cancer incidence rates primarily reflects differences in smoking prevalence; Utah ranks lowest in adult smoking prevalence and Kentucky highest. TABLE 4 Cancer Incidence Rates* by Site and State, US, 1999 to 2003 All Sites Breast Colon & Rectum Lung & Bronchus Non‐Hodgkin Lymphoma Prostate Urinary Bladder State Male Female Female Male Female Male Female Male Female Male Male Female Alabama † 526.5 365.2 115.3 60.6 41.8 108.9 49.9 18.8 13.3 140.4 30.0 7.1 Alaska † 556.8 421.2 134.2 65.5 50.3 87.6 60.9 23.7 15.7 167.7 39.5 8.4 Arizona 462.4 364.1 116.7 53.1 38.2 71.8 48.7 18.7 13.4 118.2 36.0 8.8 Arkansas 544.1 377.1 121.0 60.1 43.4 114.9 56.1 20.8 15.1 154.2 34.3 8.2 California † 520.9 398.5 129.8 56.6 41.5 70.8 48.4 22.4 15.3 158.3 34.4 8.3 Colorado † 516.2 400.3 134.2 53.7 40.7 66.6 44.7 21.7 16.7 164.8 35.4 9.3 Connecticut † 597.3 448.3 140.4 68.8 50.3 84.2 57.1 24.4 17.0 179.8 45.0 12.3 Delaware † 586.8 433.4 128.8 66.6 48.8 97.4 63.0 21.6 15.9 176.1 38.5 10.2 Dist. of Columbia † 635.6 422.6 135.3 65.6 52.0 96.4 50.1 21.0 11.9 227.1 25.3 9.8 Florida † 562.2 415.6 123.0 62.8 46.6 94.4 60.5 22.3 15.5 152.7 40.4 10.4 Georgia † 565.8 391.5 124.0 61.5 43.7 108.6 52.8 19.6 13.8 166.2 32.7 8.0 Hawaii † 481.8 375.2 127.3 65.4 42.3 68.0 37.2 18.7 13.1 132.3 23.4 5.2 Idaho † 530.0 396.0 128.2 52.4 39.5 71.1 44.8 20.8 17.6 171.9 38.2 7.6 Illinois † 580.9 425.5 129.7 71.1 49.8 96.1 56.6 23.2 16.2 165.6 40.2 10.5 Indiana † 545.7 414.4 124.8 67.6 48.5 107.1 60.3 22.0 15.7 138.6 36.1 9.2 Iowa † 557.1 424.2 128.7 71.6 53.0 90.2 50.4 22.6 16.7 154.2 39.1 9.8 Kansas ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Kentucky † 616.9 440.5 124.8 72.0 53.1 137.9 73.5 21.6 16.5 155.1 37.8 9.5 Louisiana † 613.8 402.3 122.8 72.7 49.6 114.0 56.8 22.4 15.7 179.5 34.2 8.2 Maine † 609.9 447.6 131.4 69.1 51.4 101.0 62.8 22.5 16.9 171.3 48.9 13.2 Maryland † 581.6 428.3 131.9 63.2 47.2 87.2 57.1 20.9 14.4 185.2 34.0 9.4 Massachusetts † 591.6 451.8 138.8 68.7 50.3 84.0 61.4 23.1 16.8 178.2 45.8 12.5 Michigan † 608.6 429.9 129.4 62.4 46.5 94.8 58.6 23.6 17.3 199.1 42.0 10.7 Minnesota † 559.4 412.3 135.9 60.3 44.6 72.1 47.8 25.4 18.0 188.6 38.4 10.2 Mississippi ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Missouri † 537.4 408.8 125.4 67.9 48.5 104.7 59.5 21.9 15.9 136.8 35.9 9.0 Montana † 558.8 412.0 128.4 59.0 43.9 81.2 56.0 22.6 15.1 183.6 40.8 10.1 Nebraska † 551.0 413.4 131.4 70.8 49.7 81.6 47.4 22.6 17.3 165.7 38.3 9.2 Nevada † 541.3 414.2 120.8 60.7 44.1 91.5 71.2 20.7 14.3 150.6 44.0 11.0 New Hampshire † 571.7 436.6 135.2 62.4 48.5 81.9 59.3 24.2 16.4 165.3 46.2 12.7 New Jersey † 623.9 448.7 133.9 73.1 52.3 85.0 55.7 25.7 18.0 200.3 45.3 12.0 New Mexico 485.0 357.3 115.0 52.0 35.2 60.1 36.8 17.9 13.6 152.2 28.7 7.1 New York † 565.4 424.8 126.7 68.0 50.2 82.8 53.5 23.4 16.6 168.1 41.0 11.1 North Carolina 519.2 372.6 121.5 57.0 41.8 96.2 49.9 19.0 13.4 152.4 32.7 8.4 North Dakota 518.0 366.9 123.1 64.8 43.4 70.8 41.0 21.6 14.6 181.8 37.2 9.1 Ohio 551.9 412.6 126.6 65.7 47.7 99.5 57.8 22.9 16.1 154.1 39.5 10.1 Oklahoma † 547.0 399.6 128.3 64.6 44.6 111.2 62.1 21.9 15.1 148.8 32.6 8.0 Oregon † 545.4 436.5 142.6 56.9 44.3 82.6 61.0 23.4 17.3 164.1 41.1 10.2 Pennsylvania † 594.4 436.5 129.4 72.2 51.1 92.9 53.9 24.5 17.0 172.3 44.2 11.6 Rhode Island † 627.2 448.6 130.7 72.9 50.2 98.7 60.9 23.5 17.3 177.9 51.6 14.8 South Carolina † 590.1 389.4 123.5 65.4 45.6 107.4 51.1 20.4 14.3 176.9 33.9 7.6 South Dakota (2001‐2003) 564.1 395.7 128.6 66.2 48.9 78.4 41.8 22.2 15.5 190.1 43.2 8.6 Tennessee § 442.0 351.2 113.7 54.7 40.2 95.5 50.9 17.8 12.9 108.7 28.3 7.3 Texas † 530.7 383.4 118.6 59.2 41.4 91.8 50.7 21.3 15.6 148.3 29.6 7.3 Utah † 490.2 346.3 117.1 48.3 36.6 41.8 21.5 23.1 15.3 186.5 31.3 7.0 Vermont ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Virginia 510.5 367.6 122.2 58.3 43.1 83.5 48.7 19.1 13.0 161.4 32.4 8.2 Washington † 573.7 448.0 146.7 57.9 43.5 84.4 60.5 26.0 18.1 177.1 41.7 10.3 West Virginia † 574.6 427.8 116.9 71.5 53.6 118.0 68.4 21.3 16.2 148.2 39.9 12.1 Wisconsin † 562.0 424.4 133.9 66.5 47.2 84.5 52.2 22.9 16.8 169.1 37.9 10.5 Wyoming 524.9 390.3 125.2 52.1 45.1 65.6 44.7 17.3 16.9 182.2 40.5 9.2 United States 562.1 415.3 128.2 64.2 46.7 89.6 54.7 22.6 16.0 165.0 38.2 9.8 * Per 100,000, age‐adjusted to the 2000 US standard population. Not all states submitted data for all years. †This state's registry has submitted five years of data and passed rigorous criteria for each single year's data including: completeness of reporting, non‐duplication of records, percent unknown in critical data fields, percent of cases registered with information from death certificates only, and internal consistency among data items. ‡This state's registry did not submit incidence data to the North American Association of Central Cancer Registries (NAACCR) for 1999–2003. § This state's data is excluded from interpretation in the text because completeness of case ascertainment for this state's registry is 77%–84% for the years 1999–2003. Sources: CINA+ Online and Cancer in North America: 1999–2003, Volume One: Incidence, North American Association of Central Cancer Registries. Trends in Cancer Incidence and Mortality Figures 2 , , to 5 depict long‐term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites combined and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates for all sites combined stabilized in men from 1995 to 2003 and increased in women by 0.3% per year from 1987 to 2003. FIGURE 2 Annual Age‐adjusted Cancer Incidence and Death Rates* for All Sites, by Sex, US, 1975 to 2003. * Rates are age‐adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. Source: Incidence—Surveillance, Epidemiology, and End Results (SEER) program, ( http://www.seer.cancer.gov ). Delay‐Adjusted Incidence database: “SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2003.” National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2006, based on the November 2005 SEER data submission. Mortality—US Mortality Public Use Data Tapes, 1960 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. FIGURE 3 Annual Age‐adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancers, US, 1975 to 2003. * Rates are age‐adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) Program ( http://www.seer.cancer.gov ). Delay‐Adjusted Incidence database: “SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2003.” National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2006, based on the November 2005 SEER data submission. FIGURE 4 Annual Age‐adjusted Cancer Death Rates* * Among Males for Selected Cancers, US, 1930 to 2003. *Rates are age‐adjusted to the 2000 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US Mortality Public Use Data Tapes, 1960 to 2003, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. FIGURE 5 Annual Age‐adjusted Cancer Death Rates* Among Females for Selected Cancers, US, 1930 to 2003. * Rates are age‐adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Source: US Mortality Public Use Data Tapes, 1960 to 2003, US Mortality Volumes 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, US, 1975 to 2003 Line Segment 1 Line Segment 2 Line Segment 3 Line Segment 4 Year APC * Year APC * Year APC * Year APC * All sites Incidence Male and female 1975–1983 0.9 † 1983–1992 1.8 † 1992–1995 −1.5 1995–2003 0.1 Male 1975–1989 1.3 † 1989–1992 5.1 † 1992–1995 −4.5 † 1995–2003 0.0 Female 1975–1979 −0.3 1979–1987 1.6 † 1987–2003 0.3 † Death Male and female 1975–1990 0.5 † 1990–1994 −0.4 1994–2003 −1.1 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.4 1993–2003 −1.6 † Female 1975–1992 0.5 † 1992–2003 −0.8 † Lung & bronchus Incidence Male and female 1975–1982 2.5 † 1982–1991 0.9 † 1991–2003 −0.7 † Male 1975–1982 1.5 † 1982–1991 −0.5 † 1991–2003 −1.7 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2003 0.5 † Death Male and female 1975–1980 3.0 † 1980–1990 1.8 † 1990–1994 −0.1 1994–2003 −0.9 † Male 1975–1978 2.4 † 1978–1984 1.2 † 1984–1991 0.3 † 1991–2003 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † Colon & rectum Incidence Male and female 1975–1985 0.8 † 1985–1995 −1.8 † 1995–1998 1.2 1998–2003 −2.1 † Male 1975–1986 1.1 † 1986–1995 −2.1 † 1995–1998 1.0 1998–2003 −2.5 † Female 1975–1985 0.3 1985–1995 −1.8 † 1995–1998 1.7 1998–2003 −1.9 † Death Male and female 1975–1978 0.2 1978–1985 −0.8 † 1985–2001 −1.8 † 2001–2003 −2.8 † Male 1975–1978 0.8 1978–1984 −0.4 1984–1990 −1.3 † 1990–2003 −2.1 † Female 1975–1984 −1.0 † 1984–2003 −1.9 † Breast (female) Incidence 1975–1980 −0.4 1980–1987 3.7 † 1987–2001 0.5 † 2001–2003 −4.1 Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1999 −3.1 † 1999–2003 −1.4 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.4 † 1992–1995 −10.8 † 1995–2003 1.1 † Death 1975–1987 0.9 † 1987–1991 3.1 † 1991–1994 −0.6 1994–2003 −4.0 † * Annual percent change based on incidence (delay‐adjusted) and mortality rates age‐adjusted to the 2000 US standard population. †The APC is significantly different from zero. Note: Trends were analyzed by Joinpoint Regression Program, version 3.1, with a maximum of three joinpoints (ie, four line segments). Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Lung cancer incidence rates are declining in men and appear to be plateauing in women after increasing for many decades. The lag in the temporal trend of lung cancer incidence rates in women compared with men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked about 20 years later than in men. Colorectal cancer incidence rates have decreased from 1998 through 2003 in both males and in females. Female breast cancer incidence rates leveled off from 2001 to 2003 after increasing since 1980, which may reflect the saturation of mammography utilization and reduction in the use of hormone replacement therapy. Prostate cancer incidence rates continued to increase, although at a slower rate than those reported for the early 1990s and before. The continuing increase for prostate cancer may be attributable to increased screening through prostate‐specific antigen (PSA) testing. Death rates for all cancer sites combined decreased by 1.6% per year from 1993 to 2003 in males and by 0.8% per year in females from 1992 to 2003. 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 continued to increase by 0.3% per year from 1995 to 2003 ( Table 5 ). Table 6 shows the contribution of individual cancer sites to the total decrease in overall cancer death rates. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990/1991 and 2003, death rates from cancer decreased by 16.3% among men and by 8.5% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounts for about 80% of the decrease in cancer death rates, while reduction in death rates from breast and colorectal cancers accounts for over 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of the sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use over the past 40 years, while the decrease in death rates from female breast, colorectal, and prostate cancer largely reflects improvements in early detection and treatment. Between 1990/1991 and 2003, death rates increased substantially for lung cancer in women and for liver and intrahepatic bile duct cancer in men. TABLE 6 The Contribution of Indvidual Cancer Sites to the Decrease in Cancer Death Rates, 1990–2003 Death rate (per 100,000) Change %Contribution † 1990 * 2003 Absolute % Male All Malignant Cancers 279.82 234.12 −45.70 −16.33 Decreasing Lung & Bronchus 90.56 71.92 −18.64 −20.58 38.4 Prostate 38.56 26.56 −12.00 −31.12 24.8 Colon & Rectum 30.77 22.96 −7.81 −25.38 16.1 Pancreas 12.59 12.05 −0.54 −4.29 1.1 Leukemia 10.71 9.93 −0.78 −7.28 1.6 Non‐Hodgkin Lymphoma 9.97 9.32 −0.65 −6.52 1.3 Urinary Bladder 7.97 7.37 −0.60 −7.53 1.2 Kidney & Renal Pelvis 6.16 6.07 −0.09 −1.46 0.2 Stomach 8.86 5.70 −3.16 −35.67 6.5 Brain & Other Nervous System 5.97 5.36 −0.61 −10.22 1.3 Myeloma 4.83 4.58 −0.25 −5.18 0.5 Oral Cavity & Pharynx 5.61 4.06 −1.55 −27.63 3.2 Larynx 2.97 2.36 −0.61 −20.54 1.3 Hodgkin Lymphoma 0.85 0.55 −0.30 −35.29 0.6 Bones & Joints 0.55 0.54 −0.01 −1.82 0.0 Small Intestine 0.50 0.43 −0.07 −14.00 0.1 Others 25.77 24.96 −0.81 −3.14 1.7 Total −48.48 100.0 Increasing Esophagus 7.16 7.74 0.58 8.10 20.6 Liver & Intrahepatic Bile Duct 5.27 7.38 2.11 40.04 74.8 Melanoma of the Skin 3.80 3.88 0.08 2.11 2.8 Thyroid 0.37 0.42 0.05 13.51 1.8 Total 2.82 100.0 Death rate (per 100,000) Change %Contribution † 1991 * 2003 Absolute % Females All Malignant Cancers 175.30 160.49 −14.81 −8.45 Decreasing Breast 32.69 25.19 −7.50 −22.94 39.4 Colon & Rectum 20.30 16.05 −4.25 −20.94 22.3 Pancreas 9.28 9.24 −0.04 −0.43 0.2 Ovary 9.51 8.85 −0.66 −6.94 3.5 Non‐Hodgkin Lymphoma 6.74 5.88 −0.86 −12.76 4.5 Leukemia 6.32 5.59 −0.73 −11.55 3.8 Uterine Corpus 4.18 4.13 −0.05 −1.20 0.3 Brain & Other Nervous System 4.11 3.62 −0.49 −11.92 2.6 Myeloma 3.26 3.08 −0.18 −5.52 0.9 Stomach 4.01 2.96 −1.05 −26.18 5.5 Kidney & Renal Pelvis 2.95 2.73 −0.22 −7.46 1.2 Uterine Cervix 3.49 2.48 −1.01 −28.94 5.3 Urinary Bladder 2.34 2.20 −0.14 −5.98 0.7 Esophagus 1.81 1.74 −0.07 −3.87 0.4 Melanoma of the Skin 1.82 1.74 −0.08 −4.40 0.4 Oral Cavity & Pharynx 2.03 1.47 −0.56 −27.59 2.9 Soft Tissue including Heart 1.28 1.14 −0.14 −10.94 0.7 Gallbladder 1.09 0.77 −0.32 −29.36 1.7 Others 17.97 17.28 −0.69 −3.84 3.6 Total −19.04 100.0 Increasing Lung & Bronchus 37.61 41.24 3.63 9.65 85.8 Liver & Intrahepatic Bile Duct 2.51 3.11 0.60 23.90 14.2 Total 4.23 100.0 * Death rates from cancer peaked in 1990 for men and in 1991 for women. †This calculation is based on each cancer site's contribution to the increasing or decreasing portion of the total cancer death rate, depending on the individual site's trend; it does not represent the contribution to the net decrease in cancer death rates. Changes in the Recorded Number of DeathsFrom Cancer From 2003 to 2004 A total of 553,888 cancer deaths was recorded in the United States in 2004, the most recent year for which actual data are available. There were 3,014 fewer cancer deaths reported in 2004 than in 2003, resulting in a decrease in the total number of cancer deaths for the second consecutive year. Cancer accounted for about 23% of all deaths, ranking second only to heart disease ( Table 7 ). 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 ( Table 8 ). Cancer is the leading cause of death among women aged 40 to 79 years and among men aged 60 to 79 years. When age‐adjusted death rates are considered ( Figure 6 ), cancer is the leading cause of death among men and women under age 85 years. A total of 473,535 people under age 85 years died from cancer in the United States in 2004, compared with 414,526 deaths from heart disease. FIGURE 6 Death Rates* From Cancer and Heart Disease for Ages Younger Than 85 and 85 and Older. * Rates are age‐adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 1960 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 7 Fifteen Leading Causes of Death, US, 2004 Rank Cause of Death Number of Deaths Percent (%) of Total Deaths Death Rate* All Causes 2,397,615 100.0 800.8 1 Heart diseases 652,486 27.2 217.0 2 Cancer 553,888 23.1 185.8 3 Cerebrovascular diseases 150,074 6.3 50.0 4 Chronic lower respiratory diseases 121,987 5.1 41.1 5 Accidents (unintentional injuries) 112,012 4.7 37.7 6 Diabetes mellitus 73,138 3.1 24.5 7 Alzheimer disease 65,965 2.8 21.8 8 Influenza & pneumonia 59,664 2.5 19.8 9 Nephritis, nephrotic syndrome, & nephrosis 42,480 1.8 14.2 10 Septicemia 33,373 1.4 11.2 11 Intentional self‐harm (suicide) 32,439 1.4 10.9 12 Chronic liver disease & cirrhosis 27,013 1.1 9.0 13 Hypertension & hypertensive renal disease 23,076 1.0 7.7 14 Parkinson disease 17,989 0.8 6.1 15 Assault (homocide) 17,357 0.7 5.9 All other & ill‐defined causes 414,674 17.3 * 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, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 8 Ten Leading Causes of Death by Age and Sex, US, 2004 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 1,181,668 All Causes 1,215,947 All Causes 16,326 All Causes 8,999 All Causes 63,753 All Causes 28,774 All Causes 217,755 All Causes 134,523 All Causes 467,831 All Causes 386,115 All Causes 400,011 All Causes 645,246 1 Heart diseases 321,973 Heart diseases 330,513 Accidents (unintentional injuries) 7,369 Accidents (unintentional injuries) 3,763 Accidents (unintentional injuries) 21,802 Accidents (unintentional injuries) 7,173 Heart diseases 53,449 Cancer 49,725 Cancer 152,611 Cancer 127,500 Heart diseases 132,195 Heart diseases 217,367 2 Cancer 286,830 Cancer 267,058 Assault (homicide) 2,035 Cancer 930 Intentional self‐harm (suicide) 8,685 Cancer 4,878 Cancer 53,127 Heart diseases 21,543 Heart diseases 130,219 Heart diseases 88,538 Cancer 75,579 Cancer 83,986 3 Accidents (unintentional injuries) 72,050 Cerebro vascular disease 91,274 Intentional self‐harm (suicide) 1,532 Assault (homicide) 603 Assault (homicide) 7,700 Heart diseases 2,526 Accidents (unintentional injuries) 22,159 Accidents (unintentional injuries) 9,343 Chronic lower respiratory diseases 30,114 Chronic lower respiratory diseases 29,223 Cerebro vascular diseases 28,551 Cerebro vascular diseases 61,582 4 Cerebro vascular disease 58,800 Chronic lower respiratory diseases 63,341 Cancer 1,219 Congenital anomalies 541 Heart diseases 5,394 Intentional self‐harm (suicide) 1,953 Intentional self‐harm (suicide) 9,640 Cerebro vascular diseases 5,536 Cerebro vascular diseases 22,668 Cerebro vascular diseases 23,335 Chronic lower respiratory diseases 23,749 Alzheimer disease 39,951 5 Chronic lower respiratory diseases 58,646 Alzheimer disease 46,991 Congenital anomalies 674 Intentional self‐harm (suicide) 453 Cancer 4,251 Assault (homicide) 1,478 Chronic liver disease & cirrhosis 9,357 Diabetes mellitus 4,778 Diabetes mellitus 17,160 Diabetes mellitus 15,969 Influenza & pneumonia 15,560 Chronic lower respiratory diseases 29,660 6 Diabetes mellitus 35,267 Accidents (unintentional injuries) 39,962 Heart diseases 456 Heart diseases 342 HIV disease 2,421 HIV disease 1,202 Diabetes mellitus 6,948 Chronic lower respiratory diseases 4,066 Accidents (unintentional injuries) 11,024 Nephritis, nephrotic syndrome & nephrosis 7,652 Alzheimer disease 14,353 Influenza & pneumonia 23,801 7 Influenza & pneumonia 26,861 Diabetes mellitus 37,871 Chronic lower respiratory diseases 160 Influenza & pneumonia 132 Diabetes mellitus 837 Cerebro vascular disease 680 Cerebro vascular diseases 6,655 Chronic liver disease & cirrhosis 3,736 Influenza & pneumonia 8,302 Accidents (unintentional injuries) 7,235 Diabetes mellitus 10,269 Diabetes mellitus 16,496 8 Intentional self‐harm (suicide) 25,566 Influenza & pneumonia 32,803 Influenza & pneumonia 136 Septicemia 101 Chronic liver disease & cirrhosis 752 Diabetes mellitus 584 HIV disease 6,222 Intentional self‐harm (suicide) 3,305 Nephritis, nephrotic syndrome & nephrosis 8,017 Alzheimer disease 6,887 Nephritis, nephrotic syndrome & nephrosis 9,452 Nephritis, nephrotic syndrome & nephrosis 12,205 9 Nephritis, nephrotic syndrome & nephrosis 20,370 Nephritis, nephrotic syndrome & nephrosis 22,110 Cerebro vascular disease 104 Chronic lower respiratory diseases 93 Cerebro vascular disease 748 Pregnancy, childbirth & puerperium 514 Chronic lower respiratory diseases 4,260 Septicemia 2,103 Septicemia 6,349 Influenza & pneumonia 6,881 Accidents (unintentional injuries) 9,018 Accidents (unintentional injuries) 11,986 10 Alzheimer disease 18,974 Septicemia 18,362 In situ & benign neoplasms 99 In situ & benig nneoplasms 88 Congenital anomalies 500 Chronic liver disease & cirrhosis 358 Assault (homicide) 2,918 HIV disease 2,069 Chronic liver disease & cirrhosis 6,324 Septicemia 6,507 Parkinsons disease 6,435 Hypertension & hypertensive renal disease 9,568 Note: Symptoms, signs, and abnormalities; events of undetermined intent; and other respiratory diseases were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Table 9 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among males under age 40 years, leukemia is the most common fatal cancer, while cancer of the lung and bronchus predominates in men aged 40 years and older. The second most common cause of cancer death is colorectal cancer among men aged 40 to 79 years and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at age 20 to 59 years, and lung cancer ranks first at age 60 years and older. TABLE 9 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, US, 2004 All Ages <20 20 to 39 40 to 59 60 to 79 ≥ 80 Male All Sites All Sites All Sites All Sites All Sites All Sites 286,830 1,256 4,251 53,127 152,611 75,579 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 89,575 387 543 16,013 54,959 18,261 Prostate Brain & ONS* Brain & ONS* Colon & rectum Colon & rectum Prostate 29,002 301 513 5,011 13,727 15,341 Colon & rectum Bones & joints Colon & rectum Pancreas Prostate Colon & rectum 26,881 118 384 3,384 12,511 7,749 Pancreas Other endocrine system Non‐Hodgkin lymphoma Liver & bile duct Pancreas Urinary bladder 15,776 108 349 3,301 8,724 3,736 Leukemia Soft tissue Lung & bronchus Esophagus Leukemia Pancreas 12,051 83 333 2,525 5,860 3,547 Female All Sites All Sites All Sites All Sites All Sites All Sites 267,058 967 4,878 49,725 127,500 83,986 Lung & bronchus Leukemia Breast Breast Lung & bronchus Lung & bronchus 68,431 278 1,225 12,162 39,883 17,022 Breast Brain & ONS* Uterine cervix Lung & bronchus Breast Colon & rectum 40,954 254 462 11,219 17,046 11,720 Colon & rectum Other endocrine system Leukemia Colon & rectum Colon & rectum Breast 26,699 89 386 3,694 10,934 10,521 Pancreas Soft tissue Colon & rectum Ovary Pancreas Pancreas 15,995 81 346 3,281 7,807 5,949 Ovary Bones & joints Brain & ONS* Pancreas Ovary Non‐Hodgkin lymphoma 14,716 71 312 2,162 7,328 4,076 * ONS = Other nervous system. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. Others and Unspecified Primary is excluded from cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. From 2003 to 2004, the number of recorded cancer deaths decreased by 1,160 in men and by 1,854 in women ( Table 10 ). The largest change in number of deaths from the major cancers was for colorectal cancer in both men and women (decreased by 1,110 and 1,094, respectively). TABLE 10 Trends in the Recorded Number of Deaths for Selected Cancers by Sex, US, 1989 to 2004 All Sites Lung and Bronchus Colon and Rectum Prostate Breast Year 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 2003 287,990 268,912 89,908 68,084 27,991 27,793 29,554 41,620 2004 286,830 267,058 89,575 68,431 26,881 26,699 29,002 40,954 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 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. CANCER OCCURRENCE BY RACE/ETHNICITY Cancer incidence and death rates vary considerably among racial and ethnic groups ( Table 11 ). For all cancer sites combined, African American men have a 15% higher incidence rate and 38% higher death rate than White men. African American women have a 9% lower incidence rate, but an 18% higher death rate than White women for all cancer sites combined. For the specific cancer sites listed in Table 11 , incidence and death rates are consistently higher in African Americans than in Whites, except for breast cancer (incidence) and lung and kidney cancers (incidence and mortality) among women. Death rates from prostate, stomach, and cervical cancers among African Americans are more than twice those in Whites. Factors known to contribute to racial disparities in mortality vary by cancer site. These factors include differences in exposure to underlying risk factors (eg, Helicobacter pylori for stomach cancer), access to high‐quality regular screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment (for many cancers). The higher breast cancer incidence rates among Whites are thought to reflect a combination of factors that affect diagnosis (such as more frequent mammography in White women until the most recent time period) and those that affect disease risk (such as later age at first birth and greater use of hormone replacement therapy among White than African American women). TABLE 11 Incidence and Death Rates* for Selected Cancers by Race and Ethnicity, US, 1999 to 2003 All Races White African American Asian American/Pacific Islander American Indian/Alaska Native † Hispanic‐Latino ‡ Incidence Rates All sites Male 562.1 555.0 639.8 385.5 359.9 444.1 Female 415.3 421.1 383.8 303.3 305.0 327.2 Breast (female) 128.2 130.8 111.5 91.2 74.4 92.6 Colon & rectum Male 64.2 63.7 70.2 52.6 52.7 52.4 Female 46.7 45.9 53.5 38.0 41.9 37.3 Kidney & renal pelvis Male 17.9 18.0 18.5 9.8 20.9 16.9 Female 9.2 9.3 9.5 4.9 10.0 9.4 Liver & bile duct Male 8.2 7.2 11.1 22.1 14.5 14.8 Female 3.0 2.7 3.6 8.3 6.5 5.8 Lung & bronchus Male 89.6 88.8 110.6 56.6 55.5 52.7 Female 54.7 56.2 50.3 28.7 33.8 26.7 Prostate 165.0 156.0 243.0 104.2 70.7 141.1 Stomach Male 10.7 9.7 17.4 20.0 21.6 16.1 Female 5.1 4.4 9.0 11.4 12.3 9.1 Uterine cervix 9.1 8.6 13.0 9.3 7.2 14.7 Death Rates All sites Male 243.7 239.2 331.0 144.9 153.4 166.4 Female 164.3 163.4 192.4 98.8 111.6 108.8 Breast (female) 26.0 25.4 34.4 12.6 13.8 16.3 Colon & rectum Male 24.3 23.7 33.6 15.3 15.9 17.5 Female 17.0 16.4 23.7 10.5 11.1 11.4 Kidney & renal pelvis Male 6.1 6.2 6.1 2.6 6.8 5.3 Female 2.8 2.8 2.8 1.2 3.3 2.4 Liver & bile duct Male 7.0 6.3 9.6 15.5 7.8 10.7 Female 3.0 2.8 3.8 6.7 4.0 5.0 Lung & bronchus Male 74.8 73.8 98.4 38.8 42.9 37.2 Female 41.0 42.0 39.8 18.8 27.0 14.7 Prostate 29.1 26.7 65.1 11.8 18.0 22.1 Stomach Male 6.1 5.4 12.4 11.0 7.1 9.2 Female 3.1 2.7 6.0 6.7 3.7 5.2 Uterine cervix 2.7 2.4 5.1 2.5 2.6 3.4 * Rates are per 100,000 and age‐adjusted to the 2000 US standard population. †Incidence rates are for diagnosis years 1999–2002. ‡Persons of Hispanic/Latino origin may be of any race. Source: Incidence (except American Indian and Alaska Native): Howe HL, Wu X, Ries LAG, et al. Annual report to the nation on the status of cancer 1975–2003, featuring cancer among US Hispanic/Latino populations. Cancer 2006; 107:1643–1658. Incidence (American Indian and Alaska Native) and Mortality: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Among other racial and ethnic groups, cancer incidence and death rates are lower than those in Whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, the incidence and death rates are generally higher in minority populations than in Whites for cancers of the uterine cervix, stomach, and liver. Stomach and liver cancer incidence and death rates are more than twice as high in Asian American/Pacific Islanders as in Whites, reflecting increased exposure to infectious agents such as Helicobacter pylori and hepatitis B. Kidney cancer incidence and death rates are the highest among American Indians/Alaskan Natives, although factors that contribute to this are unknown. Trends in cancer incidence can only be adjusted for delayed reporting in Whites and African Americans, and not in other racial and ethnic subgroups, because long‐term incidence data required for delay adjustment are available only for Whites and African Americans. From 1995 to 2003, sex‐specific incidence rates for all cancer sites combined, not adjusted for delayed reporting, have stabilized, except for African American and Hispanic men, in whom rates decreased by 1.3% and 1.1%, respectively. In contrast, death rates from cancer significantly decreased in each racial and ethnic group, with larger decreases in men than in women. Lifetime Probability of Developing Cancer The lifetime probability of developing cancer is higher for men (45%) than for women (38%) ( Table 12 ). However, because of the relatively early age of breast cancer onset, women have a slightly higher probability of developing cancer before age 60 years. It is noteworthy that these estimates are based on the average experience of the general population and may over‐ or underestimate individual risk because of differences in exposure and/or genetic susceptibility. TABLE 12 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, US* Birth to 39 (%) 40 to 59 (%) 60 to 69 (%) 70 and Older (%) Birth to Death (%) All sites † Male 1.42 (1 in 70) 8.69 (1 in 12) 16.58 (1 in 6) 39.44 (1 in 3) 45.31 (1 in 2) Female 2.03 (1 in 49) 9.09 (1 in 11) 10.57 (1 in 9) 26.60 (1 in 4) 37.86 (1 in 3) Urinary bladder Male .02 (1 in 4381) .41 (1 in 241) .96 (1 in 105) 3.41 (1 in 29) 3.61 (1 in 28) Female .01 (1 in 9527) .13 (1 in 782) .26 (1 in 379) .96 (1 in 105) 1.14 (1 in 87) Breast Female .48 (1 in 210) 3.98 (1 in 25) 3.65 (1 in 27) 6.84 (1 in 15) 12.67 (1 in 8) Colon & rectum Male .07 (1 in 1342) .93 (1 in 107) 1.67 (1 in 60) 4.92 (1 in 20) 5.79 (1 in 17) Female .07 (1 in 1469) .73 (1 in 138) 1.16 (1 in 86) 4.45 (1 in 22) 5.37 (1 in 19) Leukemia Male .16 (1 in 640) .22 (1 in 452) .35 (1 in 286) 1.17 (1 in 86) 1.49 (1 in 67) Female .12 (1 in 820) .14 (1 in 694) .20 (1 in 491) .75 (1 in 132) 1.05 (1 in 95) Lung & bronchus Male .03 (1 in 3146) 1.09 (1 in 92) 2.61 (1 in 38) 6.76 (1 in 15) 8.02 (1 in 12) Female .04 (1 in 2779) .85 (1 in 117) 1.84 (1 in 54) 4.52 (1 in 22) 6.15 (1 in 16) Melanoma of the skin Male .13 (1 in 775) .53 (1 in 187) .56 (1 in 178) 1.32 (1 in 76) 2.04 (1 in 49) Female .21 (1 in 467) .42 (1 in 237) .29 (1 in 347) .62 (1 in 163) 1.38 (1 in 73) Non‐Hodgkin lymphoma Male .14 (1 in 735) .45 (1 in 222) .57 (1 in 176) 1.56 (1 in 64) 2.14 (1 in 47) Female .08 (1 in 1200) .32 (1 in 313) .44 (1 in 229) 1.30 (1 in 77) 1.83 (1 in 55) Prostate Male .01 (1 in 10373) 2.59 (1 in 39) 7.03 (1 in 14) 13.83 (1 in 7) 17.12 (1 in 6) Uterine cervix Female .16 (1 in 631) .29 (1 in 346) .14 (1 in 695) .20 (1 in 512) .73 (1 in 138) Uterine corpus Female .06 (1 in 1652) .70 (1 in 142) .81 (1 in 124) 1.28 (1 in 78) 2.49 (1 in 40) * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to 2003. The “1 in” statistic and the inverse of the percentage may not be equivalent due to rounding. †Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: DevCan Software, Probability of Developing or Dying of Cancer Software, Version 6.1.0. Statistical Research and Applications Branch, National Cancer Institute, 2006. http://srab.cancer.gov/devcan . Cancer Survival by Race Compared with Whites, African American men and women have poorer 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 Whites within each stratum of 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 within‐stage differences in tumor characteristics. The contribution of these factors, individually or collectively, to the differential survival for specific cancers is unclear. However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of Whites experience similar outcomes. FIGURE 7 Distribution of Selected Cancers by Race and Stage at Diagnosis, US, 1996–2002. * The distribution for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. FIGURE 8 Five‐year Relative Survival Rates Among Patients Diagnosed With Selected Cancers, by Race and Stage at Diagnosis, US, 1996–2002. * The rate for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. There have been notable improvements over time in relative 5‐year survival rates for many cancer sites and for all cancers combined ( Table 13 ). This is true for both Whites and African Americans. Cancers for which survival has not improved substantially over the past 25 years include uterine corpus, cervix, larynx, lung, and pancreas. TABLE 13 Trends in Five‐year Relative Survival Rates* (%) for Selected Cancers by Race and Year of Diagnosis, US, 1975 to 2002. White African American All Races Site 1975 to 1977 1984 to 1986 1996 to 2002 1975 to 1977 1984 to 1986 1996 to 2002 1975 to 1977 1984 to 1986 1996 to 2002 All sites 51 55 68 † 40 41 57 † 50 53 66 † Brain 23 28 34 † 26 32 37 † 24 29 34 † Breast (female) 76 80 90 † 63 65 77 † 75 79 89 † Colon 52 60 66 † 46 50 54 † 51 59 65 † Esophagus 6 11 17 † 3 8 12 † 5 10 16 † Hodgkin lymphoma 74 80 87 † 71 75 81 † 73 79 86 † Kidney 51 56 66 † 50 54 66 † 51 56 66 † Larynx 67 68 67 59 53 52 66 66 65 Leukemia 36 43 50 † 33 34 39 35 42 49 † Liver & bile duct 4 6 10 † 2 5 7 † 4 6 10 † Lung & bronchus 13 14 16 † 12 11 13 † 13 13 16 † Melanoma of the skin 82 86 93 † 58 ‡ 71 § 75 ‡ 82 86 92 † Multiple myeloma 25 28 33 † 31 32 32 26 29 33 † Non‐Hodgkin lymphoma 48 54 64 † 48 48 56 48 53 63 † Oral cavity 55 57 62 † 36 36 40 53 55 60 † Ovary ¶ 36 39 45 † 43 41 39 37 40 45 † Pancreas 3 3 5 † 2 5 5 † 2 3 5 † Prostate 70 77 100 † 61 66 98 † 69 76 100 † Rectum 49 58 66 † 45 46 59 † 49 57 66 † Stomach 15 18 22 † 16 20 23 † 16 18 24 † Testis 83 93 96 † 82 ‡ 87 ‡ 89 83 93 96 † Thyroid 93 94 97 † 91 90 94 93 94 97 † Urinary bladder 74 79 83 † 50 61 65 † 73 78 82 † Uterine cervix 71 70 75 † 65 58 66 70 68 73 † Uterine corpus 89 85 86 † 61 58 61 87 83 84 † * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1975 to 1977, 1984 to 1986, and 1996 to 2002, and followed through2003. †The difference in rates between 1975 to 1977 and 1996 to 2002 is statistically significant ( P < 0.05). ‡The standard error of the survival rate is between 5 and 10 percentagepoints. §The standard error of the survival rate is greater than 10 percentage points. ¶Recent changes in classification of ovarian cancer, namely excluding borderline tumors, has affected 1996–2002 survival rates. Note: “All sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Relative survival rates cannot be calculated for other racial and ethnic populations because accurate life expectancies (the average number of years of life remaining for persons who have attained a given age) 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 American/Pacific Islander women, have a greater probability of dying from cancer within 5 years of diagnosis than non‐Hispanic Whites, after accounting for differences in stage 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 age 1 to 14 years in the United States; accidents are the most frequent cause of death in this age group ( Table 14 ). The most common cancers in children (aged 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) tumors. Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for many childhood cancers ( Table 15 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975 to 1977 to 79% for those diagnosed in 1996 to 2002. TABLE 14 Fifteen Leading Causes of Death Among Children Aged 1 to 14, US, 2004 Rank Cause of Death Number of Deaths * Percent (%) of Total Deaths Death Rate † All Causes 11,619 100.0 20.3 1 Accidents (unintentional injuries) 4,307 37.1 7.54 2 Cancer 1,418 12.2 2.50 3 Congenital anomalies 958 8.2 1.67 4 Assault (homicide) 706 6.1 1.23 5 Heart diseases 432 3.7 0.75 6 Intentional self‐harm (suicide) 285 2.5 0.49 7 Influenza & pneumonia 201 1.7 0.35 8 Chronic lower respiratory disease 168 1.4 0.29 9 Septicemia 150 1.3 0.26 10 In situ & benign neoplasms 137 1.2 0.24 11 Cerebrovascular disease 118 1.0 0.21 12 Anemias 79 0.7 0.14 13 Meningitis 50 0.4 0.09 14 Diabetes mellitus 45 0.4 0.08 15 Complications, medical/surgical 38 0.3 0.07 All other causes 2,527 21.7 * Excludes deaths with unknown ages. †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; events of undetermined intent; certain perinatal conditions; other respiratory diseases; and other and unspecified infectious and parasitic diseases were excluded from ranking order. Source: US Mortality Public Use Data Tape, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 15 Trends in Five‐year Relative Survival Rates* (%) for Children Under Age 15, US, 1975 to 2002. Year of Diagnosis Site 1975 to 1977 1978 to 1980 1981 to 1983 1984 to 1986 1987 to 1989 1990 to 1992 1996 to 2002 All sites 58 63 67 68 71 75 79 † Acute lymphocytic leukemia 58 66 71 73 78 83 87 † Acute myeloid leukemia 19 26 27 ‡ 30 ‡ 36 ‡ 41 53 † Bone & joint 51 ‡ 49 57 ‡ 59 ‡ 67 ‡ 67 72 † Brain & other nervous system 57 58 56 62 64 64 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 † Neuroblastoma 52 57 55 52 62 77 69 † Non‐Hodgkin lymphoma 43 53 67 70 71 76 86 † Soft tissue 61 74 69 73 65 79 72 † Wilms' tumor 73 79 86 91 92 92 92 † * Survival rates are adjusted for normal life expectancy and are based on follow up of patients through 2003. †The difference in rates between 1975 to 1977 and 1996 to 2002 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, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. 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 modeling techniques. Estimates are also affected by changes in method. The introduction of a new method for estimating new cancer cases in 2007 has substantially affected the estimates for a number of cancers, particularly leukemia and female breast (see Pickle et al for more detailed discussion). For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. Age‐standardized or age‐specific cancer death rates from the NCHS and cancer incidence rates from SEER or NPCR are the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, by the time that they become available. Despite their limitations, the ACS estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths 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 (18)

Publisher
Wiley
Copyright
Copyright © 2007 American Cancer Society
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/canjclin.57.1.43
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 2007. MATERIALS AND METHODS Data Sources Mortality data from 1930 to 2004 in the United States were obtained from the National Center for Health Statistics (NCHS). Incidence data for long‐term trends (1975 to 2003), 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, covering about 26% of the US population. , , , Incidence data (1995 to 2003) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR), through the North American Associations of Central Cancer Registries (NAACCR). State‐specific incidence rates were abstracted from Cancer in North America (1999–2003) Volume One , based on data collected by cancer registries participating in the SEER program and NPCR. 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 some states. Since the American Cancer Society (ACS) began producing estimates of new cancer cases in the current year, the method has been refined several times to take advantage of improvements in data and statistical methods. Beginning with 2007, we are using a new projection method described by Pickle et al in an accompanying article inthis issue of CA . The new method is a spatio‐temporal model based on incidence data from 1995 through 2003 from 41 states that met NAACCR's high‐quality data standard for incidence, covering about 86% of the US population. This contrasts with the previous quadratic autoregressive model based on incidence data from the nine oldest SEER registries, covering about 10% of the US population. Furthermore, the new method considers geographic variations in socio‐demographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence, and accounts for expected delays in case reporting. 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 2007. 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 2007 based on the number that occurred each year from 1969 to 2004 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 2004. Causes of death for 2004 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 1975 through 2003. 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 rates and trends (1975 to 2003) are adjusted for delays in reporting where possible. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 2001 to 2003), especially for cancers such as melanoma and prostate that are frequently diagnosed in outpatient settings. The National Cancer Institute (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 estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2007. The overall estimate of about 1.44 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. More than 1 million additional cases of basal cell and squamous cell skin cancer, about 62,030 cases of breast carcinoma in situ, and 48,290 cases of in situ melanoma are expected to be newly diagnosed in 2007. Because of the introduction of a new projection method, estimates have been affected for many individual cancer sites, particularly for leukemia, female breast, lung, and prostate cancers. 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, US, 2007* Estimated New Cases Estimated Deaths Both Sexes Male Female Both sexes Male Female All Sites 1,444,920 766,860 678,060 559,650 289,550 270,100 Oral cavity & pharynx 34,360 24,180 10,180 7,550 5,180 2,370 Tongue 9,800 6,930 2,870 1,830 1,180 650 Mouth 10,660 6,480 4,180 1,860 1,110 750 Pharynx 11,800 9,310 2,490 2,180 1,620 560 Other oral cavity 2,100 1,460 640 1,680 1,270 410 Digestive system 271,250 147,390 123,860 134,710 74,500 60,210 Esophagus 15,560 12,130 3,430 13,940 10,900 3,040 Stomach 21,260 13,000 8,260 11,210 6,610 4,600 Small intestine 5,640 2,940 2,700 1,090 570 520 Colon † 112,340 55,290 57,050 52,180 26,000 26,180 Rectum 41,420 23,840 17,580 Anus, anal canal, & anorectum 4,650 1,900 2,750 690 260 430 Liver & intrahepatic bile duct 19,160 13,650 5,510 16,780 11,280 5,500 Gallbladder & other biliary 9,250 4,380 4,870 3,250 1,260 1,990 Pancreas 37,170 18,830 18,340 33,370 16,840 16,530 Other digestive organs 4,800 1,430 3,370 2,200 780 1,420 Respiratory system 229,400 127,090 102,310 164,840 92,910 71,930 Larynx 11,300 8,960 2,340 3,660 2,900 760 Lung & bronchus 213,380 114,760 98,620 160,390 89,510 70,880 Other respiratory organs 4,720 3,370 1,350 790 500 290 Bones & joints 2,370 1,330 1,040 1,330 740 590 Soft tissue (including heart) 9,220 5,050 4,170 3,560 1,840 1,720 Skin (excluding basal & squamous) 65,050 37,070 27,980 10,850 7,140 3,710 Melanoma‐skin 59,940 33,910 26,030 8,110 5,220 2,890 Other nonepithelial skin 5,110 3,160 1,950 2,740 1,920 820 Breast 180,510 2,030 178,480 40,910 450 40,460 Genital system 306,380 228,090 78,290 55,740 27,720 28,020 Uterine cervix 11,150 11,150 3,670 3,670 Uterine corpus 39,080 39,080 7,400 7,400 Ovary 22,430 22,430 15,280 15,280 Vulva 3,490 3,490 880 880 Vagina & other genital, female 2,140 2,140 790 790 Prostate 218,890 218,890 27,050 27,050 Testis 7,920 7,920 380 380 Penis & other genital, male 1,280 1,280 290 290 Urinary system 120,400 82,960 37,440 27,340 18,100 9,240 Urinary bladder 67,160 50,040 17,120 13,750 9,630 4,120 Kidney & renal pelvis 51,190 31,590 19,600 12,890 8,080 4,810 Ureter & other urinary organs 2,050 1,330 720 700 390 310 Eye & orbit 2,340 1,310 1,030 220 110 110 Brain & other nervous system 20,500 11,170 9,330 12,740 7,150 5,590 Endocrine system 35,520 9,040 26,480 2,320 1,030 1,290 Thyroid 33,550 8,070 25,480 1,530 650 880 Other endocrine 1,970 970 1,000 790 380 410 Lymphoma 71,380 38,670 32,710 19,730 10,370 9,360 Hodgkin lymphoma 8,190 4,470 3,720 1,070 770 300 Non‐Hodgkin lymphoma 63,190 34,200 28,990 18,660 9,600 9,060 Multiple myeloma 19,900 10,960 8,940 10,790 5,550 5,240 Leukemia 44,240 24,800 19,440 21,790 12,320 9,470 Acute lymphocytic leukemia 5,200 3,060 2,140 1,420 820 600 Chronic lymphocytic leukemia 15,340 8,960 6,380 4,500 2,560 1,940 Acute myeloid leukemia 13,410 7,060 6,350 8,990 5,020 3,970 Chronic myeloid leukemia 4,570 2,570 2,000 490 240 250 Other leukemia ‡ 5,720 3,150 2,570 6,390 3,680 2,710 Other & unspecified primary sites ‡ 32,100 15,720 16,380 45,230 24,440 20,790 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 62,030 female carcinoma in situ of the breast and 48,290 melanoma in situ will be newly diagnosed in 2007. †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: Estimated new cases are based on 1995‐2003 incidence rates from 41 states as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 86% of the US population. Estimated deaths are based on data from US Mortality Public Use Data Tapes, 1969 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 2 Age‐standardized Incidence Rates for All Cancers Combined, 1999‐2003, and Estimated New Cases* for Selected Cancers by State, US, 2007 State Incidence Rate † All Cases Female Breast Uterine Cervix Colon & Rectum Uterine Corpus Leukemia Lung & Bronchus Melanoma of the Skin Non‐Hodgkin Lymphoma Prostate Urinary Bladder AL 429.0 20,590 2,750 170 2,350 460 550 3,850 740 860 3,010 850 AK 480.7 2,500 340 ‡ 270 60 70 330 80 110 420 110 AZ § 26,270 3,220 190 2,750 550 740 3,740 1,300 1,080 3,400 1,360 AR § 14,130 1,830 130 1,640 320 510 2,420 550 600 1,960 560 CA 448.2 151,250 19,790 1,350 15,000 3,870 4,610 17,920 6,860 7,190 24,590 6,590 CO 446.8 19,190 2,660 150 1,790 490 670 2,100 1,210 880 3,160 880 CT 508.0 19,780 2,510 100 2,190 650 610 2,720 1,120 870 2,890 1,090 DE 497.4 4,530 560 ‡ 480 130 110 770 190 170 800 220 DC 507.2 2,540 320 ‡ 270 70 60 380 60 100 540 90 FL 478.6 106,560 11,710 850 11,420 2,490 3,360 17,490 4,380 4,530 15,710 5,460 GA 460.3 35,440 4,520 330 3,690 810 960 5,780 1,460 1,370 5,850 1,360 HI 418.5 6,020 820 50 790 170 170 690 270 250 780 200 ID 453.2 6,140 780 ‡ 600 150 220 760 350 280 1,080 310 IL 486.4 62,010 7,030 530 6,890 1,730 2,030 9,550 2,050 2,670 8,060 2,880 IN 465.4 30,040 3,560 240 3,390 880 910 5,210 1,220 1,310 3,710 1,390 IA 476.5 16,540 2,000 100 1,930 500 620 2,290 690 800 2,140 820 KS § 12,760 1,750 100 1,360 360 420 1,870 430 600 1,490 570 KY 509.7 22,850 2,590 200 2,570 560 680 4,450 1,050 900 2,880 970 LA 487.8 22,540 2,820 200 2,520 420 680 3,510 670 920 3,640 850 ME 513.5 8,340 980 ‡ 880 270 250 1,360 410 330 1,210 470 MD 490.5 26,390 3,560 190 2,870 810 630 4,130 1,150 1,160 4,690 1,150 MA 507.2 34,920 4,260 180 3,850 1,110 1,010 5,060 1,820 1,550 5,180 1,950 MI 502.6 54,410 5,900 370 5,570 1,610 1,680 8,210 2,080 2,250 8,200 2,700 MN 472.7 25,420 3,240 150 2,650 750 920 3,160 1,130 1,170 4,800 1,250 MS § 12,470 1,620 120 1,440 230 340 2,190 320 480 2,010 480 MO 460.8 29,930 3,730 240 3,380 830 890 5,350 870 1,260 3,910 1,350 MT 475.3 4,920 630 ‡ 520 120 170 690 190 220 940 260 NE 469.0 8,720 1,160 60 920 260 290 1,190 340 400 1,260 430 NV 470.3 11,030 1,180 80 1,120 230 330 1,750 390 420 1,550 570 NH 492.1 7,140 890 ‡ 800 230 190 1,010 370 290 1,050 390 NJ 518.3 49,370 6,080 350 5,160 1,550 1,520 6,310 2,210 2,200 8,070 2,450 NM § 8,030 1,080 70 790 200 310 940 420 350 1,410 350 NY 479.7 100,960 12,580 790 10,710 3,240 3,080 13,390 3,070 4,540 15,770 4,980 NC § 38,210 4,870 280 4,290 1,020 1,070 6,290 1,630 1,610 6,040 1,690 ND § 3,340 440 ‡ 410 100 110 390 120 150 520 200 OH § 59,220 6,710 390 6,410 1,800 1,710 9,790 2,390 2,560 8,260 2,940 OK 458.7 17,170 2,200 160 1,880 400 570 3,180 720 770 2,510 710 OR 481.0 18,630 2,460 110 1,830 470 500 2,520 990 890 2,870 970 PA 499.0 75,130 8,860 420 8,220 2,400 2,240 10,500 3,120 3,330 12,230 4,030 RI 519.2 6,360 730 ‡ 690 190 170 920 300 260 920 370 SC 471.0 21,370 2,600 190 2,230 480 550 3,460 870 780 3,380 840 SD § 3,990 510 ‡ 470 120 130 490 160 180 710 220 TN § 28,440 3,690 250 3,100 660 800 5,110 980 1,180 3,000 1,230 TX 443.3 91,020 12,120 940 9,510 2,040 3,130 13,520 3,860 4,140 13,280 3,300 UT 408.4 7,660 920 50 740 220 300 600 500 380 1,510 340 VT § 3,500 420 ‡ 390 110 80 440 150 140 550 170 VA § 35,090 4,570 280 3,530 970 900 5,360 1,510 1,390 5,330 1,380 WA 499.5 31,080 4,090 150 2,920 800 960 3,970 1,630 1,500 5,000 1,490 WV 485.4 10,490 1,180 80 1,210 310 300 2,110 410 430 1,430 500 WI 480.2 28,130 3,340 170 3,090 860 1,040 3,930 1,070 1,300 4,770 1,350 WY § 2,340 310 ‡ 260 60 70 290 100 110 410 110 US 474.8 1,444,920 178,480 11,150 153,760 39,080 44,240 213,380 59,940 63,190 218,890 67,160 * Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Rates are per 100,000 and age‐adjusted to the 2000 US standard population; source: CINA+ Online, NAACCR, based on data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. ‡Estimate is fewer than 50 cases. §Combined incidence rate is not available. Note: These model‐based estimates are calculated using incidence rates from 41 states as reported by NAACCR; they are offered as a rough guide and should be interpreted with caution. 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 2007. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 54% of all newly diagnosed cancers. Prostate cancer alone accounts for about 29% (218,890) of incident cases in men. Based on cases diagnosed between 1996 and 2002, an estimated 91% of these 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 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths, by Sex, US, 2007. * Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimates are rounded to the nearest 10. The three most commonly diagnosed types of cancer among women in 2007 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for about 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 26% (178,480) of all new cancer cases among women. Expected Number of New Cancer Deaths Table 1 also shows the expected number of deaths from cancer projected for 2007 for men, women, and both sexes combined. It is estimated that about 559,650 Americans will die from cancer, corresponding to over 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 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 26% of all female cancer deaths in 2007. Table 3 provides the estimated number of cancer deaths in 2007 by state for selected cancer sites. TABLE 3 Age‐standardized Death Rates for All Cancers Combined, 1999‐2003, and Estimated Deaths* From All Cancers Combined and Selected Sites by State, US, 2007 State Death Rate † All Sites Brain & Other Nervous System Female Breast Colon & Rectum Leukemia Liver Lung & Bronchus Non‐Hodgkin Lymphoma Ovary Pancreas Prostate AL 210.7 9,740 210 680 880 350 300 3,240 330 290 530 480 AK 195.3 810 ‡ 50 70 ‡ ‡ 230 ‡ ‡ 50 ‡ AZ 174.9 10,120 250 710 970 400 330 2,850 320 300 590 520 AR 210.2 6,240 140 410 610 240 200 2,220 200 140 310 300 CA 178.7 54,890 1,460 4,130 5,230 2,150 2,270 13,220 1,830 1,680 3,480 3,040 CO 171.2 6,660 190 520 630 290 200 1,650 240 220 410 330 CT 186.5 6,990 150 490 590 270 190 1,860 230 190 480 390 DE 207.7 1,810 ‡ 120 160 70 ‡ 580 60 50 100 90 DC 230.3 1,020 ‡ 80 100 ‡ ‡ 260 ‡ ‡ 60 60 FL 186.2 40,430 790 2,700 3,530 1,630 1,190 12,360 1,300 1,040 2,350 2,180 GA 202.3 14,950 280 1,120 1,340 540 360 4,500 470 420 820 630 HI 152.9 2,260 ‡ 130 210 80 110 530 90 50 170 130 ID 178.1 2,370 80 180 200 120 50 570 100 50 140 150 IL 204.8 23,870 490 1,740 2,380 990 650 6,690 750 620 1,480 990 IN 211.9 12,730 280 860 1,180 510 290 3,800 430 350 740 600 IA 188.5 6,510 160 410 600 310 140 1,750 300 190 390 350 KS 189.0 5,290 140 380 520 230 120 1,530 220 150 310 220 KY 226.8 9,390 150 600 860 320 220 3,450 290 220 460 310 LA 226.3 9,550 200 730 960 330 330 3,020 310 220 530 400 ME 210.5 3,190 80 190 280 100 70 970 110 80 190 180 MD 203.7 10,210 230 830 970 390 250 2,900 320 270 640 540 MA 200.8 13,240 270 890 1,180 490 380 3,630 420 360 860 560 MI 199.6 19,180 450 1,320 1,750 770 560 5,840 660 540 1,180 850 MN 185.2 9,380 240 600 810 400 240 2,460 350 250 550 490 MS 219.5 5,990 160 450 610 210 180 2,040 170 150 340 290 MO 205.0 12,610 270 870 1,170 460 330 4,120 500 320 690 510 MT 191.6 1,920 50 130 160 80 ‡ 520 80 60 110 110 NE 184.6 3,320 90 220 350 150 70 900 110 90 180 170 NV 206.2 4,660 100 330 490 160 140 1,330 130 130 260 230 NH 198.4 2,630 70 180 220 100 70 740 90 60 150 140 NJ 201.6 17,140 320 1,350 1,680 680 530 4,380 600 490 1,070 750 NM 171.1 3,270 80 240 320 120 140 720 120 90 190 200 NY 187.3 35,270 720 2,670 3,350 1,360 1,090 9,500 1,030 1,020 2,330 1,630 NC 202.0 16,880 360 1,240 1,480 610 420 5,150 570 450 980 800 ND 181.8 1,220 ‡ 90 120 ‡ ‡ 350 ‡ ‡ 80 110 OH 209.0 24,600 540 1,820 2,350 950 600 7,310 610 650 1,370 1,350 OK 205.2 7,380 170 510 720 290 180 2,390 210 170 370 280 OR 196.1 7,370 200 530 640 260 190 2,140 360 230 440 340 PA 202.8 29,140 560 2,470 2,730 1,070 790 7,780 1,140 790 1,780 1,310 RI 200.2 2,370 50 140 210 80 70 640 60 60 140 110 SC 208.1 8,940 190 570 790 330 230 2,750 260 220 510 420 SD 189.0 1,600 50 100 160 70 ‡ 420 80 50 100 110 TN 214.7 12,920 350 890 1,160 480 330 4,340 410 320 700 550 TX 192.8 34,170 840 2,480 3,220 1,410 1,490 9,920 1,160 860 2,010 1,620 UT 148.0 2,690 90 240 240 130 70 470 140 90 170 140 VT 192.6 1,160 ‡ 100 120 50 ‡ 350 50 ‡ 70 80 VA 202.9 13,740 280 1,100 1,320 500 370 4,290 360 390 800 600 WA 193.2 11,370 370 770 990 490 380 3,170 440 370 740 630 WV 218.5 4,610 90 280 480 130 110 1,450 170 140 220 160 WI 189.6 10,870 260 770 960 490 310 2,890 320 290 680 540 WY 187.8 980 ‡ 60 110 ‡ ‡ 260 ‡ ‡ 60 60 US 195.7 559,650 12,740 40,460 52,180 21,790 16,780 160,390 18,660 15,280 33,370 27,050 * Rounded to the nearest 10. †Rates are per 100,000 population 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 fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Regional Variations in Cancer Rates Table 4 depicts cancer incidence for select cancers by state. Rates vary widely across states. For example, among the cancers listed in Table 4 , the largest variations in the incidence rates, in proportionate terms, occurred in lung cancer, in which rates (cases per 100,000 population) ranged from 41.8 in men and 21.5 in women in Utah to 137.9 in men and 73.5 in women in Kentucky. In contrast, the variation in female breast cancer incidence rates was small, ranging from 115 cases per 100,000 population in New Mexico to 146.7 cases in Washington. Factors that contribute to the state variations in the incidence rates include differences in the prevalence of risk factors, access to and utilization of early detection services, and completeness of reporting. For example, the state variation in lung cancer incidence rates primarily reflects differences in smoking prevalence; Utah ranks lowest in adult smoking prevalence and Kentucky highest. TABLE 4 Cancer Incidence Rates* by Site and State, US, 1999 to 2003 All Sites Breast Colon & Rectum Lung & Bronchus Non‐Hodgkin Lymphoma Prostate Urinary Bladder State Male Female Female Male Female Male Female Male Female Male Male Female Alabama † 526.5 365.2 115.3 60.6 41.8 108.9 49.9 18.8 13.3 140.4 30.0 7.1 Alaska † 556.8 421.2 134.2 65.5 50.3 87.6 60.9 23.7 15.7 167.7 39.5 8.4 Arizona 462.4 364.1 116.7 53.1 38.2 71.8 48.7 18.7 13.4 118.2 36.0 8.8 Arkansas 544.1 377.1 121.0 60.1 43.4 114.9 56.1 20.8 15.1 154.2 34.3 8.2 California † 520.9 398.5 129.8 56.6 41.5 70.8 48.4 22.4 15.3 158.3 34.4 8.3 Colorado † 516.2 400.3 134.2 53.7 40.7 66.6 44.7 21.7 16.7 164.8 35.4 9.3 Connecticut † 597.3 448.3 140.4 68.8 50.3 84.2 57.1 24.4 17.0 179.8 45.0 12.3 Delaware † 586.8 433.4 128.8 66.6 48.8 97.4 63.0 21.6 15.9 176.1 38.5 10.2 Dist. of Columbia † 635.6 422.6 135.3 65.6 52.0 96.4 50.1 21.0 11.9 227.1 25.3 9.8 Florida † 562.2 415.6 123.0 62.8 46.6 94.4 60.5 22.3 15.5 152.7 40.4 10.4 Georgia † 565.8 391.5 124.0 61.5 43.7 108.6 52.8 19.6 13.8 166.2 32.7 8.0 Hawaii † 481.8 375.2 127.3 65.4 42.3 68.0 37.2 18.7 13.1 132.3 23.4 5.2 Idaho † 530.0 396.0 128.2 52.4 39.5 71.1 44.8 20.8 17.6 171.9 38.2 7.6 Illinois † 580.9 425.5 129.7 71.1 49.8 96.1 56.6 23.2 16.2 165.6 40.2 10.5 Indiana † 545.7 414.4 124.8 67.6 48.5 107.1 60.3 22.0 15.7 138.6 36.1 9.2 Iowa † 557.1 424.2 128.7 71.6 53.0 90.2 50.4 22.6 16.7 154.2 39.1 9.8 Kansas ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Kentucky † 616.9 440.5 124.8 72.0 53.1 137.9 73.5 21.6 16.5 155.1 37.8 9.5 Louisiana † 613.8 402.3 122.8 72.7 49.6 114.0 56.8 22.4 15.7 179.5 34.2 8.2 Maine † 609.9 447.6 131.4 69.1 51.4 101.0 62.8 22.5 16.9 171.3 48.9 13.2 Maryland † 581.6 428.3 131.9 63.2 47.2 87.2 57.1 20.9 14.4 185.2 34.0 9.4 Massachusetts † 591.6 451.8 138.8 68.7 50.3 84.0 61.4 23.1 16.8 178.2 45.8 12.5 Michigan † 608.6 429.9 129.4 62.4 46.5 94.8 58.6 23.6 17.3 199.1 42.0 10.7 Minnesota † 559.4 412.3 135.9 60.3 44.6 72.1 47.8 25.4 18.0 188.6 38.4 10.2 Mississippi ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Missouri † 537.4 408.8 125.4 67.9 48.5 104.7 59.5 21.9 15.9 136.8 35.9 9.0 Montana † 558.8 412.0 128.4 59.0 43.9 81.2 56.0 22.6 15.1 183.6 40.8 10.1 Nebraska † 551.0 413.4 131.4 70.8 49.7 81.6 47.4 22.6 17.3 165.7 38.3 9.2 Nevada † 541.3 414.2 120.8 60.7 44.1 91.5 71.2 20.7 14.3 150.6 44.0 11.0 New Hampshire † 571.7 436.6 135.2 62.4 48.5 81.9 59.3 24.2 16.4 165.3 46.2 12.7 New Jersey † 623.9 448.7 133.9 73.1 52.3 85.0 55.7 25.7 18.0 200.3 45.3 12.0 New Mexico 485.0 357.3 115.0 52.0 35.2 60.1 36.8 17.9 13.6 152.2 28.7 7.1 New York † 565.4 424.8 126.7 68.0 50.2 82.8 53.5 23.4 16.6 168.1 41.0 11.1 North Carolina 519.2 372.6 121.5 57.0 41.8 96.2 49.9 19.0 13.4 152.4 32.7 8.4 North Dakota 518.0 366.9 123.1 64.8 43.4 70.8 41.0 21.6 14.6 181.8 37.2 9.1 Ohio 551.9 412.6 126.6 65.7 47.7 99.5 57.8 22.9 16.1 154.1 39.5 10.1 Oklahoma † 547.0 399.6 128.3 64.6 44.6 111.2 62.1 21.9 15.1 148.8 32.6 8.0 Oregon † 545.4 436.5 142.6 56.9 44.3 82.6 61.0 23.4 17.3 164.1 41.1 10.2 Pennsylvania † 594.4 436.5 129.4 72.2 51.1 92.9 53.9 24.5 17.0 172.3 44.2 11.6 Rhode Island † 627.2 448.6 130.7 72.9 50.2 98.7 60.9 23.5 17.3 177.9 51.6 14.8 South Carolina † 590.1 389.4 123.5 65.4 45.6 107.4 51.1 20.4 14.3 176.9 33.9 7.6 South Dakota (2001‐2003) 564.1 395.7 128.6 66.2 48.9 78.4 41.8 22.2 15.5 190.1 43.2 8.6 Tennessee § 442.0 351.2 113.7 54.7 40.2 95.5 50.9 17.8 12.9 108.7 28.3 7.3 Texas † 530.7 383.4 118.6 59.2 41.4 91.8 50.7 21.3 15.6 148.3 29.6 7.3 Utah † 490.2 346.3 117.1 48.3 36.6 41.8 21.5 23.1 15.3 186.5 31.3 7.0 Vermont ‡ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Virginia 510.5 367.6 122.2 58.3 43.1 83.5 48.7 19.1 13.0 161.4 32.4 8.2 Washington † 573.7 448.0 146.7 57.9 43.5 84.4 60.5 26.0 18.1 177.1 41.7 10.3 West Virginia † 574.6 427.8 116.9 71.5 53.6 118.0 68.4 21.3 16.2 148.2 39.9 12.1 Wisconsin † 562.0 424.4 133.9 66.5 47.2 84.5 52.2 22.9 16.8 169.1 37.9 10.5 Wyoming 524.9 390.3 125.2 52.1 45.1 65.6 44.7 17.3 16.9 182.2 40.5 9.2 United States 562.1 415.3 128.2 64.2 46.7 89.6 54.7 22.6 16.0 165.0 38.2 9.8 * Per 100,000, age‐adjusted to the 2000 US standard population. Not all states submitted data for all years. †This state's registry has submitted five years of data and passed rigorous criteria for each single year's data including: completeness of reporting, non‐duplication of records, percent unknown in critical data fields, percent of cases registered with information from death certificates only, and internal consistency among data items. ‡This state's registry did not submit incidence data to the North American Association of Central Cancer Registries (NAACCR) for 1999–2003. § This state's data is excluded from interpretation in the text because completeness of case ascertainment for this state's registry is 77%–84% for the years 1999–2003. Sources: CINA+ Online and Cancer in North America: 1999–2003, Volume One: Incidence, North American Association of Central Cancer Registries. Trends in Cancer Incidence and Mortality Figures 2 , , to 5 depict long‐term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites combined and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates for all sites combined stabilized in men from 1995 to 2003 and increased in women by 0.3% per year from 1987 to 2003. FIGURE 2 Annual Age‐adjusted Cancer Incidence and Death Rates* for All Sites, by Sex, US, 1975 to 2003. * Rates are age‐adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. Source: Incidence—Surveillance, Epidemiology, and End Results (SEER) program, ( http://www.seer.cancer.gov ). Delay‐Adjusted Incidence database: “SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2003.” National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2006, based on the November 2005 SEER data submission. Mortality—US Mortality Public Use Data Tapes, 1960 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. FIGURE 3 Annual Age‐adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancers, US, 1975 to 2003. * Rates are age‐adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) Program ( http://www.seer.cancer.gov ). Delay‐Adjusted Incidence database: “SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2003.” National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2006, based on the November 2005 SEER data submission. FIGURE 4 Annual Age‐adjusted Cancer Death Rates* * Among Males for Selected Cancers, US, 1930 to 2003. *Rates are age‐adjusted to the 2000 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US Mortality Public Use Data Tapes, 1960 to 2003, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. FIGURE 5 Annual Age‐adjusted Cancer Death Rates* Among Females for Selected Cancers, US, 1930 to 2003. * Rates are age‐adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Source: US Mortality Public Use Data Tapes, 1960 to 2003, US Mortality Volumes 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, US, 1975 to 2003 Line Segment 1 Line Segment 2 Line Segment 3 Line Segment 4 Year APC * Year APC * Year APC * Year APC * All sites Incidence Male and female 1975–1983 0.9 † 1983–1992 1.8 † 1992–1995 −1.5 1995–2003 0.1 Male 1975–1989 1.3 † 1989–1992 5.1 † 1992–1995 −4.5 † 1995–2003 0.0 Female 1975–1979 −0.3 1979–1987 1.6 † 1987–2003 0.3 † Death Male and female 1975–1990 0.5 † 1990–1994 −0.4 1994–2003 −1.1 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.4 1993–2003 −1.6 † Female 1975–1992 0.5 † 1992–2003 −0.8 † Lung & bronchus Incidence Male and female 1975–1982 2.5 † 1982–1991 0.9 † 1991–2003 −0.7 † Male 1975–1982 1.5 † 1982–1991 −0.5 † 1991–2003 −1.7 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2003 0.5 † Death Male and female 1975–1980 3.0 † 1980–1990 1.8 † 1990–1994 −0.1 1994–2003 −0.9 † Male 1975–1978 2.4 † 1978–1984 1.2 † 1984–1991 0.3 † 1991–2003 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † Colon & rectum Incidence Male and female 1975–1985 0.8 † 1985–1995 −1.8 † 1995–1998 1.2 1998–2003 −2.1 † Male 1975–1986 1.1 † 1986–1995 −2.1 † 1995–1998 1.0 1998–2003 −2.5 † Female 1975–1985 0.3 1985–1995 −1.8 † 1995–1998 1.7 1998–2003 −1.9 † Death Male and female 1975–1978 0.2 1978–1985 −0.8 † 1985–2001 −1.8 † 2001–2003 −2.8 † Male 1975–1978 0.8 1978–1984 −0.4 1984–1990 −1.3 † 1990–2003 −2.1 † Female 1975–1984 −1.0 † 1984–2003 −1.9 † Breast (female) Incidence 1975–1980 −0.4 1980–1987 3.7 † 1987–2001 0.5 † 2001–2003 −4.1 Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1999 −3.1 † 1999–2003 −1.4 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.4 † 1992–1995 −10.8 † 1995–2003 1.1 † Death 1975–1987 0.9 † 1987–1991 3.1 † 1991–1994 −0.6 1994–2003 −4.0 † * Annual percent change based on incidence (delay‐adjusted) and mortality rates age‐adjusted to the 2000 US standard population. †The APC is significantly different from zero. Note: Trends were analyzed by Joinpoint Regression Program, version 3.1, with a maximum of three joinpoints (ie, four line segments). Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Lung cancer incidence rates are declining in men and appear to be plateauing in women after increasing for many decades. The lag in the temporal trend of lung cancer incidence rates in women compared with men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked about 20 years later than in men. Colorectal cancer incidence rates have decreased from 1998 through 2003 in both males and in females. Female breast cancer incidence rates leveled off from 2001 to 2003 after increasing since 1980, which may reflect the saturation of mammography utilization and reduction in the use of hormone replacement therapy. Prostate cancer incidence rates continued to increase, although at a slower rate than those reported for the early 1990s and before. The continuing increase for prostate cancer may be attributable to increased screening through prostate‐specific antigen (PSA) testing. Death rates for all cancer sites combined decreased by 1.6% per year from 1993 to 2003 in males and by 0.8% per year in females from 1992 to 2003. 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 continued to increase by 0.3% per year from 1995 to 2003 ( Table 5 ). Table 6 shows the contribution of individual cancer sites to the total decrease in overall cancer death rates. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990/1991 and 2003, death rates from cancer decreased by 16.3% among men and by 8.5% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounts for about 80% of the decrease in cancer death rates, while reduction in death rates from breast and colorectal cancers accounts for over 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of the sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use over the past 40 years, while the decrease in death rates from female breast, colorectal, and prostate cancer largely reflects improvements in early detection and treatment. Between 1990/1991 and 2003, death rates increased substantially for lung cancer in women and for liver and intrahepatic bile duct cancer in men. TABLE 6 The Contribution of Indvidual Cancer Sites to the Decrease in Cancer Death Rates, 1990–2003 Death rate (per 100,000) Change %Contribution † 1990 * 2003 Absolute % Male All Malignant Cancers 279.82 234.12 −45.70 −16.33 Decreasing Lung & Bronchus 90.56 71.92 −18.64 −20.58 38.4 Prostate 38.56 26.56 −12.00 −31.12 24.8 Colon & Rectum 30.77 22.96 −7.81 −25.38 16.1 Pancreas 12.59 12.05 −0.54 −4.29 1.1 Leukemia 10.71 9.93 −0.78 −7.28 1.6 Non‐Hodgkin Lymphoma 9.97 9.32 −0.65 −6.52 1.3 Urinary Bladder 7.97 7.37 −0.60 −7.53 1.2 Kidney & Renal Pelvis 6.16 6.07 −0.09 −1.46 0.2 Stomach 8.86 5.70 −3.16 −35.67 6.5 Brain & Other Nervous System 5.97 5.36 −0.61 −10.22 1.3 Myeloma 4.83 4.58 −0.25 −5.18 0.5 Oral Cavity & Pharynx 5.61 4.06 −1.55 −27.63 3.2 Larynx 2.97 2.36 −0.61 −20.54 1.3 Hodgkin Lymphoma 0.85 0.55 −0.30 −35.29 0.6 Bones & Joints 0.55 0.54 −0.01 −1.82 0.0 Small Intestine 0.50 0.43 −0.07 −14.00 0.1 Others 25.77 24.96 −0.81 −3.14 1.7 Total −48.48 100.0 Increasing Esophagus 7.16 7.74 0.58 8.10 20.6 Liver & Intrahepatic Bile Duct 5.27 7.38 2.11 40.04 74.8 Melanoma of the Skin 3.80 3.88 0.08 2.11 2.8 Thyroid 0.37 0.42 0.05 13.51 1.8 Total 2.82 100.0 Death rate (per 100,000) Change %Contribution † 1991 * 2003 Absolute % Females All Malignant Cancers 175.30 160.49 −14.81 −8.45 Decreasing Breast 32.69 25.19 −7.50 −22.94 39.4 Colon & Rectum 20.30 16.05 −4.25 −20.94 22.3 Pancreas 9.28 9.24 −0.04 −0.43 0.2 Ovary 9.51 8.85 −0.66 −6.94 3.5 Non‐Hodgkin Lymphoma 6.74 5.88 −0.86 −12.76 4.5 Leukemia 6.32 5.59 −0.73 −11.55 3.8 Uterine Corpus 4.18 4.13 −0.05 −1.20 0.3 Brain & Other Nervous System 4.11 3.62 −0.49 −11.92 2.6 Myeloma 3.26 3.08 −0.18 −5.52 0.9 Stomach 4.01 2.96 −1.05 −26.18 5.5 Kidney & Renal Pelvis 2.95 2.73 −0.22 −7.46 1.2 Uterine Cervix 3.49 2.48 −1.01 −28.94 5.3 Urinary Bladder 2.34 2.20 −0.14 −5.98 0.7 Esophagus 1.81 1.74 −0.07 −3.87 0.4 Melanoma of the Skin 1.82 1.74 −0.08 −4.40 0.4 Oral Cavity & Pharynx 2.03 1.47 −0.56 −27.59 2.9 Soft Tissue including Heart 1.28 1.14 −0.14 −10.94 0.7 Gallbladder 1.09 0.77 −0.32 −29.36 1.7 Others 17.97 17.28 −0.69 −3.84 3.6 Total −19.04 100.0 Increasing Lung & Bronchus 37.61 41.24 3.63 9.65 85.8 Liver & Intrahepatic Bile Duct 2.51 3.11 0.60 23.90 14.2 Total 4.23 100.0 * Death rates from cancer peaked in 1990 for men and in 1991 for women. †This calculation is based on each cancer site's contribution to the increasing or decreasing portion of the total cancer death rate, depending on the individual site's trend; it does not represent the contribution to the net decrease in cancer death rates. Changes in the Recorded Number of DeathsFrom Cancer From 2003 to 2004 A total of 553,888 cancer deaths was recorded in the United States in 2004, the most recent year for which actual data are available. There were 3,014 fewer cancer deaths reported in 2004 than in 2003, resulting in a decrease in the total number of cancer deaths for the second consecutive year. Cancer accounted for about 23% of all deaths, ranking second only to heart disease ( Table 7 ). 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 ( Table 8 ). Cancer is the leading cause of death among women aged 40 to 79 years and among men aged 60 to 79 years. When age‐adjusted death rates are considered ( Figure 6 ), cancer is the leading cause of death among men and women under age 85 years. A total of 473,535 people under age 85 years died from cancer in the United States in 2004, compared with 414,526 deaths from heart disease. FIGURE 6 Death Rates* From Cancer and Heart Disease for Ages Younger Than 85 and 85 and Older. * Rates are age‐adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 1960 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 7 Fifteen Leading Causes of Death, US, 2004 Rank Cause of Death Number of Deaths Percent (%) of Total Deaths Death Rate* All Causes 2,397,615 100.0 800.8 1 Heart diseases 652,486 27.2 217.0 2 Cancer 553,888 23.1 185.8 3 Cerebrovascular diseases 150,074 6.3 50.0 4 Chronic lower respiratory diseases 121,987 5.1 41.1 5 Accidents (unintentional injuries) 112,012 4.7 37.7 6 Diabetes mellitus 73,138 3.1 24.5 7 Alzheimer disease 65,965 2.8 21.8 8 Influenza & pneumonia 59,664 2.5 19.8 9 Nephritis, nephrotic syndrome, & nephrosis 42,480 1.8 14.2 10 Septicemia 33,373 1.4 11.2 11 Intentional self‐harm (suicide) 32,439 1.4 10.9 12 Chronic liver disease & cirrhosis 27,013 1.1 9.0 13 Hypertension & hypertensive renal disease 23,076 1.0 7.7 14 Parkinson disease 17,989 0.8 6.1 15 Assault (homocide) 17,357 0.7 5.9 All other & ill‐defined causes 414,674 17.3 * 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, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 8 Ten Leading Causes of Death by Age and Sex, US, 2004 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 1,181,668 All Causes 1,215,947 All Causes 16,326 All Causes 8,999 All Causes 63,753 All Causes 28,774 All Causes 217,755 All Causes 134,523 All Causes 467,831 All Causes 386,115 All Causes 400,011 All Causes 645,246 1 Heart diseases 321,973 Heart diseases 330,513 Accidents (unintentional injuries) 7,369 Accidents (unintentional injuries) 3,763 Accidents (unintentional injuries) 21,802 Accidents (unintentional injuries) 7,173 Heart diseases 53,449 Cancer 49,725 Cancer 152,611 Cancer 127,500 Heart diseases 132,195 Heart diseases 217,367 2 Cancer 286,830 Cancer 267,058 Assault (homicide) 2,035 Cancer 930 Intentional self‐harm (suicide) 8,685 Cancer 4,878 Cancer 53,127 Heart diseases 21,543 Heart diseases 130,219 Heart diseases 88,538 Cancer 75,579 Cancer 83,986 3 Accidents (unintentional injuries) 72,050 Cerebro vascular disease 91,274 Intentional self‐harm (suicide) 1,532 Assault (homicide) 603 Assault (homicide) 7,700 Heart diseases 2,526 Accidents (unintentional injuries) 22,159 Accidents (unintentional injuries) 9,343 Chronic lower respiratory diseases 30,114 Chronic lower respiratory diseases 29,223 Cerebro vascular diseases 28,551 Cerebro vascular diseases 61,582 4 Cerebro vascular disease 58,800 Chronic lower respiratory diseases 63,341 Cancer 1,219 Congenital anomalies 541 Heart diseases 5,394 Intentional self‐harm (suicide) 1,953 Intentional self‐harm (suicide) 9,640 Cerebro vascular diseases 5,536 Cerebro vascular diseases 22,668 Cerebro vascular diseases 23,335 Chronic lower respiratory diseases 23,749 Alzheimer disease 39,951 5 Chronic lower respiratory diseases 58,646 Alzheimer disease 46,991 Congenital anomalies 674 Intentional self‐harm (suicide) 453 Cancer 4,251 Assault (homicide) 1,478 Chronic liver disease & cirrhosis 9,357 Diabetes mellitus 4,778 Diabetes mellitus 17,160 Diabetes mellitus 15,969 Influenza & pneumonia 15,560 Chronic lower respiratory diseases 29,660 6 Diabetes mellitus 35,267 Accidents (unintentional injuries) 39,962 Heart diseases 456 Heart diseases 342 HIV disease 2,421 HIV disease 1,202 Diabetes mellitus 6,948 Chronic lower respiratory diseases 4,066 Accidents (unintentional injuries) 11,024 Nephritis, nephrotic syndrome & nephrosis 7,652 Alzheimer disease 14,353 Influenza & pneumonia 23,801 7 Influenza & pneumonia 26,861 Diabetes mellitus 37,871 Chronic lower respiratory diseases 160 Influenza & pneumonia 132 Diabetes mellitus 837 Cerebro vascular disease 680 Cerebro vascular diseases 6,655 Chronic liver disease & cirrhosis 3,736 Influenza & pneumonia 8,302 Accidents (unintentional injuries) 7,235 Diabetes mellitus 10,269 Diabetes mellitus 16,496 8 Intentional self‐harm (suicide) 25,566 Influenza & pneumonia 32,803 Influenza & pneumonia 136 Septicemia 101 Chronic liver disease & cirrhosis 752 Diabetes mellitus 584 HIV disease 6,222 Intentional self‐harm (suicide) 3,305 Nephritis, nephrotic syndrome & nephrosis 8,017 Alzheimer disease 6,887 Nephritis, nephrotic syndrome & nephrosis 9,452 Nephritis, nephrotic syndrome & nephrosis 12,205 9 Nephritis, nephrotic syndrome & nephrosis 20,370 Nephritis, nephrotic syndrome & nephrosis 22,110 Cerebro vascular disease 104 Chronic lower respiratory diseases 93 Cerebro vascular disease 748 Pregnancy, childbirth & puerperium 514 Chronic lower respiratory diseases 4,260 Septicemia 2,103 Septicemia 6,349 Influenza & pneumonia 6,881 Accidents (unintentional injuries) 9,018 Accidents (unintentional injuries) 11,986 10 Alzheimer disease 18,974 Septicemia 18,362 In situ & benign neoplasms 99 In situ & benig nneoplasms 88 Congenital anomalies 500 Chronic liver disease & cirrhosis 358 Assault (homicide) 2,918 HIV disease 2,069 Chronic liver disease & cirrhosis 6,324 Septicemia 6,507 Parkinsons disease 6,435 Hypertension & hypertensive renal disease 9,568 Note: Symptoms, signs, and abnormalities; events of undetermined intent; and other respiratory diseases were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Table 9 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among males under age 40 years, leukemia is the most common fatal cancer, while cancer of the lung and bronchus predominates in men aged 40 years and older. The second most common cause of cancer death is colorectal cancer among men aged 40 to 79 years and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at age 20 to 59 years, and lung cancer ranks first at age 60 years and older. TABLE 9 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, US, 2004 All Ages <20 20 to 39 40 to 59 60 to 79 ≥ 80 Male All Sites All Sites All Sites All Sites All Sites All Sites 286,830 1,256 4,251 53,127 152,611 75,579 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 89,575 387 543 16,013 54,959 18,261 Prostate Brain & ONS* Brain & ONS* Colon & rectum Colon & rectum Prostate 29,002 301 513 5,011 13,727 15,341 Colon & rectum Bones & joints Colon & rectum Pancreas Prostate Colon & rectum 26,881 118 384 3,384 12,511 7,749 Pancreas Other endocrine system Non‐Hodgkin lymphoma Liver & bile duct Pancreas Urinary bladder 15,776 108 349 3,301 8,724 3,736 Leukemia Soft tissue Lung & bronchus Esophagus Leukemia Pancreas 12,051 83 333 2,525 5,860 3,547 Female All Sites All Sites All Sites All Sites All Sites All Sites 267,058 967 4,878 49,725 127,500 83,986 Lung & bronchus Leukemia Breast Breast Lung & bronchus Lung & bronchus 68,431 278 1,225 12,162 39,883 17,022 Breast Brain & ONS* Uterine cervix Lung & bronchus Breast Colon & rectum 40,954 254 462 11,219 17,046 11,720 Colon & rectum Other endocrine system Leukemia Colon & rectum Colon & rectum Breast 26,699 89 386 3,694 10,934 10,521 Pancreas Soft tissue Colon & rectum Ovary Pancreas Pancreas 15,995 81 346 3,281 7,807 5,949 Ovary Bones & joints Brain & ONS* Pancreas Ovary Non‐Hodgkin lymphoma 14,716 71 312 2,162 7,328 4,076 * ONS = Other nervous system. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. Others and Unspecified Primary is excluded from cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. From 2003 to 2004, the number of recorded cancer deaths decreased by 1,160 in men and by 1,854 in women ( Table 10 ). The largest change in number of deaths from the major cancers was for colorectal cancer in both men and women (decreased by 1,110 and 1,094, respectively). TABLE 10 Trends in the Recorded Number of Deaths for Selected Cancers by Sex, US, 1989 to 2004 All Sites Lung and Bronchus Colon and Rectum Prostate Breast Year 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 2003 287,990 268,912 89,908 68,084 27,991 27,793 29,554 41,620 2004 286,830 267,058 89,575 68,431 26,881 26,699 29,002 40,954 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 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. CANCER OCCURRENCE BY RACE/ETHNICITY Cancer incidence and death rates vary considerably among racial and ethnic groups ( Table 11 ). For all cancer sites combined, African American men have a 15% higher incidence rate and 38% higher death rate than White men. African American women have a 9% lower incidence rate, but an 18% higher death rate than White women for all cancer sites combined. For the specific cancer sites listed in Table 11 , incidence and death rates are consistently higher in African Americans than in Whites, except for breast cancer (incidence) and lung and kidney cancers (incidence and mortality) among women. Death rates from prostate, stomach, and cervical cancers among African Americans are more than twice those in Whites. Factors known to contribute to racial disparities in mortality vary by cancer site. These factors include differences in exposure to underlying risk factors (eg, Helicobacter pylori for stomach cancer), access to high‐quality regular screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment (for many cancers). The higher breast cancer incidence rates among Whites are thought to reflect a combination of factors that affect diagnosis (such as more frequent mammography in White women until the most recent time period) and those that affect disease risk (such as later age at first birth and greater use of hormone replacement therapy among White than African American women). TABLE 11 Incidence and Death Rates* for Selected Cancers by Race and Ethnicity, US, 1999 to 2003 All Races White African American Asian American/Pacific Islander American Indian/Alaska Native † Hispanic‐Latino ‡ Incidence Rates All sites Male 562.1 555.0 639.8 385.5 359.9 444.1 Female 415.3 421.1 383.8 303.3 305.0 327.2 Breast (female) 128.2 130.8 111.5 91.2 74.4 92.6 Colon & rectum Male 64.2 63.7 70.2 52.6 52.7 52.4 Female 46.7 45.9 53.5 38.0 41.9 37.3 Kidney & renal pelvis Male 17.9 18.0 18.5 9.8 20.9 16.9 Female 9.2 9.3 9.5 4.9 10.0 9.4 Liver & bile duct Male 8.2 7.2 11.1 22.1 14.5 14.8 Female 3.0 2.7 3.6 8.3 6.5 5.8 Lung & bronchus Male 89.6 88.8 110.6 56.6 55.5 52.7 Female 54.7 56.2 50.3 28.7 33.8 26.7 Prostate 165.0 156.0 243.0 104.2 70.7 141.1 Stomach Male 10.7 9.7 17.4 20.0 21.6 16.1 Female 5.1 4.4 9.0 11.4 12.3 9.1 Uterine cervix 9.1 8.6 13.0 9.3 7.2 14.7 Death Rates All sites Male 243.7 239.2 331.0 144.9 153.4 166.4 Female 164.3 163.4 192.4 98.8 111.6 108.8 Breast (female) 26.0 25.4 34.4 12.6 13.8 16.3 Colon & rectum Male 24.3 23.7 33.6 15.3 15.9 17.5 Female 17.0 16.4 23.7 10.5 11.1 11.4 Kidney & renal pelvis Male 6.1 6.2 6.1 2.6 6.8 5.3 Female 2.8 2.8 2.8 1.2 3.3 2.4 Liver & bile duct Male 7.0 6.3 9.6 15.5 7.8 10.7 Female 3.0 2.8 3.8 6.7 4.0 5.0 Lung & bronchus Male 74.8 73.8 98.4 38.8 42.9 37.2 Female 41.0 42.0 39.8 18.8 27.0 14.7 Prostate 29.1 26.7 65.1 11.8 18.0 22.1 Stomach Male 6.1 5.4 12.4 11.0 7.1 9.2 Female 3.1 2.7 6.0 6.7 3.7 5.2 Uterine cervix 2.7 2.4 5.1 2.5 2.6 3.4 * Rates are per 100,000 and age‐adjusted to the 2000 US standard population. †Incidence rates are for diagnosis years 1999–2002. ‡Persons of Hispanic/Latino origin may be of any race. Source: Incidence (except American Indian and Alaska Native): Howe HL, Wu X, Ries LAG, et al. Annual report to the nation on the status of cancer 1975–2003, featuring cancer among US Hispanic/Latino populations. Cancer 2006; 107:1643–1658. Incidence (American Indian and Alaska Native) and Mortality: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Among other racial and ethnic groups, cancer incidence and death rates are lower than those in Whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, the incidence and death rates are generally higher in minority populations than in Whites for cancers of the uterine cervix, stomach, and liver. Stomach and liver cancer incidence and death rates are more than twice as high in Asian American/Pacific Islanders as in Whites, reflecting increased exposure to infectious agents such as Helicobacter pylori and hepatitis B. Kidney cancer incidence and death rates are the highest among American Indians/Alaskan Natives, although factors that contribute to this are unknown. Trends in cancer incidence can only be adjusted for delayed reporting in Whites and African Americans, and not in other racial and ethnic subgroups, because long‐term incidence data required for delay adjustment are available only for Whites and African Americans. From 1995 to 2003, sex‐specific incidence rates for all cancer sites combined, not adjusted for delayed reporting, have stabilized, except for African American and Hispanic men, in whom rates decreased by 1.3% and 1.1%, respectively. In contrast, death rates from cancer significantly decreased in each racial and ethnic group, with larger decreases in men than in women. Lifetime Probability of Developing Cancer The lifetime probability of developing cancer is higher for men (45%) than for women (38%) ( Table 12 ). However, because of the relatively early age of breast cancer onset, women have a slightly higher probability of developing cancer before age 60 years. It is noteworthy that these estimates are based on the average experience of the general population and may over‐ or underestimate individual risk because of differences in exposure and/or genetic susceptibility. TABLE 12 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, US* Birth to 39 (%) 40 to 59 (%) 60 to 69 (%) 70 and Older (%) Birth to Death (%) All sites † Male 1.42 (1 in 70) 8.69 (1 in 12) 16.58 (1 in 6) 39.44 (1 in 3) 45.31 (1 in 2) Female 2.03 (1 in 49) 9.09 (1 in 11) 10.57 (1 in 9) 26.60 (1 in 4) 37.86 (1 in 3) Urinary bladder Male .02 (1 in 4381) .41 (1 in 241) .96 (1 in 105) 3.41 (1 in 29) 3.61 (1 in 28) Female .01 (1 in 9527) .13 (1 in 782) .26 (1 in 379) .96 (1 in 105) 1.14 (1 in 87) Breast Female .48 (1 in 210) 3.98 (1 in 25) 3.65 (1 in 27) 6.84 (1 in 15) 12.67 (1 in 8) Colon & rectum Male .07 (1 in 1342) .93 (1 in 107) 1.67 (1 in 60) 4.92 (1 in 20) 5.79 (1 in 17) Female .07 (1 in 1469) .73 (1 in 138) 1.16 (1 in 86) 4.45 (1 in 22) 5.37 (1 in 19) Leukemia Male .16 (1 in 640) .22 (1 in 452) .35 (1 in 286) 1.17 (1 in 86) 1.49 (1 in 67) Female .12 (1 in 820) .14 (1 in 694) .20 (1 in 491) .75 (1 in 132) 1.05 (1 in 95) Lung & bronchus Male .03 (1 in 3146) 1.09 (1 in 92) 2.61 (1 in 38) 6.76 (1 in 15) 8.02 (1 in 12) Female .04 (1 in 2779) .85 (1 in 117) 1.84 (1 in 54) 4.52 (1 in 22) 6.15 (1 in 16) Melanoma of the skin Male .13 (1 in 775) .53 (1 in 187) .56 (1 in 178) 1.32 (1 in 76) 2.04 (1 in 49) Female .21 (1 in 467) .42 (1 in 237) .29 (1 in 347) .62 (1 in 163) 1.38 (1 in 73) Non‐Hodgkin lymphoma Male .14 (1 in 735) .45 (1 in 222) .57 (1 in 176) 1.56 (1 in 64) 2.14 (1 in 47) Female .08 (1 in 1200) .32 (1 in 313) .44 (1 in 229) 1.30 (1 in 77) 1.83 (1 in 55) Prostate Male .01 (1 in 10373) 2.59 (1 in 39) 7.03 (1 in 14) 13.83 (1 in 7) 17.12 (1 in 6) Uterine cervix Female .16 (1 in 631) .29 (1 in 346) .14 (1 in 695) .20 (1 in 512) .73 (1 in 138) Uterine corpus Female .06 (1 in 1652) .70 (1 in 142) .81 (1 in 124) 1.28 (1 in 78) 2.49 (1 in 40) * For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2001 to 2003. The “1 in” statistic and the inverse of the percentage may not be equivalent due to rounding. †Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: DevCan Software, Probability of Developing or Dying of Cancer Software, Version 6.1.0. Statistical Research and Applications Branch, National Cancer Institute, 2006. http://srab.cancer.gov/devcan . Cancer Survival by Race Compared with Whites, African American men and women have poorer 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 Whites within each stratum of 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 within‐stage differences in tumor characteristics. The contribution of these factors, individually or collectively, to the differential survival for specific cancers is unclear. However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of Whites experience similar outcomes. FIGURE 7 Distribution of Selected Cancers by Race and Stage at Diagnosis, US, 1996–2002. * The distribution for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. FIGURE 8 Five‐year Relative Survival Rates Among Patients Diagnosed With Selected Cancers, by Race and Stage at Diagnosis, US, 1996–2002. * The rate for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. There have been notable improvements over time in relative 5‐year survival rates for many cancer sites and for all cancers combined ( Table 13 ). This is true for both Whites and African Americans. Cancers for which survival has not improved substantially over the past 25 years include uterine corpus, cervix, larynx, lung, and pancreas. TABLE 13 Trends in Five‐year Relative Survival Rates* (%) for Selected Cancers by Race and Year of Diagnosis, US, 1975 to 2002. White African American All Races Site 1975 to 1977 1984 to 1986 1996 to 2002 1975 to 1977 1984 to 1986 1996 to 2002 1975 to 1977 1984 to 1986 1996 to 2002 All sites 51 55 68 † 40 41 57 † 50 53 66 † Brain 23 28 34 † 26 32 37 † 24 29 34 † Breast (female) 76 80 90 † 63 65 77 † 75 79 89 † Colon 52 60 66 † 46 50 54 † 51 59 65 † Esophagus 6 11 17 † 3 8 12 † 5 10 16 † Hodgkin lymphoma 74 80 87 † 71 75 81 † 73 79 86 † Kidney 51 56 66 † 50 54 66 † 51 56 66 † Larynx 67 68 67 59 53 52 66 66 65 Leukemia 36 43 50 † 33 34 39 35 42 49 † Liver & bile duct 4 6 10 † 2 5 7 † 4 6 10 † Lung & bronchus 13 14 16 † 12 11 13 † 13 13 16 † Melanoma of the skin 82 86 93 † 58 ‡ 71 § 75 ‡ 82 86 92 † Multiple myeloma 25 28 33 † 31 32 32 26 29 33 † Non‐Hodgkin lymphoma 48 54 64 † 48 48 56 48 53 63 † Oral cavity 55 57 62 † 36 36 40 53 55 60 † Ovary ¶ 36 39 45 † 43 41 39 37 40 45 † Pancreas 3 3 5 † 2 5 5 † 2 3 5 † Prostate 70 77 100 † 61 66 98 † 69 76 100 † Rectum 49 58 66 † 45 46 59 † 49 57 66 † Stomach 15 18 22 † 16 20 23 † 16 18 24 † Testis 83 93 96 † 82 ‡ 87 ‡ 89 83 93 96 † Thyroid 93 94 97 † 91 90 94 93 94 97 † Urinary bladder 74 79 83 † 50 61 65 † 73 78 82 † Uterine cervix 71 70 75 † 65 58 66 70 68 73 † Uterine corpus 89 85 86 † 61 58 61 87 83 84 † * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1975 to 1977, 1984 to 1986, and 1996 to 2002, and followed through2003. †The difference in rates between 1975 to 1977 and 1996 to 2002 is statistically significant ( P < 0.05). ‡The standard error of the survival rate is between 5 and 10 percentagepoints. §The standard error of the survival rate is greater than 10 percentage points. ¶Recent changes in classification of ovarian cancer, namely excluding borderline tumors, has affected 1996–2002 survival rates. Note: “All sites” excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. Relative survival rates cannot be calculated for other racial and ethnic populations because accurate life expectancies (the average number of years of life remaining for persons who have attained a given age) 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 American/Pacific Islander women, have a greater probability of dying from cancer within 5 years of diagnosis than non‐Hispanic Whites, after accounting for differences in stage 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 age 1 to 14 years in the United States; accidents are the most frequent cause of death in this age group ( Table 14 ). The most common cancers in children (aged 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) tumors. Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for many childhood cancers ( Table 15 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975 to 1977 to 79% for those diagnosed in 1996 to 2002. TABLE 14 Fifteen Leading Causes of Death Among Children Aged 1 to 14, US, 2004 Rank Cause of Death Number of Deaths * Percent (%) of Total Deaths Death Rate † All Causes 11,619 100.0 20.3 1 Accidents (unintentional injuries) 4,307 37.1 7.54 2 Cancer 1,418 12.2 2.50 3 Congenital anomalies 958 8.2 1.67 4 Assault (homicide) 706 6.1 1.23 5 Heart diseases 432 3.7 0.75 6 Intentional self‐harm (suicide) 285 2.5 0.49 7 Influenza & pneumonia 201 1.7 0.35 8 Chronic lower respiratory disease 168 1.4 0.29 9 Septicemia 150 1.3 0.26 10 In situ & benign neoplasms 137 1.2 0.24 11 Cerebrovascular disease 118 1.0 0.21 12 Anemias 79 0.7 0.14 13 Meningitis 50 0.4 0.09 14 Diabetes mellitus 45 0.4 0.08 15 Complications, medical/surgical 38 0.3 0.07 All other causes 2,527 21.7 * Excludes deaths with unknown ages. †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; events of undetermined intent; certain perinatal conditions; other respiratory diseases; and other and unspecified infectious and parasitic diseases were excluded from ranking order. Source: US Mortality Public Use Data Tape, 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. TABLE 15 Trends in Five‐year Relative Survival Rates* (%) for Children Under Age 15, US, 1975 to 2002. Year of Diagnosis Site 1975 to 1977 1978 to 1980 1981 to 1983 1984 to 1986 1987 to 1989 1990 to 1992 1996 to 2002 All sites 58 63 67 68 71 75 79 † Acute lymphocytic leukemia 58 66 71 73 78 83 87 † Acute myeloid leukemia 19 26 27 ‡ 30 ‡ 36 ‡ 41 53 † Bone & joint 51 ‡ 49 57 ‡ 59 ‡ 67 ‡ 67 72 † Brain & other nervous system 57 58 56 62 64 64 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 † Neuroblastoma 52 57 55 52 62 77 69 † Non‐Hodgkin lymphoma 43 53 67 70 71 76 86 † Soft tissue 61 74 69 73 65 79 72 † Wilms' tumor 73 79 86 91 92 92 92 † * Survival rates are adjusted for normal life expectancy and are based on follow up of patients through 2003. †The difference in rates between 1975 to 1977 and 1996 to 2002 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, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute, based on November 2005 SEER data submission, posted to the SEER Web site, 2006. 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 modeling techniques. Estimates are also affected by changes in method. The introduction of a new method for estimating new cancer cases in 2007 has substantially affected the estimates for a number of cancers, particularly leukemia and female breast (see Pickle et al for more detailed discussion). For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. Age‐standardized or age‐specific cancer death rates from the NCHS and cancer incidence rates from SEER or NPCR are the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, by the time that they become available. Despite their limitations, the ACS estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths 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, 2007

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