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Cancer Statistics, 2009

Cancer Statistics, 2009 Introduction Cancer is a major public health problem in the United States and many other parts of the world. 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 numbers of new cancer cases and deaths in 2009. Materials and Methods Data Sources Mortality data from 1930 to 2006 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 Incidence data for long‐term trends (1975–2005), 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. 2 , 3 , 4 , 5 Incidence data (1995–2005) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Center for Disease Control (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR). State‐specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and NPCR. Population data were obtained from the US Census Bureau. 7 Causes of death were coded and classified according to the International Classification of Diseases (ICD‐8, ICD‐9, and ICD‐10). 8 , 9 , 10 Cancer cases were classi fied according to the International Classification of Diseases for Oncology . 11 Estimated New Cancer Cases The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3–4 years behind the current year because of the time required for data collection and compilation. Estimated new cancer cases in the current year (2009) were projected by using a spatiotemporal model 12 on the basis of incidence data from 1995 through 2005 from 41 states and the District of Columbia that met NAACCR's high‐quality data standard for incidence, covering about 85% of the US population. The method also considers geographic variations in sociodemographic 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 13 to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2009. Projections are based on underlying cause‐of‐death from death certificates as reported to the NCHS. 1 This model projects the number of cancer deaths expected to occur in 2009 on the basis of the number that occurred each year from 1969 to 2006 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 2006. Causes of death for 2006 were coded and classified according to ICD‐10. 8 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 2005. 3 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 2005) are adjusted for delays in reporting where possible. Delayed reporting primarily affects the most recent 1–3 years of incidence data (in this case, 2003–2005), especially for cancers such as melanoma, leukemia, and prostate that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and many specific cancer sites. 14 Delay‐adjusted rates provide a more accurate assessment of trends in the most recent years for which data are available. Long‐term incidence and mortality trends (1975–2005) for selected cancer sites were previously published in the 2008 Annual Report to the Nation on the Status of Cancer . 15 We also provide the contribution of individual cancer sites to the total decrease in overall cancer death rates since 1990 in men and since 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age‐standardized cancer death rates over these time intervals. The total number of cancer deaths avoided was calculated by applying the age‐specific cancer death rates in the peak year for the age‐standardized cancer death rates (1990 for males and 1991 for females) to the corresponding age‐specific populations in the subsequent years through 2005 to obtain the number of expected deaths in each calendar year had the death rates not decreased. We then summed the difference between the number of expected and observed deaths in each age group and calendar year for men and women separately to obtain the total number of cancer deaths avoided over the 14‐year (women) or 15‐year (men) interval. Selected Findings Expected Numbers of New Cancer Cases Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the United States in 2009. The overall estimate of about 1.5 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 cancers, about 62,280 cases of breast carcinoma in situ , and 53,120 cases of melanoma in situ are expected to be newly diagnosed in 2009. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2 . 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2009 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,479,350 766,130 713,220 562,340 292,540 269,800 Oral cavity & pharynx 35,720 25,240 10,480 7,600 5,240 2,360 Tongue 10,530 7,470 3,060 1,910 1,240 670 Mouth 10,750 6,450 4,300 1,810 1,110 700 Pharynx 12,610 10,020 2,590 2,230 1,640 590 Other oral cavity 1,830 1,300 530 1,650 1,250 400 Digestive system 275,720 150,020 125,700 135,830 76,020 59,810 Esophagus 16,470 12,940 3,530 14,530 11,490 3,040 Stomach 21,130 12,820 8,310 10,620 6,320 4,300 Small intestine 6,230 3,240 2,990 1,110 580 530 Colon † 106,100 52,010 54,090 49,920 25,240 24,680 Rectum 40,870 23,580 17,290 Anus, anal canal, & anorectum 5,290 2,100 3,190 710 260 450 Liver & intrahepatic bile duct 22,620 16,410 6,210 18,160 12,090 6,070 Gallbladder & other biliary 9,760 4,320 5,440 3,370 1,250 2,120 Pancreas 42,470 21,050 21,420 35,240 18,030 17,210 Other digestive organs 4,780 1,550 3,230 2,170 760 1,410 Respiratory system 236,990 129,710 107,280 163,790 92,240 71,550 Larynx 12,290 9,920 2,370 3,660 2,900 760 Lung & bronchus 219,440 116,090 103,350 159,390 88,900 70,490 Other respiratory organs 5,260 3,700 1,560 740 440 300 Bones & joints 2,570 1,430 1,140 1,470 800 670 Soft tissue ( including heart ) 10,660 5,780 4,880 3,820 1,960 1,860 Skin ( excluding basal & squamous ) 74,610 42,920 31,690 11,590 7,670 3,920 Melanoma‐skin 68,720 39,080 29,640 8,650 5,550 3,100 Other nonepithelial skin 5,890 3,840 2,050 2,940 2,120 820 Breast 194,280 1,910 192,370 40,610 440 40,170 Genital system 282,690 201,970 80,720 56,160 28,040 28,120 Uterine cervix 11,270 11,270 4,070 4,070 Uterine corpus 42,160 42,160 7,780 7,780 Ovary 21,550 21,550 14,600 14,600 Vulva 3,580 3,580 900 900 Vagina & other genital, female 2,160 2,160 770 770 Prostate 192,280 192,280 27,360 27,360 Testis 8,400 8,400 380 380 Penis & other genital, male 1,290 1,290 300 300 Urinary system 131,010 89,640 41,370 28,100 18,800 9,300 Urinary bladder 70,980 52,810 18,170 14,330 10,180 4,150 Kidney & renal pelvis 57,760 35,430 22,330 12,980 8,160 4,820 Ureter & other urinary organs 2,270 1,400 870 790 460 330 Eye & orbit 2,350 1,200 1,150 230 120 110 Brain & other nervous system 22,070 12,010 10,060 12,920 7,330 5,590 Endocrine system 39,330 11,070 28,260 2,470 1,100 1,370 Thyroid 37,200 10,000 27,200 1,630 690 940 Other endocrine 2,130 1,070 1,060 840 410 430 Lymphoma 74,490 40,630 33,860 20,790 10,630 10,160 Hodgkin lymphoma 8,510 4,640 3,870 1,290 800 490 Non‐Hodgkin lymphoma 65,980 35,990 29,990 19,500 9,830 9,670 Myeloma 20,580 11,680 8,900 10,580 5,640 4,940 Leukemia 44,790 25,630 19,160 21,870 12,590 9,280 Acute lymphocytic leukemia 5,760 3,350 2,410 1,400 740 660 Chronic lymphocytic leukemia 15,490 9,200 6,290 4,390 2,630 1,760 Acute myeloid leukemia 12,810 6,920 5,890 9,000 5,170 3830 Chronic myeloid leukemia 5,050 2,930 2,120 470 220 250 Other leukemia ‡ 5,680 3,230 2,450 6,610 3,830 2,780 Other & unspecified primary sites ‡ 31,490 15,290 16,200 44,510 23,920 20,590 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 62,280 female carcinoma in situ of the breast and 53,120 melanoma in situ will be newly diagnosed in 2009. † Estimated deaths for colon and rectum cancers are combined. ‡ More deaths than cases may suggest lack of specificity in recording underlying cause of death on death certificates. Source: Estimated new cases are based on 1995–2005 incidence rates from 41 states and the District of Columbia as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 85% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 2 Age‐standardized Incidence Rates for All Cancers Combined, 2001–2005, and Estimated New Cases * for Selected Cancers by State, United States, 2009 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 Alabama 449.2 24,090 2,970 190 2,480 510 590 4,040 930 950 2,800 960 Alaska 466.1 2,530 370 ‡ 250 70 70 350 80 110 360 120 Arizona 416.8 27,600 3,470 210 2,680 660 810 3,960 1,460 1,250 3,530 1,460 Arkansas 455.4 14,800 1,820 130 1,540 310 420 2,580 500 680 2,140 610 California 446.2 152,170 21,740 1,350 14,680 4,230 4,570 17,910 9,080 7,140 20,790 6,870 Colorado 447.1 20,340 2,840 150 1,860 530 720 2,240 1,260 920 3,070 940 Connecticut 508.3 20,650 2,790 110 1,950 660 540 2,720 1,260 920 2,400 1,120 Delaware 507.3 4,690 600 ‡ 440 140 120 800 220 190 550 220 Dist. of Columbia § 2,600 340 ‡ 260 80 50 370 70 90 380 90 Florida 470.3 102,210 12,650 800 10,420 2,590 3,180 17,790 4,920 4,640 12,380 5,490 Georgia 465.5 39,080 5,370 340 3,750 930 1,080 6,150 2,040 1,560 5,210 1,400 Hawaii 426.8 6,400 870 50 710 200 160 740 320 260 860 220 Idaho 462.2 6,800 810 ‡ 630 170 250 820 380 330 1,170 340 Illinois 487.4 60,960 7,610 480 6,430 1,960 1,940 9,180 2,010 2,900 7,590 3,100 Indiana 469.5 31,320 3,710 220 3,260 970 930 5,360 1,170 1,420 3,250 1,550 Iowa 481.0 16,740 2,080 90 1,800 500 590 2,620 910 750 2,330 870 Kansas § 13,080 1,790 90 1,290 400 380 2,110 610 600 1,970 620 Kentucky 512.8 24,060 2,840 180 2,620 590 690 4,650 1,260 980 2,910 1,070 Louisiana 497.7 22,170 2,700 190 2,330 430 660 3,650 630 960 3,160 910 Maine 527.2 9,000 1,080 50 870 270 270 1,390 480 360 1,130 500 Maryland § 26,650 3,660 190 2,620 840 640 4,060 1,310 1,120 3,580 1,110 Massachusetts 514.9 36,080 4,800 200 3,380 1,140 1,000 5,120 2,030 1,610 4,200 2,010 Michigan 509.1 53,550 6,480 320 5,020 1,700 1,690 8,190 2,240 2,470 7,010 2,810 Minnesota 481.0 23,670 3,280 140 2,520 810 890 3,310 890 1,130 4,910 1,200 Mississippi § 14,150 1,820 130 1,480 270 360 2,340 380 540 1,990 540 Missouri 467.7 30,090 3,880 220 3,100 870 880 5,600 1,260 1,250 3,620 1,450 Montana 477.6 5,340 640 ‡ 520 140 170 730 220 240 810 270 Nebraska 474.4 8,810 1,200 60 950 270 290 1,230 420 400 1,410 450 Nevada 471.7 12,020 1,350 110 1,240 270 380 1,910 480 480 1,660 630 New Hampshire 507.0 7,630 1,010 ‡ 730 240 210 1,100 460 310 910 420 New Jersey 515.7 47,920 6,440 410 4,590 1,620 1,380 6,250 2,530 2,160 6,060 2,640 New Mexico 421.0 8,830 1,090 80 810 210 310 970 460 360 1,400 350 New York 489.1 101,550 13,530 870 9,970 3,510 3,140 13,550 3,710 4,540 12,520 5,360 North Carolina § 42,270 5,470 340 4,230 1,030 1,150 6,670 2,190 1,730 6,130 1,790 North Dakota 458.7 3,200 410 ‡ 350 90 110 420 110 140 560 180 Ohio § 62,420 7,340 390 6,060 1,930 1,950 10,690 2,080 2,800 6,510 2,990 Oklahoma 466.4 18,110 2,340 140 1,860 400 580 3,220 690 820 2,190 770 Oregon 472.8 19,210 2,680 110 1,780 570 490 2,610 1,220 910 2,510 1,020 Pennsylvania 503.6 74,170 9,380 500 7,590 2,550 2,200 10,480 3,440 3,330 8,130 4,160 Rhode Island 514.5 6,250 810 ‡ 590 190 180 900 340 260 650 370 South Carolina 475.2 22,100 2,820 170 2,150 520 590 3,680 1,090 870 2,910 880 South Dakota 474.5 4,120 530 ‡ 440 120 140 590 180 180 740 230 Tennessee § 32,570 3,970 240 3,490 720 1,000 5,370 1,410 1,370 4,790 1,380 Texas 454.9 98,200 13,090 980 9,800 2,220 3,470 14,150 3,820 4,530 13,130 3,720 Utah 411.8 8,880 1,080 60 770 250 330 620 600 440 1,570 360 Vermont § 3,550 480 ‡ 330 120 100 500 200 140 540 190 Virginia 440.3 34,150 4,850 240 3,380 1,020 840 5,330 1,790 1,450 4,830 1,430 Washington 499.0 32,290 4,520 190 2,890 960 990 4,130 1,970 1,540 4,680 1,660 West Virginia 490.5 10,230 1,180 70 1,070 330 290 2,030 450 420 1,210 510 Wisconsin § 27,560 3,480 160 2,770 1,000 980 3,960 1,040 1,310 2,770 1,530 Wyoming 447.9 2,500 300 ‡ 240 70 70 320 130 110 390 130 United States 476.6 1,479,350 192,370 11,270 146,970 42,160 44,790 219,440 68,720 65,980 192,280 70,980 * 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. ‡ Estimate is fewer than 50 cases. § Combined incidence rate is not available. Note: These model‐based estimates are calculated by using incidence rates from 41 states and the District of Columbia as reported by NAACCR. They are offered as a rough guide and should be interpreted with caution. State estimates may not add to the US total because of rounding and exclusion of states with fewer than 50 cases. Source: North American Association of Central Cancer Registries (NAACCR), based on data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. Rates for Alabama, Louisiana, Mississippi, and Texas are for cases diagnosed through June 2005. Figure 1 indicates the most common cancers expected to occur in men and women in 2009. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 50% of all newly diagnosed cancers. Prostate cancer alone accounts for 25% (192,280) of incident cases in men. On the basis of cases diagnosed between 1996 and 2004, 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%. 1 Ten Leading Cancer Types for Estimated New Cancer Cases and Deaths, by Sex, United States, 2009. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10. The three most commonly diagnosed types of cancer among women in 2009 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 27% (192,370) of all new cancer cases among women. Expected Number of Cancer Deaths Table 1 also shows the expected number of deaths from cancer projected for 2009 for men, women, and both sexes combined. It is estimated that about 562,340 Americans will die from cancer, corresponding to more than 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common fatal cancers. These four cancers account for almost half of the total cancer deaths among men and women (Fig. 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 2009. Table 3 provides the estimated number of cancer deaths in 2009 by state for selected cancer sites. 3 Age‐standardized Death Rates for All Cancers Combined, 2001–2005, and Estimated Deaths * for Selected Cancers by State, United States, 2009 STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 206.2 9,900 200 700 940 340 280 3,140 290 270 550 510 Alaska 186.5 830 ‡ 60 70 ‡ ‡ 220 ‡ ‡ 50 ‡ Arizona 167.5 10,260 280 740 970 410 360 2,820 350 290 630 580 Arkansas 207.3 6,230 130 410 580 250 190 2,160 200 130 400 340 California 173.1 54,600 1,460 4,030 4,830 2,200 2,450 12,750 1,900 1,580 3,740 2,780 Colorado 166.4 6,740 200 520 670 300 210 1,670 230 210 430 350 Connecticut 184.3 6,990 150 480 550 270 210 1,810 220 180 540 390 Delaware 204.3 1,860 50 110 150 70 50 590 50 ‡ 110 90 Dist. of Columbia 209.5 970 ‡ 70 100 50 ‡ 240 ‡ ‡ 60 60 Florida 180.1 41,270 810 2,730 3,460 1,650 1,300 12,210 1,560 970 2,470 2,280 Georgia 194.2 14,970 320 1,130 1,370 550 400 4,660 460 400 870 800 Hawaii 152.2 2,270 ‡ 140 210 80 120 570 80 50 170 100 Idaho 173.4 2,450 90 160 200 120 80 630 80 50 200 160 Illinois 197.6 23,220 470 1,770 2,260 950 700 6,460 770 600 1,560 1,150 Indiana 205.1 12,820 290 860 1,130 520 350 4,000 420 340 770 520 Iowa 185.9 6,360 160 400 600 300 150 1,760 280 170 380 330 Kansas 187.0 5,290 150 370 510 200 140 1,620 180 150 330 210 Kentucky 222.7 9,410 150 590 840 320 240 3,430 300 210 500 390 Louisiana 221.0 8,810 210 690 910 310 330 2,700 310 210 530 450 Maine 206.8 3,190 80 180 260 110 80 980 90 70 200 160 Maryland 196.6 10,320 200 810 940 390 320 2,880 300 260 690 550 Massachusetts 193.4 13,140 270 870 1,070 490 420 3,610 430 350 880 540 Michigan 195.3 20,450 490 1,350 1,720 820 610 5,840 710 520 1,250 820 Minnesota 178.8 9,020 230 600 760 370 260 2,380 320 240 580 410 Mississippi 211.9 6,090 160 430 600 220 190 2,030 180 140 350 300 Missouri 201.9 12,620 270 890 1,100 530 360 4,100 430 290 750 660 Montana 186.6 1,980 50 120 170 90 50 550 70 50 120 120 Nebraska 179.6 3,360 80 210 350 150 80 890 130 90 190 200 Nevada 197.1 4,600 120 330 500 140 160 1,340 130 120 280 230 New Hampshire 193.0 2,620 70 170 220 100 70 750 60 60 170 130 New Jersey 193.4 16,480 320 1,470 1,580 610 540 4,190 610 450 1,080 660 New Mexico 167.3 3,300 80 240 320 120 150 710 110 90 220 210 New York 179.9 34,190 790 2,550 3,110 1,380 1,210 8,780 1,430 970 2,360 1,470 North Carolina 196.1 18,550 330 1,310 1,410 640 470 5,630 530 430 1,090 860 North Dakota 176.3 1,300 ‡ 80 120 50 ‡ 370 ‡ ‡ 90 100 Ohio 204.1 24,350 550 1,790 2,210 890 640 7,300 740 580 1,430 1,200 Oklahoma 200.1 7,420 170 520 600 290 200 2,390 240 170 380 280 Oregon 192.0 7,380 210 500 610 290 210 2,140 330 220 470 390 Pennsylvania 198.5 28,690 550 2,070 2,550 1,080 790 8,090 1,090 760 1,920 1,440 Rhode Island 194.7 2,220 50 130 160 90 70 560 70 60 120 100 South Carolina 200.7 9,100 190 640 780 330 250 2,880 310 210 530 420 South Dakota 182.8 1,640 ‡ 100 150 60 ‡ 450 70 50 100 100 Tennessee 211.2 13,340 350 910 1,140 480 350 4,520 440 310 730 570 Texas 184.9 36,030 850 2,570 3,140 1,430 1,650 9,780 1,300 890 2,120 1,700 Utah 140.9 2,760 100 260 240 130 70 480 130 90 190 170 Vermont 183.6 1,150 ‡ 80 120 60 ‡ 350 ‡ ‡ 70 60 Virginia 194.7 13,920 290 1,140 1,270 500 390 4,250 410 380 880 620 Washington 187.1 11,210 380 790 940 450 410 3,090 410 340 710 680 West Virginia 213.4 4,530 90 280 430 140 110 1,500 180 120 210 140 Wisconsin 186.7 11,170 260 750 900 500 320 2,910 400 300 710 500 Wyoming 180.0 990 ‡ 60 100 ‡ ‡ 260 ‡ ‡ 60 ‡ United States 189.8 562,340 12,920 40,170 49,920 21,870 18,160 159,390 19,500 14,600 35,240 27,360 * Rounded to the nearest 10. † Rates are per 100,000 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 states with fewer than 50 deaths. Source: US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. Regional Variations in Cancer Rates Table 4 depicts cancer incidence rates for selected cancer sites by state. By far, the largest variation in incidence among the cancer sites listed in Table 4 is seen for lung cancer, where rates (cases per 100,000 population) range from 39.6 in men and 22.4 in women in Utah to 136.2 in men and 76.2 in women in Kentucky. This variation reflects the large and continuing differences in smoking prevalence among states. Utah ranks lowest in adult‐smoking prevalence and Kentucky highest. In contrast, state variation in the incidence rates of other cancer sites shown in Table 4 was smaller in both absolute and proportionate terms. For prostate and female breast cancers in particular, variation in incidence reflects differences in the use of screening tests in addition to differences in disease occurrence. 4 Cancer Incidence Rates * by Site and State, United States, 2001–2005 STATE ALL SITES BREAST COLON AND RECTUM LUNG AND BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama † 555.6 377.6 114.2 62.2 41.9 109.5 52.5 20.5 14.0 150.7 31.1 7.7 Alaska † 533.2 410.6 127.9 61.3 46.0 82.4 62.8 23.5 16.1 151.3 39.4 7.2 Arizona 461.7 363.0 109.8 49.4 36.3 69.8 48.8 18.6 13.2 116.6 35.0 8.7 Arkansas † 558.2 381.5 114.0 59.2 43.6 113.4 59.0 21.9 15.1 158.1 33.1 8.9 California † 518.2 396.4 124.7 53.8 39.8 67.0 47.5 22.6 15.5 152.6 34.4 8.3 Colorado † 512.7 401.7 125.9 51.5 41.0 63.0 46.0 21.4 16.3 159.4 35.0 9.1 Connecticut † 589.5 454.3 137.4 65.2 47.9 82.5 58.8 25.5 17.8 166.6 44.6 12.5 Delaware † 601.7 438.6 126.4 62.6 46.4 97.8 66.2 22.5 16.7 175.5 42.4 11.0 Dist. of Columbia ‡ — — — — — — — — — — — — Florida † 549.3 410.1 116.7 57.7 43.4 91.4 60.8 21.9 15.5 143.1 38.7 10.0 Georgia † 571.3 395.2 120.6 60.1 42.6 104.1 53.4 20.6 14.2 163.6 33.0 8.1 Hawaii † 484.9 385.9 126.0 62.4 42.5 67.8 38.9 18.9 12.7 129.3 25.1 6.2 Idaho † 543.5 399.0 118.2 52.0 38.5 69.6 46.7 21.5 17.2 168.8 38.4 8.5 Illinois † 580.1 426.8 124.1 68.0 48.5 93.1 57.8 23.8 16.3 159.5 40.8 10.4 Indiana † 552.3 414.9 117.7 64.6 47.3 105.3 62.2 22.6 16.0 136.9 37.2 9.3 Iowa † 560.9 428.3 125.4 67.2 50.5 89.3 52.4 23.5 17.0 147.3 40.6 9.8 Kansas ‡ — — — — — — — — — — — — Kentucky † 612.5 447.1 120.5 70.3 51.4 136.2 76.2 22.4 16.9 144.4 38.1 9.8 Louisiana † 624.9 409.5 120.9 70.1 48.3 111.3 58.2 22.9 16.2 180.2 35.6 8.7 Maine † 621.6 460.6 130.6 67.7 49.1 99.8 65.7 24.5 18.6 166.8 48.7 12.9 Maryland ‡ — — — — — — — — — — — — Massachusetts † 604.0 455.9 133.8 67.6 48.4 86.0 63.0 24.1 17.1 170.2 46.5 12.9 Michigan † 608.0 440.2 127.0 61.0 45.7 94.3 61.3 25.0 18.5 186.4 42.5 10.7 Minnesota † 568.8 418.6 129.3 57.9 43.1 71.4 49.2 26.4 18.1 185.9 40.0 10.5 Mississippi (2002–2005) 555.6 365.5 105.8 62.9 45.2 110.1 50.9 19.9 13.0 161.9 28.3 7.4 Missouri † 545.3 414.6 123.0 64.7 46.1 105.4 61.8 21.8 15.9 131.5 36.2 9.2 Montana † 561.2 412.3 122.6 55.4 41.5 78.2 57.9 23.2 15.0 182.4 41.9 9.3 Nebraska † 557.0 417.9 127.8 68.5 48.0 84.5 48.8 24.0 16.9 157.3 37.8 10.0 Nevada † 539.9 415.8 116.0 56.9 43.1 84.3 69.5 21.9 15.0 148.7 43.0 11.2 New Hampshire † 586.7 451.9 132.3 61.7 46.9 82.3 61.5 24.4 18.1 162.7 47.9 13.5 New Jersey † 612.5 451.5 129.8 68.3 50.0 80.9 56.0 25.9 17.7 183.9 46.0 12.2 New Mexico † 490.7 367.7 111.7 50.8 35.4 59.1 38.5 18.4 14.0 149.3 28.0 7.0 New York † 575.7 432.7 124.6 63.4 47.2 80.5 53.7 24.3 16.9 165.9 42.1 11.2 North Carolina ‡ — — — — — — — — — — — — North Dakota † 543.8 396.7 122.5 68.3 44.1 74.9 47.1 22.6 15.3 170.8 36.7 9.9 Ohio 543.8 413.6 121.9 62.7 45.8 97.2 58.9 22.8 16.2 145.6 38.7 9.7 Oklahoma † 551.3 409.2 126.4 61.2 43.9 107.4 63.8 22.3 16.2 147.0 33.8 8.1 Oregon † 533.4 430.0 134.7 54.4 41.7 79.9 60.4 24.1 17.5 151.4 40.3 10.4 Pennsylvania † 593.9 444.0 125.7 68.4 49.6 91.6 55.7 24.8 17.3 161.4 44.6 11.3 Rhode Island † 616.7 446.9 127.5 67.8 46.8 94.5 59.5 25.0 16.7 161.6 51.6 12.9 South Carolina † 589.6 395.2 119.2 63.5 44.9 103.8 52.3 20.6 14.5 172.3 32.6 7.7 South Dakota † 568.5 406.0 125.5 63.8 46.7 80.3 45.0 22.4 17.4 183.0 39.7 8.3 Tennessee § 496.9 377.4 115.3 57.7 42.2 105.0 56.4 19.4 14.2 120.3 31.5 7.8 Texas † 546.5 390.9 116.3 59.5 40.5 90.4 51.2 22.2 16.1 146.6 30.2 7.4 Utah † 493.1 348.2 112.9 46.3 34.1 39.6 22.4 22.9 15.8 185.0 29.1 6.4 Vermont ‡ — — — — — — — — — — — — Virginia 515.6 376.4 119.5 56.7 42.3 86.1 51.9 19.6 13.1 154.1 32.1 8.3 Washington † 571.2 447.7 138.9 54.6 41.4 80.5 60.0 26.9 18.4 167.7 41.6 10.4 West Virginia † 576.0 433.6 115.3 70.6 51.7 117.0 69.4 22.3 16.0 139.4 40.0 11.4 Wisconsin ‡ — — — — — — — — — — — — Wyoming † 515.5 394.8 117.9 49.4 43.6 62.6 47.2 20.6 16.3 171.2 41.5 9.5 United States 562.3 417.3 123.6 61.2 44.8 87.3 55.4 23.2 16.3 158.2 38.4 9.8 * Per 100,000, age adjusted to the 2000 US standard population. † This state's registry has submitted 5 years of data and passed rigorous criteria for each single year's data, including completeness of reporting, nonduplication of records, percentage unknown in critical data fields, percentage 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 for 2001–2005. § Case ascertainment for this state's registry is incomplete for the years 2001–2005. Source : North American Association of Central Cancer Registries, based on data collected by cancer registries participating in the National Cancer Institute's Surveillence, Epidemiology, and End Results program and Centers for Disease Control's National Program of 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 and for the four most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates decreased by 1.8% per year from 2001–2005 in males and by 0.6% per year from 1998–2005 in females. Death rates for all cancer sites combined decreased by 2.0% per year from 2001–2005 in males and by 1.6% per year in females from 2002–2005, compared with declines of 1.5% per year in males from 1993–2001 and 0.8% per year in females from 1994–2002. 2 Annual Age‐adjusted Cancer Incidence and Death Rates for All Sites by Sex, United States, 1975–2005. 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 ( www.seer.cancer.gov ). Delay‐adjusted incidence database, SEER incidence delay‐adjusted rates from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released in April 2008, based on the November 2007 SEER data submission. Mortality, US mortality data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 3 Annual Age‐adjusted Cancer Incidence Rates among Males and Females for Selected Cancers, United States, 1975– 2005. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program ( www.seer.cancer.gov ). Delay‐adjusted incidence database, SEER Incidence Delay‐Adjusted Rates, from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2008, based on the November 2007 SEER data submission. 4 Annual Age‐adjusted Cancer Death Rates among Males for Selected Cancers, United States, 1930–2005. Rates are age adjusted to the 2000 US population. 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 data, 1960 to 2005, US Mortality Vol. 1930–1959, National Cancer Institute, Centers for Disease Control and Prevention, 2008. 5 Annual Age‐adjusted Cancer Death Rates* among Females for Selected Cancers, United States, 1930–2005. *Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. 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 data, 1960 to 2005, US Mortality Vol. 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975–2005 TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 YEARS APC * YEARS APC * YEARS APC * YEARS APC * YEARS APC * All sites Incidence Male and female 1975–1989 1.2 † 1989–1992 2.8 † 1992–1995 −2.4 1995–1999 0.9 1999–2005 −0.8 † Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.8 † 1995–2001 0.3 2001–2005 −1.8 † Female 1975–1979 −0.3 1979–1987 1.6 † 1987–1995 0.1 1995–1998 1.4 1998–2005 −0.6 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2002 −1.1 † 2002–2005 −1.8 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.5 1993–2001 −1.5 † 2001–2005 −2.0 † Female 1975–1990 0.6 † 1990–1994 −0.2 1994–2002 −0.8 † 2002–2005 −1.6 † Lung and bronchus Incidence Male 1975–1982 1.5 † 1982–1991 −0.5 1991–2005 −1.8 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2005 0.5 † Death Male 1975–1978 2.5 † 1978–1984 1.2 † 1984–1990 0.4 † 1990–1993 −1.1 1993–2005 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † 2003–2005 −0.9 Colon and rectum Incidence Male 1975–1985 1.1 † 1985–1991 1.2 † 1991–1995 −3.1 † 1995–1998 1.9 1998–2005 −2.8 † Female 1975–1985 0.3 1985–1995 −1.9 † 1995–1998 1.9 1998–2005 −2.2 † Death Male 1975–1978 0.8 1978–1984 −0.4 1984–1990 −1.3 † 1990–2002 −2.0 † 2002–2005 −4.3 † Female 1975–1984 −1.0 † 1984–2002 −1.8 † 2002–2005 −4.3 † Female breast Incidence 1975–1980 −0.6 1980–1987 4.0 † 1987–1994 −0.2 1994–1999 1.7 † 1999–2005 −2.2 † Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1998 −3.3 † 1998–2005 −1.8 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.5 † 1995–2001 2.1 † 2001–2005 −4.4 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2005 −4.1 † Trends were analyzed by Joinpoint Regression Program, version 3.2.0, with a maximum of four joinpoints (ie, five line segments). * Annual percentage change (APC) based on incidence (delay adjusted) and mortality rates age adjusted to the 2000 US standard population. † The APC is significantly different from zero. Source: Jemal, et al. 15 Mortality rates have continued to decrease across all four major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2005 after increasing for many decades (Table 5 ). Similarly, incidence trends decreased for all four major cancer sites except for lung cancer in women, in whom rates are still increasing although at a much slower rate than in the previous years. The lag in the temporal trend of lung cancer 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. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2005 largely reflects increases in screening that can detect and remove precancerous polyps. The decrease in the breast cancer incidence rate since 1999 likely reflects a combination of two factors: the decrease in use of menopausal hormone therapy among postmenopausal women and delayed diagnosis because of decreased mammography utilization. 16–17 The sharp decrease in prostate cancer incidence rates (by 4.4% per year from 2001–2005) may reflect recent stabilization of prostate‐specific antigen (PSA) testing, which has resulted in decreased detection, or reduced number of undiagnosed cases. 18–20 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 2005, death rates from cancer decreased by 19.2% among men and by 11.4% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in cancer death rates, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use during the past 50 years, while the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment. Between 1990–1991 and 2005, death rates increased for liver cancer in both men and women, for esophageal cancer and melanoma in men, and for lung and pancreatic cancer in women. 6 Contribution of Indvidual Cancer Sites to Decreases in Cancer Death Rates, 1990–2005 for Males and 1991–2005 for Females MALES DEATH RATES PER 100,000 CHANGE CONTRIBUTION (%) † 1990 * 2005 ABSOLUTE PERCENT All malignant cancers 279.82 226.11 −53.71 −19.19 Decreasing Lung and bronchus 90.56 69.39 −21.17 −23.38 37.0 Prostate 38.56 24.65 −13.91 −36.07 24.3 Colon and rectum 30.77 20.98 −9.79 −31.82 17.1 Pancreas 12.59 12.36 −0.23 −1.83 0.4 Leukemia 10.71 9.70 −1.01 −9.43 1.8 Non‐Hodgkin lymphoma 9.97 8.77 −1.20 −12.04 2.1 Urinary bladder 7.97 7.56 −0.41 −5.14 0.7 Kidney and renal pelvis 6.16 5.92 −0.24 −3.90 0.4 Brain and other nervous system 5.97 5.31 −0.66 −11.06 1.2 Stomach 8.86 5.24 −3.62 −40.86 6.3 Myeloma 4.83 4.48 −0.35 −7.25 0.6 Oral cavity and pharynx 5.61 3.84 −1.77 −31.55 3.1 Larynx 2.97 2.24 −0.73 −24.58 1.3 Soft tissue including heart 1.52 1.43 −0.09 −5.92 0.2 Hodgkin lymphoma 0.85 0.50 −0.35 −41.18 0.6 Gallbladder 0.60 0.46 −0.14 −23.33 0.2 Small intestine 0.50 0.44 −0.06 −12.00 0.1 Other 24.58 23.13 −1.45 −5.90 2.5 Total − 57.18 100.0 Increasing Esophagus 7.16 7.94 0.78 10.89 22.5 Liver and intrahepatic bile duct 5.27 7.76 2.49 47.25 71.8 Melanoma of the skin 3.80 4.00 0.20 5.26 5.8 Total 3.47 100.0 DEATH RATE PER 100,000 CHANGE CONTRIBUTION (%) † FEMALES 1991 * 2005 ABSOLUTE PERCENT All malignant cancers 175.30 155.34 −19.96 −11.39 Decreasing Breast 32.69 24.00 −8.69 −26.58 36.5 Colon and rectum 20.30 14.62 −5.68 −27.98 23.9 Ovary 9.51 8.62 −0.89 −9.36 3.7 Non‐Hodgkin lymphoma 6.74 5.49 −1.25 −18.55 5.3 Leukemia 6.32 5.40 −0.92 −14.56 3.9 Corpus and uterus, NOS 4.18 4.10 −0.08 −1.91 0.3 Brain and other nervous system 4.11 3.52 −0.59 −14.36 2.5 Myeloma 3.26 2.89 −0.37 −11.35 1.6 Kidney and renal pelvis 2.95 2.72 −0.23 −7.80 1.0 Stomach 4.01 2.71 −1.30 −32.42 5.5 Cervix Uteri 3.49 2.42 −1.07 −30.66 4.5 Urinary bladder 2.34 2.21 −0.13 −5.56 0.5 Melanoma of the skin 1.82 1.80 −0.02 −1.10 0.1 Esophagus 1.81 1.66 −0.15 −8.29 0.6 Oral cavity and pharynx 2.03 1.43 −0.60 −29.56 2.5 Soft tissue including heart 1.28 1.15 −0.13 −10.16 0.5 Gallbladder 1.09 0.80 −0.29 −26.61 1.2 Other 17.97 16.57 −1.40 −7.79 5.9 Total − 23.79 100.0 Increasing Lung and bronchus 37.61 40.59 2.98 7.92 77.8 Pancreas 9.28 9.45 0.17 1.83 4.4 Liver and intrahepatic bile duct 2.51 3.19 0.68 27.09 17.8 Total 3.83 100.0 * 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. Recorded Number of Deaths from Cancer in 2006 A total of 559,888 cancer deaths were recorded in the United States in 2006, the most recent year for which actual data are available, accounting for about 23% of all deaths (Table 7 ). Despite a decrease in age‐standardized death rates, there were 568 more cancer deaths reported in 2006 than in 2005 due to the growth and aging of the population (Table 8 ). This is because the decrease in the age‐standardized death rates did not offset the influence of the aging and growth of the population on the total number of cancer deaths. When causes of death are ranked within age groups separated into 20‐year intervals, cancer is one of the five leading causes of death in all age groups among both males and females (Table 9 ). Cancer is the leading cause of death among women ages 40 to 79 years and among men ages 60 to 79 years. It is also the leading cause of death among men and women younger than age 85 years (Fig. 6 ). A total of 474,808 persons younger than age 85 years died from cancer in the United States in 2006, compared with 394,257 deaths from heart disease. 7 Fifteen Leading Causes of Death, United States, 2006 RANK CAUSE OF DEATH NO. OF DEATHS PERCENTAGE (%) OF TOTAL DEATHS DEATH RATE * All Causes 2,426,264 100.0 776.5 1 Heart diseases 631,636 26.0 200.2 2 Cancer 559,888 23.1 180.7 3 Cerebrovascular diseases 137,119 5.7 43.6 4 Chronic lower respiratory diseases 124,583 5.1 40.5 5 Accidents (unintentional injuries) 121,599 5.0 39.8 6 Diabetes mellitus 72,449 3.0 23.3 7 Alzheimer disease 72,432 3.0 22.6 8 Influenza & pneumonia 56,326 2.3 17.8 9 Nephritis, nephrotic syndrome, & nephrosis 45,344 1.9 14.5 10 Septicemia 34,234 1.4 11.0 11 Intentional self‐harm (suicide) 33,300 1.4 10.9 12 Chronic liver disease & cirrhosis 27,555 1.1 8.8 13 Essential hypertension & hypertensive renal disease † 23,855 1.0 7.5 14 Parkinson disease 19,566 0.8 6.3 15 Assault (homicide) 18,573 0.8 6.2 All other & ill‐defined causes 447,805 18.5 — * Rates are per 100,000 population and age adjusted to the 2000 US standard population. † Includes primary and secondary hypertension. Note: Percentages may not total 100 because of rounding. In accordance with the National Center for Health Statistics' cause‐of‐death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 8 Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990–2006 YEAR ALL SITES LUNG AND BRONCHUS COLORECTUM PROSTATE BREAST MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE 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 2005 290,422 268,890 90,141 69,079 26,783 26,224 28,905 41,116 2006 290,069 269,819 89,243 69,357 26,803 26,396 28,372 40,821 Note: Effective with the mortality data for 1999, causes of death are classified by ICD‐10, replacing ICD‐9 used for 1990 to 1998 data. Source: US Mortality Data, 1990 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 9 Ten Leading Causes of Death by Age and Sex, United States, 2006 All Ages Ages 1 to 19 y Ages 20 to 39 y Ages 40 to 59 y Ages 60 to 79 y Ages ≥80 y Male Female Male Female Male Female Male Female Male Female Male Female All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes 1,201,942 1,224,322 16,084 8,435 66,471 29,128 228,564 141,064 460,006 376,145 414,666 656,954 1 Heart Heart Accidents Accidents Accidents Accidents Heart Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional diseases 51,449 150,835 126,619 diseases diseases 315,706 315,930 injuries) injuries) injuries) injuries) 54,918 131,920 209,723 7,009 3,518 24,620 7,712 2 Cancer Cancer Assault Cancer Intentional Cancer Cancer Heart Heart Heart Cancer Cancer 290,069 269,819 (homicide) 829 self‐harm 4,835 54,461 diseases diseases diseases 79,411 86,047 2,444 (suicide) 22,130 122,655 81,157 8,738 3 Accidents Cerebro‐ Intentional Assault Assault Heart Accidents Accidents Chronic Chronic Cerebro‐ Cerebro‐ (unintentional vascular self‐harm (homicide) (homicide) diseases (unintentional (unintentional lower lower vascular vascular injuries) disease (suicide) 603 8,202 2,442 injuries) injuries) respiratory respiratory disease disease 78,941 82,595 1,415 25,333 10,833 diseases diseases 25,952 55,096 29,478 29,204 4 Chronic Chronic Cancer Congenital Heart Intentional Intentional Cerebro‐ Cerebro‐ Cerebro‐ Chronic Alzheimer lower lower 1,130 anomalies diseases self‐harm self‐harm vascular vascular vascular lower disease respiratory respiratory 522 5,531 (suicide) (suicide) disease disease disease respiratory 44,265 diseases diseases 1,996 10,337 5,648 20,600 21,069 diseases 59,260 65,323 24,641 5 Cerebro‐ Alzheimer Congenital Intentional Cancer Assault Chronic Diabetes Diabetes Diabetes Alzheimer Chronic vascular disease anomalies self‐harm 4,188 (homicide) disease mellitus mellitus mellitus disease lower disease 51,281 565 (suicide) 1,551 & cirrhosis 4,891 17,190 14,963 16,111 respiratory 54,524 359 9,707 diseases 31,198 6 Diabetes Accidents Heart Heart HIV disease HIV disease Diabetes Chronic Accidents Nephritis, Influenza & Influenza & mellitus (unintentional diseases diseases 1,906 1,033 mellitus lower (unintentional nephrotic pneumonia pneumonia 36,006 injuries) 465 309 7,420 respiratory injuries) syndrome & 14,843 22,077 42,658 diseases 11,726 nephrosis 4,566 7,724 7 Intentional Diabetes Chronic Influenza & Diabetes Diabetes Cerebro‐ Chronic liver Nephritis, Accidents Diabetes Diabetes self‐harm mellitus lower pneumonia mellitus mellitus vascular disease & nephrotic (unintentional mellitus mellitus (suicide) 36,443 respiratory 132 871 633 disease cirrhosis syndrome & injuries) 10,480 15,917 26,308 diseases 7,008 4,001 nephrosis 7,379 146 8,529 8 Influenza & Influenza Influenza & Cerebro‐ Cerebro‐ Cerebro‐ HIV disease Intentional Influenza & Alzheimer Nephritis, Nephritis, pneumonia & pneumonia pneumonia vascular vascular vascular 5,927 self‐harm pneumonia disease nephrotic nephrotic 25,650 30,676 134 disease disease disease (suicide) 7,790 6,841 syndrome & syndrome & 104 763 618 3,357 nephrosis nephrosis 10,334 13,213 9 Nephritis, Nephritis, Septicemia Septicemia Chronic liver Pregnancy, Chronic Septicemia Septicemia Septicemia Accidents Accidents nephrotic nephrotic 119 103 disease & childbirth & lower 2,098 6,477 6,621 (unintentional (unintentional syndrome & syndrome & cirrhosis puerperium respiratory injuries) injuries) nephrosis nephrosis 687 610 diseases 9,538 12,727 22,094 23,250 4,676 10 Alzheimer Septicemia Cerebro‐ In situ & Congenital Chronic liver Viral hepatitis HIV disease Chronic liver Influenza & Parkinson Hypertension disease 18,712 vascular benign anomalies disease 3,442 2,045 disease & pneumonia disease & hypertensive 21,151 disease neoplasms 537 & cirrhosis cirrhosis 6,399 7,085 renal disease * 118 100 362 6,272 9,718 * Includes primary and secondary hypertension. Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. In accordance with the National Center for Health Statistics' cause‐of‐death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 6 Death Rates for Cancer and Heart Disease for Ages Younger than 85 Years and 85 Years and Older, 1975–2005. Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Table 10 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 younger than age 40 years, leukemia is the most common fatal cancer, whereas cancer of the lung and bronchus predominates in men aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men aged 40 to 79 years, and prostate cancer among those aged 80 years and older. Among females, leukemia is the leading cause of cancer death before the age of 20 years, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at ages 60 years and older. 10 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, United States, 2006 ALL AGES <20 Y 20 TO 39 Y 40 TO 59 Y 60 TO 79 Y ≥80 Y MALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 290,069 1,169 4,188 54,461 150,835 79,411 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 89,243 359 609 15,814 53,536 19,579 Prostate Brain & ONS * Brain & ONS * Colorectum Colorectum Prostate 28,372 287 479 5,146 13,340 15,120 Colorectum Other endocrine Colorectum Liver & bile duct Prostate Colorectum 26,803 system 395 3,713 11,967 7,913 102 Pancreas Bones & joints Lung & bronchus Pancreas Pancreas Urinary bladder 16,559 99 307 3,582 8,983 4,091 Leukemia Soft tissue Non‐Hodgkin lymphoma Esophagus Esophagus Pancreas 12,426 84 297 2,769 5,918 3,881 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 269,819 866 4,835 51,449 126,619 86,047 Lung & bronchus Leukemia Breast Breast Lung & bronchus Lung & bronchus 69,357 259 1,170 12,082 39,614 17,986 Breast Brain & ONS * Uterine cervix Lung & bronchus Breast Colorectum 40,821 237 437 11,458 16,803 11,366 Colorectum Other endocrine Leukemia Colorectum Colorectum Breast 26,396 system 416 4,063 10,595 10,763 83 Pancreas Bones & joints Colorectum Ovary Pancreas Pancreas 16,895 75 369 3,346 8,172 6,330 Ovary Soft tissue Brain & ONS * Pancreas Ovary Non‐Hodgkin lymphoma 14,857 56 337 2,326 7,318 4,153 * ONS indicates other nervous system. Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. “Other and unspecified malignant neoplasm” is excluded from cause‐of‐death ranking order. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. Figure 7 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. About 650,000 cancer deaths (481,300 in men and 169,100 in women) were averted during the 1991–1992 through 2005 time interval. 7 Total Number of Cancer Deaths Avoided from 1991–2005 in Men and from 1992–2005 in Women. The blue line represents the actual number of cancer deaths recorded in each year, and the bold red line represents the expected number of cancer deaths if cancer mortality rates had remained the same since 1990 and 1991. 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 an 18% higher incidence rate and a 36% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 17% higher death rate than white women. For the specific cancer sites listed in Table 11 , incidence and death rates are consistently higher in African Americans than in whites except for cancers of the breast (incidence) and lung (incidence and mortality) among women, and kidney (mortality) among both men and women. Factors known to contribute to racial disparities in mortality vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer among men), 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 white women is thought to reflect a combination of factors that affect both diagnosis (more frequent mammography in white women) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy among white than black women). 21 11 Incidence and Mortality Rates * by Site, Race, and Ethnicity, United States, 2001–2005 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE † HISPANIC/LATINO ‡ § Incidence All sites Male 551.4 651.5 354.0 336.6 419.4 Female 423.6 398.9 287.8 296.4 317.8 Breast, female 130.6 117.5 89.6 75.0 90.1 Colon and rectum Male 58.9 71.2 48.0 46.0 47.3 Female 43.2 54.5 35.4 41.2 32.8 Kidney and renal pelvis Male 18.8 21.3 9.1 19.5 17.4 Female 9.5 10.1 4.6 12.7 9.6 Liver and bile duct Male 8.2 13.2 21.7 14.4 15.0 Female 2.9 4.0 8.3 6.3 5.8 Lung and bronchus Male 79.3 107.6 53.9 54.3 44.2 Female 54.9 54.6 28.0 39.7 25.4 Prostate 156.7 248.5 93.8 73.3 138.0 Stomach Male 10.0 17.4 18.6 16.8 15.5 Female 4.7 8.9 10.5 7.7 9.5 Uterine cervix 8.2 10.8 8.0 6.9 13.2 Mortality All sites Male 230.7 313.0 138.8 190.0 159.0 Female 159.2 186.7 95.9 142.0 105.2 Breast, female 24.4 33.5 12.6 17.1 15.8 Colon and rectum Male 22.1 31.8 14.4 20.5 16.5 Female 15.3 22.4 10.2 14.2 10.8 Kidney and renal pelvis Male 6.2 6.1 2.4 9.3 5.3 Female 2.8 2.7 1.2 4.3 2.4 Liver and bile duct Male 6.7 10.3 15.2 10.6 11.1 Female 2.9 3.9 6.6 6.6 5.1 Lung and bronchus Male 71.3 93.1 37.5 50.2 35.1 Female 42.0 39.9 18.5 33.8 14.6 Prostate 24.6 59.4 11.0 21.1 20.6 Stomach Male 5.0 11.5 10.1 9.9 8.7 Female 2.5 5.5 5.9 5.2 4.9 Uterine cervix 2.3 4.7 2.2 3.7 3.2 * Per 100,000 population, age adjusted to the 2000 US standard population. † Data based on Contract Health Service Delivery Areas, 624 counties comprising 54% of the US American Indian/Alaska Native population; for more information please see: Espey DK, Wu XC, Swan J, et al. 19 ‡ Persons of Hispanic/Latino origin may be of any race. § Data unavailable from the Alaska Native Registry and Kentucky. ¶Data unavailable from Minnesota, New Hampshire, and North Dakota. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, 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 twice as high in Asian American/Pacific Islanders as they are in whites, reflecting increased prevalence of chronic infection with H pylori and hepatitis B and C viruses. 22 Kidney cancer incidence and death rates are highest among American Indians/Alaskan Natives, although obesity is the only factor known to contribute to this disparity. Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because long‐term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1996 to 2005, incidence (unadjusted for delayed reporting) and death rates for all cancer sites combined decreased among whites, African Americans, Asian Americans/Pacific Islanders, and Hispanics in both men and women. 15 Among American Indians/Alaska Natives residing in Indian Health Service (IHS) Contract Health Service Delivery Areas, mortality rates during this time period remained stable; trends in incidence rates could not be examined because the linkage of incident cancer cases with IHS was not complete at the time of this report. 15 Death Rates by Educational Attainment, Race, and Sex Table 12 shows trends in death rates from 1993 to 2001 for the four major cancers by educational attainment among white and African American men and women aged 25 to 64 years. 23 In general, death rates decreased significantly from 1993 through 2001 for those with 13 or more years of education but increased or remained constant in those with 12 or fewer years of education. For example, lung cancer death rates in white women decreased for those with 13 or more years of education, leveled in those with 12 years of education, and increased in those with fewer than 12 years of education. Similarly, colorectal cancer death rates among black men decreased for those with 16 or more years of education, leveled in those with 12–15 years of education, and increased in those with fewer than 12 years of education. Notably, the rate of decreases in death rates for each race‐, sex‐, and cancer‐specific category followed an educational gradient in that each group of increasing educational level experienced a progressively steeper decrease. As a result, educational disparity in cancer mortality increased from 1993 to 2001 for lung and colorectal cancers (except among black women) and prostate cancer. Factors that may have contributed to this disparity include higher prevalence of risk factors, such as smoking and obesity, and limited access to medical services among less educated individuals. If everyone ages 25 to 64 years experienced the same cancer death rates as the most educated, 17,650 cancer deaths in women and 30,940 cancer deaths in men could have been averted or postponed in 2001, accounting for over 30% of the total number of cancer deaths in this age group. 12 Trends in Cancer Death Rates * by Education, Race, and Sex, United States, 1993–2001 EDUCATION WHITE NON‐HISPANIC BLACK NON‐HISPANIC 1993 2001 APC † 1993 2001 APC † Lung and bronchus All ‡ 48.8 36.4 −3.5 § 88.5 60.2 −4.4 § <12 y 88.1 87.3 −0.1 98.3 90.4 −0.2 12 y 59.5 53.2 −1.5 § 98.6 73.7 −3.2 § 13–15 y 32.7 24.2 −3.5 § 45.6 32.2 −4.7 § ≥16 y 20.7 13.7 −4.9 § 38.3 21.0 −6.8 § RR ¶ (95% CI) 4.2 (4.1–4.4) 6.4 (6.2–6.6) — 2.6 (2.5–2.8) 4.3 (3.9–4.8) — Female All ‡ 28.4 25.1 −1.6 § 30.5 26.9 −1.5 § <12 y 45.5 55.4 2.4 § 32.7 30.4 0.8 12 y 32.1 33.1 0.1 37.3 35.7 −0.7 13–15 y 19.8 16.6 −1.7 § 20.1 19.3 −1.3 ≥16 y 13.9 11.6 −2.9 § 14.8 16.7 −2.2 RR ¶ (95% CI) 3.3 (3.1–3.5) 4.8 (4.5–5.0) — 2.2 (1.8–2.7) 1.8 (1.6–2.1) — Colon and rectum Male All ‡ 12.0 10.7 −1.6 § 19.7 18.3 −0.7 <12 y 14.1 16.0 0.9 17.4 20.9 2.7 § 12 y 14.6 13.9 −0.9 21.9 23.9 1.0 13–15 y 9.2 8.1 −1.1 § 15.4 11.7 −2.7 ≥16 y 9.3 7.9 −2.4 § 16.3 11.5 −4.8 § RR ¶ (95% CI) 1.5 (1.4–1.6) 2.0 (1.9–2.2) — 1.1 (0.9–1.3) 1.8 (1.5–2.2) — Female All ‡ 8.5 7.3 −1.8 § 13.7 13.3 −0.7 <12 y 9.5 10.4 1.4 11.0 10.3 −0.3 12 y 9.7 9.2 −1.0 § 16.1 17.8 −0.3 13–15 y 6.4 5.5 −1.6 § 9.4 10.0 0.7 ≥16 y 6.8 5.4 −3.0 § 15.6 12.2 −2.6 § RR ¶ (95% CI) 1.4 (1.3–1.6) 1.9 (1.7–2.1) — 0.7 (0.6–0.9) 0.8 (0.7–1.0) — Breast Female All ‡ 28.2 21.7 −3.5 § 40.1 35.5 −1.5 § <12 y 27.4 24.1 −1.4 § 30.0 28.7 0.1 12 y 30.6 25.4 −2.9 § 45.3 43.4 −1.5 13–15 y 23.2 17.3 −3.6 § 35.3 30.0 −0.9 ≥16 y 27.4 20.1 −4.3 § 45.7 35.8 −3.8 § RR ¶ (95% CI) 1.0 (1.0–1.1) 1.2 (1.1–1.3) — 0.7 (0.6–0.7) 0.8 (0.7–0.9) — Prostate Male All ‡ 4.0 2.8 −4.7 § 12.7 9.1 −3.6 § <12 y 4.0 3.4 −1.6 10.4 9.6 −1.6 12 y 4.3 3.3 −3.5 § 16.2 12.7 −1.6 13‐15 y 3.4 2.3 −5.5 § 10.3 5.3 −7.4 § ≥16 y 3.8 2.3 −6.3 § 7.6 4.8 −5.9 RR ¶ (95% CI) 1.1 (0.9–1.2) 1.5 (1.3–1.7) — 1.4 (1.0–1.8) 2.0 (1.5–2.7) — * Rates are for individuals aged 25–64 years at death, per 100,000 population, and age adjusted to the 2000 US standard population. † Annual percentage change. ‡ Includes persons with missing data for educational attainment. § The APC is significantly different from zero. ¶ Rate ratio comparing rate for less than 12 years of education to less than 16 or more years of education for the indicated year. Source: Adapted from Kinsey T, Jemal A, Liff J, et al. 23 Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (37%) (Table 13 ). However, because of the earlier median age of diagnosis for breast cancer compared with other major cancers, 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 overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility. 13 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2003–2005 * BIRTH TO 39 Y 40 TO 59 Y 60 TO 69 Y 70 Y AND OLDER BIRTH TO DEATH PERCENTAGE PERCENTAGE PERCENTAGE PERCENTAGE PERCENTAGE All sites † Male 1.42 (1 in 70) 8.44 (1 in 12) 15.71 (1 in 6) 37.74 (1 in 3) 43.89 (1 in 2) Female 2.07 (1 in 48) 8.97 (1 in 11) 10.23 (1 in 10) 26.17 (1 in 4) 37.35 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4448) 0.41 (1 in 246) 0.96 (1 in 104) 3.57 (1 in 28) 3.74 (1 in 27) Female 0.01 (1 in 10,185) 0.12 (1 in 810) 0.26 (1 in 378) 1.01 (1 in 99) 1.18 (1 in 84) Breast Female 0.48 (1 in 208) 3.79 (1 in 26) 3.41 (1 in 29) 6.44 (1 in 16) 12.03 (1 in 8) Colon & rectum Male 0.08 (1 in 1296) 0.92 (1 in 109) 1.55 (1 in 65) 4.63 (1 in 22) 5.51 (1 in 18) Female 0.07 (1 in 1343) 0.72 (1 in 138) 1.10 (1 in 91) 4.16 (1 in 24) 5.10 (1 in 20) Leukemia Male 0.16 (1 in 611) 0.22 (1 in 463) 0.35 (1 in 289) 1.17 (1 in 85) 1.50 (1 in 67) Female 0.12 (1 in 835) 0.14 (1 in 693) 0.20 (1 in 496) 0.77 (1 in 130) 1.07 (1 in 94) Lung & bronchus Male 0.03 (1 in 3398) 0.99 (1 in 101) 2.43 (1 in 41) 6.70 (1 in 18) 7.78 (1 in 13) Female 0.03 (1 in 2997) 0.81 (1 in 124) 1.78 (1 in 56) 4.70 (1 in 21) 6.22 (1 in 16) Melanoma of the skin § Male 0.16 (1 in 645) 0.64 (1 in 157) 0.70 (1 in 143) 1.67 (1 in 60) 2.56 (1 in 39) Female 0.27 (1 in 370) 0.53 (1 in 189) 0.35 (1 in 282) 0.76 (1 in 131) 1.73 (1 in 58) Non‐Hodgkin lymphoma Male 0.13 (1 in 763) 0.45 (1 in 225) 0.58 (1 in 171) 1.66 (1 in 60) 2.23 (1 in 45) Female 0.08 (1 in 1191) 0.32 (1 in 316) 0.45 (1 in 223) 1.36 (1 in 73) 1.90 (1 in 53) Prostate Male 0.01 (1 in 10,002) 2.43 (1 in 41) 6.42 (1 in 16) 12.49 (1 in 8) 15.78 (1 in 6) Uterine cervix Female 0.15 (1 in 651) 0.27 (1 in 368) 0.13 (1 in 761) 0.19 (1 in 530) 0.69 (1 in 145) Uterine corpus Female 0.07 (1 in 1499) 0.72 (1 in 140) 0.81 (1 in 123) 1.22 (1 in 82) 2.48 (1 in 40) * For people free of cancer at beginning of age interval. † All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder. ‡ Includes invasive and in situ cancer cases. § Statistics for whites only. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0. Statistical Research and Applications Branch, National Cancer Institute, 2008. www.srab.cancer.gov/devcan Cancer Survival by Race Compared with whites, African American men and women have poorer survival once cancer is diagnosed. Five‐year relative survival is lower in African Americans than in whites within every stratum of stage of diagnosis for nearly every cancer site (Fig. 8 ). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. As shown in Figure 9 , African Americans areless 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. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear. 24 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 25 8 Five‐year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004. *The rate for localized stage represents localized and regional stages combined. †The standard error of the mean for the survival rate is between 5 and 10 percentage points. Staging is according to Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. Source: Ries LAG, Melbert D, and Krapcho M, et al. 3 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004. *The rate for localized stage represents localized and regional stages combined. †Staging was performed according to the Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. For each cancer type, stage categories do not total 100% because sufficient information was not available to assign a stage to all cancer cases. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 There have been notable improvements since 1975 in relative 5‐year survival rates for many cancer sites and for all cancers combined (Table 14 ). This is true for both whites and African Americans. Cancers for which survival has not improved substantially during the past 30 years include lung and pancreas. The improvement in survival reflects a combination of earlier diagnoses and improved treatments. 14 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975–2004 ALL RACES WHITE AFRICAN AMERICAN 1975–1977 1984–1986 1996–2004 1975–1977 1984–1986 1996–2004 1975–1977 1984–1986 1996–2004 All sites 50 54 66 † 51 55 68 † 40 41 58 † Brain 24 29 35 † 23 28 34 † 27 33 39 † Breast, female 75 79 89 † 76 80 91 † 62 65 78 † Colon 52 59 65 † 52 60 66 † 46 50 55 † Esophagus 5 10 17 † 6 11 18 † 3 8 11 † Hodgkin lymphoma 74 79 86 † 74 80 87 † 71 75 80 † Kidney 51 56 67 † 51 56 67 † 50 54 66 † Larynx 67 66 64 † 67 68 66 59 53 50 Leukemia 35 42 51 † 36 43 52 † 34 34 42 Liver # 4 6 11 † 4 6 10 † 2 5 8 † Lung and bronchus 13 13 16 † 13 14 16 † 11 11 13 † Melanoma of the skin 82 87 92 † 82 87 92 † 60 ‡ 70 § 78 Myeloma 26 29 35 † 25 27 35 † 31 32 33 Non‐Hodgkin lymphoma 48 53 65 † 48 54 66 † 49 48 58 Oral cavity 53 55 60 † 55 57 62 † 36 36 42 † Ovary 37 40 46 † 37 39 45 † 43 41 38 Pancreas 3 3 5 † 3 3 5 † 2 5 5 † Prostate 69 76 99 † 70 77 99 † 61 66 96 † Rectum 49 57 67 † 49 58 67 † 45 46 59 † Stomach 16 18 25 † 15 18 23 † 16 20 25 † Testis 83 93 96 † 83 93 96 † 82 ‡ 87 ‡ 87 Thyroid 93 94 97 † 93 94 97 † 91 90 95 Urinary bladder 74 78 81 † 75 79 82 † 51 61 66 † Uterine cervix 70 68 73 † 71 70 74 † 65 58 65 Uterine corpus 88 84 84 † 89 85 86 † 61 58 61 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillence, Epidemiology, and End Results 9 areas from 1975–77, 1984–86, and 1996 to 2004 and followed through 2005. † The difference in rates between 1975–1977 and 1996–2004 is statistically significant ( P <.05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. § The standard error of the survival rate is greater than 10 percentage points. # Includes intrahepatic bile duct. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Relative survival rates cannot be calculated for racial and ethnic populations other than for whites and African Americans 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, compared to non‐Hispanic whites, all minority populations except Asian American/Pacific Islander women have a greater probability of dying from cancer within five years of diagnosis after accounting for differences in stage at diagnosis. 20 , 26 For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely than non‐Hispanic whites to be diagnosed at a distant stage. 26 Cancer in Children In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, surpassed only by accidents (Table 15 ). Leukemia (particularly acute lymphocytic leukemia) is the most common cancer in children (aged 0–14 years), followed by cancer of the brain and other nervous system, soft tissue sarcomas, renal (Wilms) tumors, and non‐Hodgkin lymphoma. 3 During the past 25 years, there have been significant improvements in the 5‐year relative survival rate for all of the major childhood cancers (Table 16 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975–1977 to 80% for those diagnosed in 1996–2004. 3 15 Ten Leading Causes of Death Among Children Aged 1 to 14 Years, United States, 2006 RANK CAUSE OF DEATH NO. OF DEATHS % OF TOTAL DEATHS DEATH RATE * ALL CAUSES 10,780 100.0 19.0 1 Accidents (unintentional injuries) 3,868 35.9 6.8 2 Cancer 1,284 11.9 2.3 3 Congenital anomalies 859 8.0 1.5 4 Assault (homicide) 756 7.0 1.3 5 Heart diseases 414 3.8 0.7 6 Intentional self‐harm (suicide) 219 2.0 0.4 7 Influenza & pneumonia 193 1.8 0.3 8 Septicemia 172 1.6 0.3 9 Chronic lower respiratory diseases 158 1.5 0.3 10 Cerebrovascular disease 149 1.4 0.3 All other causes 2,708 25.1 — * Rates are per 100,000 population and age adjusted to the 2000 US standard population. Note: “Symptoms, signs, and abnormal clinical or laboratory findings” and “Other respiratory diseases” were excluded from ranking order. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 16 Trends in 5‐Year Relative Survival Rates * (%) for Children Younger than Age 15 Years, US, 1975–2004 YEAR OF DIAGNOSIS SITE 1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 2004 All sites 58 63 67 68 71 76 77 80 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 88 † Acute myeloid leukemia 19 26 27‡ 31‡ 37‡ 41 42‡ 55 † Bone and joint 51‡ 49 57‡ 58‡ 67‡ 67 74 71 † Brain and other nervous system 57 58 56 62 64 64 70 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 96 † Neuroblastoma 52 57 55 52 62 76 67 70 † Non‐Hodgkin lymphoma 43 53 67 70 71 76 81 86 † Soft tissue 61 75 69 73 65 80 77 74 † Wilms tumor 73 79 87 91 92 92 92 92 † Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. * Survival rates are adjusted for normal life expectancy and are based on follow up of patients through 2005. † Difference in rates between 1975 to 1977 and 1996 to 2004 is statistically significant ( P <.05). Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Limitations 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. Estimates are also affected by changes in method. The introduction of a new method for projecting incident cancer cases beginning with the 2007 estimates substantially affected the estimates for several cancers, particularly leukemia and female breast. (See Pickle et al for more detailed discussion.) Not all changes in cancer trendsare captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. The preferred data sources for tracking cancer trends are the age‐standardized or age‐specific cancer death rates from the National Center for Health Statistics and cancer incidence rates from SEER or NPCR, although these data are 3 and 4 years old, respectively, by the time that they become available. Nevertheless, the American Cancer Society 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CA: A Cancer Journal for Clinicians Wiley

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References (35)

Publisher
Wiley
Copyright
Copyright © 2009 American Cancer Society, Inc.
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/caac.20006
pmid
19474385
Publisher site
See Article on Publisher Site

Abstract

Introduction Cancer is a major public health problem in the United States and many other parts of the world. 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 numbers of new cancer cases and deaths in 2009. Materials and Methods Data Sources Mortality data from 1930 to 2006 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 Incidence data for long‐term trends (1975–2005), 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. 2 , 3 , 4 , 5 Incidence data (1995–2005) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Center for Disease Control (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR). State‐specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and NPCR. Population data were obtained from the US Census Bureau. 7 Causes of death were coded and classified according to the International Classification of Diseases (ICD‐8, ICD‐9, and ICD‐10). 8 , 9 , 10 Cancer cases were classi fied according to the International Classification of Diseases for Oncology . 11 Estimated New Cancer Cases The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3–4 years behind the current year because of the time required for data collection and compilation. Estimated new cancer cases in the current year (2009) were projected by using a spatiotemporal model 12 on the basis of incidence data from 1995 through 2005 from 41 states and the District of Columbia that met NAACCR's high‐quality data standard for incidence, covering about 85% of the US population. The method also considers geographic variations in sociodemographic 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 13 to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2009. Projections are based on underlying cause‐of‐death from death certificates as reported to the NCHS. 1 This model projects the number of cancer deaths expected to occur in 2009 on the basis of the number that occurred each year from 1969 to 2006 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 2006. Causes of death for 2006 were coded and classified according to ICD‐10. 8 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 2005. 3 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 2005) are adjusted for delays in reporting where possible. Delayed reporting primarily affects the most recent 1–3 years of incidence data (in this case, 2003–2005), especially for cancers such as melanoma, leukemia, and prostate that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and many specific cancer sites. 14 Delay‐adjusted rates provide a more accurate assessment of trends in the most recent years for which data are available. Long‐term incidence and mortality trends (1975–2005) for selected cancer sites were previously published in the 2008 Annual Report to the Nation on the Status of Cancer . 15 We also provide the contribution of individual cancer sites to the total decrease in overall cancer death rates since 1990 in men and since 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age‐standardized cancer death rates over these time intervals. The total number of cancer deaths avoided was calculated by applying the age‐specific cancer death rates in the peak year for the age‐standardized cancer death rates (1990 for males and 1991 for females) to the corresponding age‐specific populations in the subsequent years through 2005 to obtain the number of expected deaths in each calendar year had the death rates not decreased. We then summed the difference between the number of expected and observed deaths in each age group and calendar year for men and women separately to obtain the total number of cancer deaths avoided over the 14‐year (women) or 15‐year (men) interval. Selected Findings Expected Numbers of New Cancer Cases Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the United States in 2009. The overall estimate of about 1.5 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 cancers, about 62,280 cases of breast carcinoma in situ , and 53,120 cases of melanoma in situ are expected to be newly diagnosed in 2009. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2 . 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2009 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,479,350 766,130 713,220 562,340 292,540 269,800 Oral cavity & pharynx 35,720 25,240 10,480 7,600 5,240 2,360 Tongue 10,530 7,470 3,060 1,910 1,240 670 Mouth 10,750 6,450 4,300 1,810 1,110 700 Pharynx 12,610 10,020 2,590 2,230 1,640 590 Other oral cavity 1,830 1,300 530 1,650 1,250 400 Digestive system 275,720 150,020 125,700 135,830 76,020 59,810 Esophagus 16,470 12,940 3,530 14,530 11,490 3,040 Stomach 21,130 12,820 8,310 10,620 6,320 4,300 Small intestine 6,230 3,240 2,990 1,110 580 530 Colon † 106,100 52,010 54,090 49,920 25,240 24,680 Rectum 40,870 23,580 17,290 Anus, anal canal, & anorectum 5,290 2,100 3,190 710 260 450 Liver & intrahepatic bile duct 22,620 16,410 6,210 18,160 12,090 6,070 Gallbladder & other biliary 9,760 4,320 5,440 3,370 1,250 2,120 Pancreas 42,470 21,050 21,420 35,240 18,030 17,210 Other digestive organs 4,780 1,550 3,230 2,170 760 1,410 Respiratory system 236,990 129,710 107,280 163,790 92,240 71,550 Larynx 12,290 9,920 2,370 3,660 2,900 760 Lung & bronchus 219,440 116,090 103,350 159,390 88,900 70,490 Other respiratory organs 5,260 3,700 1,560 740 440 300 Bones & joints 2,570 1,430 1,140 1,470 800 670 Soft tissue ( including heart ) 10,660 5,780 4,880 3,820 1,960 1,860 Skin ( excluding basal & squamous ) 74,610 42,920 31,690 11,590 7,670 3,920 Melanoma‐skin 68,720 39,080 29,640 8,650 5,550 3,100 Other nonepithelial skin 5,890 3,840 2,050 2,940 2,120 820 Breast 194,280 1,910 192,370 40,610 440 40,170 Genital system 282,690 201,970 80,720 56,160 28,040 28,120 Uterine cervix 11,270 11,270 4,070 4,070 Uterine corpus 42,160 42,160 7,780 7,780 Ovary 21,550 21,550 14,600 14,600 Vulva 3,580 3,580 900 900 Vagina & other genital, female 2,160 2,160 770 770 Prostate 192,280 192,280 27,360 27,360 Testis 8,400 8,400 380 380 Penis & other genital, male 1,290 1,290 300 300 Urinary system 131,010 89,640 41,370 28,100 18,800 9,300 Urinary bladder 70,980 52,810 18,170 14,330 10,180 4,150 Kidney & renal pelvis 57,760 35,430 22,330 12,980 8,160 4,820 Ureter & other urinary organs 2,270 1,400 870 790 460 330 Eye & orbit 2,350 1,200 1,150 230 120 110 Brain & other nervous system 22,070 12,010 10,060 12,920 7,330 5,590 Endocrine system 39,330 11,070 28,260 2,470 1,100 1,370 Thyroid 37,200 10,000 27,200 1,630 690 940 Other endocrine 2,130 1,070 1,060 840 410 430 Lymphoma 74,490 40,630 33,860 20,790 10,630 10,160 Hodgkin lymphoma 8,510 4,640 3,870 1,290 800 490 Non‐Hodgkin lymphoma 65,980 35,990 29,990 19,500 9,830 9,670 Myeloma 20,580 11,680 8,900 10,580 5,640 4,940 Leukemia 44,790 25,630 19,160 21,870 12,590 9,280 Acute lymphocytic leukemia 5,760 3,350 2,410 1,400 740 660 Chronic lymphocytic leukemia 15,490 9,200 6,290 4,390 2,630 1,760 Acute myeloid leukemia 12,810 6,920 5,890 9,000 5,170 3830 Chronic myeloid leukemia 5,050 2,930 2,120 470 220 250 Other leukemia ‡ 5,680 3,230 2,450 6,610 3,830 2,780 Other & unspecified primary sites ‡ 31,490 15,290 16,200 44,510 23,920 20,590 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 62,280 female carcinoma in situ of the breast and 53,120 melanoma in situ will be newly diagnosed in 2009. † Estimated deaths for colon and rectum cancers are combined. ‡ More deaths than cases may suggest lack of specificity in recording underlying cause of death on death certificates. Source: Estimated new cases are based on 1995–2005 incidence rates from 41 states and the District of Columbia as reported by the North American Association of Central Cancer Registries (NAACCR), representing about 85% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 2 Age‐standardized Incidence Rates for All Cancers Combined, 2001–2005, and Estimated New Cases * for Selected Cancers by State, United States, 2009 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 Alabama 449.2 24,090 2,970 190 2,480 510 590 4,040 930 950 2,800 960 Alaska 466.1 2,530 370 ‡ 250 70 70 350 80 110 360 120 Arizona 416.8 27,600 3,470 210 2,680 660 810 3,960 1,460 1,250 3,530 1,460 Arkansas 455.4 14,800 1,820 130 1,540 310 420 2,580 500 680 2,140 610 California 446.2 152,170 21,740 1,350 14,680 4,230 4,570 17,910 9,080 7,140 20,790 6,870 Colorado 447.1 20,340 2,840 150 1,860 530 720 2,240 1,260 920 3,070 940 Connecticut 508.3 20,650 2,790 110 1,950 660 540 2,720 1,260 920 2,400 1,120 Delaware 507.3 4,690 600 ‡ 440 140 120 800 220 190 550 220 Dist. of Columbia § 2,600 340 ‡ 260 80 50 370 70 90 380 90 Florida 470.3 102,210 12,650 800 10,420 2,590 3,180 17,790 4,920 4,640 12,380 5,490 Georgia 465.5 39,080 5,370 340 3,750 930 1,080 6,150 2,040 1,560 5,210 1,400 Hawaii 426.8 6,400 870 50 710 200 160 740 320 260 860 220 Idaho 462.2 6,800 810 ‡ 630 170 250 820 380 330 1,170 340 Illinois 487.4 60,960 7,610 480 6,430 1,960 1,940 9,180 2,010 2,900 7,590 3,100 Indiana 469.5 31,320 3,710 220 3,260 970 930 5,360 1,170 1,420 3,250 1,550 Iowa 481.0 16,740 2,080 90 1,800 500 590 2,620 910 750 2,330 870 Kansas § 13,080 1,790 90 1,290 400 380 2,110 610 600 1,970 620 Kentucky 512.8 24,060 2,840 180 2,620 590 690 4,650 1,260 980 2,910 1,070 Louisiana 497.7 22,170 2,700 190 2,330 430 660 3,650 630 960 3,160 910 Maine 527.2 9,000 1,080 50 870 270 270 1,390 480 360 1,130 500 Maryland § 26,650 3,660 190 2,620 840 640 4,060 1,310 1,120 3,580 1,110 Massachusetts 514.9 36,080 4,800 200 3,380 1,140 1,000 5,120 2,030 1,610 4,200 2,010 Michigan 509.1 53,550 6,480 320 5,020 1,700 1,690 8,190 2,240 2,470 7,010 2,810 Minnesota 481.0 23,670 3,280 140 2,520 810 890 3,310 890 1,130 4,910 1,200 Mississippi § 14,150 1,820 130 1,480 270 360 2,340 380 540 1,990 540 Missouri 467.7 30,090 3,880 220 3,100 870 880 5,600 1,260 1,250 3,620 1,450 Montana 477.6 5,340 640 ‡ 520 140 170 730 220 240 810 270 Nebraska 474.4 8,810 1,200 60 950 270 290 1,230 420 400 1,410 450 Nevada 471.7 12,020 1,350 110 1,240 270 380 1,910 480 480 1,660 630 New Hampshire 507.0 7,630 1,010 ‡ 730 240 210 1,100 460 310 910 420 New Jersey 515.7 47,920 6,440 410 4,590 1,620 1,380 6,250 2,530 2,160 6,060 2,640 New Mexico 421.0 8,830 1,090 80 810 210 310 970 460 360 1,400 350 New York 489.1 101,550 13,530 870 9,970 3,510 3,140 13,550 3,710 4,540 12,520 5,360 North Carolina § 42,270 5,470 340 4,230 1,030 1,150 6,670 2,190 1,730 6,130 1,790 North Dakota 458.7 3,200 410 ‡ 350 90 110 420 110 140 560 180 Ohio § 62,420 7,340 390 6,060 1,930 1,950 10,690 2,080 2,800 6,510 2,990 Oklahoma 466.4 18,110 2,340 140 1,860 400 580 3,220 690 820 2,190 770 Oregon 472.8 19,210 2,680 110 1,780 570 490 2,610 1,220 910 2,510 1,020 Pennsylvania 503.6 74,170 9,380 500 7,590 2,550 2,200 10,480 3,440 3,330 8,130 4,160 Rhode Island 514.5 6,250 810 ‡ 590 190 180 900 340 260 650 370 South Carolina 475.2 22,100 2,820 170 2,150 520 590 3,680 1,090 870 2,910 880 South Dakota 474.5 4,120 530 ‡ 440 120 140 590 180 180 740 230 Tennessee § 32,570 3,970 240 3,490 720 1,000 5,370 1,410 1,370 4,790 1,380 Texas 454.9 98,200 13,090 980 9,800 2,220 3,470 14,150 3,820 4,530 13,130 3,720 Utah 411.8 8,880 1,080 60 770 250 330 620 600 440 1,570 360 Vermont § 3,550 480 ‡ 330 120 100 500 200 140 540 190 Virginia 440.3 34,150 4,850 240 3,380 1,020 840 5,330 1,790 1,450 4,830 1,430 Washington 499.0 32,290 4,520 190 2,890 960 990 4,130 1,970 1,540 4,680 1,660 West Virginia 490.5 10,230 1,180 70 1,070 330 290 2,030 450 420 1,210 510 Wisconsin § 27,560 3,480 160 2,770 1,000 980 3,960 1,040 1,310 2,770 1,530 Wyoming 447.9 2,500 300 ‡ 240 70 70 320 130 110 390 130 United States 476.6 1,479,350 192,370 11,270 146,970 42,160 44,790 219,440 68,720 65,980 192,280 70,980 * 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. ‡ Estimate is fewer than 50 cases. § Combined incidence rate is not available. Note: These model‐based estimates are calculated by using incidence rates from 41 states and the District of Columbia as reported by NAACCR. They are offered as a rough guide and should be interpreted with caution. State estimates may not add to the US total because of rounding and exclusion of states with fewer than 50 cases. Source: North American Association of Central Cancer Registries (NAACCR), based on data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. Rates for Alabama, Louisiana, Mississippi, and Texas are for cases diagnosed through June 2005. Figure 1 indicates the most common cancers expected to occur in men and women in 2009. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 50% of all newly diagnosed cancers. Prostate cancer alone accounts for 25% (192,280) of incident cases in men. On the basis of cases diagnosed between 1996 and 2004, 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%. 1 Ten Leading Cancer Types for Estimated New Cancer Cases and Deaths, by Sex, United States, 2009. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10. The three most commonly diagnosed types of cancer among women in 2009 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 27% (192,370) of all new cancer cases among women. Expected Number of Cancer Deaths Table 1 also shows the expected number of deaths from cancer projected for 2009 for men, women, and both sexes combined. It is estimated that about 562,340 Americans will die from cancer, corresponding to more than 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common fatal cancers. These four cancers account for almost half of the total cancer deaths among men and women (Fig. 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 2009. Table 3 provides the estimated number of cancer deaths in 2009 by state for selected cancer sites. 3 Age‐standardized Death Rates for All Cancers Combined, 2001–2005, and Estimated Deaths * for Selected Cancers by State, United States, 2009 STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 206.2 9,900 200 700 940 340 280 3,140 290 270 550 510 Alaska 186.5 830 ‡ 60 70 ‡ ‡ 220 ‡ ‡ 50 ‡ Arizona 167.5 10,260 280 740 970 410 360 2,820 350 290 630 580 Arkansas 207.3 6,230 130 410 580 250 190 2,160 200 130 400 340 California 173.1 54,600 1,460 4,030 4,830 2,200 2,450 12,750 1,900 1,580 3,740 2,780 Colorado 166.4 6,740 200 520 670 300 210 1,670 230 210 430 350 Connecticut 184.3 6,990 150 480 550 270 210 1,810 220 180 540 390 Delaware 204.3 1,860 50 110 150 70 50 590 50 ‡ 110 90 Dist. of Columbia 209.5 970 ‡ 70 100 50 ‡ 240 ‡ ‡ 60 60 Florida 180.1 41,270 810 2,730 3,460 1,650 1,300 12,210 1,560 970 2,470 2,280 Georgia 194.2 14,970 320 1,130 1,370 550 400 4,660 460 400 870 800 Hawaii 152.2 2,270 ‡ 140 210 80 120 570 80 50 170 100 Idaho 173.4 2,450 90 160 200 120 80 630 80 50 200 160 Illinois 197.6 23,220 470 1,770 2,260 950 700 6,460 770 600 1,560 1,150 Indiana 205.1 12,820 290 860 1,130 520 350 4,000 420 340 770 520 Iowa 185.9 6,360 160 400 600 300 150 1,760 280 170 380 330 Kansas 187.0 5,290 150 370 510 200 140 1,620 180 150 330 210 Kentucky 222.7 9,410 150 590 840 320 240 3,430 300 210 500 390 Louisiana 221.0 8,810 210 690 910 310 330 2,700 310 210 530 450 Maine 206.8 3,190 80 180 260 110 80 980 90 70 200 160 Maryland 196.6 10,320 200 810 940 390 320 2,880 300 260 690 550 Massachusetts 193.4 13,140 270 870 1,070 490 420 3,610 430 350 880 540 Michigan 195.3 20,450 490 1,350 1,720 820 610 5,840 710 520 1,250 820 Minnesota 178.8 9,020 230 600 760 370 260 2,380 320 240 580 410 Mississippi 211.9 6,090 160 430 600 220 190 2,030 180 140 350 300 Missouri 201.9 12,620 270 890 1,100 530 360 4,100 430 290 750 660 Montana 186.6 1,980 50 120 170 90 50 550 70 50 120 120 Nebraska 179.6 3,360 80 210 350 150 80 890 130 90 190 200 Nevada 197.1 4,600 120 330 500 140 160 1,340 130 120 280 230 New Hampshire 193.0 2,620 70 170 220 100 70 750 60 60 170 130 New Jersey 193.4 16,480 320 1,470 1,580 610 540 4,190 610 450 1,080 660 New Mexico 167.3 3,300 80 240 320 120 150 710 110 90 220 210 New York 179.9 34,190 790 2,550 3,110 1,380 1,210 8,780 1,430 970 2,360 1,470 North Carolina 196.1 18,550 330 1,310 1,410 640 470 5,630 530 430 1,090 860 North Dakota 176.3 1,300 ‡ 80 120 50 ‡ 370 ‡ ‡ 90 100 Ohio 204.1 24,350 550 1,790 2,210 890 640 7,300 740 580 1,430 1,200 Oklahoma 200.1 7,420 170 520 600 290 200 2,390 240 170 380 280 Oregon 192.0 7,380 210 500 610 290 210 2,140 330 220 470 390 Pennsylvania 198.5 28,690 550 2,070 2,550 1,080 790 8,090 1,090 760 1,920 1,440 Rhode Island 194.7 2,220 50 130 160 90 70 560 70 60 120 100 South Carolina 200.7 9,100 190 640 780 330 250 2,880 310 210 530 420 South Dakota 182.8 1,640 ‡ 100 150 60 ‡ 450 70 50 100 100 Tennessee 211.2 13,340 350 910 1,140 480 350 4,520 440 310 730 570 Texas 184.9 36,030 850 2,570 3,140 1,430 1,650 9,780 1,300 890 2,120 1,700 Utah 140.9 2,760 100 260 240 130 70 480 130 90 190 170 Vermont 183.6 1,150 ‡ 80 120 60 ‡ 350 ‡ ‡ 70 60 Virginia 194.7 13,920 290 1,140 1,270 500 390 4,250 410 380 880 620 Washington 187.1 11,210 380 790 940 450 410 3,090 410 340 710 680 West Virginia 213.4 4,530 90 280 430 140 110 1,500 180 120 210 140 Wisconsin 186.7 11,170 260 750 900 500 320 2,910 400 300 710 500 Wyoming 180.0 990 ‡ 60 100 ‡ ‡ 260 ‡ ‡ 60 ‡ United States 189.8 562,340 12,920 40,170 49,920 21,870 18,160 159,390 19,500 14,600 35,240 27,360 * Rounded to the nearest 10. † Rates are per 100,000 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 states with fewer than 50 deaths. Source: US Mortality Data, 1969 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. Regional Variations in Cancer Rates Table 4 depicts cancer incidence rates for selected cancer sites by state. By far, the largest variation in incidence among the cancer sites listed in Table 4 is seen for lung cancer, where rates (cases per 100,000 population) range from 39.6 in men and 22.4 in women in Utah to 136.2 in men and 76.2 in women in Kentucky. This variation reflects the large and continuing differences in smoking prevalence among states. Utah ranks lowest in adult‐smoking prevalence and Kentucky highest. In contrast, state variation in the incidence rates of other cancer sites shown in Table 4 was smaller in both absolute and proportionate terms. For prostate and female breast cancers in particular, variation in incidence reflects differences in the use of screening tests in addition to differences in disease occurrence. 4 Cancer Incidence Rates * by Site and State, United States, 2001–2005 STATE ALL SITES BREAST COLON AND RECTUM LUNG AND BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama † 555.6 377.6 114.2 62.2 41.9 109.5 52.5 20.5 14.0 150.7 31.1 7.7 Alaska † 533.2 410.6 127.9 61.3 46.0 82.4 62.8 23.5 16.1 151.3 39.4 7.2 Arizona 461.7 363.0 109.8 49.4 36.3 69.8 48.8 18.6 13.2 116.6 35.0 8.7 Arkansas † 558.2 381.5 114.0 59.2 43.6 113.4 59.0 21.9 15.1 158.1 33.1 8.9 California † 518.2 396.4 124.7 53.8 39.8 67.0 47.5 22.6 15.5 152.6 34.4 8.3 Colorado † 512.7 401.7 125.9 51.5 41.0 63.0 46.0 21.4 16.3 159.4 35.0 9.1 Connecticut † 589.5 454.3 137.4 65.2 47.9 82.5 58.8 25.5 17.8 166.6 44.6 12.5 Delaware † 601.7 438.6 126.4 62.6 46.4 97.8 66.2 22.5 16.7 175.5 42.4 11.0 Dist. of Columbia ‡ — — — — — — — — — — — — Florida † 549.3 410.1 116.7 57.7 43.4 91.4 60.8 21.9 15.5 143.1 38.7 10.0 Georgia † 571.3 395.2 120.6 60.1 42.6 104.1 53.4 20.6 14.2 163.6 33.0 8.1 Hawaii † 484.9 385.9 126.0 62.4 42.5 67.8 38.9 18.9 12.7 129.3 25.1 6.2 Idaho † 543.5 399.0 118.2 52.0 38.5 69.6 46.7 21.5 17.2 168.8 38.4 8.5 Illinois † 580.1 426.8 124.1 68.0 48.5 93.1 57.8 23.8 16.3 159.5 40.8 10.4 Indiana † 552.3 414.9 117.7 64.6 47.3 105.3 62.2 22.6 16.0 136.9 37.2 9.3 Iowa † 560.9 428.3 125.4 67.2 50.5 89.3 52.4 23.5 17.0 147.3 40.6 9.8 Kansas ‡ — — — — — — — — — — — — Kentucky † 612.5 447.1 120.5 70.3 51.4 136.2 76.2 22.4 16.9 144.4 38.1 9.8 Louisiana † 624.9 409.5 120.9 70.1 48.3 111.3 58.2 22.9 16.2 180.2 35.6 8.7 Maine † 621.6 460.6 130.6 67.7 49.1 99.8 65.7 24.5 18.6 166.8 48.7 12.9 Maryland ‡ — — — — — — — — — — — — Massachusetts † 604.0 455.9 133.8 67.6 48.4 86.0 63.0 24.1 17.1 170.2 46.5 12.9 Michigan † 608.0 440.2 127.0 61.0 45.7 94.3 61.3 25.0 18.5 186.4 42.5 10.7 Minnesota † 568.8 418.6 129.3 57.9 43.1 71.4 49.2 26.4 18.1 185.9 40.0 10.5 Mississippi (2002–2005) 555.6 365.5 105.8 62.9 45.2 110.1 50.9 19.9 13.0 161.9 28.3 7.4 Missouri † 545.3 414.6 123.0 64.7 46.1 105.4 61.8 21.8 15.9 131.5 36.2 9.2 Montana † 561.2 412.3 122.6 55.4 41.5 78.2 57.9 23.2 15.0 182.4 41.9 9.3 Nebraska † 557.0 417.9 127.8 68.5 48.0 84.5 48.8 24.0 16.9 157.3 37.8 10.0 Nevada † 539.9 415.8 116.0 56.9 43.1 84.3 69.5 21.9 15.0 148.7 43.0 11.2 New Hampshire † 586.7 451.9 132.3 61.7 46.9 82.3 61.5 24.4 18.1 162.7 47.9 13.5 New Jersey † 612.5 451.5 129.8 68.3 50.0 80.9 56.0 25.9 17.7 183.9 46.0 12.2 New Mexico † 490.7 367.7 111.7 50.8 35.4 59.1 38.5 18.4 14.0 149.3 28.0 7.0 New York † 575.7 432.7 124.6 63.4 47.2 80.5 53.7 24.3 16.9 165.9 42.1 11.2 North Carolina ‡ — — — — — — — — — — — — North Dakota † 543.8 396.7 122.5 68.3 44.1 74.9 47.1 22.6 15.3 170.8 36.7 9.9 Ohio 543.8 413.6 121.9 62.7 45.8 97.2 58.9 22.8 16.2 145.6 38.7 9.7 Oklahoma † 551.3 409.2 126.4 61.2 43.9 107.4 63.8 22.3 16.2 147.0 33.8 8.1 Oregon † 533.4 430.0 134.7 54.4 41.7 79.9 60.4 24.1 17.5 151.4 40.3 10.4 Pennsylvania † 593.9 444.0 125.7 68.4 49.6 91.6 55.7 24.8 17.3 161.4 44.6 11.3 Rhode Island † 616.7 446.9 127.5 67.8 46.8 94.5 59.5 25.0 16.7 161.6 51.6 12.9 South Carolina † 589.6 395.2 119.2 63.5 44.9 103.8 52.3 20.6 14.5 172.3 32.6 7.7 South Dakota † 568.5 406.0 125.5 63.8 46.7 80.3 45.0 22.4 17.4 183.0 39.7 8.3 Tennessee § 496.9 377.4 115.3 57.7 42.2 105.0 56.4 19.4 14.2 120.3 31.5 7.8 Texas † 546.5 390.9 116.3 59.5 40.5 90.4 51.2 22.2 16.1 146.6 30.2 7.4 Utah † 493.1 348.2 112.9 46.3 34.1 39.6 22.4 22.9 15.8 185.0 29.1 6.4 Vermont ‡ — — — — — — — — — — — — Virginia 515.6 376.4 119.5 56.7 42.3 86.1 51.9 19.6 13.1 154.1 32.1 8.3 Washington † 571.2 447.7 138.9 54.6 41.4 80.5 60.0 26.9 18.4 167.7 41.6 10.4 West Virginia † 576.0 433.6 115.3 70.6 51.7 117.0 69.4 22.3 16.0 139.4 40.0 11.4 Wisconsin ‡ — — — — — — — — — — — — Wyoming † 515.5 394.8 117.9 49.4 43.6 62.6 47.2 20.6 16.3 171.2 41.5 9.5 United States 562.3 417.3 123.6 61.2 44.8 87.3 55.4 23.2 16.3 158.2 38.4 9.8 * Per 100,000, age adjusted to the 2000 US standard population. † This state's registry has submitted 5 years of data and passed rigorous criteria for each single year's data, including completeness of reporting, nonduplication of records, percentage unknown in critical data fields, percentage 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 for 2001–2005. § Case ascertainment for this state's registry is incomplete for the years 2001–2005. Source : North American Association of Central Cancer Registries, based on data collected by cancer registries participating in the National Cancer Institute's Surveillence, Epidemiology, and End Results program and Centers for Disease Control's National Program of 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 and for the four most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates decreased by 1.8% per year from 2001–2005 in males and by 0.6% per year from 1998–2005 in females. Death rates for all cancer sites combined decreased by 2.0% per year from 2001–2005 in males and by 1.6% per year in females from 2002–2005, compared with declines of 1.5% per year in males from 1993–2001 and 0.8% per year in females from 1994–2002. 2 Annual Age‐adjusted Cancer Incidence and Death Rates for All Sites by Sex, United States, 1975–2005. 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 ( www.seer.cancer.gov ). Delay‐adjusted incidence database, SEER incidence delay‐adjusted rates from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released in April 2008, based on the November 2007 SEER data submission. Mortality, US mortality data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 3 Annual Age‐adjusted Cancer Incidence Rates among Males and Females for Selected Cancers, United States, 1975– 2005. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program ( www.seer.cancer.gov ). Delay‐adjusted incidence database, SEER Incidence Delay‐Adjusted Rates, from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2008, based on the November 2007 SEER data submission. 4 Annual Age‐adjusted Cancer Death Rates among Males for Selected Cancers, United States, 1930–2005. Rates are age adjusted to the 2000 US population. 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 data, 1960 to 2005, US Mortality Vol. 1930–1959, National Cancer Institute, Centers for Disease Control and Prevention, 2008. 5 Annual Age‐adjusted Cancer Death Rates* among Females for Selected Cancers, United States, 1930–2005. *Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. 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 data, 1960 to 2005, US Mortality Vol. 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975–2005 TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 YEARS APC * YEARS APC * YEARS APC * YEARS APC * YEARS APC * All sites Incidence Male and female 1975–1989 1.2 † 1989–1992 2.8 † 1992–1995 −2.4 1995–1999 0.9 1999–2005 −0.8 † Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.8 † 1995–2001 0.3 2001–2005 −1.8 † Female 1975–1979 −0.3 1979–1987 1.6 † 1987–1995 0.1 1995–1998 1.4 1998–2005 −0.6 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2002 −1.1 † 2002–2005 −1.8 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.5 1993–2001 −1.5 † 2001–2005 −2.0 † Female 1975–1990 0.6 † 1990–1994 −0.2 1994–2002 −0.8 † 2002–2005 −1.6 † Lung and bronchus Incidence Male 1975–1982 1.5 † 1982–1991 −0.5 1991–2005 −1.8 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2005 0.5 † Death Male 1975–1978 2.5 † 1978–1984 1.2 † 1984–1990 0.4 † 1990–1993 −1.1 1993–2005 −1.9 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † 2003–2005 −0.9 Colon and rectum Incidence Male 1975–1985 1.1 † 1985–1991 1.2 † 1991–1995 −3.1 † 1995–1998 1.9 1998–2005 −2.8 † Female 1975–1985 0.3 1985–1995 −1.9 † 1995–1998 1.9 1998–2005 −2.2 † Death Male 1975–1978 0.8 1978–1984 −0.4 1984–1990 −1.3 † 1990–2002 −2.0 † 2002–2005 −4.3 † Female 1975–1984 −1.0 † 1984–2002 −1.8 † 2002–2005 −4.3 † Female breast Incidence 1975–1980 −0.6 1980–1987 4.0 † 1987–1994 −0.2 1994–1999 1.7 † 1999–2005 −2.2 † Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1998 −3.3 † 1998–2005 −1.8 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.5 † 1995–2001 2.1 † 2001–2005 −4.4 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2005 −4.1 † Trends were analyzed by Joinpoint Regression Program, version 3.2.0, with a maximum of four joinpoints (ie, five line segments). * Annual percentage change (APC) based on incidence (delay adjusted) and mortality rates age adjusted to the 2000 US standard population. † The APC is significantly different from zero. Source: Jemal, et al. 15 Mortality rates have continued to decrease across all four major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2005 after increasing for many decades (Table 5 ). Similarly, incidence trends decreased for all four major cancer sites except for lung cancer in women, in whom rates are still increasing although at a much slower rate than in the previous years. The lag in the temporal trend of lung cancer 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. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2005 largely reflects increases in screening that can detect and remove precancerous polyps. The decrease in the breast cancer incidence rate since 1999 likely reflects a combination of two factors: the decrease in use of menopausal hormone therapy among postmenopausal women and delayed diagnosis because of decreased mammography utilization. 16–17 The sharp decrease in prostate cancer incidence rates (by 4.4% per year from 2001–2005) may reflect recent stabilization of prostate‐specific antigen (PSA) testing, which has resulted in decreased detection, or reduced number of undiagnosed cases. 18–20 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 2005, death rates from cancer decreased by 19.2% among men and by 11.4% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in cancer death rates, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use during the past 50 years, while the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment. Between 1990–1991 and 2005, death rates increased for liver cancer in both men and women, for esophageal cancer and melanoma in men, and for lung and pancreatic cancer in women. 6 Contribution of Indvidual Cancer Sites to Decreases in Cancer Death Rates, 1990–2005 for Males and 1991–2005 for Females MALES DEATH RATES PER 100,000 CHANGE CONTRIBUTION (%) † 1990 * 2005 ABSOLUTE PERCENT All malignant cancers 279.82 226.11 −53.71 −19.19 Decreasing Lung and bronchus 90.56 69.39 −21.17 −23.38 37.0 Prostate 38.56 24.65 −13.91 −36.07 24.3 Colon and rectum 30.77 20.98 −9.79 −31.82 17.1 Pancreas 12.59 12.36 −0.23 −1.83 0.4 Leukemia 10.71 9.70 −1.01 −9.43 1.8 Non‐Hodgkin lymphoma 9.97 8.77 −1.20 −12.04 2.1 Urinary bladder 7.97 7.56 −0.41 −5.14 0.7 Kidney and renal pelvis 6.16 5.92 −0.24 −3.90 0.4 Brain and other nervous system 5.97 5.31 −0.66 −11.06 1.2 Stomach 8.86 5.24 −3.62 −40.86 6.3 Myeloma 4.83 4.48 −0.35 −7.25 0.6 Oral cavity and pharynx 5.61 3.84 −1.77 −31.55 3.1 Larynx 2.97 2.24 −0.73 −24.58 1.3 Soft tissue including heart 1.52 1.43 −0.09 −5.92 0.2 Hodgkin lymphoma 0.85 0.50 −0.35 −41.18 0.6 Gallbladder 0.60 0.46 −0.14 −23.33 0.2 Small intestine 0.50 0.44 −0.06 −12.00 0.1 Other 24.58 23.13 −1.45 −5.90 2.5 Total − 57.18 100.0 Increasing Esophagus 7.16 7.94 0.78 10.89 22.5 Liver and intrahepatic bile duct 5.27 7.76 2.49 47.25 71.8 Melanoma of the skin 3.80 4.00 0.20 5.26 5.8 Total 3.47 100.0 DEATH RATE PER 100,000 CHANGE CONTRIBUTION (%) † FEMALES 1991 * 2005 ABSOLUTE PERCENT All malignant cancers 175.30 155.34 −19.96 −11.39 Decreasing Breast 32.69 24.00 −8.69 −26.58 36.5 Colon and rectum 20.30 14.62 −5.68 −27.98 23.9 Ovary 9.51 8.62 −0.89 −9.36 3.7 Non‐Hodgkin lymphoma 6.74 5.49 −1.25 −18.55 5.3 Leukemia 6.32 5.40 −0.92 −14.56 3.9 Corpus and uterus, NOS 4.18 4.10 −0.08 −1.91 0.3 Brain and other nervous system 4.11 3.52 −0.59 −14.36 2.5 Myeloma 3.26 2.89 −0.37 −11.35 1.6 Kidney and renal pelvis 2.95 2.72 −0.23 −7.80 1.0 Stomach 4.01 2.71 −1.30 −32.42 5.5 Cervix Uteri 3.49 2.42 −1.07 −30.66 4.5 Urinary bladder 2.34 2.21 −0.13 −5.56 0.5 Melanoma of the skin 1.82 1.80 −0.02 −1.10 0.1 Esophagus 1.81 1.66 −0.15 −8.29 0.6 Oral cavity and pharynx 2.03 1.43 −0.60 −29.56 2.5 Soft tissue including heart 1.28 1.15 −0.13 −10.16 0.5 Gallbladder 1.09 0.80 −0.29 −26.61 1.2 Other 17.97 16.57 −1.40 −7.79 5.9 Total − 23.79 100.0 Increasing Lung and bronchus 37.61 40.59 2.98 7.92 77.8 Pancreas 9.28 9.45 0.17 1.83 4.4 Liver and intrahepatic bile duct 2.51 3.19 0.68 27.09 17.8 Total 3.83 100.0 * 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. Recorded Number of Deaths from Cancer in 2006 A total of 559,888 cancer deaths were recorded in the United States in 2006, the most recent year for which actual data are available, accounting for about 23% of all deaths (Table 7 ). Despite a decrease in age‐standardized death rates, there were 568 more cancer deaths reported in 2006 than in 2005 due to the growth and aging of the population (Table 8 ). This is because the decrease in the age‐standardized death rates did not offset the influence of the aging and growth of the population on the total number of cancer deaths. When causes of death are ranked within age groups separated into 20‐year intervals, cancer is one of the five leading causes of death in all age groups among both males and females (Table 9 ). Cancer is the leading cause of death among women ages 40 to 79 years and among men ages 60 to 79 years. It is also the leading cause of death among men and women younger than age 85 years (Fig. 6 ). A total of 474,808 persons younger than age 85 years died from cancer in the United States in 2006, compared with 394,257 deaths from heart disease. 7 Fifteen Leading Causes of Death, United States, 2006 RANK CAUSE OF DEATH NO. OF DEATHS PERCENTAGE (%) OF TOTAL DEATHS DEATH RATE * All Causes 2,426,264 100.0 776.5 1 Heart diseases 631,636 26.0 200.2 2 Cancer 559,888 23.1 180.7 3 Cerebrovascular diseases 137,119 5.7 43.6 4 Chronic lower respiratory diseases 124,583 5.1 40.5 5 Accidents (unintentional injuries) 121,599 5.0 39.8 6 Diabetes mellitus 72,449 3.0 23.3 7 Alzheimer disease 72,432 3.0 22.6 8 Influenza & pneumonia 56,326 2.3 17.8 9 Nephritis, nephrotic syndrome, & nephrosis 45,344 1.9 14.5 10 Septicemia 34,234 1.4 11.0 11 Intentional self‐harm (suicide) 33,300 1.4 10.9 12 Chronic liver disease & cirrhosis 27,555 1.1 8.8 13 Essential hypertension & hypertensive renal disease † 23,855 1.0 7.5 14 Parkinson disease 19,566 0.8 6.3 15 Assault (homicide) 18,573 0.8 6.2 All other & ill‐defined causes 447,805 18.5 — * Rates are per 100,000 population and age adjusted to the 2000 US standard population. † Includes primary and secondary hypertension. Note: Percentages may not total 100 because of rounding. In accordance with the National Center for Health Statistics' cause‐of‐death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 8 Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990–2006 YEAR ALL SITES LUNG AND BRONCHUS COLORECTUM PROSTATE BREAST MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE 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 2005 290,422 268,890 90,141 69,079 26,783 26,224 28,905 41,116 2006 290,069 269,819 89,243 69,357 26,803 26,396 28,372 40,821 Note: Effective with the mortality data for 1999, causes of death are classified by ICD‐10, replacing ICD‐9 used for 1990 to 1998 data. Source: US Mortality Data, 1990 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 9 Ten Leading Causes of Death by Age and Sex, United States, 2006 All Ages Ages 1 to 19 y Ages 20 to 39 y Ages 40 to 59 y Ages 60 to 79 y Ages ≥80 y Male Female Male Female Male Female Male Female Male Female Male Female All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes 1,201,942 1,224,322 16,084 8,435 66,471 29,128 228,564 141,064 460,006 376,145 414,666 656,954 1 Heart Heart Accidents Accidents Accidents Accidents Heart Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional diseases 51,449 150,835 126,619 diseases diseases 315,706 315,930 injuries) injuries) injuries) injuries) 54,918 131,920 209,723 7,009 3,518 24,620 7,712 2 Cancer Cancer Assault Cancer Intentional Cancer Cancer Heart Heart Heart Cancer Cancer 290,069 269,819 (homicide) 829 self‐harm 4,835 54,461 diseases diseases diseases 79,411 86,047 2,444 (suicide) 22,130 122,655 81,157 8,738 3 Accidents Cerebro‐ Intentional Assault Assault Heart Accidents Accidents Chronic Chronic Cerebro‐ Cerebro‐ (unintentional vascular self‐harm (homicide) (homicide) diseases (unintentional (unintentional lower lower vascular vascular injuries) disease (suicide) 603 8,202 2,442 injuries) injuries) respiratory respiratory disease disease 78,941 82,595 1,415 25,333 10,833 diseases diseases 25,952 55,096 29,478 29,204 4 Chronic Chronic Cancer Congenital Heart Intentional Intentional Cerebro‐ Cerebro‐ Cerebro‐ Chronic Alzheimer lower lower 1,130 anomalies diseases self‐harm self‐harm vascular vascular vascular lower disease respiratory respiratory 522 5,531 (suicide) (suicide) disease disease disease respiratory 44,265 diseases diseases 1,996 10,337 5,648 20,600 21,069 diseases 59,260 65,323 24,641 5 Cerebro‐ Alzheimer Congenital Intentional Cancer Assault Chronic Diabetes Diabetes Diabetes Alzheimer Chronic vascular disease anomalies self‐harm 4,188 (homicide) disease mellitus mellitus mellitus disease lower disease 51,281 565 (suicide) 1,551 & cirrhosis 4,891 17,190 14,963 16,111 respiratory 54,524 359 9,707 diseases 31,198 6 Diabetes Accidents Heart Heart HIV disease HIV disease Diabetes Chronic Accidents Nephritis, Influenza & Influenza & mellitus (unintentional diseases diseases 1,906 1,033 mellitus lower (unintentional nephrotic pneumonia pneumonia 36,006 injuries) 465 309 7,420 respiratory injuries) syndrome & 14,843 22,077 42,658 diseases 11,726 nephrosis 4,566 7,724 7 Intentional Diabetes Chronic Influenza & Diabetes Diabetes Cerebro‐ Chronic liver Nephritis, Accidents Diabetes Diabetes self‐harm mellitus lower pneumonia mellitus mellitus vascular disease & nephrotic (unintentional mellitus mellitus (suicide) 36,443 respiratory 132 871 633 disease cirrhosis syndrome & injuries) 10,480 15,917 26,308 diseases 7,008 4,001 nephrosis 7,379 146 8,529 8 Influenza & Influenza Influenza & Cerebro‐ Cerebro‐ Cerebro‐ HIV disease Intentional Influenza & Alzheimer Nephritis, Nephritis, pneumonia & pneumonia pneumonia vascular vascular vascular 5,927 self‐harm pneumonia disease nephrotic nephrotic 25,650 30,676 134 disease disease disease (suicide) 7,790 6,841 syndrome & syndrome & 104 763 618 3,357 nephrosis nephrosis 10,334 13,213 9 Nephritis, Nephritis, Septicemia Septicemia Chronic liver Pregnancy, Chronic Septicemia Septicemia Septicemia Accidents Accidents nephrotic nephrotic 119 103 disease & childbirth & lower 2,098 6,477 6,621 (unintentional (unintentional syndrome & syndrome & cirrhosis puerperium respiratory injuries) injuries) nephrosis nephrosis 687 610 diseases 9,538 12,727 22,094 23,250 4,676 10 Alzheimer Septicemia Cerebro‐ In situ & Congenital Chronic liver Viral hepatitis HIV disease Chronic liver Influenza & Parkinson Hypertension disease 18,712 vascular benign anomalies disease 3,442 2,045 disease & pneumonia disease & hypertensive 21,151 disease neoplasms 537 & cirrhosis cirrhosis 6,399 7,085 renal disease * 118 100 362 6,272 9,718 * Includes primary and secondary hypertension. Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. In accordance with the National Center for Health Statistics' cause‐of‐death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 6 Death Rates for Cancer and Heart Disease for Ages Younger than 85 Years and 85 Years and Older, 1975–2005. Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Table 10 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 younger than age 40 years, leukemia is the most common fatal cancer, whereas cancer of the lung and bronchus predominates in men aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men aged 40 to 79 years, and prostate cancer among those aged 80 years and older. Among females, leukemia is the leading cause of cancer death before the age of 20 years, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at ages 60 years and older. 10 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, United States, 2006 ALL AGES <20 Y 20 TO 39 Y 40 TO 59 Y 60 TO 79 Y ≥80 Y MALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 290,069 1,169 4,188 54,461 150,835 79,411 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 89,243 359 609 15,814 53,536 19,579 Prostate Brain & ONS * Brain & ONS * Colorectum Colorectum Prostate 28,372 287 479 5,146 13,340 15,120 Colorectum Other endocrine Colorectum Liver & bile duct Prostate Colorectum 26,803 system 395 3,713 11,967 7,913 102 Pancreas Bones & joints Lung & bronchus Pancreas Pancreas Urinary bladder 16,559 99 307 3,582 8,983 4,091 Leukemia Soft tissue Non‐Hodgkin lymphoma Esophagus Esophagus Pancreas 12,426 84 297 2,769 5,918 3,881 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 269,819 866 4,835 51,449 126,619 86,047 Lung & bronchus Leukemia Breast Breast Lung & bronchus Lung & bronchus 69,357 259 1,170 12,082 39,614 17,986 Breast Brain & ONS * Uterine cervix Lung & bronchus Breast Colorectum 40,821 237 437 11,458 16,803 11,366 Colorectum Other endocrine Leukemia Colorectum Colorectum Breast 26,396 system 416 4,063 10,595 10,763 83 Pancreas Bones & joints Colorectum Ovary Pancreas Pancreas 16,895 75 369 3,346 8,172 6,330 Ovary Soft tissue Brain & ONS * Pancreas Ovary Non‐Hodgkin lymphoma 14,857 56 337 2,326 7,318 4,153 * ONS indicates other nervous system. Note: Deaths within each age group do not sum to all ages combined because of the inclusion of unknown ages. “Other and unspecified malignant neoplasm” is excluded from cause‐of‐death ranking order. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. Figure 7 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. About 650,000 cancer deaths (481,300 in men and 169,100 in women) were averted during the 1991–1992 through 2005 time interval. 7 Total Number of Cancer Deaths Avoided from 1991–2005 in Men and from 1992–2005 in Women. The blue line represents the actual number of cancer deaths recorded in each year, and the bold red line represents the expected number of cancer deaths if cancer mortality rates had remained the same since 1990 and 1991. 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 an 18% higher incidence rate and a 36% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 17% higher death rate than white women. For the specific cancer sites listed in Table 11 , incidence and death rates are consistently higher in African Americans than in whites except for cancers of the breast (incidence) and lung (incidence and mortality) among women, and kidney (mortality) among both men and women. Factors known to contribute to racial disparities in mortality vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer among men), 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 white women is thought to reflect a combination of factors that affect both diagnosis (more frequent mammography in white women) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy among white than black women). 21 11 Incidence and Mortality Rates * by Site, Race, and Ethnicity, United States, 2001–2005 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE † HISPANIC/LATINO ‡ § Incidence All sites Male 551.4 651.5 354.0 336.6 419.4 Female 423.6 398.9 287.8 296.4 317.8 Breast, female 130.6 117.5 89.6 75.0 90.1 Colon and rectum Male 58.9 71.2 48.0 46.0 47.3 Female 43.2 54.5 35.4 41.2 32.8 Kidney and renal pelvis Male 18.8 21.3 9.1 19.5 17.4 Female 9.5 10.1 4.6 12.7 9.6 Liver and bile duct Male 8.2 13.2 21.7 14.4 15.0 Female 2.9 4.0 8.3 6.3 5.8 Lung and bronchus Male 79.3 107.6 53.9 54.3 44.2 Female 54.9 54.6 28.0 39.7 25.4 Prostate 156.7 248.5 93.8 73.3 138.0 Stomach Male 10.0 17.4 18.6 16.8 15.5 Female 4.7 8.9 10.5 7.7 9.5 Uterine cervix 8.2 10.8 8.0 6.9 13.2 Mortality All sites Male 230.7 313.0 138.8 190.0 159.0 Female 159.2 186.7 95.9 142.0 105.2 Breast, female 24.4 33.5 12.6 17.1 15.8 Colon and rectum Male 22.1 31.8 14.4 20.5 16.5 Female 15.3 22.4 10.2 14.2 10.8 Kidney and renal pelvis Male 6.2 6.1 2.4 9.3 5.3 Female 2.8 2.7 1.2 4.3 2.4 Liver and bile duct Male 6.7 10.3 15.2 10.6 11.1 Female 2.9 3.9 6.6 6.6 5.1 Lung and bronchus Male 71.3 93.1 37.5 50.2 35.1 Female 42.0 39.9 18.5 33.8 14.6 Prostate 24.6 59.4 11.0 21.1 20.6 Stomach Male 5.0 11.5 10.1 9.9 8.7 Female 2.5 5.5 5.9 5.2 4.9 Uterine cervix 2.3 4.7 2.2 3.7 3.2 * Per 100,000 population, age adjusted to the 2000 US standard population. † Data based on Contract Health Service Delivery Areas, 624 counties comprising 54% of the US American Indian/Alaska Native population; for more information please see: Espey DK, Wu XC, Swan J, et al. 19 ‡ Persons of Hispanic/Latino origin may be of any race. § Data unavailable from the Alaska Native Registry and Kentucky. ¶Data unavailable from Minnesota, New Hampshire, and North Dakota. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, 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 twice as high in Asian American/Pacific Islanders as they are in whites, reflecting increased prevalence of chronic infection with H pylori and hepatitis B and C viruses. 22 Kidney cancer incidence and death rates are highest among American Indians/Alaskan Natives, although obesity is the only factor known to contribute to this disparity. Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because long‐term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1996 to 2005, incidence (unadjusted for delayed reporting) and death rates for all cancer sites combined decreased among whites, African Americans, Asian Americans/Pacific Islanders, and Hispanics in both men and women. 15 Among American Indians/Alaska Natives residing in Indian Health Service (IHS) Contract Health Service Delivery Areas, mortality rates during this time period remained stable; trends in incidence rates could not be examined because the linkage of incident cancer cases with IHS was not complete at the time of this report. 15 Death Rates by Educational Attainment, Race, and Sex Table 12 shows trends in death rates from 1993 to 2001 for the four major cancers by educational attainment among white and African American men and women aged 25 to 64 years. 23 In general, death rates decreased significantly from 1993 through 2001 for those with 13 or more years of education but increased or remained constant in those with 12 or fewer years of education. For example, lung cancer death rates in white women decreased for those with 13 or more years of education, leveled in those with 12 years of education, and increased in those with fewer than 12 years of education. Similarly, colorectal cancer death rates among black men decreased for those with 16 or more years of education, leveled in those with 12–15 years of education, and increased in those with fewer than 12 years of education. Notably, the rate of decreases in death rates for each race‐, sex‐, and cancer‐specific category followed an educational gradient in that each group of increasing educational level experienced a progressively steeper decrease. As a result, educational disparity in cancer mortality increased from 1993 to 2001 for lung and colorectal cancers (except among black women) and prostate cancer. Factors that may have contributed to this disparity include higher prevalence of risk factors, such as smoking and obesity, and limited access to medical services among less educated individuals. If everyone ages 25 to 64 years experienced the same cancer death rates as the most educated, 17,650 cancer deaths in women and 30,940 cancer deaths in men could have been averted or postponed in 2001, accounting for over 30% of the total number of cancer deaths in this age group. 12 Trends in Cancer Death Rates * by Education, Race, and Sex, United States, 1993–2001 EDUCATION WHITE NON‐HISPANIC BLACK NON‐HISPANIC 1993 2001 APC † 1993 2001 APC † Lung and bronchus All ‡ 48.8 36.4 −3.5 § 88.5 60.2 −4.4 § <12 y 88.1 87.3 −0.1 98.3 90.4 −0.2 12 y 59.5 53.2 −1.5 § 98.6 73.7 −3.2 § 13–15 y 32.7 24.2 −3.5 § 45.6 32.2 −4.7 § ≥16 y 20.7 13.7 −4.9 § 38.3 21.0 −6.8 § RR ¶ (95% CI) 4.2 (4.1–4.4) 6.4 (6.2–6.6) — 2.6 (2.5–2.8) 4.3 (3.9–4.8) — Female All ‡ 28.4 25.1 −1.6 § 30.5 26.9 −1.5 § <12 y 45.5 55.4 2.4 § 32.7 30.4 0.8 12 y 32.1 33.1 0.1 37.3 35.7 −0.7 13–15 y 19.8 16.6 −1.7 § 20.1 19.3 −1.3 ≥16 y 13.9 11.6 −2.9 § 14.8 16.7 −2.2 RR ¶ (95% CI) 3.3 (3.1–3.5) 4.8 (4.5–5.0) — 2.2 (1.8–2.7) 1.8 (1.6–2.1) — Colon and rectum Male All ‡ 12.0 10.7 −1.6 § 19.7 18.3 −0.7 <12 y 14.1 16.0 0.9 17.4 20.9 2.7 § 12 y 14.6 13.9 −0.9 21.9 23.9 1.0 13–15 y 9.2 8.1 −1.1 § 15.4 11.7 −2.7 ≥16 y 9.3 7.9 −2.4 § 16.3 11.5 −4.8 § RR ¶ (95% CI) 1.5 (1.4–1.6) 2.0 (1.9–2.2) — 1.1 (0.9–1.3) 1.8 (1.5–2.2) — Female All ‡ 8.5 7.3 −1.8 § 13.7 13.3 −0.7 <12 y 9.5 10.4 1.4 11.0 10.3 −0.3 12 y 9.7 9.2 −1.0 § 16.1 17.8 −0.3 13–15 y 6.4 5.5 −1.6 § 9.4 10.0 0.7 ≥16 y 6.8 5.4 −3.0 § 15.6 12.2 −2.6 § RR ¶ (95% CI) 1.4 (1.3–1.6) 1.9 (1.7–2.1) — 0.7 (0.6–0.9) 0.8 (0.7–1.0) — Breast Female All ‡ 28.2 21.7 −3.5 § 40.1 35.5 −1.5 § <12 y 27.4 24.1 −1.4 § 30.0 28.7 0.1 12 y 30.6 25.4 −2.9 § 45.3 43.4 −1.5 13–15 y 23.2 17.3 −3.6 § 35.3 30.0 −0.9 ≥16 y 27.4 20.1 −4.3 § 45.7 35.8 −3.8 § RR ¶ (95% CI) 1.0 (1.0–1.1) 1.2 (1.1–1.3) — 0.7 (0.6–0.7) 0.8 (0.7–0.9) — Prostate Male All ‡ 4.0 2.8 −4.7 § 12.7 9.1 −3.6 § <12 y 4.0 3.4 −1.6 10.4 9.6 −1.6 12 y 4.3 3.3 −3.5 § 16.2 12.7 −1.6 13‐15 y 3.4 2.3 −5.5 § 10.3 5.3 −7.4 § ≥16 y 3.8 2.3 −6.3 § 7.6 4.8 −5.9 RR ¶ (95% CI) 1.1 (0.9–1.2) 1.5 (1.3–1.7) — 1.4 (1.0–1.8) 2.0 (1.5–2.7) — * Rates are for individuals aged 25–64 years at death, per 100,000 population, and age adjusted to the 2000 US standard population. † Annual percentage change. ‡ Includes persons with missing data for educational attainment. § The APC is significantly different from zero. ¶ Rate ratio comparing rate for less than 12 years of education to less than 16 or more years of education for the indicated year. Source: Adapted from Kinsey T, Jemal A, Liff J, et al. 23 Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (37%) (Table 13 ). However, because of the earlier median age of diagnosis for breast cancer compared with other major cancers, 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 overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility. 13 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2003–2005 * BIRTH TO 39 Y 40 TO 59 Y 60 TO 69 Y 70 Y AND OLDER BIRTH TO DEATH PERCENTAGE PERCENTAGE PERCENTAGE PERCENTAGE PERCENTAGE All sites † Male 1.42 (1 in 70) 8.44 (1 in 12) 15.71 (1 in 6) 37.74 (1 in 3) 43.89 (1 in 2) Female 2.07 (1 in 48) 8.97 (1 in 11) 10.23 (1 in 10) 26.17 (1 in 4) 37.35 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4448) 0.41 (1 in 246) 0.96 (1 in 104) 3.57 (1 in 28) 3.74 (1 in 27) Female 0.01 (1 in 10,185) 0.12 (1 in 810) 0.26 (1 in 378) 1.01 (1 in 99) 1.18 (1 in 84) Breast Female 0.48 (1 in 208) 3.79 (1 in 26) 3.41 (1 in 29) 6.44 (1 in 16) 12.03 (1 in 8) Colon & rectum Male 0.08 (1 in 1296) 0.92 (1 in 109) 1.55 (1 in 65) 4.63 (1 in 22) 5.51 (1 in 18) Female 0.07 (1 in 1343) 0.72 (1 in 138) 1.10 (1 in 91) 4.16 (1 in 24) 5.10 (1 in 20) Leukemia Male 0.16 (1 in 611) 0.22 (1 in 463) 0.35 (1 in 289) 1.17 (1 in 85) 1.50 (1 in 67) Female 0.12 (1 in 835) 0.14 (1 in 693) 0.20 (1 in 496) 0.77 (1 in 130) 1.07 (1 in 94) Lung & bronchus Male 0.03 (1 in 3398) 0.99 (1 in 101) 2.43 (1 in 41) 6.70 (1 in 18) 7.78 (1 in 13) Female 0.03 (1 in 2997) 0.81 (1 in 124) 1.78 (1 in 56) 4.70 (1 in 21) 6.22 (1 in 16) Melanoma of the skin § Male 0.16 (1 in 645) 0.64 (1 in 157) 0.70 (1 in 143) 1.67 (1 in 60) 2.56 (1 in 39) Female 0.27 (1 in 370) 0.53 (1 in 189) 0.35 (1 in 282) 0.76 (1 in 131) 1.73 (1 in 58) Non‐Hodgkin lymphoma Male 0.13 (1 in 763) 0.45 (1 in 225) 0.58 (1 in 171) 1.66 (1 in 60) 2.23 (1 in 45) Female 0.08 (1 in 1191) 0.32 (1 in 316) 0.45 (1 in 223) 1.36 (1 in 73) 1.90 (1 in 53) Prostate Male 0.01 (1 in 10,002) 2.43 (1 in 41) 6.42 (1 in 16) 12.49 (1 in 8) 15.78 (1 in 6) Uterine cervix Female 0.15 (1 in 651) 0.27 (1 in 368) 0.13 (1 in 761) 0.19 (1 in 530) 0.69 (1 in 145) Uterine corpus Female 0.07 (1 in 1499) 0.72 (1 in 140) 0.81 (1 in 123) 1.22 (1 in 82) 2.48 (1 in 40) * For people free of cancer at beginning of age interval. † All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder. ‡ Includes invasive and in situ cancer cases. § Statistics for whites only. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0. Statistical Research and Applications Branch, National Cancer Institute, 2008. www.srab.cancer.gov/devcan Cancer Survival by Race Compared with whites, African American men and women have poorer survival once cancer is diagnosed. Five‐year relative survival is lower in African Americans than in whites within every stratum of stage of diagnosis for nearly every cancer site (Fig. 8 ). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. As shown in Figure 9 , African Americans areless 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. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear. 24 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 25 8 Five‐year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004. *The rate for localized stage represents localized and regional stages combined. †The standard error of the mean for the survival rate is between 5 and 10 percentage points. Staging is according to Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. Source: Ries LAG, Melbert D, and Krapcho M, et al. 3 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004. *The rate for localized stage represents localized and regional stages combined. †Staging was performed according to the Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. For each cancer type, stage categories do not total 100% because sufficient information was not available to assign a stage to all cancer cases. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 There have been notable improvements since 1975 in relative 5‐year survival rates for many cancer sites and for all cancers combined (Table 14 ). This is true for both whites and African Americans. Cancers for which survival has not improved substantially during the past 30 years include lung and pancreas. The improvement in survival reflects a combination of earlier diagnoses and improved treatments. 14 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975–2004 ALL RACES WHITE AFRICAN AMERICAN 1975–1977 1984–1986 1996–2004 1975–1977 1984–1986 1996–2004 1975–1977 1984–1986 1996–2004 All sites 50 54 66 † 51 55 68 † 40 41 58 † Brain 24 29 35 † 23 28 34 † 27 33 39 † Breast, female 75 79 89 † 76 80 91 † 62 65 78 † Colon 52 59 65 † 52 60 66 † 46 50 55 † Esophagus 5 10 17 † 6 11 18 † 3 8 11 † Hodgkin lymphoma 74 79 86 † 74 80 87 † 71 75 80 † Kidney 51 56 67 † 51 56 67 † 50 54 66 † Larynx 67 66 64 † 67 68 66 59 53 50 Leukemia 35 42 51 † 36 43 52 † 34 34 42 Liver # 4 6 11 † 4 6 10 † 2 5 8 † Lung and bronchus 13 13 16 † 13 14 16 † 11 11 13 † Melanoma of the skin 82 87 92 † 82 87 92 † 60 ‡ 70 § 78 Myeloma 26 29 35 † 25 27 35 † 31 32 33 Non‐Hodgkin lymphoma 48 53 65 † 48 54 66 † 49 48 58 Oral cavity 53 55 60 † 55 57 62 † 36 36 42 † Ovary 37 40 46 † 37 39 45 † 43 41 38 Pancreas 3 3 5 † 3 3 5 † 2 5 5 † Prostate 69 76 99 † 70 77 99 † 61 66 96 † Rectum 49 57 67 † 49 58 67 † 45 46 59 † Stomach 16 18 25 † 15 18 23 † 16 20 25 † Testis 83 93 96 † 83 93 96 † 82 ‡ 87 ‡ 87 Thyroid 93 94 97 † 93 94 97 † 91 90 95 Urinary bladder 74 78 81 † 75 79 82 † 51 61 66 † Uterine cervix 70 68 73 † 71 70 74 † 65 58 65 Uterine corpus 88 84 84 † 89 85 86 † 61 58 61 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillence, Epidemiology, and End Results 9 areas from 1975–77, 1984–86, and 1996 to 2004 and followed through 2005. † The difference in rates between 1975–1977 and 1996–2004 is statistically significant ( P <.05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. § The standard error of the survival rate is greater than 10 percentage points. # Includes intrahepatic bile duct. Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Relative survival rates cannot be calculated for racial and ethnic populations other than for whites and African Americans 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, compared to non‐Hispanic whites, all minority populations except Asian American/Pacific Islander women have a greater probability of dying from cancer within five years of diagnosis after accounting for differences in stage at diagnosis. 20 , 26 For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely than non‐Hispanic whites to be diagnosed at a distant stage. 26 Cancer in Children In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, surpassed only by accidents (Table 15 ). Leukemia (particularly acute lymphocytic leukemia) is the most common cancer in children (aged 0–14 years), followed by cancer of the brain and other nervous system, soft tissue sarcomas, renal (Wilms) tumors, and non‐Hodgkin lymphoma. 3 During the past 25 years, there have been significant improvements in the 5‐year relative survival rate for all of the major childhood cancers (Table 16 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975–1977 to 80% for those diagnosed in 1996–2004. 3 15 Ten Leading Causes of Death Among Children Aged 1 to 14 Years, United States, 2006 RANK CAUSE OF DEATH NO. OF DEATHS % OF TOTAL DEATHS DEATH RATE * ALL CAUSES 10,780 100.0 19.0 1 Accidents (unintentional injuries) 3,868 35.9 6.8 2 Cancer 1,284 11.9 2.3 3 Congenital anomalies 859 8.0 1.5 4 Assault (homicide) 756 7.0 1.3 5 Heart diseases 414 3.8 0.7 6 Intentional self‐harm (suicide) 219 2.0 0.4 7 Influenza & pneumonia 193 1.8 0.3 8 Septicemia 172 1.6 0.3 9 Chronic lower respiratory diseases 158 1.5 0.3 10 Cerebrovascular disease 149 1.4 0.3 All other causes 2,708 25.1 — * Rates are per 100,000 population and age adjusted to the 2000 US standard population. Note: “Symptoms, signs, and abnormal clinical or laboratory findings” and “Other respiratory diseases” were excluded from ranking order. Source: US Mortality Data, 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 16 Trends in 5‐Year Relative Survival Rates * (%) for Children Younger than Age 15 Years, US, 1975–2004 YEAR OF DIAGNOSIS SITE 1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 2004 All sites 58 63 67 68 71 76 77 80 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 88 † Acute myeloid leukemia 19 26 27‡ 31‡ 37‡ 41 42‡ 55 † Bone and joint 51‡ 49 57‡ 58‡ 67‡ 67 74 71 † Brain and other nervous system 57 58 56 62 64 64 70 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 96 † Neuroblastoma 52 57 55 52 62 76 67 70 † Non‐Hodgkin lymphoma 43 53 67 70 71 76 81 86 † Soft tissue 61 75 69 73 65 80 77 74 † Wilms tumor 73 79 87 91 92 92 92 92 † Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. * Survival rates are adjusted for normal life expectancy and are based on follow up of patients through 2005. † Difference in rates between 1975 to 1977 and 1996 to 2004 is statistically significant ( P <.05). Source: Ries LAG, Melbert D, Krapcho M, et al. 3 Limitations 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. Estimates are also affected by changes in method. The introduction of a new method for projecting incident cancer cases beginning with the 2007 estimates substantially affected the estimates for several cancers, particularly leukemia and female breast. (See Pickle et al for more detailed discussion.) Not all changes in cancer trendsare captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. The preferred data sources for tracking cancer trends are the age‐standardized or age‐specific cancer death rates from the National Center for Health Statistics and cancer incidence rates from SEER or NPCR, although these data are 3 and 4 years old, respectively, by the time that they become available. Nevertheless, the American Cancer Society 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.

Journal

CA: A Cancer Journal for CliniciansWiley

Published: Jul 1, 2009

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