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Cancer Statistics, 2010

Cancer Statistics, 2010 Introduction Cancer is a major public health problem in the United States and many other parts of the world. Currently, 1 in 4 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 2010. Materials and Methods Data Sources Mortality data from 1930 to 2007 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 Incidence data for long‐term trends (1975–2006), 5‐year relative survival rates, and lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), covering approximately 26% of the US population. 2–5 Incidence data (1995–2006) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR) covering approximately 89% of the US population. State‐specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and the NPCR. 6 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). 8–10 Cancer cases were classified according to the International Classification of Diseases for Oncology . 11 Estimated New Cancer Cases and Deaths The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer case reporting is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection and compilation. Therefore, we project the expected number of new cancer cases and deaths in the United States in 2010 to provide an estimate of the current cancer burden. Estimated new cancer cases in the current year (2010) were projected using a spatiotemporal model based on incidence data from 1995 through 2006 from 44 states and the District of Columbia that met the NAACCR's high‐quality data standard for incidence, covering approximately 89% of the US population. 12 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. We used the state‐space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2010. 13 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 2010 based on the number that occurred each year from 1969 to 2007 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 2007. Causes of death for 2007 were coded and classified according to ICD‐10. 10 This report also provides updated statistics regarding 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 2006. 2 , 6 All age‐adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population. The incidence rates (2002–2006) and long‐term trends (1975–2006) are adjusted for delays in reporting when possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 2004–2006), 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 for selected cancer sites were previously published in the 2010 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 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age‐standardized cancer death rates through 2006. 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 2006 to obtain the number of expected deaths in each calendar year if the death rates had 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 15‐year (women) or 16‐year (men) interval. Selected Findings Expected Numbers of New Cancer Cases in 2010 Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the US in 2010. The overall estimate of approximately 1.53 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. Greater than 2 million unreported cases of basal cell and squamous cell skin cancer, approximately 54,010 cases of breast carcinoma in situ, and 46,770 cases of melanoma in situ are expected to be newly diagnosed in 2010. 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, 2010 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,529,560 789,620 739,940 569,490 299,200 270,290 Oral cavity & pharynx 36,540 25,420 11,120 7,880 5,430 2,450 Tongue 10,990 7,690 3,300 1,990 1,300 690 Mouth 10,840 6,430 4,410 1,830 1,140 690 Pharynx 12,660 9,880 2,780 2,410 1,730 680 Other oral cavity 2,050 1,420 630 1,650 1,260 390 Digestive system 274,330 148,540 125,790 139,580 79,010 60,570 Esophagus 16,640 13,130 3,510 14,500 11,650 2,850 Stomach 21,000 12,730 8,270 10,570 6,350 4,220 Small intestine 6,960 3,680 3,280 1,100 610 490 Colon † 102,900 49,470 53,430 51,370 26,580 24,790 Rectum 39,670 22,620 17,050 Anus, anal canal, & anorectum 5,260 2,000 3,260 720 280 440 Liver & intrahepatic bile duct 24,120 17,430 6,690 18,910 12,720 6,190 Gallbladder & other biliary 9,760 4,450 5,310 3,320 1,240 2,080 Pancreas 43,140 21,370 21,770 36,800 18,770 18,030 Other digestive organs 4,880 1,660 3,220 2,290 810 1,480 Respiratory system 240,610 130,600 110,010 161,670 89,550 72,120 Larynx 12,720 10,110 2,610 3,600 2,870 730 Lung & bronchus 222,520 116,750 105,770 157,300 86,220 71,080 Other respiratory organs 5,370 3,740 1,630 770 460 310 Bones & joints 2,650 1,530 1,120 1,460 830 630 Soft tissue (including heart) 10,520 5,680 4,840 3,920 2,020 1,900 Skin (excluding basal & squamous) 74,010 42,610 31,400 11,790 7,910 3,880 Melanoma‐skin 68,130 38,870 29,260 8,700 5,670 3,030 Other nonepithelial skin 5,880 3,740 2,140 3,090 2,240 850 Breast 209,060 1,970 207,090 40,230 390 39,840 Genital system 311,210 227,460 83,750 60,420 32,710 27,710 Uterine cervix 12,200 12,200 4,210 4,210 Uterine corpus 43,470 43,470 7,950 7,950 Ovary 21,880 21,880 13,850 13,850 Vulva 3,900 3,900 920 920 Vagina & other genital, female 2,300 2,300 780 780 Prostate 217,730 217,730 32,050 32,050 Testis 8,480 8,480 350 350 Penis & other genital, male 1,250 1,250 310 310 Urinary system 131,260 89,620 41,640 28,550 19,110 9,440 Urinary bladder 70,530 52,760 17,770 14,680 10,410 4,270 Kidney & renal pelvis 58,240 35,370 22,870 13,040 8,210 4,830 Ureter & other urinary organs 2,490 1,490 1,000 830 490 340 Eye & orbit 2,480 1,240 1,240 230 120 110 Brain & other nervous system 22,020 11,980 10,040 13,140 7,420 5,720 Endocrine system 46,930 11,890 35,040 2,570 1,140 1,430 Thyroid 44,670 10,740 33,930 1,690 730 960 Other endocrine 2,260 1,150 1,110 880 410 470 Lymphoma 74,030 40,050 33,980 21,530 11,450 10,080 Hodgkin lymphoma 8,490 4,670 3,820 1,320 740 580 Non‐Hodgkin lymphoma 65,540 35,380 30,160 20,210 10,710 9,500 Myeloma 20,180 11,170 9,010 10,650 5,760 4,890 Leukemia 43,050 24,690 18,360 21,840 12,660 9,180 Acute lymphocytic leukemia 5,330 3,150 2,180 1,420 790 630 Chronic lymphocytic leukemia 14,990 8,870 6,120 4,390 2,650 1,740 Acute myeloid leukemia 12,330 6,590 5,740 8,950 5,280 3,670 Chronic myeloid leukemia 4,870 2,800 2,070 440 190 250 Other leukemia ‡ 5,530 3,280 2,250 6,640 3,750 2,890 Other & unspecified primary sites ‡ 30,680 15,170 15,510 44,030 23,690 20,340 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 54,010 female carcinoma in situ of the breast and 46,770 melanoma in situ will be newly diagnosed in 2010. †, ‡ Estimated deaths for colon and rectum cancers are combined. ‡ More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates or an undercount in the case estimate. Source: Estimated new cases are based on 1995–2006 incidence rates from 41 states and the District of Columbia as reported by the 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, representing about 89% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 2 Age‐standardized Incidence Rates for All Cancers Combined, 2002–2006, and Estimated New Cases * for Selected Cancers by State, United States, 2010 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 453.6 23,640 3,450 200 2,300 520 560 4,160 1,210 940 3,300 920 Alaska 468.3 2,860 410 ‡ 260 70 70 360 80 130 440 140 Arizona § 29,780 3,950 210 2,620 710 760 4,030 1,430 1,210 3,850 1,530 Arkansas 459.3 15,320 1,770 140 1,500 330 420 2,620 460 640 2,330 610 California 441.0 157,320 21,130 1,540 13,950 4,470 4,460 18,490 8,030 7,010 22,640 6,620 Colorado 438.1 21,340 3,100 150 1,770 570 650 2,270 1,180 920 3,430 960 Connecticut 509.4 20,750 2,960 120 1,770 650 510 2,640 1,090 860 2,940 1,110 Delaware 511.9 4,890 690 ‡ 440 140 120 800 210 200 710 250 Dist. of Columbia § 2,760 390 ‡ 260 80 60 360 70 100 450 90 Florida 462.4 107,000 14,080 940 10,500 2,710 3,330 18,390 4,980 4,660 14,610 5,600 Georgia 462.2 40,480 6,130 390 3,840 950 1,040 6,280 2,020 1,600 6,380 1,470 Hawaii 425.7 6,670 910 50 680 220 160 770 310 230 1,060 200 Idaho 461.7 7,220 910 60 600 200 230 860 360 310 1,300 380 Illinois 488.8 63,890 8,770 490 6,340 1,960 1,860 9,190 2,060 2,690 8,730 3,050 Indiana 469.4 33,020 4,350 230 3,330 960 890 5,430 1,200 1,370 4,160 1,510 Iowa 481.0 17,260 2,020 100 1,760 550 560 2,450 900 750 2,420 840 Kansas § 13,550 1,780 90 1,270 410 400 1,990 650 590 1,630 550 Kentucky 511.2 24,240 3,290 210 2,370 610 630 4,780 1,440 1,030 3,180 1,030 Louisiana 496.0 20,950 2,530 180 2,060 440 590 3,320 600 920 3,410 850 Maine 530.3 8,650 1,160 50 800 280 260 1,370 410 360 1,410 530 Maryland § 27,700 4,150 200 2,630 810 620 4,170 1,290 1,110 4,010 1,180 Massachusetts 507.8 36,040 5,320 200 3,120 1,150 910 5,020 1,770 1,460 4,820 2,000 Michigan 503.4 55,660 7,340 330 5,170 1,700 1,600 8,150 2,240 2,400 8,490 2,790 Minnesota 479.3 25,080 3,330 140 2,410 850 830 3,150 970 1,100 3,870 1,160 Mississippi § 14,330 1,970 130 1,480 300 340 2,360 470 540 2,260 510 Missouri 468.9 31,160 3,880 210 3,080 910 870 5,360 1,320 1,260 3,600 1,360 Montana 466.2 5,570 680 ‡ 490 150 160 740 200 240 960 280 Nebraska 476.8 9,230 1,160 60 910 290 290 1,200 450 410 1,470 420 Nevada 466.2 12,230 1,350 130 1,090 290 320 1,920 410 480 1,750 620 New Hampshire 508.1 7,810 990 ‡ 720 240 200 1,070 390 310 1,100 430 New Jersey 511.0 48,100 6,820 420 4,430 1,580 1,330 6,260 2,650 2,130 6,790 2,510 New Mexico 416.0 9,210 1,180 90 790 230 280 920 420 370 1,610 350 New York 491.0 103,340 14,610 930 9,780 3,430 2,980 13,720 4,050 4,680 14,840 5,230 North Carolina 460.9 45,120 6,500 360 4,220 1,190 1,150 7,520 2,130 1,800 6,910 1,890 North Dakota 465.1 3,300 400 ‡ 340 100 100 410 120 150 580 180 Ohio § 64,450 8,280 410 5,960 2,010 1,810 10,710 2,200 2,720 8,010 2,970 Oklahoma 478.3 18,670 2,300 150 1,730 460 560 3,250 640 810 2,440 770 Oregon 471.2 20,750 2,910 130 1,710 600 530 2,810 1,200 930 3,010 1,040 Pennsylvania 503.7 75,260 10,000 540 7,440 2,450 2,070 10,520 3,550 3,430 9,800 4,050 Rhode Island 515.5 5,970 790 ‡ 540 190 160 840 290 240 740 350 South Carolina 476.4 23,240 3,260 170 2,140 560 590 3,970 1,060 950 3,600 950 South Dakota 460.2 4,220 530 ‡ 450 130 130 540 170 180 760 230 Tennessee § 33,070 4,700 270 3,130 750 850 5,980 1,720 1,360 4,600 1,350 Texas 451.5 101,120 12,920 1,070 9,190 2,420 3,240 14,030 3,570 4,410 13,740 3,650 Utah 408.5 9,970 1,260 80 740 280 310 620 610 430 1,730 390 Vermont § 3,720 520 ‡ 320 110 90 490 190 150 600 210 Virginia 444.5 36,410 5,470 280 3,370 1,040 880 5,510 1,810 1,470 5,550 1,520 Washington 494.9 34,500 4,900 220 2,740 1,010 1,000 4,320 1,930 1,600 5,220 1,720 West Virginia 494.2 10,610 1,310 80 1,060 330 280 2,070 440 450 1,440 530 Wisconsin § 29,610 4,120 200 2,760 1,040 940 3,990 1,050 1,340 4,670 1,510 Wyoming 447.6 2,540 330 ‡ 220 70 70 320 110 110 420 130 United States 472.9 1,529,560 207,090 12,200 142,570 43,470 43,050 222,520 68,130 65,540 217,730 70,530 * 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. Source: Data as of June 2009 reported by the North American Association of Central Cancer Registries (NAACCR) as meeting high quality standards for 2002–2006 and include data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. To account for population anomalies caused by Hurricane Katrina in 2005, statistics exclude data for AL, LA, and TX from July 2005‐December 2005. Note: These model‐based estimates are calculated using incidence rates from 41 states and the District of Columbia; they are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and exclusion of states with fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2010. Among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,730) of incident cases in men. Based on cases diagnosed between 1999 and 2005, an estimated 92% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which the 5‐year relative survival approaches 100%. 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, 2010. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10. The 3 most commonly diagnosed types of cancer among women in 2010 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (207,090) of all new cancer cases among women. Expected Number of Cancer Deaths in 2010 Table 1 also shows the expected number of deaths from cancer projected for 2010 for men, women, and both sexes combined. It is estimated that approximately 569,490 Americans will die from cancer, corresponding to greater than 1500 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 4 cancers account for approximately 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 and is expected to account for 26% of all female cancer deaths in 2010. Table 3 provides the estimated number of cancer deaths in 2010 by state for selected cancer sites. 3 Age‐standardized Death Rates for All Cancers Combined, 2002–2006, and Estimated Deaths * for Selected Cancers by State, United States, 2010 STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 203.7 10,150 210 690 950 350 310 3,190 320 260 590 600 Alaska 182.0 880 ‡ 70 80 ‡ ‡ 250 ‡ ‡ 60 ‡ Arizona 163.9 10,630 280 740 1,020 420 380 2,670 360 290 740 650 Arkansas 205.0 6,460 150 430 600 240 200 1,900 200 140 430 460 California 169.7 55,710 1,490 4,230 4,970 2,220 2,600 12,630 2,110 1,500 3,900 3,710 Colorado 163.5 6,880 210 500 660 270 230 1,670 280 210 460 390 Connecticut 182.6 6,850 150 490 540 230 200 1,760 230 180 540 410 Delaware 198.7 1,900 ‡ 120 160 70 50 580 60 ‡ 120 100 Dist. of Columbia 204.9 960 ‡ 80 100 ‡ ‡ 230 ‡ ‡ 70 70 Florida 177.3 40,880 800 2,650 3,540 1,560 1,360 11,620 1,480 930 2,560 2,590 Georgia 190.3 15,570 340 1,100 1,430 560 430 4,620 500 390 940 930 Hawaii 150.3 2,330 ‡ 140 220 80 120 570 90 50 180 120 Idaho 171.6 2,530 80 160 220 120 70 640 90 60 190 180 Illinois 194.5 23,360 470 1,790 2,310 900 700 6,490 740 570 1,580 1,420 Indiana 202.7 12,900 340 860 1,130 520 340 4,000 440 300 790 620 Iowa 184.3 6,370 170 380 620 300 160 1,770 290 170 380 370 Kansas 184.7 5,370 140 370 530 260 140 1,590 200 140 330 300 Kentucky 219.3 9,670 180 580 880 320 250 3,410 310 200 540 470 Louisiana 217.0 8,480 210 620 920 310 340 2,550 280 200 540 440 Maine 204.1 3,170 80 170 270 110 80 960 90 70 200 150 Maryland 193.3 10,250 210 800 950 390 360 2,760 310 250 710 650 Massachusetts 190.9 12,990 280 780 1,050 470 440 3,530 400 330 920 600 Michigan 193.4 20,740 500 1,320 1,740 810 600 5,830 700 500 1,330 1,010 Minnesota 176.6 9,200 240 610 780 390 280 2,450 330 220 600 440 Mississippi 211.3 6,060 130 400 630 230 190 2,010 190 130 360 330 Missouri 200.1 12,620 280 860 1,120 540 380 3,950 450 250 790 710 Montana 182.7 1,980 60 110 170 90 50 580 80 50 120 130 Nebraska 178.2 3,500 90 210 360 140 80 900 150 80 200 240 Nevada 193.0 4,640 120 330 530 110 180 1,300 150 110 300 270 New Hampshire 190.6 2,660 70 190 210 90 80 750 70 60 190 140 New Jersey 189.4 16,520 340 1,430 1,600 600 470 4,220 640 430 1,130 940 New Mexico 165.2 3,400 80 230 340 120 150 780 120 80 230 240 New York 176.1 34,540 800 2,490 3,120 1,380 1,270 8,720 1,480 910 2,440 1,690 North Carolina 194.3 19,100 350 1,340 1,520 650 500 5,650 570 390 1,160 980 North Dakota 175.5 1,280 ‡ 80 120 60 ‡ 320 ‡ ‡ 90 70 Ohio 202.3 24,980 540 1,730 2,280 930 680 7,260 840 540 1,530 1,440 Oklahoma 198.1 7,660 170 520 700 290 220 2,390 280 160 400 320 Oregon 189.2 7,510 210 490 690 280 230 2,100 310 210 490 430 Pennsylvania 196.4 28,690 550 1,980 2,610 1,100 840 7,960 1,100 730 2,010 1,660 Rhode Island 191.4 2,170 50 130 150 90 70 600 60 60 120 80 South Carolina 197.7 9,180 200 640 770 330 270 2,870 300 220 560 490 South Dakota 178.8 1,670 ‡ 100 160 70 ‡ 450 60 50 100 100 Tennessee 208.8 13,600 340 890 1,190 490 380 4,520 470 250 750 690 Texas 181.7 36,540 840 2,780 3,340 1,410 1,660 9,600 1,280 840 2,200 1,820 Utah 139.2 2,820 100 250 250 140 80 480 100 80 200 200 Vermont 179.4 1,280 ‡ 90 120 50 ‡ 370 ‡ ‡ 80 50 Virginia 191.9 14,230 300 1,120 1,300 510 410 4,050 450 370 930 710 Washington 183.4 11,640 370 790 980 480 440 3,110 440 330 760 770 West Virginia 211.4 4,670 100 270 440 150 120 1,480 190 110 220 130 Wisconsin 184.3 11,310 270 690 900 490 330 2,940 410 290 720 600 Wyoming 176.7 1,000 ‡ 60 110 ‡ ‡ 260 50 ‡ 70 ‡ United States 186.9 569,490 13,140 39,840 51,370 21,840 18,910 157,300 20,210 13,850 36,800 32,050 * 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 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 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 for lung cancer, for which rates (cases per 100,000 population) range from 37.8 in men and 23.0 in women in Utah to 133.1 in men and 76.9 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 is smaller in both absolute and proportionate terms. For screenable cancers, such as those of the prostate and female breast, variation in incidence rates 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, 2002 to 2006 STATE ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama † 561.2 379.6 114.6 61.7 42.0 107.8 52.9 20.5 13.8 154.2 31.8 7.6 Alaska 529.4 417.7 126.4 60.0 45.6 84.6 64.3 22.6 17.6 141.4 41.6 7.3 Arizona ‡ 465.9 364.0 108.8 48.9 36.0 69.6 49.1 18.9 13.5 118.9 35.3 8.9 Arkansas 562.8 383.5 113.1 58.8 42.7 111.3 59.5 21.8 15.6 161.3 33.0 8.6 California 510.1 393.3 122.3 52.2 39.2 65.1 47.0 22.4 15.5 149.0 34.0 8.2 Colorado 501.5 394.1 123.1 50.0 39.5 60.5 45.2 21.0 16.2 156.4 33.6 8.8 Connecticut 591.0 455.5 135.0 62.8 46.5 81.8 60.1 25.8 18.1 164.6 45.4 12.6 Delaware 607.7 440.8 123.9 62.0 44.8 97.6 70.0 23.5 16.1 179.9 42.8 11.1 Dist. of Columbia ‡ 556.0 412.1 132.7 57.4 46.3 81.4 46.6 22.8 13.7 175.2 24.0 8.3 Florida 537.3 404.2 114.1 55.2 41.7 89.2 60.3 21.6 15.4 138.4 37.4 9.7 Georgia 566.4 392.4 118.5 58.7 42.3 101.7 53.3 20.8 14.1 162.4 32.7 8.0 Hawaii 486.7 383.0 121.4 61.3 41.5 68.8 40.1 19.0 12.6 128.6 26.2 6.2 Idaho 538.4 401.7 117.5 49.9 38.0 68.7 48.3 21.4 17.2 165.8 37.0 8.8 Illinois 579.8 429.1 123.1 67.2 48.3 92.3 58.8 24.1 16.2 157.9 40.7 10.5 Indiana 551.3 415.1 115.3 62.8 46.4 103.6 63.3 22.8 16.4 135.9 37.4 9.4 Iowa 558.9 429.2 124.0 64.4 49.6 89.9 53.1 24.4 17.6 144.9 40.7 9.6 Kansas 557.2 417.2 126.1 61.3 43.6 87.6 53.2 24.1 18.0 159.6 36.2 8.5 Kentucky 608.4 446.4 119.8 68.0 49.8 133.1 76.9 23.1 16.9 142.5 39.0 9.9 Louisiana † 619.2 409.6 119.6 68.5 47.3 109.5 57.9 23.2 16.7 176.8 35.2 8.6 Maine 620.9 465.8 128.6 65.9 48.8 99.2 66.0 24.5 19.2 164.8 49.4 13.4 Maryland § — — — — — — — — — — — — Massachusetts 591.8 452.9 132.2 63.9 45.7 83.7 62.4 23.4 16.5 164.6 46.7 12.9 Michigan 597.5 437.9 124.2 58.8 44.6 93.0 61.5 25.2 18.7 179.4 41.9 10.5 Minnesota 567.2 416.4 126.4 56.4 42.3 69.8 49.5 26.4 17.7 184.6 40.1 10.3 Mississippi † ‡ 574.7 382.1 108.2 64.5 46.3 111.7 54.5 20.9 13.5 166.7 29.6 7.5 Missouri 544.3 417.2 121.9 62.3 44.9 105.2 63.4 21.8 15.5 129.3 35.8 8.9 Montana 541.9 406.3 119.6 52.5 40.3 75.3 57.4 22.8 14.9 174.5 40.8 9.1 Nebraska 561.8 418.2 126.4 67.6 47.5 84.6 49.3 24.7 17.4 157.6 37.2 9.5 Nevada 531.2 412.0 112.1 55.2 43.4 83.3 69.0 22.2 15.3 144.2 40.7 11.0 New Hampshire 584.3 455.3 131.2 59.0 44.5 82.1 62.7 23.5 18.2 159.5 48.0 13.4 New Jersey 603.9 449.5 128.0 65.4 48.0 79.6 56.0 25.6 17.7 177.9 46.2 12.2 New Mexico 480.5 366.1 109.6 49.4 35.8 57.5 39.0 17.9 14.3 146.1 26.7 7.0 New York 577.5 434.4 124.5 60.8 45.8 79.4 54.1 24.7 17.3 166.3 42.3 11.1 North Carolina 553.4 398.1 120.3 57.2 41.6 101.3 56.0 21.2 15.1 153.2 34.9 8.8 North Dakota 549.3 402.7 122.8 66.6 43.1 74.6 48.0 22.7 15.8 169.5 39.6 10.0 Ohio § — — — — — — — — — — — — Oklahoma 561.4 422.2 127.2 60.1 43.7 105.6 65.1 22.9 17.5 150.0 34.9 8.6 Oregon 529.3 429.7 131.9 52.8 41.1 79.4 60.4 24.4 17.0 148.0 39.2 10.0 Pennsylvania 592.7 444.6 124.5 66.1 48.3 91.0 56.4 25.1 17.5 159.7 44.8 11.2 Rhode Island 608.9 455.3 128.3 65.7 46.2 92.2 62.2 24.8 17.5 152.2 53.1 13.0 South Carolina 587.4 397.5 119.2 61.2 44.1 102.2 53.0 20.7 14.6 171.5 32.4 7.8 South Dakota 547.8 395.3 119.6 60.2 44.5 78.7 46.3 22.1 17.0 171.0 39.1 8.1 Tennessee ‡ ¶ 548.3 400.6 116.4 58.4 43.2 113.6 60.6 21.6 15.8 132.7 34.0 8.3 Texas † 539.6 389.9 114.9 57.5 39.7 88.3 51.2 22.3 16.1 144.0 30.2 7.3 Utah 486.8 346.6 110.0 45.3 33.7 37.8 23.0 22.4 16.3 182.2 28.3 6.1 Vermont § — — — — — — — — — — — — Virginia 529.5 385.8 120.7 55.5 41.8 88.5 53.6 20.6 13.4 155.0 33.3 8.4 Washington 566.9 443.3 134.8 52.6 40.1 78.7 59.5 27.2 18.3 165.3 41.3 10.2 West Virginia 578.6 437.1 114.7 69.5 50.7 117.7 70.1 22.9 16.8 138.6 39.8 11.4 Wisconsin § — — — — — — — — — — — — Wyoming 516.5 392.9 117.8 52.0 43.0 62.1 47.7 21.4 15.8 168.0 42.1 10.0 United States 556.5 414.8 121.8 59.0 43.6 86.4 55.5 23.1 16.3 155.5 37.9 9.6 * Per 100,000, age adjusted to the 2000 US standard population. † Due to the displacement of populations after Hurricane Katrina in September 2005, 2005 statistics are based on cases diagnosed in January to June. ‡ This state's registry did not achieve high quality data standards for one or more years during 2002–2006 according to the North American Association of Central Cancer Registry (NAACCR) data quality indicators. § This state's registry did not submit incidence data to NAACCR for 2002–2006. ¶ Case assertainment for this state's registry is incomplete for the years 2002–2006. Source: NAACCR, 2009. Data are collected by cancer registries participating in the National Cancer Institute's SEER program and the Centers for Disease Control and Prevention'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 4 most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates decreased by 1.3% per year from 2000 through 2006 in males and by 0.5% per year from 1998 through 2006 in females. 15 Incidence trends decreased for all 4 major cancer sites except for lung cancer in women, in whom rates are still increasing, though at a much slower rate than in 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 approximately 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2006 largely reflects increases in screening that can detect and remove precancerous polyps. 15 The decrease in prostate cancer incidence rates (by 2.4% per year from 2000–2006) may reflect recent stabilization of prostate‐specific antigen testing, resulting in decreased detection or a reduced number of undiagnosed cases. 16–18 The decrease in the breast cancer incidence rate since 1999 likely reflects the large discontinuity in the use of menopausal hormone therapy among postmenopausal women beginning in 2001, and it may also reflect delayed diagnosis due to decreased mammography use. 19–20 However, close inspection of incidence data by individual year (Fig. 3 ) shows that after a 6% decrease from 2002 to 2003, incidence rates from 2003 to 2006 remained relatively unchanged. This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer. 20 2 Annual Age‐Adjusted Cancer Incidence and Death Rates* by Sex, United States, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population. Incidences rates are adjusted for delays in reporting. Sources: Incidence: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov ). Delay‐adjusted incidence database: SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. Mortality: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention. 3 Annual Age‐Adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov ). Delay‐adjusted incidence database: SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. 4 Annual Age‐Adjusted Cancer Death Rates*Among Males for Selected Cancers, United States, 1930 to 2006. *Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (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 2006, US Mortality Vol. 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention. 5 Annual Age‐Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2006. *Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Due to changes in International Classification of Diseases (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 2006, US Mortality Volumes 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention. 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975 to 2006 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 1999–2006 −0.7 † Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.9 † 1995–2000 0.5 2000–2006 −1.3 † Female 1975–1979 −0.3 1979–1987 1.6 † 1987–1995 0.1 1995–1998 1.4 1998–2006 −0.5 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2001 −1.1 † 2001–2006 −1.6 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.5 1993–2001 −1.5 † 2001–2006 −2.0 † Female 1975–1990 0.6 † 1990–1994 −0.1 1994–2002 −0.8 † 2002–2006 −1.5 † Lung & bronchus Incidence Male 1975–1982 1.4 † 1982–1991 −0.4 1991–2006 −1.8 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2006 0.4 † Death Male 1975–1978 2.5 † 1978–1984 1.2 † 1984–1990 0.4 † 1990–1994 −1.3 † 1994–2006 −2.0 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † 2003–2006 −0.9 Colorectum Incidence Male 1975–1985 1.1 † 1985–1991 −1.2 † 1991–1995 −3.2 † 1995–1998 2.1 1998–2006 −3.0 † Female 1975–1985 0.3 1985–1995 −1.8 † 1995–1998 1.9 1998–2006 −2.2 † Death Male 1975–1984 −0.1 1984–1990 −1.4 † 1990–2002 −2.0 † 2002–2006 −3.9 † Female 1975–1984 −1.0 † 1984–2001 −1.8 † 2001–2006 −3.4 † Female breast Incidence 1975–1980 −0.5 1980–1987 4.0 † 1987–1994 −0.1 1994–1999 1.6 † 1999–2006 −2.0 † Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1998 −3.3 † 1998–2006 −1.9 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.7 † 1995–2000 2.4 2000–2006 −2.4 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2006 −4.1 † * Annual percent 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 ( P < 0.05). Note: Trends were analyzed by Joinpoint Regression Program, version 3.3.1, with a maximum of four joinpoints (ie, five line segments). Source: Edwards, et al. 15 Death rates for all cancer sites combined decreased by 2.0% per year in men from 2001 through 2006 and by 1.5% per year in women from 2002 to 2006, compared with declines of 1.5% per year in men from 1993 to 2001 and 0.8% per year in women from 1994 through 2002 (Table 5 ). Mortality rates have continued to decrease across all 4 major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2006 after increasing for many decades. Table 6 shows the contribution of individual cancer sites to the decreasing portion of the total cancer death rate for each sex. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2006, death rates for cancer decreased by 21.0% among men and by 12.3% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in the cancer death rate, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease noted among women. Lung cancer in men and breast cancer in women each account for nearly 40% of the sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to a reduction in tobacco use over the past 50 years, whereas 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 2006, death rates increased for liver cancer in both men and women, esophageal cancer and melanoma in men, and lung and pancreatic cancer in women. 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. Approximately 767,000 cancer deaths (561,400 in men and 205,700 in women) were averted between 1991–1992 and 2006. 6 The Contribution of Individual Cancer Sites to the Decrease in Cancer Death Rates, 1990–2006 MALE DEATH RATE (PER 100,000) CHANGE % CONTRIBUTION † 1990 * 2006 ABSOLUTE % All malignant cancers 279.82 221.11 −58.71 −20.98 Decreasing Lung & bronchus 90.56 67.45 −23.11 −25.52 37.2 Prostate 38.56 23.56 .15.01 −38.91 24.2 Colorectum 30.77 20.51 −10.27 −33.36 16.5 Stomach 8.86 5.04 −3.82 −43.12 6.1 Oral cavity & pharynx 5.61 3.78 −1.83 −32.61 2.9 Non‐Hodgkin lymphoma 9.97 8.41 −1.56 −15.63 2.5 Leukemia 10.71 9.61 −1.10 −10.31 1.8 Brain & other nervous system 5.97 5.13 −0.84 −14.10 1.4 Larynx 2.97 2.19 −0.78 −26.22 1.3 Myeloma 4.83 4.36 −0.47 −9.70 0.8 Kidney & renal pelvis 6.16 5.74 −0.42 −6.86 0.7 Urinary bladder 7.97 7.57 −0.40 −5.00 0.6 Hodgkin lymphoma 0.85 0.56 −0.30 −34.70 0.5 Other 39.79 37.56 −2.23 −5.61 3.6 Total 263.59 201.46 −62.13 100.0 Increasing Esophagus 7.16 7.852 0.69 9.70 Liver & Intrahepatic Bile Duct 5.27 7.73 2.45 46.54 Melanoma of the Skin 3.80 4.07 0.27 7.07 Total 16.23 19.65 3.42 FEMALE DEATH RATE ( per 100,000 ) CHANGE % CONTRIBUTION † 1991 * 2006 ABSOLUTE % All malignant cancers 175.30 153.66 −21.64 −12.34 Decreasing Breast 32.69 −9.24 −28.26 36.7 Colorectum 20.30 −5.77 −28.40 22.9 Non‐Hodgkin Lymphoma 6.74 −1.37 −20.30 5.4 Stomach 4.01 −1.36 −33.98 5.4 Cervix Uteri 3.49 −1.07 −30.65 4.3 Ovary 9.51 −0.97 −10.24 3.9 Leukemia 6.32 −0.92 −14.61 3.7 Brain & Other Nervous System 4.11 −0.72 −17.63 2.9 Oral Cavity & Pharynx 2.03 −0.64 −31.56 2.5 Other 36.69 −3.08 −8.40 12.3 Total 125.90 −25.15 −19.98 100.0 Increasing Lung & bronchus 37.61 40.17 2.56 6.82 Liver & intrahepatic bile duct 2.52 3.27 0.75 29.98 Pancreas 9.28 9.48 0.20 2.10 Total 49.40 52.92 3.51 * Death rates for cancer peaked in 1990 in men and in 1991 in 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 2007 A total of 562,875 cancer deaths were recorded in the United States in 2007, the most recent year for which actual data are available, accounting for approximately 23% of all deaths (Table 7 ). Despite a decrease in age‐standardized death rates, from 180.7 in 2006 to 178.4 in 2007, there were 2987 more cancer deaths reported in 2007 than in 2006 due to the influence of the aging and growth of the population (Table 8 ). When causes of death are ranked within 20‐year age groups, cancer is one of the 5 leading causes of death in all age groups among both males and females; it is the leading cause of death among men and women ages 40 to 79 years (Table 9 ). Cancer is the leading cause of death among men and women aged younger than 85 years (Fig. 6 ). A total of 475,211 persons aged younger than 85 years died from cancer in the United States in 2007, compared with 380,791 deaths from heart disease, which is the leading cause of death overall in the United States. 1 7 Fifteen Leading Causes of Death, United States, 2007 RANK CAUSE OF DEATH NUMBER OF DEATHS PERCENT (%) OF TOTAL DEATHS DEATH RATE * All Causes 2,423,712 100.0 760.2 1 Heart diseases 616,067 25.4 190.9 2 Cancer 562,875 23.2 178.4 3 Cerebrovascular diseases 135,952 5.6 42.2 4 Chronic lower respiratory diseases 127,924 5.3 40.8 5 Accidents (unintentional injuries) 123,706 5.1 40.0 6 Alzheimer disease 74,632 3.1 22.7 7 Diabetes mellitus 71,382 2.9 22.5 8 Influenza & pneumonia 52,717 2.2 16.2 9 Nephritis, nephrotic syndrome, & nephrosis 46,448 1.9 14.5 10 Septicemia 34,828 1.4 11.0 11 Intentional self‐harm (suicide) 34,598 1.4 11.3 12 Chronic liver disease & cirrhosis 29,165 1.2 9.1 13 Essential hypertension & hypertensive renal disease † 23,965 1.0 7.4 14 Parkinson disease 20,058 0.8 6.4 15 Assault (homicide) 18,361 0.8 6.1 All other & ill‐defined causes 451,034 18.6 * 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 due to 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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 8 Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990 to 2007 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 2007 292,857 270,018 88,331 70,355 27,005 26,216 29,093 40,599 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 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 9 Ten Leading Causes of Death by Age and Sex, United States, 2007 ALL AGES AGES 1 TO 19 AGES 20 TO 39 AGES 40 TO 59 AGES 60 TO 79 AGES 80+ MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE All Causes 1,203,968 All Causes 1,219,744 All Causes 15,777 All Causes 8,372 All Causes 65,305 All Causes 28,831 All Causes 226,396 All Causes 139,473 All Causes 460,041 All Causes 372,878 All Causes 420,000 All Causes 657,300 1 Heart diseases 309,821 Heart diseases 306,246 Accidents (unintentional injuries) 6,875 Accidents (unintentional injuries) 3,400 Accidents (unintentional injuries) 24,329 Accidents (unintentional injuries) 7,789 Cancer 54,054 Cancer 50,640 Cancer 152,231 Cancer 126,918 Heart diseases 130,779 Heart diseases 204,138 2 Cancer 292,857 Cancer 270,018 Assault (homicide) 2,355 Cancer 911 Intentional self‐harm (suicide) 8,901 Cancer 4,639 Heart diseases 53,779 Heart diseases 21,389 Heart diseases 119,209 Heart diseases 77,703 Cancer 81,403 Cancer 86,873 3 Accidents (unintentional injuries) 79,827 Cerebro‐vascular disease 81,841 Intentional self‐harm (suicide) 1,352 Assault (homicide) 613 Assault (homicide) 8,170 Heart diseases 2,508 Accidents (unintentional injuries) 25,401 Accidents (unintentional injuries) 11,208 Chronic lower respiratory diseases 30,237 Chronic lower respiratory diseases 29,321 Cerebro‐vascular disease 25,747 Cerebro‐vascular disease 55,234 4 Chronic lower respiratory diseases 61,235 Chronic lower respiratory diseases 66,689 Cancer 1,085 Congenital anomalies 518 Heart diseases 5,351 Intentional self‐harm (suicide) 2,058 Intentional self‐harm (suicide) 10,828 Cerebro‐vascular disease 5,524 Cerebro‐vascular disease 20,454 Cerebro‐vascular disease 20,281 Chronic lower respiratory diseases 25,616 Alzheimer disease 45,458 5 Cerebro‐vascular disease 54,111 Alzheimer disease 52,832 Congenital anomalies 593 Heart diseases 315 Cancer 4,041 Assault (homicide) 1,534 Chronic liver disease & cirrhosis 10,296 Diabetes mellitus 4,769 Diabetes mellitus 16,722 Diabetes mellitus 14,621 Alzheimer disease 16,780 Chronic lower respiratory diseases 32,524 6 Diabetes mellitus 35,478 Accidents (unintentional injuries) 43,879 Heart diseases 445 Intentional self‐harm (suicide) 313 HIV disease 1,650 HIV disease 950 Diabetes mellitus 7,304 Chronic lower respiratory diseases 4,475 Accidents (unintentional injuries) 12,311 Nephritis, nephrotic syndrome & nephrosis 7,935 Influenza & pneumonia 14,099 Influenza & pneumonia 20,555 7 Intentional self‐harm (suicide) 27,269 Diabetes mellitus 35,904 Chronic lower respiratory diseases 151 Influenza & pneumonia 134 Diabetes mellitus 905 Cerebro‐ vascular disease 636 Cerebro‐vascular disease 7,006 Chronic liver disease & cirrhosis 4,229 Nephritis, nephrotic syndrome & nephrosis 8,665 Accidents (unintentional injuries) 7,457 Nephritis, nephrotic syndrome & nephrosis 10,868 Diabetes mellitus 15,909 8 Influenza & pneumonia 24,071 Influenza & pneumonia 28,646 Influenza & pneumonia 130 Cerebro‐vascular disease 109 Chronic liver disease & cirrhosis 765 Pregnancy, childbirth & puerperium 598 HIV disease 5,451 Intentional self‐harm (suicide) 3,612 Influenza & pneumonia 7,046 Alzheimer disease 7,191 Diabetes mellitus 10,495 Nephritis, nephrotic syndrome & nephrosis 13,479 9 Nephritis, nephrotic syndrome & nephrosis 22,616 Nephritis, nephrotic syndrome & nephrosis 23,832 Septecemia 113 Chronic lower respiratory diseases 95 Cerebro‐ vascular disease 726 Diabetes mellitus 567 Chronic lower respiratory diseases 4,887 Septicemia 2,321 Chronic liver disease & cirrhosis 6,859 Septicemia 6,639 Accidents (unintentional injuries) 10,164 Accidents (unintentional injuries) 13,453 10 Alzheimer disease 21,800 Septicemia 18,989 Cerebro‐ vascular disease 97 Septecemia 92 Congenital anomalies 490 Chronic liver disease & cirrhosis 388 Viral hepatitis 3,463 Nephritis, nephrotic syndrome & nephrosis 2,036 Septicemia 6,608 Influenza & pneumonia 5,997 Parkinson disease 7,422 Hypertension & hypertensive renal disease * 10,126 * Includes primary and secondary hypertension. Note: Deaths within each age group do not sum to all ages combined due to 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, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 6 Death Rates* For Cancer and Heart Disease for Ages Younger Than 85 Years and 85 Years and Older, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention. 7 Total Number of Cancer Deaths Avoided From 1991 to 2006 in Males and From 1992 to 2006 in Females. 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. Table 10 presents the number of deaths from all cancers combined and from the 5 most common cancer sites for each 20‐year age group. Among males aged younger than 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 ages 40 to 79 years, and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at 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, 2007 ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥ 80 MALE ALL SITES 292,857 ALL SITES 1,124 ALL SITES 4,041 ALL SITES 54,054 ALL SITES 152,231 ALL SITES 81,403 Lung & bronchus 88,331 Leukemia 365 Leukemia 522 Lung & bronchus 15,174 Lung & bronchus 53,125 Lung & bronchus 19,751 Prostate 29,093 Brain & ONS * 260 Brain & ONS * 502 Colorectum 5,434 Colorectum 13,370 Prostate 15,670 Colorectum 27,005 Bones & joints 92 Colorectum 395 Liver & bile duct 3,944 Prostate 12,187 Colorectum 7,795 Pancreas 17,132 Other endocrine system 92 Non‐Hodgkin lymphoma 301 Pancreas 3,638 Pancreas 9,293 Urinary bladder 4,216 Leukemia 12,435 Soft tissue 72 Lung & bronchus 268 Esophagus 2,695 Esophagus 5,958 Pancreas 4,084 FEMALE ALL SITES 270,018 ALL SITES 944 ALL SITES 4,639 ALL SITES 50,640 ALL SITES 126,918 ALL SITES 86,873 Lung & bronchus 70,355 Leukemia 278 Breast 1,094 Breast 11,630 Lung & bronchus 40,187 Lung & bronchus 18,519 Breast 40,599 Brain & ONS * 261 Uterine cervix 468 Lung & bronchus 11,412 Breast 16,900 Colorectum 11,298 Colorectum 26,216 Other endocrine system 81 Leukemia 393 Colorectum 4,150 Colorectum 10,459 Breast 10,973 Pancreas 16,985 Bones & joints 80 Colorectum 304 Ovary 3,151 Pancreas 8,211 Pancreas 6,283 Ovary 14,621 Soft tissue 68 Brain & ONS * 300 Pancreas 2,417 Ovary 7,195 Non‐Hodgkin lymphoma 4,171 * ONS = Other nervous system. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. “Other and unspecified malignant neoplasm” is excluded from cause of death ranking order. Source: US Mortality Data, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. Cancer Occurrence by Race/Ethnicity Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11 ), although the extent of variation may be affected by misclassification of race and ethnicity on medical records, including death certificates. 26 For all cancer sites combined, African American men have a 14% higher incidence rate and a 34% higher death rate than white men, whereas African American women have a 7% 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 compared with 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 screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. The higher breast cancer incidence rates observed among white women are believed to reflect a combination of factors that affect both diagnosis (eg, more frequent mammography in white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white compared with black women). 21 11 Incidence and Death Rates * by Site, Race, and Ethnicity, United States, 2002–2006 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE † HISPANIC/LATINO ‡ Incidence All sites Male 550.1 626.0 334.5 318.4 430.3 Female 420.0 389.5 276.3 265.1 326.8 Breast (female) 123.5 113.0 81.6 67.2 90.2 Colorectum Male 58.2 68.4 44.1 38.1 50.0 Female 42.6 51.7 33.1 30.7 35.1 Kidney & renal pelvis Male 19.7 20.6 9.0 16.6 18.2 Female 10.3 10.6 4.5 10.6 10.3 Liver & bile duct Male 8.0 12.5 21.4 8.9 15.9 Female 2.8 3.8 8.1 4.6 6.2 Lung & bronchus Male 85.9 104.8 50.6 57.9 49.2 Female 57.1 50.7 27.6 41.3 26.5 Prostate 146.3 231.9 82.3 82.7 131.1 Stomach Male 8.9 16.7 17.5 9.4 14.3 Female 4.2 8.5 9.8 4.7 8.6 Uterine cervix 7.9 11.1 7.6 6.6 12.7 Mortality All sites Male 226.7 304.2 135.4 183.3 154.8 Female 157.3 183.7 95.1 140.1 103.9 Breast (female) 23.9 33.0 12.5 17.6 15.5 Colorectum Male 21.4 31.4 13.8 20.0 16.1 Female 14.9 21.6 10.0 13.7 10.7 Kidney & renal pelvis Male 6.1 6.0 2.4 9.0 5.2 Female 2.8 2.7 1.2 4.2 2.4 Liver & bile duct Male 6.8 10.8 15.0 10.3 11.3 Female 2.9 3.9 6.6 6.5 5.1 Lung & bronchus Male 69.9 90.1 36.9 48.0 33.9 Female 41.9 40.0 18.2 33.5 14.4 Prostate 23.6 56.3 10.6 20.0 19.6 Stomach Male 4.8 11.0 9.6 9.8 8.3 Female 2.4 5.3 5.8 4.6 4.8 Uterine cervix 2.2 4.6 2.2 3.4 3.1 * Per 100,000 population, age adjusted to the 2000 US standard population. † Data based on Contract Health Service Delivery Areas, compromising about 55% of the US American Indian/Alaska Native population; for more information please see: Espey DK, et al. 16 ‡ Persons of Hispanic/Latino origin may be of any race. Source: Edwards, et al. 15 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 4 most common cancer sites. However, incidence and death rates for cancer sites related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders compared with whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses, respectively, in this population. 22 Kidney cancer death rates are the highest among American Indians/Alaskan Natives; the higher prevalence of obesity and smoking in this population may contribute to this disparity. 16 Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because the long‐term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1997 through 2006, 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 males and females. Among American Indians/Alska Natives residing in Indian Health Service Contract Health Service Delivery Areas, incidence and mortality rates decreased in men but remained stable in women during this time period. 15 Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (38%) (Table 12 ). 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. 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. 12 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2004–2006 * BIRTH TO 39 (%) 40 TO 59 (%) 60 TO 69 (%) 70 AND OLDER (%) BIRTH TO DEATH (%) All sites † Male 1.43 (1 in 70) 8.42 (1 in 12) 15.61 (1 in 6) 37.84 (1 in 3) 44.05 (1 in 2) Female 2.10 (1 in 48) 8.97 (1 in 11) 10.18 (1 in 10) 26.47 (1 in 4) 37.63 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4,741) 0.39 (1 in 257) 0.95 (1 in 106) 3.66 (1 in 27) 3.81 (1 in 26) Female 0.01 (1 in 10,613) 0.12 (1 in 815) 0.26 (1 in 385) 1.01 (1 in 99) 1.18 (1 in 84) Breast Female 0.49 (1 in 206) 3.75 (1 in 27) 3.40 (1 in 29) 6.50 (1 in 15) 12.08 (1 in 8) Colorectum Male 0.08 (1 in 1,269) 0.91 (1 in 110) 1.48 (1 in 67) 4.50 (1 in 22) 5.39 (1 in 19) Female 0.08 (1 in 1,300) 0.72 (1 in 139) 1.07 (1 in 94) 4.09 (1 in 24) 5.03 (1 in 20) Leukemia Male 0.17 (1 in 603) 0.21 (1 in 475) 0.33 (1 in 299) 1.19 (1 in 84) 1.51 (1 in 66) Female 0.13 (1 in 798) 0.15 (1 in 690) 0.20 (1 in 504) 0.78 (1 in 128) 1.08 (1 in 92) Lung & bronchus Male 0.03 (1 in 3,461) 0.95 (1 in 105) 2.35 (1 in 43) 6.71 (1 in 15) 7.73 (1 in 13) Female 0.03 (1 in 3,066) 0.79 (1 in 126) 1.75 (1 in 57) 4.83 (1 in 21) 6.31 (1 in 16) Melanoma of the skin § Male 0.16 (1 in 638) 0.64 (1 in 155) 0.72 (1 in 138) 1.77 (1 in 56) 2.67 (1 in 37) Female 0.28 (1 in 360) 0.55 (1 in 183) 0.36 (1 in 274) 0.79 (1 in 126) 1.79 (1 in 56) Non‐Hodgkin lymphona Male 0.13 (1 in 782) 0.44 (1 in 225) 0.59 (1 in 171) 1.71 (1 in 58) 2.28 (1 in 44) Female 0.09 (1 in 1,172) 0.32 (1 in 315) 0.44 (1 in 227) 1.39 (1 in 72) 1.92 (1 in 52) Prostate Male 0.01 (1 in 9,422) 2.44 (1 in 41) 6.45 (1 in 16) 12.48 (1 in 8) 15.90 (1 in 6) Uterine cervix Female 0.15 (1 in 648) 0.27 (1 in 374) 0.13 (1 in 755) 0.19 (1 in 552) 0.69 (1 in 145) Uterine corpus Female 0.07 (1 in 1,453) 0.73 (1 in 136) 0.83 (1 in 121) 1.23 (1 in 81) 2.53 (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 6.4.0. Statistical Research and Applications Branch, National Cancer Institute, 2009. www.srab.cancer.gov/devcan Cancer Survival By Race Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5‐year relative survival is lower in African Americans than in whites for every 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 are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear. 23 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 24 8 Five‐Year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005. *The standard error of the survival rate is between 5 and 10 percentage points. †The survival rate for in situ urinary bladder cancer is 97% for all races combined, whites, and African Americans. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005. *The proportion of in situ urinary bladder cancer cases is 50%, 51%, and 36% in all races combined, whites, and African Americans, respectively. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 There have been notable improvements since 1975 in the relative 5‐year survival rates for many cancer sites for both whites and African Americans (Table 13 ). Cancers for which survival has not improved substantially over the past 30 years include those of the lung and pancreas. The improvement in survival reflects a combination of earlier diagnosis and improved treatments. 13 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975–2005 ALL RACES WHITE AFRICAN AMERICAN 1975 TO 1977 1984 TO 1986 1999 TO 2005 1975 TO 1977 1984 TO 1986 1999 TO 2005 1975 TO 1977 1984 TO 1986 1999 TO 2005 All sites 50 54 68 † 51 55 69 † 40 41 59 † Brain 24 29 36 † 23 28 35 † 27 32 41 † Breast (female) 75 79 90 † 76 80 91 † 62 65 79 † Colon 52 59 66 † 52 60 67 † 46 50 56 † Esophagus 5 10 19 † 6 11 20 † 3 8 13 † Hodgkin lymphoma 74 79 86 † 74 80 87 † 71 75 81 † Kidney 51 56 69 † 51 56 69 † 50 54 66 † Larynx 67 66 63 † 67 68 66 59 53 50 Leukemia 35 42 54 † 36 43 55 † 34 34 46 † Liver & bile duct 4 6 14 † 4 6 13 † 2 5 10 † Lung & bronchus 13 13 16 † 13 14 17 † 12 11 13 † Melanoma of the skin 82 87 93 † 82 87 93 † 60 ‡ 70 § 78 ‡ Myeloma 26 29 37 † 25 27 38 † 31 32 36 † Non‐Hodgkin lymphoma 48 53 69 † 48 54 70 † 49 48 60 † Oral cavity 53 55 63 † 55 57 64 † 36 36 46 † Ovary 37 40 46 † 37 39 46 † 43 41 37 Pancreas 3 3 6 † 3 3 6 † 2 5 5 † Prostate 69 76 100 † 70 77 100 † 61 66 98 † Rectum 49 57 69 † 49 58 69 † 45 46 61 † Stomach 16 18 27 † 15 18 25 † 16 20 26 † Testis 83 93 96 † 83 93 97 † 73 ‡ # 87 ‡ 87 Thyroid 93 94 97 † 93 94 98 † 91 90 96 Urinary bladder 74 78 82 † 75 79 83 † 51 61 68 † Uterine cervix 70 68 72 † 71 70 73 65 58 65 Uterine corpus 88 84 84 † 89 85 87 † 61 58 62 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 9 areas from 1975–77, 1984–86, and 1999–2005 and followed through 2006. † The difference in rates between 1975–1977 and 1999–2005 is statistically significant ( P < 0.05). ‡ 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. # Survival rate is for 1978–1980. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 Relative survival rates cannot be calculated for racial and ethnic populations other than 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 between 1999 and 2005 in SEER areas of the United States, all minority male populations have a greater probability of dying from cancer within 5 years of diagnosis than whites. Among women, African Americans have the lowest 5‐year, cancer‐specific survival (55.8%), followed by American Indians/Alaska Natives (60.0%), whites (65.5%), Hispanics (66.4%), and Asians/Pacific Islanders (68.0%). 2 For all 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely to be diagnosed at distant stage, compared with whites (Fig. 9 ). 25 Cancer in Children Cancer is the second most common cause of death among children between the ages of 1 and 14 years in the United States, surpassed only by accidents (Table 14 ). Nearly one‐third of the cancers diagnosed in children ages birth to 14 years are leukemias (particularly acute lymphocytic leukemia), followed by cancer of the brain and other nervous system (21%), soft tissue sarcomas (including neuroblastoma [7%] and rhabdomyosarcoma [3%]), renal (Wilms) tumors (5%), and non‐Hodgkin lymphoma (4%). Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for all of the major childhood cancers (Table 15 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed between 1975 and 1977 to 81% for those diagnosed between 1999 and 2005. 2 14 Ten Leading Causes of Death Among Children Ages 1 to 14, United States, 2007 RANK CAUSE OF DEATH NUMBER OF DEATHS % OF TOTAL DEATHS DEATH RATE * ALL CAUSES 10,850 100.0 18.9 1 Accidents (unintentional injuries) 3,782 34.9 6.6 2 Cancer 1,323 12.2 2.3 3 Congenital anomalies 920 8.5 1.6 4 Assault (homicide) 744 6.9 1.3 5 Heart diseases 414 3.8 0.7 6 Influenza & pneumonia 212 2.0 0.4 7 Intentional self‐harm (suicide) 184 1.7 0.3 8 Chronic lower respiratory diseases 175 1.6 0.3 9 Septicemia 152 1.4 0.3 10 In situ, benign, & unknown neoplasms 143 1.3 0.3 All other causes 2,801 25.8 * 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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 15 Trends in Five‐year Relative Survival Rates * (%) for Children Under Age 15, US, 1975 to 2005 SITE YEAR OF DIAGNOSIS 1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 1998 1999 TO 2005 All sites 58 63 67 68 72 76 77 79 81 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 87 89 † Acute myeloid leukemia 19 26 27 ‡ 31 ‡ 37 ‡ 41 42 ‡ 49 60 † Bone & joint 50 ‡ 48 57 ‡ 58 ‡ 67 ‡ 67 74 70 72 † Brain & other nervous system 57 58 56 62 64 64 70 75 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 96 95 † Neuroblastoma 52 57 55 52 62 76 67 66 74 † Non‐Hodgkin lymphoma 44 53 67 70 71 76 81 83 86 † Soft tissue 61 75 69 73 66 80 77 70 81 † Wilms tumor 73 79 87 91 92 92 92 92 91 † * Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2006. † The difference in rates between 1975 to 1977 and 1999 to 2005 is statistically significant ( P < 0.05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. Note: Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 Limitations Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are based on models and may vary considerably from year to year. 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. 12 Not all changes in cancer trends are captured by modeling techniques and sometimes the model may be too sensitive to recent trends, resulting in over‐ or underestimates. 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 age‐standardized or age‐specific cancer incidence rates from SEER or NPCR and cancer death rates from the NCHS. 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. Errors in reporting race/ethnicity in medical records and death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and nonblack populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic minority groups that are not homogenous, and thus significant differences in the cancer burden within racial/ethnic subgroups may be masked. 26 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CA: A Cancer Journal for Clinicians Wiley

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References (25)

Publisher
Wiley
Copyright
Copyright © 2010 American Cancer Society, Inc.
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/caac.20073
pmid
20610543
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, 1 in 4 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 2010. Materials and Methods Data Sources Mortality data from 1930 to 2007 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 Incidence data for long‐term trends (1975–2006), 5‐year relative survival rates, and lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), covering approximately 26% of the US population. 2–5 Incidence data (1995–2006) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR) covering approximately 89% of the US population. State‐specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and the NPCR. 6 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). 8–10 Cancer cases were classified according to the International Classification of Diseases for Oncology . 11 Estimated New Cancer Cases and Deaths The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer case reporting is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection and compilation. Therefore, we project the expected number of new cancer cases and deaths in the United States in 2010 to provide an estimate of the current cancer burden. Estimated new cancer cases in the current year (2010) were projected using a spatiotemporal model based on incidence data from 1995 through 2006 from 44 states and the District of Columbia that met the NAACCR's high‐quality data standard for incidence, covering approximately 89% of the US population. 12 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. We used the state‐space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2010. 13 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 2010 based on the number that occurred each year from 1969 to 2007 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 2007. Causes of death for 2007 were coded and classified according to ICD‐10. 10 This report also provides updated statistics regarding 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 2006. 2 , 6 All age‐adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population. The incidence rates (2002–2006) and long‐term trends (1975–2006) are adjusted for delays in reporting when possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 2004–2006), 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 for selected cancer sites were previously published in the 2010 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 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age‐standardized cancer death rates through 2006. 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 2006 to obtain the number of expected deaths in each calendar year if the death rates had 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 15‐year (women) or 16‐year (men) interval. Selected Findings Expected Numbers of New Cancer Cases in 2010 Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the US in 2010. The overall estimate of approximately 1.53 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. Greater than 2 million unreported cases of basal cell and squamous cell skin cancer, approximately 54,010 cases of breast carcinoma in situ, and 46,770 cases of melanoma in situ are expected to be newly diagnosed in 2010. 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, 2010 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,529,560 789,620 739,940 569,490 299,200 270,290 Oral cavity & pharynx 36,540 25,420 11,120 7,880 5,430 2,450 Tongue 10,990 7,690 3,300 1,990 1,300 690 Mouth 10,840 6,430 4,410 1,830 1,140 690 Pharynx 12,660 9,880 2,780 2,410 1,730 680 Other oral cavity 2,050 1,420 630 1,650 1,260 390 Digestive system 274,330 148,540 125,790 139,580 79,010 60,570 Esophagus 16,640 13,130 3,510 14,500 11,650 2,850 Stomach 21,000 12,730 8,270 10,570 6,350 4,220 Small intestine 6,960 3,680 3,280 1,100 610 490 Colon † 102,900 49,470 53,430 51,370 26,580 24,790 Rectum 39,670 22,620 17,050 Anus, anal canal, & anorectum 5,260 2,000 3,260 720 280 440 Liver & intrahepatic bile duct 24,120 17,430 6,690 18,910 12,720 6,190 Gallbladder & other biliary 9,760 4,450 5,310 3,320 1,240 2,080 Pancreas 43,140 21,370 21,770 36,800 18,770 18,030 Other digestive organs 4,880 1,660 3,220 2,290 810 1,480 Respiratory system 240,610 130,600 110,010 161,670 89,550 72,120 Larynx 12,720 10,110 2,610 3,600 2,870 730 Lung & bronchus 222,520 116,750 105,770 157,300 86,220 71,080 Other respiratory organs 5,370 3,740 1,630 770 460 310 Bones & joints 2,650 1,530 1,120 1,460 830 630 Soft tissue (including heart) 10,520 5,680 4,840 3,920 2,020 1,900 Skin (excluding basal & squamous) 74,010 42,610 31,400 11,790 7,910 3,880 Melanoma‐skin 68,130 38,870 29,260 8,700 5,670 3,030 Other nonepithelial skin 5,880 3,740 2,140 3,090 2,240 850 Breast 209,060 1,970 207,090 40,230 390 39,840 Genital system 311,210 227,460 83,750 60,420 32,710 27,710 Uterine cervix 12,200 12,200 4,210 4,210 Uterine corpus 43,470 43,470 7,950 7,950 Ovary 21,880 21,880 13,850 13,850 Vulva 3,900 3,900 920 920 Vagina & other genital, female 2,300 2,300 780 780 Prostate 217,730 217,730 32,050 32,050 Testis 8,480 8,480 350 350 Penis & other genital, male 1,250 1,250 310 310 Urinary system 131,260 89,620 41,640 28,550 19,110 9,440 Urinary bladder 70,530 52,760 17,770 14,680 10,410 4,270 Kidney & renal pelvis 58,240 35,370 22,870 13,040 8,210 4,830 Ureter & other urinary organs 2,490 1,490 1,000 830 490 340 Eye & orbit 2,480 1,240 1,240 230 120 110 Brain & other nervous system 22,020 11,980 10,040 13,140 7,420 5,720 Endocrine system 46,930 11,890 35,040 2,570 1,140 1,430 Thyroid 44,670 10,740 33,930 1,690 730 960 Other endocrine 2,260 1,150 1,110 880 410 470 Lymphoma 74,030 40,050 33,980 21,530 11,450 10,080 Hodgkin lymphoma 8,490 4,670 3,820 1,320 740 580 Non‐Hodgkin lymphoma 65,540 35,380 30,160 20,210 10,710 9,500 Myeloma 20,180 11,170 9,010 10,650 5,760 4,890 Leukemia 43,050 24,690 18,360 21,840 12,660 9,180 Acute lymphocytic leukemia 5,330 3,150 2,180 1,420 790 630 Chronic lymphocytic leukemia 14,990 8,870 6,120 4,390 2,650 1,740 Acute myeloid leukemia 12,330 6,590 5,740 8,950 5,280 3,670 Chronic myeloid leukemia 4,870 2,800 2,070 440 190 250 Other leukemia ‡ 5,530 3,280 2,250 6,640 3,750 2,890 Other & unspecified primary sites ‡ 30,680 15,170 15,510 44,030 23,690 20,340 * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 54,010 female carcinoma in situ of the breast and 46,770 melanoma in situ will be newly diagnosed in 2010. †, ‡ Estimated deaths for colon and rectum cancers are combined. ‡ More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates or an undercount in the case estimate. Source: Estimated new cases are based on 1995–2006 incidence rates from 41 states and the District of Columbia as reported by the 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, representing about 89% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 2 Age‐standardized Incidence Rates for All Cancers Combined, 2002–2006, and Estimated New Cases * for Selected Cancers by State, United States, 2010 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 453.6 23,640 3,450 200 2,300 520 560 4,160 1,210 940 3,300 920 Alaska 468.3 2,860 410 ‡ 260 70 70 360 80 130 440 140 Arizona § 29,780 3,950 210 2,620 710 760 4,030 1,430 1,210 3,850 1,530 Arkansas 459.3 15,320 1,770 140 1,500 330 420 2,620 460 640 2,330 610 California 441.0 157,320 21,130 1,540 13,950 4,470 4,460 18,490 8,030 7,010 22,640 6,620 Colorado 438.1 21,340 3,100 150 1,770 570 650 2,270 1,180 920 3,430 960 Connecticut 509.4 20,750 2,960 120 1,770 650 510 2,640 1,090 860 2,940 1,110 Delaware 511.9 4,890 690 ‡ 440 140 120 800 210 200 710 250 Dist. of Columbia § 2,760 390 ‡ 260 80 60 360 70 100 450 90 Florida 462.4 107,000 14,080 940 10,500 2,710 3,330 18,390 4,980 4,660 14,610 5,600 Georgia 462.2 40,480 6,130 390 3,840 950 1,040 6,280 2,020 1,600 6,380 1,470 Hawaii 425.7 6,670 910 50 680 220 160 770 310 230 1,060 200 Idaho 461.7 7,220 910 60 600 200 230 860 360 310 1,300 380 Illinois 488.8 63,890 8,770 490 6,340 1,960 1,860 9,190 2,060 2,690 8,730 3,050 Indiana 469.4 33,020 4,350 230 3,330 960 890 5,430 1,200 1,370 4,160 1,510 Iowa 481.0 17,260 2,020 100 1,760 550 560 2,450 900 750 2,420 840 Kansas § 13,550 1,780 90 1,270 410 400 1,990 650 590 1,630 550 Kentucky 511.2 24,240 3,290 210 2,370 610 630 4,780 1,440 1,030 3,180 1,030 Louisiana 496.0 20,950 2,530 180 2,060 440 590 3,320 600 920 3,410 850 Maine 530.3 8,650 1,160 50 800 280 260 1,370 410 360 1,410 530 Maryland § 27,700 4,150 200 2,630 810 620 4,170 1,290 1,110 4,010 1,180 Massachusetts 507.8 36,040 5,320 200 3,120 1,150 910 5,020 1,770 1,460 4,820 2,000 Michigan 503.4 55,660 7,340 330 5,170 1,700 1,600 8,150 2,240 2,400 8,490 2,790 Minnesota 479.3 25,080 3,330 140 2,410 850 830 3,150 970 1,100 3,870 1,160 Mississippi § 14,330 1,970 130 1,480 300 340 2,360 470 540 2,260 510 Missouri 468.9 31,160 3,880 210 3,080 910 870 5,360 1,320 1,260 3,600 1,360 Montana 466.2 5,570 680 ‡ 490 150 160 740 200 240 960 280 Nebraska 476.8 9,230 1,160 60 910 290 290 1,200 450 410 1,470 420 Nevada 466.2 12,230 1,350 130 1,090 290 320 1,920 410 480 1,750 620 New Hampshire 508.1 7,810 990 ‡ 720 240 200 1,070 390 310 1,100 430 New Jersey 511.0 48,100 6,820 420 4,430 1,580 1,330 6,260 2,650 2,130 6,790 2,510 New Mexico 416.0 9,210 1,180 90 790 230 280 920 420 370 1,610 350 New York 491.0 103,340 14,610 930 9,780 3,430 2,980 13,720 4,050 4,680 14,840 5,230 North Carolina 460.9 45,120 6,500 360 4,220 1,190 1,150 7,520 2,130 1,800 6,910 1,890 North Dakota 465.1 3,300 400 ‡ 340 100 100 410 120 150 580 180 Ohio § 64,450 8,280 410 5,960 2,010 1,810 10,710 2,200 2,720 8,010 2,970 Oklahoma 478.3 18,670 2,300 150 1,730 460 560 3,250 640 810 2,440 770 Oregon 471.2 20,750 2,910 130 1,710 600 530 2,810 1,200 930 3,010 1,040 Pennsylvania 503.7 75,260 10,000 540 7,440 2,450 2,070 10,520 3,550 3,430 9,800 4,050 Rhode Island 515.5 5,970 790 ‡ 540 190 160 840 290 240 740 350 South Carolina 476.4 23,240 3,260 170 2,140 560 590 3,970 1,060 950 3,600 950 South Dakota 460.2 4,220 530 ‡ 450 130 130 540 170 180 760 230 Tennessee § 33,070 4,700 270 3,130 750 850 5,980 1,720 1,360 4,600 1,350 Texas 451.5 101,120 12,920 1,070 9,190 2,420 3,240 14,030 3,570 4,410 13,740 3,650 Utah 408.5 9,970 1,260 80 740 280 310 620 610 430 1,730 390 Vermont § 3,720 520 ‡ 320 110 90 490 190 150 600 210 Virginia 444.5 36,410 5,470 280 3,370 1,040 880 5,510 1,810 1,470 5,550 1,520 Washington 494.9 34,500 4,900 220 2,740 1,010 1,000 4,320 1,930 1,600 5,220 1,720 West Virginia 494.2 10,610 1,310 80 1,060 330 280 2,070 440 450 1,440 530 Wisconsin § 29,610 4,120 200 2,760 1,040 940 3,990 1,050 1,340 4,670 1,510 Wyoming 447.6 2,540 330 ‡ 220 70 70 320 110 110 420 130 United States 472.9 1,529,560 207,090 12,200 142,570 43,470 43,050 222,520 68,130 65,540 217,730 70,530 * 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. Source: Data as of June 2009 reported by the North American Association of Central Cancer Registries (NAACCR) as meeting high quality standards for 2002–2006 and include data collected by cancer registries participating in NCI's SEER Program and CDC's National Program of Cancer Registries. To account for population anomalies caused by Hurricane Katrina in 2005, statistics exclude data for AL, LA, and TX from July 2005‐December 2005. Note: These model‐based estimates are calculated using incidence rates from 41 states and the District of Columbia; they are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and exclusion of states with fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2010. Among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,730) of incident cases in men. Based on cases diagnosed between 1999 and 2005, an estimated 92% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which the 5‐year relative survival approaches 100%. 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, 2010. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10. The 3 most commonly diagnosed types of cancer among women in 2010 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (207,090) of all new cancer cases among women. Expected Number of Cancer Deaths in 2010 Table 1 also shows the expected number of deaths from cancer projected for 2010 for men, women, and both sexes combined. It is estimated that approximately 569,490 Americans will die from cancer, corresponding to greater than 1500 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 4 cancers account for approximately 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 and is expected to account for 26% of all female cancer deaths in 2010. Table 3 provides the estimated number of cancer deaths in 2010 by state for selected cancer sites. 3 Age‐standardized Death Rates for All Cancers Combined, 2002–2006, and Estimated Deaths * for Selected Cancers by State, United States, 2010 STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 203.7 10,150 210 690 950 350 310 3,190 320 260 590 600 Alaska 182.0 880 ‡ 70 80 ‡ ‡ 250 ‡ ‡ 60 ‡ Arizona 163.9 10,630 280 740 1,020 420 380 2,670 360 290 740 650 Arkansas 205.0 6,460 150 430 600 240 200 1,900 200 140 430 460 California 169.7 55,710 1,490 4,230 4,970 2,220 2,600 12,630 2,110 1,500 3,900 3,710 Colorado 163.5 6,880 210 500 660 270 230 1,670 280 210 460 390 Connecticut 182.6 6,850 150 490 540 230 200 1,760 230 180 540 410 Delaware 198.7 1,900 ‡ 120 160 70 50 580 60 ‡ 120 100 Dist. of Columbia 204.9 960 ‡ 80 100 ‡ ‡ 230 ‡ ‡ 70 70 Florida 177.3 40,880 800 2,650 3,540 1,560 1,360 11,620 1,480 930 2,560 2,590 Georgia 190.3 15,570 340 1,100 1,430 560 430 4,620 500 390 940 930 Hawaii 150.3 2,330 ‡ 140 220 80 120 570 90 50 180 120 Idaho 171.6 2,530 80 160 220 120 70 640 90 60 190 180 Illinois 194.5 23,360 470 1,790 2,310 900 700 6,490 740 570 1,580 1,420 Indiana 202.7 12,900 340 860 1,130 520 340 4,000 440 300 790 620 Iowa 184.3 6,370 170 380 620 300 160 1,770 290 170 380 370 Kansas 184.7 5,370 140 370 530 260 140 1,590 200 140 330 300 Kentucky 219.3 9,670 180 580 880 320 250 3,410 310 200 540 470 Louisiana 217.0 8,480 210 620 920 310 340 2,550 280 200 540 440 Maine 204.1 3,170 80 170 270 110 80 960 90 70 200 150 Maryland 193.3 10,250 210 800 950 390 360 2,760 310 250 710 650 Massachusetts 190.9 12,990 280 780 1,050 470 440 3,530 400 330 920 600 Michigan 193.4 20,740 500 1,320 1,740 810 600 5,830 700 500 1,330 1,010 Minnesota 176.6 9,200 240 610 780 390 280 2,450 330 220 600 440 Mississippi 211.3 6,060 130 400 630 230 190 2,010 190 130 360 330 Missouri 200.1 12,620 280 860 1,120 540 380 3,950 450 250 790 710 Montana 182.7 1,980 60 110 170 90 50 580 80 50 120 130 Nebraska 178.2 3,500 90 210 360 140 80 900 150 80 200 240 Nevada 193.0 4,640 120 330 530 110 180 1,300 150 110 300 270 New Hampshire 190.6 2,660 70 190 210 90 80 750 70 60 190 140 New Jersey 189.4 16,520 340 1,430 1,600 600 470 4,220 640 430 1,130 940 New Mexico 165.2 3,400 80 230 340 120 150 780 120 80 230 240 New York 176.1 34,540 800 2,490 3,120 1,380 1,270 8,720 1,480 910 2,440 1,690 North Carolina 194.3 19,100 350 1,340 1,520 650 500 5,650 570 390 1,160 980 North Dakota 175.5 1,280 ‡ 80 120 60 ‡ 320 ‡ ‡ 90 70 Ohio 202.3 24,980 540 1,730 2,280 930 680 7,260 840 540 1,530 1,440 Oklahoma 198.1 7,660 170 520 700 290 220 2,390 280 160 400 320 Oregon 189.2 7,510 210 490 690 280 230 2,100 310 210 490 430 Pennsylvania 196.4 28,690 550 1,980 2,610 1,100 840 7,960 1,100 730 2,010 1,660 Rhode Island 191.4 2,170 50 130 150 90 70 600 60 60 120 80 South Carolina 197.7 9,180 200 640 770 330 270 2,870 300 220 560 490 South Dakota 178.8 1,670 ‡ 100 160 70 ‡ 450 60 50 100 100 Tennessee 208.8 13,600 340 890 1,190 490 380 4,520 470 250 750 690 Texas 181.7 36,540 840 2,780 3,340 1,410 1,660 9,600 1,280 840 2,200 1,820 Utah 139.2 2,820 100 250 250 140 80 480 100 80 200 200 Vermont 179.4 1,280 ‡ 90 120 50 ‡ 370 ‡ ‡ 80 50 Virginia 191.9 14,230 300 1,120 1,300 510 410 4,050 450 370 930 710 Washington 183.4 11,640 370 790 980 480 440 3,110 440 330 760 770 West Virginia 211.4 4,670 100 270 440 150 120 1,480 190 110 220 130 Wisconsin 184.3 11,310 270 690 900 490 330 2,940 410 290 720 600 Wyoming 176.7 1,000 ‡ 60 110 ‡ ‡ 260 50 ‡ 70 ‡ United States 186.9 569,490 13,140 39,840 51,370 21,840 18,910 157,300 20,210 13,850 36,800 32,050 * 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 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 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 for lung cancer, for which rates (cases per 100,000 population) range from 37.8 in men and 23.0 in women in Utah to 133.1 in men and 76.9 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 is smaller in both absolute and proportionate terms. For screenable cancers, such as those of the prostate and female breast, variation in incidence rates 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, 2002 to 2006 STATE ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama † 561.2 379.6 114.6 61.7 42.0 107.8 52.9 20.5 13.8 154.2 31.8 7.6 Alaska 529.4 417.7 126.4 60.0 45.6 84.6 64.3 22.6 17.6 141.4 41.6 7.3 Arizona ‡ 465.9 364.0 108.8 48.9 36.0 69.6 49.1 18.9 13.5 118.9 35.3 8.9 Arkansas 562.8 383.5 113.1 58.8 42.7 111.3 59.5 21.8 15.6 161.3 33.0 8.6 California 510.1 393.3 122.3 52.2 39.2 65.1 47.0 22.4 15.5 149.0 34.0 8.2 Colorado 501.5 394.1 123.1 50.0 39.5 60.5 45.2 21.0 16.2 156.4 33.6 8.8 Connecticut 591.0 455.5 135.0 62.8 46.5 81.8 60.1 25.8 18.1 164.6 45.4 12.6 Delaware 607.7 440.8 123.9 62.0 44.8 97.6 70.0 23.5 16.1 179.9 42.8 11.1 Dist. of Columbia ‡ 556.0 412.1 132.7 57.4 46.3 81.4 46.6 22.8 13.7 175.2 24.0 8.3 Florida 537.3 404.2 114.1 55.2 41.7 89.2 60.3 21.6 15.4 138.4 37.4 9.7 Georgia 566.4 392.4 118.5 58.7 42.3 101.7 53.3 20.8 14.1 162.4 32.7 8.0 Hawaii 486.7 383.0 121.4 61.3 41.5 68.8 40.1 19.0 12.6 128.6 26.2 6.2 Idaho 538.4 401.7 117.5 49.9 38.0 68.7 48.3 21.4 17.2 165.8 37.0 8.8 Illinois 579.8 429.1 123.1 67.2 48.3 92.3 58.8 24.1 16.2 157.9 40.7 10.5 Indiana 551.3 415.1 115.3 62.8 46.4 103.6 63.3 22.8 16.4 135.9 37.4 9.4 Iowa 558.9 429.2 124.0 64.4 49.6 89.9 53.1 24.4 17.6 144.9 40.7 9.6 Kansas 557.2 417.2 126.1 61.3 43.6 87.6 53.2 24.1 18.0 159.6 36.2 8.5 Kentucky 608.4 446.4 119.8 68.0 49.8 133.1 76.9 23.1 16.9 142.5 39.0 9.9 Louisiana † 619.2 409.6 119.6 68.5 47.3 109.5 57.9 23.2 16.7 176.8 35.2 8.6 Maine 620.9 465.8 128.6 65.9 48.8 99.2 66.0 24.5 19.2 164.8 49.4 13.4 Maryland § — — — — — — — — — — — — Massachusetts 591.8 452.9 132.2 63.9 45.7 83.7 62.4 23.4 16.5 164.6 46.7 12.9 Michigan 597.5 437.9 124.2 58.8 44.6 93.0 61.5 25.2 18.7 179.4 41.9 10.5 Minnesota 567.2 416.4 126.4 56.4 42.3 69.8 49.5 26.4 17.7 184.6 40.1 10.3 Mississippi † ‡ 574.7 382.1 108.2 64.5 46.3 111.7 54.5 20.9 13.5 166.7 29.6 7.5 Missouri 544.3 417.2 121.9 62.3 44.9 105.2 63.4 21.8 15.5 129.3 35.8 8.9 Montana 541.9 406.3 119.6 52.5 40.3 75.3 57.4 22.8 14.9 174.5 40.8 9.1 Nebraska 561.8 418.2 126.4 67.6 47.5 84.6 49.3 24.7 17.4 157.6 37.2 9.5 Nevada 531.2 412.0 112.1 55.2 43.4 83.3 69.0 22.2 15.3 144.2 40.7 11.0 New Hampshire 584.3 455.3 131.2 59.0 44.5 82.1 62.7 23.5 18.2 159.5 48.0 13.4 New Jersey 603.9 449.5 128.0 65.4 48.0 79.6 56.0 25.6 17.7 177.9 46.2 12.2 New Mexico 480.5 366.1 109.6 49.4 35.8 57.5 39.0 17.9 14.3 146.1 26.7 7.0 New York 577.5 434.4 124.5 60.8 45.8 79.4 54.1 24.7 17.3 166.3 42.3 11.1 North Carolina 553.4 398.1 120.3 57.2 41.6 101.3 56.0 21.2 15.1 153.2 34.9 8.8 North Dakota 549.3 402.7 122.8 66.6 43.1 74.6 48.0 22.7 15.8 169.5 39.6 10.0 Ohio § — — — — — — — — — — — — Oklahoma 561.4 422.2 127.2 60.1 43.7 105.6 65.1 22.9 17.5 150.0 34.9 8.6 Oregon 529.3 429.7 131.9 52.8 41.1 79.4 60.4 24.4 17.0 148.0 39.2 10.0 Pennsylvania 592.7 444.6 124.5 66.1 48.3 91.0 56.4 25.1 17.5 159.7 44.8 11.2 Rhode Island 608.9 455.3 128.3 65.7 46.2 92.2 62.2 24.8 17.5 152.2 53.1 13.0 South Carolina 587.4 397.5 119.2 61.2 44.1 102.2 53.0 20.7 14.6 171.5 32.4 7.8 South Dakota 547.8 395.3 119.6 60.2 44.5 78.7 46.3 22.1 17.0 171.0 39.1 8.1 Tennessee ‡ ¶ 548.3 400.6 116.4 58.4 43.2 113.6 60.6 21.6 15.8 132.7 34.0 8.3 Texas † 539.6 389.9 114.9 57.5 39.7 88.3 51.2 22.3 16.1 144.0 30.2 7.3 Utah 486.8 346.6 110.0 45.3 33.7 37.8 23.0 22.4 16.3 182.2 28.3 6.1 Vermont § — — — — — — — — — — — — Virginia 529.5 385.8 120.7 55.5 41.8 88.5 53.6 20.6 13.4 155.0 33.3 8.4 Washington 566.9 443.3 134.8 52.6 40.1 78.7 59.5 27.2 18.3 165.3 41.3 10.2 West Virginia 578.6 437.1 114.7 69.5 50.7 117.7 70.1 22.9 16.8 138.6 39.8 11.4 Wisconsin § — — — — — — — — — — — — Wyoming 516.5 392.9 117.8 52.0 43.0 62.1 47.7 21.4 15.8 168.0 42.1 10.0 United States 556.5 414.8 121.8 59.0 43.6 86.4 55.5 23.1 16.3 155.5 37.9 9.6 * Per 100,000, age adjusted to the 2000 US standard population. † Due to the displacement of populations after Hurricane Katrina in September 2005, 2005 statistics are based on cases diagnosed in January to June. ‡ This state's registry did not achieve high quality data standards for one or more years during 2002–2006 according to the North American Association of Central Cancer Registry (NAACCR) data quality indicators. § This state's registry did not submit incidence data to NAACCR for 2002–2006. ¶ Case assertainment for this state's registry is incomplete for the years 2002–2006. Source: NAACCR, 2009. Data are collected by cancer registries participating in the National Cancer Institute's SEER program and the Centers for Disease Control and Prevention'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 4 most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay‐adjusted cancer incidence rates decreased by 1.3% per year from 2000 through 2006 in males and by 0.5% per year from 1998 through 2006 in females. 15 Incidence trends decreased for all 4 major cancer sites except for lung cancer in women, in whom rates are still increasing, though at a much slower rate than in 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 approximately 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2006 largely reflects increases in screening that can detect and remove precancerous polyps. 15 The decrease in prostate cancer incidence rates (by 2.4% per year from 2000–2006) may reflect recent stabilization of prostate‐specific antigen testing, resulting in decreased detection or a reduced number of undiagnosed cases. 16–18 The decrease in the breast cancer incidence rate since 1999 likely reflects the large discontinuity in the use of menopausal hormone therapy among postmenopausal women beginning in 2001, and it may also reflect delayed diagnosis due to decreased mammography use. 19–20 However, close inspection of incidence data by individual year (Fig. 3 ) shows that after a 6% decrease from 2002 to 2003, incidence rates from 2003 to 2006 remained relatively unchanged. This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer. 20 2 Annual Age‐Adjusted Cancer Incidence and Death Rates* by Sex, United States, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population. Incidences rates are adjusted for delays in reporting. Sources: Incidence: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov ). Delay‐adjusted incidence database: SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. Mortality: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention. 3 Annual Age‐Adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov ). Delay‐adjusted incidence database: SEER Incidence Delay‐Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. 4 Annual Age‐Adjusted Cancer Death Rates*Among Males for Selected Cancers, United States, 1930 to 2006. *Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (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 2006, US Mortality Vol. 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention. 5 Annual Age‐Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2006. *Rates are age adjusted to the 2000 US standard population. †Uterus includes uterine cervix and uterine corpus. Due to changes in International Classification of Diseases (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 2006, US Mortality Volumes 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention. 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975 to 2006 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 1999–2006 −0.7 † Male 1975–1989 1.3 † 1989–1992 5.2 † 1992–1995 −4.9 † 1995–2000 0.5 2000–2006 −1.3 † Female 1975–1979 −0.3 1979–1987 1.6 † 1987–1995 0.1 1995–1998 1.4 1998–2006 −0.5 † Death Male and female 1975–1990 0.5 † 1990–1993 −0.3 1993–2001 −1.1 † 2001–2006 −1.6 † Male 1975–1979 1.0 † 1979–1990 0.3 † 1990–1993 −0.5 1993–2001 −1.5 † 2001–2006 −2.0 † Female 1975–1990 0.6 † 1990–1994 −0.1 1994–2002 −0.8 † 2002–2006 −1.5 † Lung & bronchus Incidence Male 1975–1982 1.4 † 1982–1991 −0.4 1991–2006 −1.8 † Female 1975–1982 5.6 † 1982–1991 3.4 † 1991–2006 0.4 † Death Male 1975–1978 2.5 † 1978–1984 1.2 † 1984–1990 0.4 † 1990–1994 −1.3 † 1994–2006 −2.0 † Female 1975–1982 6.0 † 1982–1990 4.2 † 1990–1995 1.7 † 1995–2003 0.3 † 2003–2006 −0.9 Colorectum Incidence Male 1975–1985 1.1 † 1985–1991 −1.2 † 1991–1995 −3.2 † 1995–1998 2.1 1998–2006 −3.0 † Female 1975–1985 0.3 1985–1995 −1.8 † 1995–1998 1.9 1998–2006 −2.2 † Death Male 1975–1984 −0.1 1984–1990 −1.4 † 1990–2002 −2.0 † 2002–2006 −3.9 † Female 1975–1984 −1.0 † 1984–2001 −1.8 † 2001–2006 −3.4 † Female breast Incidence 1975–1980 −0.5 1980–1987 4.0 † 1987–1994 −0.1 1994–1999 1.6 † 1999–2006 −2.0 † Death 1975–1990 0.4 † 1990–1995 −1.8 † 1995–1998 −3.3 † 1998–2006 −1.9 † Prostate Incidence 1975–1988 2.6 † 1988–1992 16.5 † 1992–1995 −11.7 † 1995–2000 2.4 2000–2006 −2.4 † Death 1975–1987 0.9 † 1987–1991 3.0 † 1991–1994 −0.6 1994–2006 −4.1 † * Annual percent 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 ( P < 0.05). Note: Trends were analyzed by Joinpoint Regression Program, version 3.3.1, with a maximum of four joinpoints (ie, five line segments). Source: Edwards, et al. 15 Death rates for all cancer sites combined decreased by 2.0% per year in men from 2001 through 2006 and by 1.5% per year in women from 2002 to 2006, compared with declines of 1.5% per year in men from 1993 to 2001 and 0.8% per year in women from 1994 through 2002 (Table 5 ). Mortality rates have continued to decrease across all 4 major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2006 after increasing for many decades. Table 6 shows the contribution of individual cancer sites to the decreasing portion of the total cancer death rate for each sex. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2006, death rates for cancer decreased by 21.0% among men and by 12.3% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in the cancer death rate, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease noted among women. Lung cancer in men and breast cancer in women each account for nearly 40% of the sex‐specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to a reduction in tobacco use over the past 50 years, whereas 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 2006, death rates increased for liver cancer in both men and women, esophageal cancer and melanoma in men, and lung and pancreatic cancer in women. 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. Approximately 767,000 cancer deaths (561,400 in men and 205,700 in women) were averted between 1991–1992 and 2006. 6 The Contribution of Individual Cancer Sites to the Decrease in Cancer Death Rates, 1990–2006 MALE DEATH RATE (PER 100,000) CHANGE % CONTRIBUTION † 1990 * 2006 ABSOLUTE % All malignant cancers 279.82 221.11 −58.71 −20.98 Decreasing Lung & bronchus 90.56 67.45 −23.11 −25.52 37.2 Prostate 38.56 23.56 .15.01 −38.91 24.2 Colorectum 30.77 20.51 −10.27 −33.36 16.5 Stomach 8.86 5.04 −3.82 −43.12 6.1 Oral cavity & pharynx 5.61 3.78 −1.83 −32.61 2.9 Non‐Hodgkin lymphoma 9.97 8.41 −1.56 −15.63 2.5 Leukemia 10.71 9.61 −1.10 −10.31 1.8 Brain & other nervous system 5.97 5.13 −0.84 −14.10 1.4 Larynx 2.97 2.19 −0.78 −26.22 1.3 Myeloma 4.83 4.36 −0.47 −9.70 0.8 Kidney & renal pelvis 6.16 5.74 −0.42 −6.86 0.7 Urinary bladder 7.97 7.57 −0.40 −5.00 0.6 Hodgkin lymphoma 0.85 0.56 −0.30 −34.70 0.5 Other 39.79 37.56 −2.23 −5.61 3.6 Total 263.59 201.46 −62.13 100.0 Increasing Esophagus 7.16 7.852 0.69 9.70 Liver & Intrahepatic Bile Duct 5.27 7.73 2.45 46.54 Melanoma of the Skin 3.80 4.07 0.27 7.07 Total 16.23 19.65 3.42 FEMALE DEATH RATE ( per 100,000 ) CHANGE % CONTRIBUTION † 1991 * 2006 ABSOLUTE % All malignant cancers 175.30 153.66 −21.64 −12.34 Decreasing Breast 32.69 −9.24 −28.26 36.7 Colorectum 20.30 −5.77 −28.40 22.9 Non‐Hodgkin Lymphoma 6.74 −1.37 −20.30 5.4 Stomach 4.01 −1.36 −33.98 5.4 Cervix Uteri 3.49 −1.07 −30.65 4.3 Ovary 9.51 −0.97 −10.24 3.9 Leukemia 6.32 −0.92 −14.61 3.7 Brain & Other Nervous System 4.11 −0.72 −17.63 2.9 Oral Cavity & Pharynx 2.03 −0.64 −31.56 2.5 Other 36.69 −3.08 −8.40 12.3 Total 125.90 −25.15 −19.98 100.0 Increasing Lung & bronchus 37.61 40.17 2.56 6.82 Liver & intrahepatic bile duct 2.52 3.27 0.75 29.98 Pancreas 9.28 9.48 0.20 2.10 Total 49.40 52.92 3.51 * Death rates for cancer peaked in 1990 in men and in 1991 in 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 2007 A total of 562,875 cancer deaths were recorded in the United States in 2007, the most recent year for which actual data are available, accounting for approximately 23% of all deaths (Table 7 ). Despite a decrease in age‐standardized death rates, from 180.7 in 2006 to 178.4 in 2007, there were 2987 more cancer deaths reported in 2007 than in 2006 due to the influence of the aging and growth of the population (Table 8 ). When causes of death are ranked within 20‐year age groups, cancer is one of the 5 leading causes of death in all age groups among both males and females; it is the leading cause of death among men and women ages 40 to 79 years (Table 9 ). Cancer is the leading cause of death among men and women aged younger than 85 years (Fig. 6 ). A total of 475,211 persons aged younger than 85 years died from cancer in the United States in 2007, compared with 380,791 deaths from heart disease, which is the leading cause of death overall in the United States. 1 7 Fifteen Leading Causes of Death, United States, 2007 RANK CAUSE OF DEATH NUMBER OF DEATHS PERCENT (%) OF TOTAL DEATHS DEATH RATE * All Causes 2,423,712 100.0 760.2 1 Heart diseases 616,067 25.4 190.9 2 Cancer 562,875 23.2 178.4 3 Cerebrovascular diseases 135,952 5.6 42.2 4 Chronic lower respiratory diseases 127,924 5.3 40.8 5 Accidents (unintentional injuries) 123,706 5.1 40.0 6 Alzheimer disease 74,632 3.1 22.7 7 Diabetes mellitus 71,382 2.9 22.5 8 Influenza & pneumonia 52,717 2.2 16.2 9 Nephritis, nephrotic syndrome, & nephrosis 46,448 1.9 14.5 10 Septicemia 34,828 1.4 11.0 11 Intentional self‐harm (suicide) 34,598 1.4 11.3 12 Chronic liver disease & cirrhosis 29,165 1.2 9.1 13 Essential hypertension & hypertensive renal disease † 23,965 1.0 7.4 14 Parkinson disease 20,058 0.8 6.4 15 Assault (homicide) 18,361 0.8 6.1 All other & ill‐defined causes 451,034 18.6 * 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 due to 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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 8 Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990 to 2007 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 2007 292,857 270,018 88,331 70,355 27,005 26,216 29,093 40,599 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 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 9 Ten Leading Causes of Death by Age and Sex, United States, 2007 ALL AGES AGES 1 TO 19 AGES 20 TO 39 AGES 40 TO 59 AGES 60 TO 79 AGES 80+ MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE All Causes 1,203,968 All Causes 1,219,744 All Causes 15,777 All Causes 8,372 All Causes 65,305 All Causes 28,831 All Causes 226,396 All Causes 139,473 All Causes 460,041 All Causes 372,878 All Causes 420,000 All Causes 657,300 1 Heart diseases 309,821 Heart diseases 306,246 Accidents (unintentional injuries) 6,875 Accidents (unintentional injuries) 3,400 Accidents (unintentional injuries) 24,329 Accidents (unintentional injuries) 7,789 Cancer 54,054 Cancer 50,640 Cancer 152,231 Cancer 126,918 Heart diseases 130,779 Heart diseases 204,138 2 Cancer 292,857 Cancer 270,018 Assault (homicide) 2,355 Cancer 911 Intentional self‐harm (suicide) 8,901 Cancer 4,639 Heart diseases 53,779 Heart diseases 21,389 Heart diseases 119,209 Heart diseases 77,703 Cancer 81,403 Cancer 86,873 3 Accidents (unintentional injuries) 79,827 Cerebro‐vascular disease 81,841 Intentional self‐harm (suicide) 1,352 Assault (homicide) 613 Assault (homicide) 8,170 Heart diseases 2,508 Accidents (unintentional injuries) 25,401 Accidents (unintentional injuries) 11,208 Chronic lower respiratory diseases 30,237 Chronic lower respiratory diseases 29,321 Cerebro‐vascular disease 25,747 Cerebro‐vascular disease 55,234 4 Chronic lower respiratory diseases 61,235 Chronic lower respiratory diseases 66,689 Cancer 1,085 Congenital anomalies 518 Heart diseases 5,351 Intentional self‐harm (suicide) 2,058 Intentional self‐harm (suicide) 10,828 Cerebro‐vascular disease 5,524 Cerebro‐vascular disease 20,454 Cerebro‐vascular disease 20,281 Chronic lower respiratory diseases 25,616 Alzheimer disease 45,458 5 Cerebro‐vascular disease 54,111 Alzheimer disease 52,832 Congenital anomalies 593 Heart diseases 315 Cancer 4,041 Assault (homicide) 1,534 Chronic liver disease & cirrhosis 10,296 Diabetes mellitus 4,769 Diabetes mellitus 16,722 Diabetes mellitus 14,621 Alzheimer disease 16,780 Chronic lower respiratory diseases 32,524 6 Diabetes mellitus 35,478 Accidents (unintentional injuries) 43,879 Heart diseases 445 Intentional self‐harm (suicide) 313 HIV disease 1,650 HIV disease 950 Diabetes mellitus 7,304 Chronic lower respiratory diseases 4,475 Accidents (unintentional injuries) 12,311 Nephritis, nephrotic syndrome & nephrosis 7,935 Influenza & pneumonia 14,099 Influenza & pneumonia 20,555 7 Intentional self‐harm (suicide) 27,269 Diabetes mellitus 35,904 Chronic lower respiratory diseases 151 Influenza & pneumonia 134 Diabetes mellitus 905 Cerebro‐ vascular disease 636 Cerebro‐vascular disease 7,006 Chronic liver disease & cirrhosis 4,229 Nephritis, nephrotic syndrome & nephrosis 8,665 Accidents (unintentional injuries) 7,457 Nephritis, nephrotic syndrome & nephrosis 10,868 Diabetes mellitus 15,909 8 Influenza & pneumonia 24,071 Influenza & pneumonia 28,646 Influenza & pneumonia 130 Cerebro‐vascular disease 109 Chronic liver disease & cirrhosis 765 Pregnancy, childbirth & puerperium 598 HIV disease 5,451 Intentional self‐harm (suicide) 3,612 Influenza & pneumonia 7,046 Alzheimer disease 7,191 Diabetes mellitus 10,495 Nephritis, nephrotic syndrome & nephrosis 13,479 9 Nephritis, nephrotic syndrome & nephrosis 22,616 Nephritis, nephrotic syndrome & nephrosis 23,832 Septecemia 113 Chronic lower respiratory diseases 95 Cerebro‐ vascular disease 726 Diabetes mellitus 567 Chronic lower respiratory diseases 4,887 Septicemia 2,321 Chronic liver disease & cirrhosis 6,859 Septicemia 6,639 Accidents (unintentional injuries) 10,164 Accidents (unintentional injuries) 13,453 10 Alzheimer disease 21,800 Septicemia 18,989 Cerebro‐ vascular disease 97 Septecemia 92 Congenital anomalies 490 Chronic liver disease & cirrhosis 388 Viral hepatitis 3,463 Nephritis, nephrotic syndrome & nephrosis 2,036 Septicemia 6,608 Influenza & pneumonia 5,997 Parkinson disease 7,422 Hypertension & hypertensive renal disease * 10,126 * Includes primary and secondary hypertension. Note: Deaths within each age group do not sum to all ages combined due to 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, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. 6 Death Rates* For Cancer and Heart Disease for Ages Younger Than 85 Years and 85 Years and Older, 1975 to 2006. *Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention. 7 Total Number of Cancer Deaths Avoided From 1991 to 2006 in Males and From 1992 to 2006 in Females. 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. Table 10 presents the number of deaths from all cancers combined and from the 5 most common cancer sites for each 20‐year age group. Among males aged younger than 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 ages 40 to 79 years, and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 20 years, breast cancer ranks first at 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, 2007 ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥ 80 MALE ALL SITES 292,857 ALL SITES 1,124 ALL SITES 4,041 ALL SITES 54,054 ALL SITES 152,231 ALL SITES 81,403 Lung & bronchus 88,331 Leukemia 365 Leukemia 522 Lung & bronchus 15,174 Lung & bronchus 53,125 Lung & bronchus 19,751 Prostate 29,093 Brain & ONS * 260 Brain & ONS * 502 Colorectum 5,434 Colorectum 13,370 Prostate 15,670 Colorectum 27,005 Bones & joints 92 Colorectum 395 Liver & bile duct 3,944 Prostate 12,187 Colorectum 7,795 Pancreas 17,132 Other endocrine system 92 Non‐Hodgkin lymphoma 301 Pancreas 3,638 Pancreas 9,293 Urinary bladder 4,216 Leukemia 12,435 Soft tissue 72 Lung & bronchus 268 Esophagus 2,695 Esophagus 5,958 Pancreas 4,084 FEMALE ALL SITES 270,018 ALL SITES 944 ALL SITES 4,639 ALL SITES 50,640 ALL SITES 126,918 ALL SITES 86,873 Lung & bronchus 70,355 Leukemia 278 Breast 1,094 Breast 11,630 Lung & bronchus 40,187 Lung & bronchus 18,519 Breast 40,599 Brain & ONS * 261 Uterine cervix 468 Lung & bronchus 11,412 Breast 16,900 Colorectum 11,298 Colorectum 26,216 Other endocrine system 81 Leukemia 393 Colorectum 4,150 Colorectum 10,459 Breast 10,973 Pancreas 16,985 Bones & joints 80 Colorectum 304 Ovary 3,151 Pancreas 8,211 Pancreas 6,283 Ovary 14,621 Soft tissue 68 Brain & ONS * 300 Pancreas 2,417 Ovary 7,195 Non‐Hodgkin lymphoma 4,171 * ONS = Other nervous system. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. “Other and unspecified malignant neoplasm” is excluded from cause of death ranking order. Source: US Mortality Data, 2007, National Center for Health Statistics, Centers for Disease Control and Prevention. Cancer Occurrence by Race/Ethnicity Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11 ), although the extent of variation may be affected by misclassification of race and ethnicity on medical records, including death certificates. 26 For all cancer sites combined, African American men have a 14% higher incidence rate and a 34% higher death rate than white men, whereas African American women have a 7% 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 compared with 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 screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. The higher breast cancer incidence rates observed among white women are believed to reflect a combination of factors that affect both diagnosis (eg, more frequent mammography in white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white compared with black women). 21 11 Incidence and Death Rates * by Site, Race, and Ethnicity, United States, 2002–2006 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE † HISPANIC/LATINO ‡ Incidence All sites Male 550.1 626.0 334.5 318.4 430.3 Female 420.0 389.5 276.3 265.1 326.8 Breast (female) 123.5 113.0 81.6 67.2 90.2 Colorectum Male 58.2 68.4 44.1 38.1 50.0 Female 42.6 51.7 33.1 30.7 35.1 Kidney & renal pelvis Male 19.7 20.6 9.0 16.6 18.2 Female 10.3 10.6 4.5 10.6 10.3 Liver & bile duct Male 8.0 12.5 21.4 8.9 15.9 Female 2.8 3.8 8.1 4.6 6.2 Lung & bronchus Male 85.9 104.8 50.6 57.9 49.2 Female 57.1 50.7 27.6 41.3 26.5 Prostate 146.3 231.9 82.3 82.7 131.1 Stomach Male 8.9 16.7 17.5 9.4 14.3 Female 4.2 8.5 9.8 4.7 8.6 Uterine cervix 7.9 11.1 7.6 6.6 12.7 Mortality All sites Male 226.7 304.2 135.4 183.3 154.8 Female 157.3 183.7 95.1 140.1 103.9 Breast (female) 23.9 33.0 12.5 17.6 15.5 Colorectum Male 21.4 31.4 13.8 20.0 16.1 Female 14.9 21.6 10.0 13.7 10.7 Kidney & renal pelvis Male 6.1 6.0 2.4 9.0 5.2 Female 2.8 2.7 1.2 4.2 2.4 Liver & bile duct Male 6.8 10.8 15.0 10.3 11.3 Female 2.9 3.9 6.6 6.5 5.1 Lung & bronchus Male 69.9 90.1 36.9 48.0 33.9 Female 41.9 40.0 18.2 33.5 14.4 Prostate 23.6 56.3 10.6 20.0 19.6 Stomach Male 4.8 11.0 9.6 9.8 8.3 Female 2.4 5.3 5.8 4.6 4.8 Uterine cervix 2.2 4.6 2.2 3.4 3.1 * Per 100,000 population, age adjusted to the 2000 US standard population. † Data based on Contract Health Service Delivery Areas, compromising about 55% of the US American Indian/Alaska Native population; for more information please see: Espey DK, et al. 16 ‡ Persons of Hispanic/Latino origin may be of any race. Source: Edwards, et al. 15 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 4 most common cancer sites. However, incidence and death rates for cancer sites related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders compared with whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses, respectively, in this population. 22 Kidney cancer death rates are the highest among American Indians/Alaskan Natives; the higher prevalence of obesity and smoking in this population may contribute to this disparity. 16 Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because the long‐term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1997 through 2006, 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 males and females. Among American Indians/Alska Natives residing in Indian Health Service Contract Health Service Delivery Areas, incidence and mortality rates decreased in men but remained stable in women during this time period. 15 Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (38%) (Table 12 ). 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. 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. 12 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2004–2006 * BIRTH TO 39 (%) 40 TO 59 (%) 60 TO 69 (%) 70 AND OLDER (%) BIRTH TO DEATH (%) All sites † Male 1.43 (1 in 70) 8.42 (1 in 12) 15.61 (1 in 6) 37.84 (1 in 3) 44.05 (1 in 2) Female 2.10 (1 in 48) 8.97 (1 in 11) 10.18 (1 in 10) 26.47 (1 in 4) 37.63 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4,741) 0.39 (1 in 257) 0.95 (1 in 106) 3.66 (1 in 27) 3.81 (1 in 26) Female 0.01 (1 in 10,613) 0.12 (1 in 815) 0.26 (1 in 385) 1.01 (1 in 99) 1.18 (1 in 84) Breast Female 0.49 (1 in 206) 3.75 (1 in 27) 3.40 (1 in 29) 6.50 (1 in 15) 12.08 (1 in 8) Colorectum Male 0.08 (1 in 1,269) 0.91 (1 in 110) 1.48 (1 in 67) 4.50 (1 in 22) 5.39 (1 in 19) Female 0.08 (1 in 1,300) 0.72 (1 in 139) 1.07 (1 in 94) 4.09 (1 in 24) 5.03 (1 in 20) Leukemia Male 0.17 (1 in 603) 0.21 (1 in 475) 0.33 (1 in 299) 1.19 (1 in 84) 1.51 (1 in 66) Female 0.13 (1 in 798) 0.15 (1 in 690) 0.20 (1 in 504) 0.78 (1 in 128) 1.08 (1 in 92) Lung & bronchus Male 0.03 (1 in 3,461) 0.95 (1 in 105) 2.35 (1 in 43) 6.71 (1 in 15) 7.73 (1 in 13) Female 0.03 (1 in 3,066) 0.79 (1 in 126) 1.75 (1 in 57) 4.83 (1 in 21) 6.31 (1 in 16) Melanoma of the skin § Male 0.16 (1 in 638) 0.64 (1 in 155) 0.72 (1 in 138) 1.77 (1 in 56) 2.67 (1 in 37) Female 0.28 (1 in 360) 0.55 (1 in 183) 0.36 (1 in 274) 0.79 (1 in 126) 1.79 (1 in 56) Non‐Hodgkin lymphona Male 0.13 (1 in 782) 0.44 (1 in 225) 0.59 (1 in 171) 1.71 (1 in 58) 2.28 (1 in 44) Female 0.09 (1 in 1,172) 0.32 (1 in 315) 0.44 (1 in 227) 1.39 (1 in 72) 1.92 (1 in 52) Prostate Male 0.01 (1 in 9,422) 2.44 (1 in 41) 6.45 (1 in 16) 12.48 (1 in 8) 15.90 (1 in 6) Uterine cervix Female 0.15 (1 in 648) 0.27 (1 in 374) 0.13 (1 in 755) 0.19 (1 in 552) 0.69 (1 in 145) Uterine corpus Female 0.07 (1 in 1,453) 0.73 (1 in 136) 0.83 (1 in 121) 1.23 (1 in 81) 2.53 (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 6.4.0. Statistical Research and Applications Branch, National Cancer Institute, 2009. www.srab.cancer.gov/devcan Cancer Survival By Race Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5‐year relative survival is lower in African Americans than in whites for every 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 are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear. 23 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 24 8 Five‐Year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005. *The standard error of the survival rate is between 5 and 10 percentage points. †The survival rate for in situ urinary bladder cancer is 97% for all races combined, whites, and African Americans. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005. *The proportion of in situ urinary bladder cancer cases is 50%, 51%, and 36% in all races combined, whites, and African Americans, respectively. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 There have been notable improvements since 1975 in the relative 5‐year survival rates for many cancer sites for both whites and African Americans (Table 13 ). Cancers for which survival has not improved substantially over the past 30 years include those of the lung and pancreas. The improvement in survival reflects a combination of earlier diagnosis and improved treatments. 13 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975–2005 ALL RACES WHITE AFRICAN AMERICAN 1975 TO 1977 1984 TO 1986 1999 TO 2005 1975 TO 1977 1984 TO 1986 1999 TO 2005 1975 TO 1977 1984 TO 1986 1999 TO 2005 All sites 50 54 68 † 51 55 69 † 40 41 59 † Brain 24 29 36 † 23 28 35 † 27 32 41 † Breast (female) 75 79 90 † 76 80 91 † 62 65 79 † Colon 52 59 66 † 52 60 67 † 46 50 56 † Esophagus 5 10 19 † 6 11 20 † 3 8 13 † Hodgkin lymphoma 74 79 86 † 74 80 87 † 71 75 81 † Kidney 51 56 69 † 51 56 69 † 50 54 66 † Larynx 67 66 63 † 67 68 66 59 53 50 Leukemia 35 42 54 † 36 43 55 † 34 34 46 † Liver & bile duct 4 6 14 † 4 6 13 † 2 5 10 † Lung & bronchus 13 13 16 † 13 14 17 † 12 11 13 † Melanoma of the skin 82 87 93 † 82 87 93 † 60 ‡ 70 § 78 ‡ Myeloma 26 29 37 † 25 27 38 † 31 32 36 † Non‐Hodgkin lymphoma 48 53 69 † 48 54 70 † 49 48 60 † Oral cavity 53 55 63 † 55 57 64 † 36 36 46 † Ovary 37 40 46 † 37 39 46 † 43 41 37 Pancreas 3 3 6 † 3 3 6 † 2 5 5 † Prostate 69 76 100 † 70 77 100 † 61 66 98 † Rectum 49 57 69 † 49 58 69 † 45 46 61 † Stomach 16 18 27 † 15 18 25 † 16 20 26 † Testis 83 93 96 † 83 93 97 † 73 ‡ # 87 ‡ 87 Thyroid 93 94 97 † 93 94 98 † 91 90 96 Urinary bladder 74 78 82 † 75 79 83 † 51 61 68 † Uterine cervix 70 68 72 † 71 70 73 65 58 65 Uterine corpus 88 84 84 † 89 85 87 † 61 58 62 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 9 areas from 1975–77, 1984–86, and 1999–2005 and followed through 2006. † The difference in rates between 1975–1977 and 1999–2005 is statistically significant ( P < 0.05). ‡ 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. # Survival rate is for 1978–1980. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 Relative survival rates cannot be calculated for racial and ethnic populations other than 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 between 1999 and 2005 in SEER areas of the United States, all minority male populations have a greater probability of dying from cancer within 5 years of diagnosis than whites. Among women, African Americans have the lowest 5‐year, cancer‐specific survival (55.8%), followed by American Indians/Alaska Natives (60.0%), whites (65.5%), Hispanics (66.4%), and Asians/Pacific Islanders (68.0%). 2 For all 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely to be diagnosed at distant stage, compared with whites (Fig. 9 ). 25 Cancer in Children Cancer is the second most common cause of death among children between the ages of 1 and 14 years in the United States, surpassed only by accidents (Table 14 ). Nearly one‐third of the cancers diagnosed in children ages birth to 14 years are leukemias (particularly acute lymphocytic leukemia), followed by cancer of the brain and other nervous system (21%), soft tissue sarcomas (including neuroblastoma [7%] and rhabdomyosarcoma [3%]), renal (Wilms) tumors (5%), and non‐Hodgkin lymphoma (4%). Over the past 25 years, there have been significant improvements in the 5‐year relative survival rate for all of the major childhood cancers (Table 15 ). The 5‐year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed between 1975 and 1977 to 81% for those diagnosed between 1999 and 2005. 2 14 Ten Leading Causes of Death Among Children Ages 1 to 14, United States, 2007 RANK CAUSE OF DEATH NUMBER OF DEATHS % OF TOTAL DEATHS DEATH RATE * ALL CAUSES 10,850 100.0 18.9 1 Accidents (unintentional injuries) 3,782 34.9 6.6 2 Cancer 1,323 12.2 2.3 3 Congenital anomalies 920 8.5 1.6 4 Assault (homicide) 744 6.9 1.3 5 Heart diseases 414 3.8 0.7 6 Influenza & pneumonia 212 2.0 0.4 7 Intentional self‐harm (suicide) 184 1.7 0.3 8 Chronic lower respiratory diseases 175 1.6 0.3 9 Septicemia 152 1.4 0.3 10 In situ, benign, & unknown neoplasms 143 1.3 0.3 All other causes 2,801 25.8 * 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, 2007. National Center for Health Statistics, Centers for Disease Control and Prevention. 15 Trends in Five‐year Relative Survival Rates * (%) for Children Under Age 15, US, 1975 to 2005 SITE YEAR OF DIAGNOSIS 1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 1998 1999 TO 2005 All sites 58 63 67 68 72 76 77 79 81 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 87 89 † Acute myeloid leukemia 19 26 27 ‡ 31 ‡ 37 ‡ 41 42 ‡ 49 60 † Bone & joint 50 ‡ 48 57 ‡ 58 ‡ 67 ‡ 67 74 70 72 † Brain & other nervous system 57 58 56 62 64 64 70 75 74 † Hodgkin lymphoma 81 88 88 91 87 97 95 96 95 † Neuroblastoma 52 57 55 52 62 76 67 66 74 † Non‐Hodgkin lymphoma 44 53 67 70 71 76 81 83 86 † Soft tissue 61 75 69 73 66 80 77 70 81 † Wilms tumor 73 79 87 91 92 92 92 92 91 † * Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2006. † The difference in rates between 1975 to 1977 and 1999 to 2005 is statistically significant ( P < 0.05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. Note: Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Horner MJ, Ries LAG, Krapcho M, et al. 2 Limitations Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are based on models and may vary considerably from year to year. 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. 12 Not all changes in cancer trends are captured by modeling techniques and sometimes the model may be too sensitive to recent trends, resulting in over‐ or underestimates. 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 age‐standardized or age‐specific cancer incidence rates from SEER or NPCR and cancer death rates from the NCHS. 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. Errors in reporting race/ethnicity in medical records and death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and nonblack populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic minority groups that are not homogenous, and thus significant differences in the cancer burden within racial/ethnic subgroups may be masked. 26

Journal

CA: A Cancer Journal for CliniciansWiley

Published: Sep 1, 2010

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