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Cancer statistics, 2013

Cancer statistics, 2013 Introduction Cancer is a major public health problem in the United States and many other parts of the world. One in 4 deaths in the United States is due to cancer. In this article, we provide the expected numbers of new cancer cases and deaths in 2013 nationally and by state, as well as an overview of current cancer statistics using data through 2009, including incidence, mortality, and survival rates and trends. We also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s, and provide the actual reported numbers of deaths in 2009 by age for the 10 leading causes of death and the 5 leading cancer types. Materials and Methods Incidence and Mortality Data Mortality data from 1930 to 2009 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 , 2 There are several sources for cancer incidence data. The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute reports long‐term (beginning in 1973), high‐quality, population‐based incidence data covering up to 26% of the US population. Cancer incidence rates for long‐term trends (1975‐2009), 5‐year relative and cause‐specific survival rates (2002‐2008), and estimations of the lifetime probability of developing cancer (2007‐2009) were obtained from SEER registries. 3‐6 The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). Incidence data for state‐level rates (2005‐2009), trends by race/ethnicity (2000‐2009), and estimated new cancer cases in 2013 were obtained from NAACCR. 7 Cancer cases were classified according to the International Classification of Diseases for Oncology . 8 All incidence and death rates are age‐standardized to the 2000 US standard population and expressed per 100,000 persons. Cancer incidence rates in this report are delay‐adjusted whenever possible in order to account for anticipated future corrections to registry data due to inherent delays and errors in case reporting. Delay‐adjusted rates primarily affect the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate) and provide a more accurate portrayal of the cancer burden in the most recent time period. 9 For example, melanoma incidence rates adjusted for delays in reporting are 14% higher than unadjusted rates in the most recent reporting year. Delay‐adjusted rates are available for SEER registry data and were obtained from the National Cancer Institute. Incidence trends presented for the most recent 5 years (2005‐2009) are based on delay‐adjusted rates from SEER 13 cancer registries. 4 Projected Cancer Cases and Deaths in 2013 The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection, compilation, quality control, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in 2013 in order to provide an estimate of the contemporary cancer burden. The methods for projecting both new cases and deaths in the current year were recently modified so estimates should not be compared from year to year. We projected the number of new invasive cancer cases that will be diagnosed in 2013 (with the exception of urinary bladder, for which in situ cases are included) using a 2‐step process that first estimates complete incidence counts by state during years for which observed data are available, and then projects these counts 4 years ahead for the United States overall and each state individually. 10 To estimate counts for each state through 2009, we used a spatiotemporal model based on incidence data for 1995 through 2009 from 49 states and the District of Columbia that met NAACCR's high‐quality data standard for incidence, covering about 98% of the US population. 11 (Minnesota cancer registry data could not be included in the model because county‐level data were unavailable.) This method accounts for expected delays in case reporting and considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. A temporal projection method (the vector autoregressive model) was then applied to the estimated counts to obtain projections for 2013. For the complete details of this methodology, please refer to Zhu et al. 10 To estimate the numbers of new breast carcinoma in situ (female) and melanoma in situ cases in 2013, we first estimated the number of in situ cases occurring annually from 2000 through 2009 in the United States by applying the age‐specific incidence rates in the 18 SEER areas to the corresponding US population estimates provided in SEER*Stat. 12 We then projected the total number of cases in 2013 based on the annual percent change from 2000 through 2009 generated by the joinpoint regression model. 13 We estimated the number of cancer deaths expected to occur in 2013 in the United States overall and in each state using the joinpoint regression model based on the actual numbers of cancer deaths from 1995 through 2009 at the state and national levels as reported to the NCHS. 1 For the complete details of this methodology, please refer to Chen et al. 14 Other Statistics The estimated numbers of cancer deaths averted in men and women due to the reduction in overall cancer death rates were calculated by applying the 5‐year age‐specific cancer death rates in the peak year for age‐standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age‐specific populations in the subsequent years through 2009 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. Selected Findings Expected Numbers of New Cancer Cases Table 1 presents the estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2013. The overall estimate of more than 1.6 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell or squamous cell cancers of the skin. About 64,640 cases of breast carcinoma in situ and 61,300 cases of melanoma in situ are expected to be newly diagnosed in 2013. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2 . 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2013 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All sites 1,660,290 854,790 805,500 580,350 306,920 273,430 Oral cavity & pharynx 41,380 29,620 11,760 7,890 5,500 2,390 Tongue 13,590 9,900 3,690 2,070 1,380 690 Mouth 11,400 6,730 4,670 1,800 1,080 720 Pharynx 13,930 11,200 2,730 2,400 1,790 610 Other oral cavity 2,460 1,790 670 1,640 1,260 380 Digestive system 290,200 160,750 129,450 144,570 82,700 61,870 Esophagus 17,990 14,440 3,550 15,210 12,220 2,990 Stomach 21,600 13,230 8,370 10,990 6,740 4,250 Small intestine 8,810 4,670 4,140 1,170 610 560 Colon † 102,480 50,090 52,390 50,830 26,300 24,530 Rectum 40,340 23,590 16,750 Anus, anal canal, & anorectum 7,060 2,630 4,430 880 330 550 Liver & intrahepatic bile duct 30,640 22,720 7,920 21,670 14,890 6,780 Gallbladder & other biliary 10,310 4,740 5,570 3,230 1,260 1,970 Pancreas 45,220 22,740 22,480 38,460 19,480 18,980 Other digestive organs 5,750 1,900 3,850 2,130 870 1,260 Respiratory system 246,210 131,760 114,450 163,890 90,600 73,290 Larynx 12,260 9,680 2,580 3,630 2,860 770 Lung & bronchus 228,190 118,080 110,110 159,480 87,260 72,220 Other respiratory organs 5,760 4,000 1,760 780 480 300 Bones & joints 3,010 1,680 1,330 1,440 810 630 Soft tissue (including heart ) 11,410 6,290 5,120 4,390 2,500 1,890 Skin (excluding basal & squamous ) 82,770 48,660 34,110 12,650 8,560 4,090 Melanoma‐skin 76,690 45,060 31,630 9,480 6,280 3,200 Other nonepithelial skin 6,080 3,600 2,480 3,170 2,280 890 Breast 234,580 2,240 232,340 40,030 410 39,620 Genital system 339,810 248,080 91,730 58,480 30,400 28,080 Uterine cervix 12,340 12,340 4,030 4,030 Uterine corpus 49,560 49,560 8,190 8,190 Ovary 22,240 22,240 14,030 14,030 Vulva 4,700 4,700 990 990 Vagina & other genital, female 2,890 2,890 840 840 Prostate 238,590 238,590 29,720 29,720 Testis 7,920 7,920 370 370 Penis & other genital, male 1,570 1,570 310 310 Urinary system 140,430 96,800 43,630 29,790 20,120 9,670 Urinary bladder 72,570 54,610 17,960 15,210 10,820 4,390 Kidney & renal pelvis 65,150 40,430 24,720 13,680 8,780 4,900 Ureter & other urinary organs 2,710 1,760 950 900 520 380 Eye & orbit 2,800 1,490 1,310 320 120 200 Brain & other nervous system 23,130 12,770 10,360 14,080 7,930 6,150 Endocrine system 62,710 16,210 46,500 2,770 1,270 1,500 Thyroid 60,220 14,910 45,310 1,850 810 1,040 Other endocrine 2,490 1,300 1,190 920 460 460 Lymphoma 79,030 42,670 36,360 20,200 11,250 8,950 Hodgkin lymphoma 9,290 5,070 4,220 1,180 660 520 Non‐Hodgkin lymphoma 69,740 37,600 32,140 19,020 10,590 8,430 Myeloma 22,350 12,440 9,910 10,710 6,070 4,640 Leukemia 48,610 27,880 20,730 23,720 13,660 10,060 Acute lymphocytic leukemia 6,070 3,350 2,720 1,430 820 610 Chronic lymphocytic leukemia 15,680 9,720 5,960 4,580 2,750 1,830 Acute myeloid leukemia 14,590 7,820 6,770 10,370 5,930 4,440 Chronic myeloid leukemia 5,920 3,420 2,500 610 340 270 Other leukemia ‡ 6,350 3,570 2,780 6,730 3,820 2,910 Other & unspecified primary sites ‡ 31,860 15,450 16,410 45,420 25,020 20,400 * Rounded to the nearest 10; estimated new cases exclude basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 64,640 carcinoma in situ of the female breast and 61,300 melanoma in situ will be newly diagnosed in 2013. † 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 and/or an undercount in the case estimate. 2 Incidence Rates for All Cancers Combined (2005‐2009) and Estimated New Cases * for Selected Cancers (2013) by State STATE INCIDENCE RATE † ALL SITES FEMALE BREAST UTERINE CERVIX COLORECTUM UTERINE CORPUS LEUKEMIA LUNG & BRONCHUS MELANOMA OF THE SKIN NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER Alabama 473.2 27,080 3,720 200 2,390 610 640 4,550 1,300 990 3,940 960 Alaska 474.6 3,290 510 ‡ 310 90 100 470 90 140 440 140 Arizona 394.9 34,010 4,660 220 2,630 860 920 4,250 1,400 1,360 4,340 1,400 Arkansas § 461.8 16,330 2,280 150 1,540 370 450 2,700 530 680 2,370 610 California 444.1 171,330 25,360 1,480 14,690 5,160 5,210 18,720 8,530 7,280 23,740 6,920 Colorado 436.6 23,410 3,300 160 1,880 690 840 2,550 1,310 1,050 3,870 990 Connecticut 515.0 21,180 3,050 110 1,670 740 570 2,780 1,080 890 2,940 1,090 Delaware 519.7 5,370 770 ‡ 430 170 140 760 300 220 860 250 Dist. of Columbia § 468.5 2,920 450 ‡ 240 90 70 320 90 100 500 90 Florida 458.1 118,320 15,710 940 10,290 3,110 3,490 17,960 5,330 5,060 17,330 5,720 Georgia 467.3 49,280 7,310 420 3,970 1,230 1,290 6,690 2,360 1,810 7,930 1,610 Hawaii 443.4 6,650 960 50 730 240 180 900 380 240 800 200 Idaho 463.2 7,670 1,010 50 670 220 270 930 420 360 1,330 380 Illinois 491.4 66,090 9,350 500 6,140 2,150 2,020 9,270 2,480 2,840 9,230 2,990 Indiana 467.8 35,550 4,540 260 3,250 1,040 1,000 5,500 1,470 1,460 4,310 1,560 Iowa 489.9 17,480 2,310 90 1,640 580 590 2,350 980 790 2,270 810 Kansas 480.3 14,370 2,160 90 1,250 440 450 1,930 800 650 2,020 600 Kentucky 523.1 25,100 3,300 190 2,300 700 720 4,560 1,540 1,100 3,130 1,060 Louisiana 496.6 24,930 3,630 220 2,400 550 660 3,740 770 950 4,040 930 Maine 522.3 9,190 1,150 50 730 310 280 1,380 440 390 1,290 530 Maryland 460.6 30,680 4,760 220 2,410 950 780 4,040 1,530 1,180 4,880 1,220 Massachusetts 506.8 38,250 5,820 210 2,910 1,280 990 4,880 1,840 1,590 5,700 2,060 Michigan 492.7 57,560 8,140 330 4,730 1,920 1,750 8,250 2,900 2,530 9,490 2,860 Minnesota 483.8 28,410 4,260 120 2,220 890 950 3,860 1,020 1,210 4,090 1,190 Mississippi 485.2 15,830 2,080 130 1,580 340 390 2,630 550 560 2,490 540 Missouri 474.6 33,950 4,680 250 3,110 1,040 980 5,410 1,500 1,480 4,170 1,480 Montana 468.8 5,450 740 ‡ 510 160 180 700 250 260 870 280 Nebraska 475.9 9,060 1,230 50 910 290 310 1,220 460 430 1,290 420 Nevada 454.6 13,830 1,760 120 1,350 330 400 1,970 440 520 1,900 660 New Hampshire 507.6 8,470 1,180 50 640 290 240 1,150 410 350 1,180 460 New Jersey 509.0 49,440 6,960 460 4,640 1,740 1,430 5,960 2,520 2,190 7,190 2,450 New Mexico 418.8 10,090 1,360 80 860 270 330 1,050 460 400 1,610 380 New York 498.5 108,760 14,950 850 9,210 3,850 3,270 13,480 4,200 4,740 16,720 5,510 North Carolina 484.1 53,200 7,430 360 4,260 1,430 1,470 8,040 2,620 2,080 8,150 2,070 North Dakota 478.4 3,510 450 ‡ 370 100 120 460 150 150 550 170 Ohio 470.8 66,610 9,060 440 5,890 2,230 1,770 10,230 2,960 2,840 8,530 3,020 Oklahoma 484.2 20,160 2,690 170 1,780 500 610 3,370 770 840 2,500 790 Oregon 469.3 21,720 3,310 120 1,610 670 620 2,860 1,410 950 3,380 1,030 Pennsylvania 505.3 79,560 10,490 480 7,390 2,720 2,240 10,980 3,890 3,440 9,450 3,980 Rhode Island 514.1 6,280 900 ‡ 530 210 180 870 270 250 820 340 South Carolina 465.6 27,620 3,580 220 2,340 710 760 4,390 1,320 1,040 4,160 1,070 South Dakota 433.9 4,570 600 ‡ 430 140 150 620 200 200 730 220 Tennessee 475.7 36,580 5,070 280 3,180 900 990 6,200 1,900 1,450 4,990 1,440 Texas 452.1 112,230 14,980 1,110 9,750 2,870 3,740 15,000 3,930 4,830 15,730 4,030 Utah 400.1 10,810 1,550 70 740 320 380 800 720 490 1,960 420 Vermont 496.3 4,200 550 ‡ 320 130 110 590 220 170 560 210 Virginia § 460.3 40,870 6,280 300 3,270 1,240 990 5,380 2,380 1,590 6,840 1,590 Washington 486.4 37,290 5,610 230 2,730 1,140 1,160 4,700 2,350 1,650 5,690 1,690 West Virginia 496.8 11,450 1,460 80 1,180 350 330 2,100 540 470 1,470 530 Wisconsin § 463.2 31,590 4,490 190 2,610 1,080 1,050 4,310 1,250 1,400 4,370 1,530 Wyoming 444.7 2,700 380 ‡ 240 80 80 320 130 120 430 130 United States 473.4 1,660,290 232,340 12,340 142,820 49,560 48,610 228,190 76,690 69,740 238,590 72,570 * Rounded to the nearest 10; excludes basal cell 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. § Rate is for cases diagnosed during 2005 to 2008. Note: These model‐based estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusion of states with fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2013. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about 50% of all newly diagnosed cancers; prostate cancer alone will account for 28% (238,590) of incident cases in men. The 3 most commonly diagnosed types of cancer among women in 2013 will be breast, lung and bronchus, and colorectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 29% (232,340) of all new cancer cases among women. 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2013. *Estimates are rounded to the nearest 10 and exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Expected Numbers of Cancer Deaths Table 1 also shows the expected numbers of deaths from cancer projected for 2013. It is estimated that about 580,350 Americans will die from cancer this year, corresponding to almost 1600 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 causes of cancer death. These 4 cancers account for almost half (48%) of the total cancer deaths among men and women (Fig. 1 ). In 2013, lung cancer is expected to account for 26% of all female cancer deaths and 28% of all male cancer deaths. Table 3 provides the estimated numbers of cancer deaths in 2013 by state for selected cancer sites. 3 Death Rates for All Cancers Combined (2005‐2009) and Estimated Deaths * for Selected Cancers (2013) by State STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLORECTUM LEUKEMIA LIVER & INTRAHEPATIC BILE DUCT LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 198.2 10,430 250 690 970 400 330 3,290 320 270 630 550 Alaska 181.3 980 ‡ 70 80 ‡ ‡ 270 ‡ ‡ 60 50 Arizona 152.8 11,210 310 790 990 480 460 2,850 400 310 740 630 Arkansas 199.7 6,650 150 420 610 270 200 2,170 200 150 390 320 California 163.1 57,290 1,590 4,220 5,150 2,460 2,980 12,700 2,000 1,540 4,010 3,390 Colorado 154.6 7,350 230 510 680 320 290 1,710 250 230 500 440 Connecticut 173.4 6,890 170 460 470 290 230 1,740 230 170 530 400 Delaware 190.4 1,940 50 120 170 70 80 580 60 50 120 100 Dist. of Columbia 196.5 1,030 ‡ 80 100 ‡ 50 240 ‡ ‡ 80 80 Florida 170.0 42,370 880 2,660 3,640 1,770 1,550 12,070 1,400 930 2,770 2,200 Georgia 179.2 16,010 360 1,200 1,450 600 530 4,670 460 410 1,010 790 Hawaii 147.8 2,400 ‡ 140 230 80 120 580 80 50 210 110 Idaho 165.8 2,660 90 180 220 120 80 670 100 60 200 180 Illinois 186.6 24,000 530 1,610 2,230 1,010 750 6,560 780 550 1,620 1,230 Indiana 195.4 13,250 320 850 1,120 550 370 4,110 440 300 820 590 Iowa 178.3 6,420 190 400 580 280 200 1,780 230 170 390 350 Kansas 178.8 5,430 150 360 490 250 170 1,590 210 140 350 240 Kentucky 211.3 9,970 200 590 880 340 270 3,510 300 200 540 390 Louisiana 204.0 9,040 210 650 860 330 380 2,670 260 190 580 420 Maine 192.8 3,240 90 190 250 130 90 950 110 60 200 160 Maryland 184.1 10,480 230 800 930 410 380 2,810 310 250 730 560 Massachusetts 180.0 12,840 310 810 1,020 500 500 3,530 400 340 910 650 Michigan 187.5 20,570 540 1,360 1,700 910 670 5,940 730 490 1,460 890 Minnesota 169.9 9,610 250 610 770 440 330 2,500 340 240 630 520 Mississippi 204.7 6,300 140 420 630 250 210 2,010 170 110 380 330 Missouri 191.4 12,730 310 890 1,100 540 420 3,940 380 240 820 560 Montana 172.5 2,000 50 120 180 90 50 550 70 50 130 140 Nebraska 174.0 3,440 100 210 340 140 90 900 130 80 230 210 Nevada 183.0 4,760 140 360 450 180 210 1,480 140 100 350 290 New Hampshire 179.5 2,680 70 170 200 100 80 750 80 60 200 140 New Jersey 179.0 16,410 340 1,330 1,560 630 570 4,060 530 440 1,180 750 New Mexico 158.2 3,540 90 240 350 140 170 770 110 90 240 230 New York 166.7 34,240 780 2,390 3,020 1,450 1,410 8,790 1,090 900 2,500 1,770 North Carolina 186.3 18,620 390 1,260 1,510 710 620 5,660 550 420 1,150 910 North Dakota 171.1 1,280 ‡ 90 130 60 ‡ 310 ‡ ‡ 90 80 Ohio 194.9 25,130 590 1,720 2,170 980 750 7,350 800 560 1,620 1,240 Oklahoma 194.8 7,850 190 490 720 300 270 2,440 260 170 440 380 Oregon 179.8 7,820 230 490 660 320 310 2,110 280 220 520 460 Pennsylvania 187.5 28,680 600 1,950 2,540 1,190 930 7,640 1,020 730 1,950 1,430 Rhode Island 180.4 2,140 50 130 170 100 80 600 60 50 130 100 South Carolina 187.9 9,800 220 660 820 360 340 2,990 280 210 600 500 South Dakota 168.2 1,590 50 110 150 60 ‡ 440 50 ‡ 110 90 Tennessee 200.6 14,080 360 910 1,220 520 460 4,600 440 280 800 630 Texas 171.3 37,180 940 2,650 3,390 1,490 1,950 9,670 1,210 850 2,340 1,650 Utah 128.4 2,790 110 260 240 150 90 450 120 80 220 210 Vermont 176.2 1,300 ‡ 80 100 50 50 380 ‡ ‡ 90 60 Virginia 183.2 14,720 320 1,110 1,270 580 480 4,130 460 370 1,020 740 Washington 176.7 12,390 350 800 980 520 530 3,260 440 360 850 730 West Virginia 206.6 4,660 100 280 440 170 120 1,480 160 100 230 190 Wisconsin 178.6 11,220 310 700 880 520 370 2,980 400 300 770 630 Wyoming 169.8 950 ‡ 60 80 ‡ ‡ 240 ‡ ‡ 70 50 United States 178.7 580,350 14,080 39,620 50,830 23,720 21,670 159,480 19,020 14,030 38,460 29,720 * 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 the exclusion of states with fewer than 50 deaths. Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (45%) than for women (38%) (Table 4 ). However, because of the earlier median age at 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 over‐ or underestimate individual risk because of differences in exposure (eg, smoking history) and/or genetic susceptibility. 4 Probability (%) of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2007 to 2009 * BIRTH TO 39 40 TO 59 60 TO 69 70 AND OLDER BIRTH TO DEATH All sites † Male 1.46 (1 in 69) 8.79 (1 in 11) 16.03 (1 in 6) 38.07 (1 in 3) 44.81 (1 in 2) Female 2.20 (1 in 46) 9.19 (1 in 11) 10.39 (1 in 10) 26.69 (1 in 4) 38.17 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4,924) 0.37 (1 in 272) 0.92 (1 in 109) 3.69 (1 in 27) 3.81 (1 in 26) Female 0.01 (1 in 12,663) 0.12 (1 in 864) 0.24 (1 in 410) 0.98 (1 in 106) 1.15 (1 in 90) Breast Female 0.50 (1 in 202) 3.78 (1 in 26) 3.56 (1 in 28) 6.65 (1 in 15) 12.38 (1 in 8) Colorectum Male 0.08 (1 in 1,212) 0.94 (1 in 106) 1.40 (1 in 71) 4.19 (1 in 24) 5.17 (1 in 19) Female 0.08 (1 in 1,236) 0.75 (1 in 134) 0.98 (1 in 102) 3.80 (1 in 26) 4.78 (1 in 21) Leukemia Male 0.16 (1 in 612) 0.23 (1 in 440) 0.35 (1 in 288) 1.26 (1 in 80) 1.59 (1 in 63) Female 0.13 (1 in 746) 0.15 (1 in 655) 0.21 (1 in 481) 0.81 (1 in 123) 1.14 (1 in 88) Lung & bronchus Male 0.03 (1 in 3,552) 0.92 (1 in 109) 2.27 (1 in 44) 6.82 (1 in 15) 7.77 (1 in 13) Female 0.03 (1 in 3,287) 0.76 (1 in 131) 1.72 (1 in 58) 4.93 (1 in 20) 6.35 (1 in 16) Melanoma of the skin § Male 0.15 (1 in 691) 0.63 (1 in 160) 0.77 (1 in 130) 2.02 (1 in 50) 2.87 (1 in 35) Female 0.26 (1 in 391) 0.55 (1 in 181) 0.40 (1 in 248) 0.84 (1 in 120) 1.85 (1 in 54) Non‐Hodgkin lymphoma Male 0.13 (1 in 753) 0.44 (1 in 225) 0.60 (1 in 167) 1.77 (1 in 57) 2.34 (1 in 43) Female 0.09 (1 in 1,147) 0.31 (1 in 322) 0.44 (1 in 229) 1.40 (1 in 72) 1.93 (1 in 52) Prostate Male 0.01 (1 in 7,964) 2.68 (1 in 37) 6.78 (1 in 15) 12.06 (1 in 8) 16.15 (1 in 6) Uterine cervix Female 0.16 (1 in 641) 0.27 (1 in 374) 0.13 (1 in 795) 0.18 (1 in 551) 0.68 (1 in 147) Uterine corpus Female 0.07 (1 in 1,348) 0.77 (1 in 129) 0.89 (1 in 112) 1.25 (1 in 80) 2.64 (1 in 38) * For people free of cancer at beginning of age interval. † All sites excludes basal cell and squamous cell skin cancers and in situ cancers except urinary bladder. ‡ Includes in situ cancer cases. § Statistics for whites only. Trends in Cancer Incidence 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. While incidence rates are declining for most cancer sites, they are increasing among both men and women for melanoma of the skin and cancers of the liver and thyroid (Fig. 3 , Table 5 ). Table 5 shows incidence (delay‐adjusted) and mortality trends for all cancers combined and for selected cancer sites based on joinpoint regression analysis. Joinpoint is a tool used to describe and quantify trends by fitting observed rates to lines connected at “joinpoints” where trends change in direction or magnitude. 13 , 15 According to data from the SEER 13 cancer registries, incidence rates in the most recent 5 years (2005‐2009) decreased in males by 0.6% per year and were stable in females (Table 5 ). Incidence rates are decreasing for all 4 major cancer sites except female breast, for which rates remained relatively stable from 2005 to 2009 after decreasing by 2% per year from 1999 to 2005. Lung cancer incidence rates in women began declining in the late 1990s, more than a decade after the decline began in men. 6 Differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use; cigarette smoking prevalence peaked about 20 years later in women than in men. 16 Recent rapid declines in colorectal cancer incidence rates have largely been attributed to increases in screening that can detect and allow the removal of precancerous polyps. 17‐19 Although joinpoint trend analysis shows that the incidence rate for prostate cancer declined steadily by 1.9% per year from 2000 to 2009, it is important to realize that annual rates fluctuate widely (Fig. 3 ), likely reflecting variation in the prevalence of prostate‐specific antigen testing for the detection of prostate cancer. For example, in the SEER 13 areas, the delay‐adjusted prostate cancer incidence rate increased from 154 (per 100,000) to 164 from 2005 to 2006, then dropped from 168 to 153 from 2007 to 2008. 2 Trends in Cancer Incidence and Death Rates by Sex, United States, 1975 to 2009. Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. 3 Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2009. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Liver includes intrahepatic bile duct. 4 Trends in Death Rates Among Males for Selected Cancers, United States, 1930 to 2009. 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, colorectum, and liver are affected by these changes. 5 Trends in Death Rates Among Females for Selected Cancers, United States, 1930 to 2009. 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 uterus, ovary, lung and bronchus, and colorectum are affected by these changes. *Uterus includes uterine cervix and uterine corpus. 5 Trends in Cancer Incidence (Delay‐Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1992 to 2009 TREND 1 TREND 2 TREND 3 YEARS APC YEARS APC YEARS APC 2005‐2009 AAPC All sites Incidence Male 1992‐1994 −5.6 * 1994‐2009 −0.6 * −0.6 * Female 1992‐1998 0.8 * 1998‐2006 −0.5 * 2006‐2009 1.0 0.6 Death Male 1992‐2001 −1.4 * 2001‐2009 −1.8 * −1.8 * Female 1992‐1994 −0.2 1994‐2002 −0.8 * 2002‐2009 −1.5 * −1.5 * Lung & bronchus Incidence Male 1992‐2009 −1.9 * −1.9 * Female 1992‐1997 0.7 1997‐2009 −0.3 * −0.3 * Death Male 1992‐2005 −1.9 * 2005‐2009 −2.8 * −2.8 * Female 1992‐2002 0.6 * 2002‐2009 −1.0 * −1.0 * Colorectum Incidence Male 1992‐1995 −2.6 * 1995‐1998 1.5 1998‐2009 −2.6 * −2.6 * Female 1992‐1995 −1.8 * 1995‐1998 1.9 1998‐2009 −2.1 * −2.1 * Death Male 1992‐2002 −2.0 * 2002‐2005 −4.0 * 2005‐2009 −2.4 * −2.4 * Female 1992‐2001 −1.7 * 2001‐2009 −3.1 * −3.1 * Liver & intrahepatic bile duct Incidence Male 1992‐2009 3.7 * 3.7 * Female 1992‐2009 3.0 * 3.0 * Death Male 1992‐2009 2.3 * 2.3 * Female 1992‐2009 1.3 * 1.3 * Melanoma of skin Incidence Male 1992‐2009 2.5 * 2.5 * Female 1992‐1997 3.9 * 1997‐2009 1.7 * 1.7 * Death Male 1992‐2009 0.4 * 0.4 * Female 1992‐2009 −0.5 * −0.5 * Thyroid Incidence Male 1992‐1996 −1.4 1996‐2009 5.6 * 5.6 * Female 1992‐1999 4.1 * 1999‐2009 7.0 * 7.0 * Death Male 1992‐2009 1.6 * 1.6 * Female 1992‐1994 −6.4 1994‐2009 0.8 * 0.8 * Female breast Incidence 1992‐1999 1.3 * 1999‐2005 −2.0 * 2005‐2009 1.1 1.1 Death 1992‐1995 −1.3 * 1995‐1998 −3.4 * 1998‐2009 −1.9 * −1.9 * Prostate Incidence 1992‐1995 −11.1 * 1995‐2000 2.0 2000‐2009 −1.9 * −1.9 * Death 1992‐1994 −1.3 1994‐2009 −3.7 * −3.7 * APC indicates annual percent change based on incidence (delay‐adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change. * The APC or AAPC is significantly different from 0 ( P < .05). Note: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 3 joinpoints. Incidence trends based on Surveillance, Epidemiology, and End Results (SEER) 13 areas. Trends in Cancer Mortality Cancer death rates decreased by 1.8% per year in males and by 1.5% per year in females during the most recent 5 years of data (2005‐2009). These declines have been consistent since 2001 and 2002 in men and women, respectively, and are larger in magnitude than those occurring in the previous decade (Table 5 ). Death rates peaked in men in 1990 (279.8 per 100,000), in women in 1991 (175.3 per 100,000), and overall in 1991 (215.1 per 100,000). Between 1990/1991 and 2009, cancer death rates decreased 24% in men, 16% in women, and 20% overall. Figure 6 shows that as a result of almost two decades of consistent declines in cancer death rates, about 1,177,300 cancer deaths were averted, 152,900 of these in 2009 alone. Death rates continue to decrease for the 4 major cancer sites (Figs. 4 and 5 ). Over the past two decades of data, death rates have decreased from their peak by more than 30% for cancers of the colorectum, female breast, and male lung, and by more than 40% for prostate cancer. The decrease in lung cancer death rates—among men since 1990 and among women since 2002—is due to the reduction in tobacco use, 20 while the decrease in death rates for female breast, colorectal, and prostate cancers largely reflects improvements in early detection and/or treatment. 17 , 21 , 22 Over the past 10 years of data (2000‐2009), the largest annual declines in death rates were for chronic myeloid leukemia (8.4%), cancers of the stomach (3.1%) and colorectum (3.0%), and non‐Hodgkin lymphoma (3.0%). 6 Total Number of Cancer Deaths Averted From 1991 to 2009 in Men and From 1992 to 2009 in Women. The blue line represents the actual number of cancer deaths recorded in each year, and the red line represents the number of cancer deaths that would have been expected if cancer death rates had remained at their peak. Recorded Number of Deaths From Cancer in 2009 A total of 2,437,163 deaths were recorded in the United States in 2009, 567,628 of these from cancer. 23 Cancer is the second leading cause of death, following heart disease, accounting for 23% of all deaths. However, within 20‐year age groups, cancer is the leading cause of death among both men and women aged 40 to 79 years (Table 6 ). 6 Ten Leading Causes of Death by Age and Sex, United States, 2009 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 All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes 1,217,379 1,219,784 13,919 7,702 62,116 28,792 227,801 142,628 467,962 373,658 430,581 655,337 1 Heart Heart Accidents Accidents Accidents Accidents Cancer Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional 54,483 50,579 154,168 127,506 diseases diseases 307,225 292,188 injuries) injuries) injuries) injuries) 130,332 193,676 5,317 2,645 21,388 7,228 2 Cancer Cancer Assault Cancer Intentional Cancer Heart Heart Heart Heart Cancer Cancer 296,763 270,865 (homicide) 848 self‐harm 4,629 diseases diseases diseases diseases 82,765 87,264 2,031 (suicide) 52,826 21,353 118,163 74,294 8,977 3 Accidents Cerebro‐ Intentional Assault Assault Heart Accidents Accidents Chronic Chronic Chronic Cerebro‐ (unintentional vascular self‐harm (homicide) (homicide) diseases (unintentional (unintentional lower lower lower vascular injuries) disease (suicide) 569 7,214 2,393 injuries) injuries) respiratory respiratory respiratory disease 75,022 76,769 1,500 24,265 11,333 diseases diseases diseases 51,445 31,425 31,457 27,930 4 Chronic Chronic Cancer Congenital Heart Intentional Intentional Cerebro‐ Cerebro‐ Cerebro‐ Cerebro‐ Alzheimer lower lower 1,042 anomalies diseases self‐harm self‐harm vascular vascular vascular vascular disease respiratory respiratory 495 5,256 (suicide) (suicide) disease disease disease disease 47,856 diseases diseases 2,140 11,858 5,283 19,751 19,317 24,649 65,119 72,234 5 Cerebro‐ Alzheimer Congenital Intentional Cancer Assault Chronic liver Chronic Diabetes Diabetes Alzheimer Chronic vascular disease anomalies self‐harm 4,256 (homicide) disease & lower mellitus mellitus disease lower disease 55,103 563 (suicide) 1,443 cirrhosis respiratory 16,646 13,572 18,689 respiratory 52,073 434 10,562 diseases diseases 5,134 35,212 6 Diabetes Accidents Heart Heart HIV Pregnancy, Diabetes Chronic liver Accidents Nephritis, Influenza & Influenza & mellitus (unintentional diseases diseases disease childbirth mellitus disease & (unintentional nephrotic pneumonia pneumonia 35,054 injuries) 411 295 1,295 & puerperium 7,346 cirrhosis injuries) syndrome & 13,134 18,559 42,999 721 4,654 12,728 nephrosis 8,254 7 Intentional Diabetes Influenza & Influenza & Influenza & Influenza & Cerebro‐ Diabetes Nephritis, Accidents Nephritis, Diabetes self‐harm mellitus pneumonia pneumonia pneumonia pneumonia vascular mellitus nephrotic (unintentional nephrotic mellitus (suicide) 33,651 265 272 847 718 disease 4,477 syndrome & injuries) syndrome & 15,002 29,089 6,730 nephrosis 7,431 nephrosis 9,174 11,482 8 Influenza & Influenza & Chronic Chronic Chronic liver HIV Chronic Intentional Influenza & Alzheimer Accidents Nephritis, pneumonia pneumonia lower lower disease & disease lower self‐harm pneumonia disease (unintentional nephrotic 25,128 28,564 respiratory respiratory cirrhosis 686 respiratory (suicide) 7,616 7,060 injuries) syndrome & diseases diseases 825 diseases 3,813 10,590 nephrosis 157 118 5,265 14,302 9 Nephritis, Nephritis, Cerebro‐ Septicemia Diabetes Cerebro‐ HIV Influenza & Chronic liver Septicemia Diabetes Accidents nephrotic nephrotic vascular 99 mellitus vascular disease pneumonia disease & 6,919 mellitus (unintentional syndrome & syndrome & disease 812 disease 4,462 2,564 cirrhosis 10,209 injuries) nephrosis nephrosis 109 591 7,183 13,870 23,930 25,005 10 Alzheimer Septicemia Septicemia Cerebro‐ Cerebro‐ Diabetes Viral Septicemia Septicemia Influenza & Parkinson Hypertension disease 19,268 103 vascular vascular mellitus hepatitis 2,384 6,955 pneumonia disease & hypertensive 23,900 disease disease 564 3,456 6,350 7,864 renal disease * 72 744 10,444 HIV indicates human immunodeficiency virus. * 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, 2009, National Center for Health Statistics, Centers for Disease Control and Prevention, 2012. Table 7 presents the numbers of deaths for all cancers combined and for the 5 most common sites for each 20‐year age group. Among males, leukemia is the leading cause of cancer death among those aged younger than 40 years, while lung cancer ranks first among men aged 40 years and older. Among females, tumors of the brain and other nervous system are the leading cause of cancer death among children and adolescents (aged younger than 20 years), breast cancer ranks first among women aged 20 to 59 years, and lung cancer causes the most cancer deaths in those aged 60 years and older. 7 Five Leading Types of Cancer Death by Age and Sex, United States, 2009 ALL AGES < 20 20 TO 39 40 TO 59 60 TO 79 ≥ 80 MALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 296,758 1,086 4,256 54,483 154,168 82,765 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 87,697 330 590 14,960 52,272 20,171 Prostate Brain & ONS Brain & ONS Colorectum Colorectum Prostate 28,088 281 556 5,495 13,200 15,099 Colorectum Other endocrine system Colorectum Liver & intrahepatic bile duct Prostate Colorectum 26,807 99 456 4,553 11,717 7,652 Pancreas Bones & joints Non‐Hodgkin lymphoma Pancreas Pancreas Urinary bladder 17,870 93 305 3,662 9,871 4,579 Liver & intrahepatic bile duct Soft tissue Lung & bronchus Esophagus Liver & intrahepatic bile duct Pancreas 13,035 83 279 2,615 6,309 4,215 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 270,856 878 4,629 50,579 127,506 87,264 Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus 70,389 241 1,056 11,572 39,782 19,188 Breast Leukemia Uterine cervix Lung & bronchus Breast Breast 40,678 231 438 11,174 17,165 10,882 Colorectum Bones & joints Leukemia Colorectum Colorectum Colorectum 25,042 86 388 4,139 9,968 10,600 Pancreas Soft tissue Brain & ONS Ovary Pancreas Pancreas 17,758 81 333 3,189 8,782 6,371 Ovary Other endocrine system Colorectum Pancreas Ovary Non‐Hodgkin lymphoma 14,436 63 331 2,523 7,171 4,129 ONS indicates other nervous system. Note: Ranking order excludes “Miscellaneous malignant cancer” and “In situ, benign, or unknown behavior neoplasm.” Regional Variations in Cancer Rates Tables 8 and 9 depict cancer incidence and death rates for selected cancers by state. Lung cancer shows the largest geographic variation in cancer occurrence by far, reflecting the large historical and continuing differences in smoking prevalence among states. 20 For example, lung cancer incidence rates in Kentucky, which has historically had the highest smoking prevalence, are almost 4‐fold higher than those in Utah, which has the lowest smoking prevalence (128 vs 34 cases per 100,000 men). In contrast, state variations for other cancer sites are smaller in both absolute and proportionate terms. For example, the breast cancer incidence rate in Connecticut, which has the highest rate (137 per 100,000 women), is only 28% higher than that in Arizona, which has the lowest rate (107 per 100,000 women). For cancers that can be detected by screening or other testing practices, such as those of the prostate, female breast, and colorectum, state variation in incidence rates reflects differences in the utilization of these tests as well as differences in disease occurrence. 8 Incidence Rates for Selected Cancers by State, United States, 2005 to 2009 ALL CANCERS BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama * 582.4 395.4 119.4 59.7 41.3 104.8 54.6 19.5 13.4 162.1 33.2 7.4 Alaska 523.7 435.7 130.0 55.4 44.2 83.8 63.0 22.0 18.3 139.9 38.2 9.5 Arizona 439.6 361.0 106.7 41.9 31.8 62.5 48.2 17.6 13.3 118.1 31.5 8.3 Arkansas † 551.6 381.6 109.2 54.7 39.8 107.4 59.6 21.9 15.0 153.4 32.5 7.9 California 510.5 398.9 123.3 50.7 38.1 62.4 45.2 23.0 15.6 143.0 33.9 8.0 Colorado 493.9 396.4 125.4 46.0 35.1 57.2 44.6 22.2 15.8 152.3 31.8 8.3 Connecticut 594.1 462.5 137.3 55.3 41.1 78.5 61.0 25.9 17.9 165.2 47.9 12.5 Delaware 613.1 448.2 127.9 56.4 41.4 90.6 68.8 24.0 17.1 182.8 44.2 11.3 Dist. of Columbia † 562.6 399.0 128.3 53.0 42.2 77.2 45.9 21.3 13.5 185.1 24.6 8.0 Florida 528.3 403.1 114.9 49.6 37.9 82.8 58.1 21.7 15.2 137.7 35.6 8.8 Georgia 569.8 397.2 119.7 53.4 38.8 95.6 54.7 21.6 14.2 167.8 33.0 7.8 Hawaii 504.3 401.6 125.1 59.6 38.7 68.7 40.4 20.9 13.0 128.4 26.2 6.4 Idaho 528.7 411.6 119.1 45.8 36.5 64.6 48.1 22.1 17.3 160.1 36.7 8.9 Illinois 573.5 437.8 125.4 61.3 44.8 88.9 60.6 23.8 16.3 157.9 40.2 10.3 Indiana 539.3 421.5 116.9 57.5 43.3 99.5 64.0 23.1 17.0 129.2 36.3 8.9 Iowa 568.2 436.5 123.5 59.6 45.9 87.6 56.3 26.5 18.5 142.2 43.0 8.7 Kansas 563.8 422.2 124.6 57.6 40.4 85.0 55.0 23.6 17.2 157.3 38.2 9.3 Kentucky 615.4 459.7 121.2 65.7 46.9 128.2 80.1 25.1 17.3 139.0 40.3 9.9 Louisiana * 614.5 410.9 118.9 64.6 43.7 101.9 58.2 24.2 16.8 173.7 34.4 8.2 Maine 600.1 467.3 128.5 55.8 43.9 95.5 67.6 25.6 18.4 153.6 48.1 13.5 Maryland 532.8 411.8 124.8 49.9 37.9 77.3 56.6 21.1 14.2 158.4 33.5 9.3 Massachusetts 581.1 459.2 132.8 53.3 40.3 81.0 64.0 25.1 16.3 157.5 45.0 12.3 Michigan 578.0 433.3 120.3 52.9 40.9 87.3 61.3 24.8 17.8 166.5 42.5 10.9 Minnesota 566.5 424.4 128.5 51.2 40.1 66.7 49.8 26.9 18.1 179.0 40.0 9.6 Mississippi * 612.1 395.5 114.3 62.7 44.7 116.4 56.3 21.8 14.4 174.2 31.4 7.2 Missouri 548.3 423.4 121.9 58.3 42.0 100.0 64.7 22.3 15.9 132.9 36.3 8.4 Montana 531.6 417.9 123.0 52.7 38.5 73.0 58.5 23.0 15.3 164.1 37.6 9.7 Nebraska 547.1 426.6 124.7 62.8 46.2 78.2 51.7 24.2 17.7 150.9 35.8 8.9 Nevada 514.4 405.1 114.3 52.1 39.3 76.8 65.5 20.9 15.4 138.4 38.4 11.0 New Hampshire 584.8 452.4 132.5 51.9 39.5 81.4 62.2 23.9 17.4 155.1 48.1 13.3 New Jersey 593.0 454.1 130.0 58.2 43.0 76.1 56.8 25.5 17.6 172.4 45.1 11.8 New Mexico 480.8 370.5 111.4 46.4 34.6 55.7 39.3 19.1 14.5 141.6 26.9 6.4 New York 583.3 442.7 125.8 54.6 41.5 77.1 55.1 25.9 17.8 167.2 42.5 10.9 North Carolina 579.2 418.1 125.0 54.5 38.7 100.1 58.2 23.0 15.6 158.3 37.5 9.1 North Dakota 555.6 421.0 126.4 62.9 44.1 71.5 46.2 22.0 17.8 169.4 40.9 10.1 Ohio 546.5 421.5 119.6 56.3 42.3 93.2 60.0 23.0 16.0 144.1 39.0 9.7 Oklahoma 567.8 426.7 123.9 56.1 42.1 101.9 64.7 22.6 17.6 153.2 35.5 8.7 Oregon 521.7 432.3 130.7 47.9 38.3 74.2 59.2 23.3 16.1 145.1 37.6 10.0 Pennsylvania 583.8 453.7 125.8 59.4 44.5 87.5 58.2 25.4 17.8 154.1 44.5 11.0 Rhode Island 590.8 466.7 133.2 55.2 43.0 88.2 64.7 23.9 17.6 152.6 52.4 13.8 South Carolina 559.9 397.7 121.4 52.2 38.7 96.7 53.7 20.6 13.6 159.0 30.4 8.0 South Dakota 494.3 389.8 118.4 54.2 41.0 72.2 47.1 20.5 16.0 149.1 34.2 8.0 Tennessee 565.6 413.7 119.6 56.2 41.3 106.1 61.5 23.0 16.2 145.6 34.9 8.4 Texas * 533.7 394.6 116.1 53.0 37.0 81.8 49.9 22.6 15.9 142.7 30.1 6.9 Utah 469.7 345.2 108.0 39.3 31.3 33.8 22.8 23.0 15.5 169.8 28.8 5.6 Vermont 554.3 455.5 129.4 45.8 40.4 82.0 64.6 24.0 17.7 150.9 43.6 12.6 Virginia † 537.0 396.9 124.0 49.8 37.9 85.2 54.5 21.4 14.3 157.7 33.8 8.1 Washington 552.6 438.4 131.8 48.6 37.2 73.3 57.7 26.6 17.5 155.3 39.5 9.5 West Virginia 576.5 441.6 112.2 61.8 45.4 112.7 73.6 24.0 16.8 138.4 39.3 11.4 Wisconsin † 513.8 404.6 118.8 48.2 37.4 70.6 51.2 22.5 16.5 144.4 36.4 9.3 Wyoming 513.8 388.8 113.2 49.5 38.7 59.7 47.9 20.9 15.5 162.6 42.6 10.4 United States 550.7 419.3 122.3 54.0 40.3 82.7 55.9 23.3 16.2 151.4 37.5 9.3 Rates are per 100,000 and age adjusted to the 2000 US standard population. * Data for 2005 are limited to cases diagnosed from January through June due to the effect of large migrations of populations on this state as a result of Hurricane Katrina in September 2005. † This state's incidence data are not included in overall US rates because registry data submitted for 2009 did not meet high‐quality standards according to the North American Association of Central Cancer Registries. 9 Death Rates for Selected Cancers by State, United States, 2005 to 2009 ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PANCREAS PROSTATE STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE Alabama 259.0 157.4 24.0 22.9 15.1 89.4 41.1 8.3 5.3 13.3 9.5 28.7 Alaska 209.5 159.6 23.5 20.0 14.1 62.9 45.5 7.9 5.8 12.3 10.0 22.1 Arizona 182.1 130.0 20.5 16.8 11.6 50.2 33.2 7.5 4.8 10.9 7.9 19.7 Arkansas 253.7 161.2 23.6 22.5 15.2 92.5 46.3 8.8 5.2 13.6 9.4 25.3 California 194.9 141.7 22.3 18.1 12.9 49.2 33.1 8.1 5.0 11.8 9.4 23.2 Colorado 185.0 134.4 19.9 17.4 13.0 45.1 31.9 8.0 4.4 10.9 8.9 23.8 Connecticut 212.0 149.6 22.5 17.3 13.0 55.9 38.8 8.1 5.2 14.7 10.2 24.8 Delaware 229.6 162.8 23.0 20.3 14.3 69.2 48.5 8.4 5.0 12.3 9.7 24.9 Dist. of Columbia 256.3 160.4 28.0 23.1 17.7 64.7 34.8 9.4 3.5 16.3 10.7 41.3 Florida 206.0 141.9 21.5 18.3 13.0 63.5 39.3 7.8 4.9 12.0 8.7 19.6 Georgia 230.8 146.8 23.0 20.2 13.8 75.8 38.7 7.7 4.6 12.4 8.9 27.5 Hawaii 184.6 119.6 17.8 18.7 10.8 51.2 27.0 7.5 4.2 12.9 9.4 16.2 Idaho 195.9 143.5 21.3 15.9 13.4 51.3 35.6 8.1 5.4 11.5 9.8 26.7 Illinois 229.4 160.1 24.2 22.5 15.6 67.8 41.9 8.8 5.5 13.1 10.1 25.5 Indiana 244.9 163.2 23.9 22.5 15.0 82.0 47.2 9.7 5.6 13.1 9.4 23.8 Iowa 220.1 151.0 21.8 20.6 15.2 67.5 39.4 9.2 5.5 12.0 8.8 23.9 Kansas 221.5 149.9 22.9 21.2 14.0 70.6 41.0 9.6 5.2 12.5 9.4 21.4 Kentucky 267.2 173.6 23.4 24.3 16.6 99.7 55.5 9.2 5.9 12.5 9.4 24.6 Louisiana 260.8 165.8 26.3 25.1 15.7 84.4 44.1 9.0 5.2 13.8 11.0 27.1 Maine 240.0 161.6 21.4 20.5 14.4 73.1 46.4 9.2 5.5 12.2 9.8 24.4 Maryland 226.5 157.3 24.9 22.0 14.6 65.6 41.8 7.9 4.9 12.9 10.4 26.7 Massachusetts 222.6 154.0 21.9 19.6 13.8 62.6 42.5 8.3 5.1 13.1 10.3 23.4 Michigan 228.1 160.9 24.0 20.2 14.7 70.3 43.9 9.2 6.1 13.9 10.1 22.6 Minnesota 206.8 146.0 21.3 18.0 12.6 55.2 37.2 9.6 5.2 11.8 9.5 24.3 Mississippi 274.2 158.8 24.9 24.9 16.2 97.3 42.3 8.3 4.8 13.8 9.9 31.0 Missouri 237.6 160.4 24.9 21.6 14.6 79.8 46.0 8.4 5.3 13.1 9.7 22.7 Montana 203.4 150.5 20.5 17.8 14.7 57.1 41.3 8.1 5.4 12.4 8.7 27.2 Nebraska 215.2 145.7 21.2 22.5 15.1 62.4 36.0 9.0 5.7 12.2 9.4 24.7 Nevada 213.3 158.4 23.3 20.7 15.3 62.5 48.8 6.7 4.8 12.3 9.8 23.4 New Hampshire 218.2 154.7 21.4 19.3 13.2 62.0 43.0 7.7 5.0 13.4 10.6 23.2 New Jersey 213.8 157.7 26.1 22.0 15.5 57.9 38.3 8.1 5.5 13.3 10.0 22.4 New Mexico 190.1 134.3 21.1 18.7 13.5 44.4 29.1 6.7 4.4 11.6 8.9 24.3 New York 201.3 145.2 22.5 19.4 14.0 55.2 35.8 8.0 4.9 12.6 9.7 22.2 North Carolina 236.9 152.7 23.5 19.8 13.6 79.3 41.6 7.6 5.0 12.1 9.7 25.9 North Dakota 210.2 144.1 22.0 21.6 14.8 56.5 34.3 7.4 5.5 12.8 8.7 25.2 Ohio 243.4 163.4 25.2 22.5 15.5 77.4 44.5 9.4 5.6 13.1 9.9 25.4 Oklahoma 243.0 161.2 23.8 22.9 14.8 82.7 46.9 8.9 5.9 12.0 8.7 23.6 Oregon 214.4 155.5 21.5 18.5 13.9 61.2 43.6 8.6 5.7 12.2 10.0 25.7 Pennsylvania 232.4 158.5 24.1 22.3 15.2 68.5 40.0 9.2 5.6 13.4 10.0 23.7 Rhode Island 228.8 151.3 21.9 19.6 13.3 66.3 43.0 8.8 4.6 12.4 8.4 22.5 South Carolina 241.3 151.0 24.0 20.5 14.1 79.6 40.0 8.0 4.8 12.5 9.7 26.9 South Dakota 206.0 141.5 20.9 20.1 14.2 62.2 35.5 7.8 5.1 11.1 9.1 22.9 Tennessee 257.9 162.0 24.0 22.4 15.1 91.5 47.2 9.3 5.5 13.0 9.3 25.3 Texas 212.5 142.8 22.2 20.2 13.1 63.4 35.9 8.1 5.0 11.7 8.7 21.4 Utah 154.1 109.6 21.5 14.3 10.4 28.1 16.1 7.5 4.6 9.5 8.0 24.5 Vermont 211.9 152.8 20.7 18.8 14.2 61.6 44.3 8.1 5.0 12.5 9.6 22.0 Virginia 228.5 153.9 24.8 19.9 14.2 70.6 40.7 8.3 5.0 13.0 9.9 26.0 Washington 209.6 153.9 21.9 17.7 12.7 58.1 42.8 8.8 5.5 12.4 9.8 24.9 West Virginia 254.8 173.2 23.6 24.2 16.8 87.5 51.9 9.1 6.4 11.2 7.7 21.7 Wisconsin 218.8 152.0 21.6 18.7 13.1 59.9 38.7 9.4 5.7 12.9 9.8 25.6 Wyoming 199.5 148.3 21.4 18.9 14.2 52.8 38.5 8.1 5.9 13.2 9.7 20.9 United States 219.4 151.1 23.0 20.2 14.1 65.7 39.6 8.4 5.2 12.5 9.5 23.6 Rates are per 100,000 and age adjusted to the 2000 US standard population. Cancer Occurrence by Race/Ethnicity Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 10 ). For all cancer sites combined, African American men have a 14% higher incidence rate and a 33% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 16% higher death rate than white women. Cancer incidence and death rates are higher among African American men than white men for every cancer site listed in Table 10 . 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), access to high‐quality screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. 24 The higher breast cancer incidence rate among whites compared to women of other racial or ethnic groups is thought to reflect a combination of factors that affect both diagnosis (ie, more prevalent mammography among white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white women). 25 10 Incidence and Death Rates by Site, Race, and Ethnicity, United States, 2005 to 2009 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE * HISPANIC/LATINO Incidence All sites Male 543.1 619.7 327.5 423.2 418.7 Female 424.0 396.8 286.2 360.3 333.2 Breast (female ) 123.3 118.0 85.9 89.1 93.0 Colorectum Male 52.8 65.1 41.4 50.7 46.9 Female 39.2 48.0 32.1 41.1 33.3 Kidney & renal pelvis Male 21.2 23.3 10.1 29.0 19.8 Female 11.2 12.1 5.1 16.6 11.4 Liver & intrahepatic bile duct Male 9.1 15.0 21.6 16.4 17.5 Female 3.1 4.2 8.1 7.6 6.6 Lung & bronchus Male 82.3 99.3 49.4 67.4 45.4 Female 57.5 51.3 28.1 49.5 26.6 Prostate 141.0 228.7 77.2 98.8 124.9 Stomach Male 8.4 16.3 16.1 13.0 13.5 Female 4.0 8.2 9.3 6.4 8.1 Uterine cervix 7.8 10.4 7.2 10.1 11.8 Mortality All sites Male 216.7 288.3 132.6 184.9 146.4 Female 150.8 174.6 93.2 135.9 100.6 Breast (female ) 22.4 31.6 11.9 16.6 14.9 Colorectum Male 19.5 29.8 13.1 18.8 15.3 Female 13.6 19.8 9.6 14.6 10.2 Kidney & renal pelvis Male 5.9 6.0 2.9 8.8 5.0 Female 2.7 2.6 1.3 4.1 2.3 Liver & intrahepatic bile duct Male 7.4 11.9 14.5 11.9 11.8 Female 3.1 4.0 6.1 5.9 5.3 Lung & bronchus Male 65.3 82.6 35.9 48.3 30.8 Female 40.8 38.0 18.5 33.2 14.1 Prostate 21.7 53.1 10.0 19.7 17.8 Stomach Male 4.3 10.3 9.0 8.3 7.4 Female 2.2 4.8 5.3 3.8 4.3 Uterine cervix 2.2 4.3 2.0 3.5 3.0 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Race and ethnicity categories are not mutually exclusive of Hispanic origin. * Data based on Indian Health Service Contract Health Service Delivery Areas. 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 cancers related to infectious agents, such as 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 Americans/Pacific Islanders as in whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B virus in this population. 26 Kidney cancer incidence and death rates are the highest among American Indians/Alaskan Natives, which may reflect the high prevalence of obesity and smoking in this population. 27 Cancer incidence rates can only be adjusted for delayed reporting in whites and African Americans because the long‐term incidence data required for delay adjustment are not available for other racial and ethnic groups. During the past 10 years of data (2000‐2009), while incidence rates (unadjusted for delayed reporting) declined by 1% or more per year among men of all racial/ethnic groups except American Indians/Alaska Natives, among women only slight declines (0.2%‐0.3% per year) occurred among non‐Hispanic whites and Hispanics (Table 11 ). In contrast, cancer death rates declined by 1.5% or more per year among men and by 1.1% or more per year among women of all races/ethnicities except American Indians/Alaska Natives, among whom rates were stable. Notably, the largest declines in death rates occurred among men of African American (2.4% per year) and Hispanic (2.3% per year) heritage. 11 Ten‐Year Trends in Cancer Incidence and Mortality Rates by Race/Ethnicity, United States, 2000 to 2009 2000‐2009 AAPC INCIDENCE MORTALITY MALE FEMALE MALE FEMALE All races/ethnicities −1.1 * −0.3 * −1.8 * −1.4 * Non‐Hispanic white −1.0 * −0.2 * −1.5 * −1.3 * African American −1.4 * 0.0 −2.4 * −1.5 * Asian American/Pacific Islander −1.8 * 0.2 −1.5 * −1.1 * American Indian/Alaska Native † −0.7 0.0 −0.8 −0.8 Hispanic ‡ −1.7 * −0.3 * −2.3 * −1.4 * AAPC indicates average annual percent change. * AAPC is statistically significant ( P < .05). † Data based on Indian Health Service Contract Health Service Delivery Areas. ‡ Excludes deaths from the District of Columbia, Minnesota, New Hampshire, and North Dakota due to unreliable Hispanic origin data for some years. Notes: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 2 joinpoints. Incidence trends based on the North American Association of Central Cancer Registries (NAACCR) data. Race and ethnicity categories are not mutually exclusive of Hispanic origin. Cancer Survival African Americans are less likely to survive cancer than whites. The 5‐year relative survival is lower among African Americans for every stage of diagnosis for nearly every type of cancer (Fig. 7 ). 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 8 , African Americans are less likely than whites to be diagnosed with cancer at a localized stage, when treatment is usually less extensive and more successful. The extent to which factors other than stage at diagnosis contribute to the overall survival differential is unclear. 28 A study of Medicare‐insured patients showed that African Americans remain less likely than whites to receive standard cancer therapies for lung, breast, colorectal, and prostate cancers. 29 Some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 30 7 Five‐Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2002 to 2008. *The standard error of the survival rate is between 5 and 10 percentage points. The survival rate for carcinoma in situ of the urinary bladder is 96% for All Races, 97% for Whites, and 91% for African Americans. 8 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 2002 to 2008. *The proportions of carcinoma in situ of the urinary bladder are 51% for All Races, 52% for Whites, and 37% for African Americans. Stage categories do not sum to 100% because sufficient information is not available to assign a stage to all cancer cases. There have been notable improvements in survival over the past 3 decades for most cancers for both whites and African Americans (Table 12 ). Between 1975 to 1977 and 2002 to 2008, overall 5‐year relative survival rates increased 19% among whites and 21% among African Americans. The largest improvements in survival have been for leukemia and non‐Hodgkin lymphoma, while cancers of the lung and pancreas have shown the least improvement. 12 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975 to 2008 ALL RACES WHITE AFRICAN AMERICAN 1975 TO 1977 1987 TO 1989 2002 TO 2008 1975 TO 1977 1987 TO 1989 2002 TO 2008 1975 TO 1977 1987 TO 1989 2002 TO 2008 All sites 49 56 68 † 50 57 69 † 39 43 60 † Brain & other nervous system 22 29 35 † 22 28 34 † 25 32 41 † Breast (female) 75 84 90 † 76 85 92 † 62 71 78 † Colon 51 61 65 † 51 61 66 † 45 53 55 † Esophagus 5 10 19 † 6 11 21 † 3 7 14 † Hodgkin lymphoma 72 79 87 † 72 80 88 † 70 72 83 † Kidney & renal pelvis 50 57 72 † 50 57 72 † 49 55 70 † Larynx 66 66 63 † 67 67 65 59 56 51 Leukemia 34 43 58 † 35 44 59 † 33 35 51 † Liver & intrahepatic bile duct 3 5 16 † 3 6 16 † 2 3 11 † Lung & bronchus 12 13 17 † 12 13 17 † 11 11 14 † Melanoma of the skin 82 88 93 † 82 88 93 † 57 ‡ 79 ‡ 70 ‡ Myeloma 25 28 43 † 25 27 43 † 30 30 43 † Non‐Hodgkin lymphoma 47 51 71 † 47 52 72 † 48 46 63 † Oral cavity & pharynx 53 54 65 † 54 56 67 † 36 34 45 † Ovary 36 38 43 † 35 38 43 † 42 34 36 Pancreas 2 4 6 † 3 3 6 † 2 6 5 † Prostate 68 83 100 † 69 85 100 † 61 72 98 † Rectum 48 58 68 † 48 59 69 † 45 52 61 † Stomach 15 20 28 † 14 19 27 † 16 19 28 † Testis 83 95 96 † 83 96 97 † 73 ‡ , § 88 ‡ 89 Thyroid 92 95 98 † 92 94 98 † 90 92 96 † Urinary bladder 73 79 80 † 74 80 81 † 50 63 62 † Uterine cervix 69 70 69 70 73 70 65 57 61 Uterine corpus 87 83 83 † 88 84 85 † 60 57 63 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillance, Epidemiology, and End Results (SEER) 9 areas from 1975 to 1977, 1987 to 1989, and 2002 to 2008 and followed through 2009. † The difference in rates between 1975 to 1977 and 2002 to 2008 is statistically significant ( P < .05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. § Survival rate is for 1978 to 1980. Relative survival rates cannot be calculated for some minority populations because accurate life expectancies are not available. Comparison of cause‐specific survival rates of cancer patients diagnosed from 2002 to 2008 in SEER registry areas of the United States indicate that all minority male populations have a greater probability than whites of dying from cancer within 5 years of diagnosis, although the difference is small for Hispanic men. 6 In contrast, among women, Asian Americans/Pacific Islanders (69.1%) and Hispanics (67.2%) have the highest 5‐year cause‐specific survival, followed by whites (66.2%), American Indians/Alaska Natives (60.6%), and African Americans (57.6%). Minority populations are generally more likely than non‐Hispanic whites to be diagnosed at a distant stage of disease for all 4 major cancer sites. 31 Cancer in Children Cancer is the second most common cause of death among children ages 1 to 14 years in the United States, surpassed only by accidents; 1,320 children died from cancer in 2009. 1 Leukemia accounts for almost one‐third of all cancers (including benign brain tumors) diagnosed in children aged 0 to 14 years, 77% of which are acute lymphocytic leukemias. Cancers of the brain and other nervous system are the second most common cancer type (25%), followed by soft tissue sarcomas (7%, half of which are rhabdomyosarcoma), neuroblastoma (6%), renal (Wilms) tumors (5%), and Hodgkin and non‐Hodgkin lymphomas (4% each). 6 From 2005 to 2009, the overall incidence rate for cancer in children aged 14 years and younger increased slightly by 0.5% per year, a trend that has been consistent since 1975. The death rate for childhood cancer has decreased by more than half over the past 3 decades, from 4.9 (per 100,000) in 1975 to 2.1 in 2009. Table 13 provides trends in survival rates for the most common childhood cancers. The 5‐year relative survival rate for all cancer sites combined improved from 58% for children diagnosed between 1975 and 1977 to 83% for those diagnosed between 2002 and 2008. The substantial progress for all of the major childhood cancers reflects both improvements in treatment and high levels of participation in clinical trials. 13 Trends in 5‐Year Relative Survival Rates * (%) for Children (0 to 14 Years) by Year of Diagnosis, United States, 1975 to 2008 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 2001 2002 TO 2008 All sites 58 63 67 68 72 76 77 79 81 83 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 87 88 91 † Acute myeloid leukemia 19 26 27 ‡ 31 ‡ 37 ‡ 42 42 ‡ 49 58 64 † Bone & joint 50 ‡ 48 57 ‡ 57 ‡ 67 ‡ 67 74 70 70 79 † Brain & other nervous system 57 58 56 62 64 65 71 75 74 75 Hodgkin lymphoma 81 87 88 91 87 97 95 96 94 97 † Neuroblastoma 53 57 55 52 63 76 67 66 73 74 † Non‐Hodgkin lymphoma 43 53 67 70 71 77 81 84 89 85 † Soft tissue 61 75 69 73 66 80 77 70 77 82 † Wilms tumor 73 79 87 91 92 92 92 92 94 90 † * Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2009. † The difference in rates between 1975 to 1977 and 2002 to 2008 is statistically significant ( P < .05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. Limitations The projected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are model‐based and may vary considerably from year to year for reasons other than changes in cancer occurrence. For instance, estimates are affected by changes in method, which occur regularly as modeling techniques improve over time and cancer registration becomes more complete. In addition, not all changes in cancer trends can be captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. The data used for tracking cancer trends are age‐standardized or age‐specific cancer death rates from the NCHS and cancer incidence rates from SEER and/or NPCR. Nevertheless, the American Cancer Society projections of the numbers of new cancer cases and deaths provide a reasonably accurate estimate of the current cancer burden in the United States. Errors in reporting race/ethnicity in medical records and on death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and non‐African American 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 important differences in the cancer burden within racial/ethnic subgroups are masked. Conclusions In 2009, Americans had a 20% lower risk of death from cancer than in 1991, when cancer death rates peaked. Despite this substantial progress, all demographic groups have not benefitted equally, particularly for cancers such as colorectal and breast, for which mortality declines have been attributed to earlier detection and improvements in treatment. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket as well as other disadvantaged populations. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CA: A Cancer Journal for Clinicians Wiley

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References (37)

Publisher
Wiley
Copyright
Copyright © 2012 American Cancer Society, Inc.
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/caac.21166
pmid
23335087
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. One in 4 deaths in the United States is due to cancer. In this article, we provide the expected numbers of new cancer cases and deaths in 2013 nationally and by state, as well as an overview of current cancer statistics using data through 2009, including incidence, mortality, and survival rates and trends. We also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s, and provide the actual reported numbers of deaths in 2009 by age for the 10 leading causes of death and the 5 leading cancer types. Materials and Methods Incidence and Mortality Data Mortality data from 1930 to 2009 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 , 2 There are several sources for cancer incidence data. The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute reports long‐term (beginning in 1973), high‐quality, population‐based incidence data covering up to 26% of the US population. Cancer incidence rates for long‐term trends (1975‐2009), 5‐year relative and cause‐specific survival rates (2002‐2008), and estimations of the lifetime probability of developing cancer (2007‐2009) were obtained from SEER registries. 3‐6 The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). Incidence data for state‐level rates (2005‐2009), trends by race/ethnicity (2000‐2009), and estimated new cancer cases in 2013 were obtained from NAACCR. 7 Cancer cases were classified according to the International Classification of Diseases for Oncology . 8 All incidence and death rates are age‐standardized to the 2000 US standard population and expressed per 100,000 persons. Cancer incidence rates in this report are delay‐adjusted whenever possible in order to account for anticipated future corrections to registry data due to inherent delays and errors in case reporting. Delay‐adjusted rates primarily affect the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate) and provide a more accurate portrayal of the cancer burden in the most recent time period. 9 For example, melanoma incidence rates adjusted for delays in reporting are 14% higher than unadjusted rates in the most recent reporting year. Delay‐adjusted rates are available for SEER registry data and were obtained from the National Cancer Institute. Incidence trends presented for the most recent 5 years (2005‐2009) are based on delay‐adjusted rates from SEER 13 cancer registries. 4 Projected Cancer Cases and Deaths in 2013 The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection, compilation, quality control, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in 2013 in order to provide an estimate of the contemporary cancer burden. The methods for projecting both new cases and deaths in the current year were recently modified so estimates should not be compared from year to year. We projected the number of new invasive cancer cases that will be diagnosed in 2013 (with the exception of urinary bladder, for which in situ cases are included) using a 2‐step process that first estimates complete incidence counts by state during years for which observed data are available, and then projects these counts 4 years ahead for the United States overall and each state individually. 10 To estimate counts for each state through 2009, we used a spatiotemporal model based on incidence data for 1995 through 2009 from 49 states and the District of Columbia that met NAACCR's high‐quality data standard for incidence, covering about 98% of the US population. 11 (Minnesota cancer registry data could not be included in the model because county‐level data were unavailable.) This method accounts for expected delays in case reporting and considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. A temporal projection method (the vector autoregressive model) was then applied to the estimated counts to obtain projections for 2013. For the complete details of this methodology, please refer to Zhu et al. 10 To estimate the numbers of new breast carcinoma in situ (female) and melanoma in situ cases in 2013, we first estimated the number of in situ cases occurring annually from 2000 through 2009 in the United States by applying the age‐specific incidence rates in the 18 SEER areas to the corresponding US population estimates provided in SEER*Stat. 12 We then projected the total number of cases in 2013 based on the annual percent change from 2000 through 2009 generated by the joinpoint regression model. 13 We estimated the number of cancer deaths expected to occur in 2013 in the United States overall and in each state using the joinpoint regression model based on the actual numbers of cancer deaths from 1995 through 2009 at the state and national levels as reported to the NCHS. 1 For the complete details of this methodology, please refer to Chen et al. 14 Other Statistics The estimated numbers of cancer deaths averted in men and women due to the reduction in overall cancer death rates were calculated by applying the 5‐year age‐specific cancer death rates in the peak year for age‐standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age‐specific populations in the subsequent years through 2009 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. Selected Findings Expected Numbers of New Cancer Cases Table 1 presents the estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2013. The overall estimate of more than 1.6 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell or squamous cell cancers of the skin. About 64,640 cases of breast carcinoma in situ and 61,300 cases of melanoma in situ are expected to be newly diagnosed in 2013. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2 . 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2013 * ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All sites 1,660,290 854,790 805,500 580,350 306,920 273,430 Oral cavity & pharynx 41,380 29,620 11,760 7,890 5,500 2,390 Tongue 13,590 9,900 3,690 2,070 1,380 690 Mouth 11,400 6,730 4,670 1,800 1,080 720 Pharynx 13,930 11,200 2,730 2,400 1,790 610 Other oral cavity 2,460 1,790 670 1,640 1,260 380 Digestive system 290,200 160,750 129,450 144,570 82,700 61,870 Esophagus 17,990 14,440 3,550 15,210 12,220 2,990 Stomach 21,600 13,230 8,370 10,990 6,740 4,250 Small intestine 8,810 4,670 4,140 1,170 610 560 Colon † 102,480 50,090 52,390 50,830 26,300 24,530 Rectum 40,340 23,590 16,750 Anus, anal canal, & anorectum 7,060 2,630 4,430 880 330 550 Liver & intrahepatic bile duct 30,640 22,720 7,920 21,670 14,890 6,780 Gallbladder & other biliary 10,310 4,740 5,570 3,230 1,260 1,970 Pancreas 45,220 22,740 22,480 38,460 19,480 18,980 Other digestive organs 5,750 1,900 3,850 2,130 870 1,260 Respiratory system 246,210 131,760 114,450 163,890 90,600 73,290 Larynx 12,260 9,680 2,580 3,630 2,860 770 Lung & bronchus 228,190 118,080 110,110 159,480 87,260 72,220 Other respiratory organs 5,760 4,000 1,760 780 480 300 Bones & joints 3,010 1,680 1,330 1,440 810 630 Soft tissue (including heart ) 11,410 6,290 5,120 4,390 2,500 1,890 Skin (excluding basal & squamous ) 82,770 48,660 34,110 12,650 8,560 4,090 Melanoma‐skin 76,690 45,060 31,630 9,480 6,280 3,200 Other nonepithelial skin 6,080 3,600 2,480 3,170 2,280 890 Breast 234,580 2,240 232,340 40,030 410 39,620 Genital system 339,810 248,080 91,730 58,480 30,400 28,080 Uterine cervix 12,340 12,340 4,030 4,030 Uterine corpus 49,560 49,560 8,190 8,190 Ovary 22,240 22,240 14,030 14,030 Vulva 4,700 4,700 990 990 Vagina & other genital, female 2,890 2,890 840 840 Prostate 238,590 238,590 29,720 29,720 Testis 7,920 7,920 370 370 Penis & other genital, male 1,570 1,570 310 310 Urinary system 140,430 96,800 43,630 29,790 20,120 9,670 Urinary bladder 72,570 54,610 17,960 15,210 10,820 4,390 Kidney & renal pelvis 65,150 40,430 24,720 13,680 8,780 4,900 Ureter & other urinary organs 2,710 1,760 950 900 520 380 Eye & orbit 2,800 1,490 1,310 320 120 200 Brain & other nervous system 23,130 12,770 10,360 14,080 7,930 6,150 Endocrine system 62,710 16,210 46,500 2,770 1,270 1,500 Thyroid 60,220 14,910 45,310 1,850 810 1,040 Other endocrine 2,490 1,300 1,190 920 460 460 Lymphoma 79,030 42,670 36,360 20,200 11,250 8,950 Hodgkin lymphoma 9,290 5,070 4,220 1,180 660 520 Non‐Hodgkin lymphoma 69,740 37,600 32,140 19,020 10,590 8,430 Myeloma 22,350 12,440 9,910 10,710 6,070 4,640 Leukemia 48,610 27,880 20,730 23,720 13,660 10,060 Acute lymphocytic leukemia 6,070 3,350 2,720 1,430 820 610 Chronic lymphocytic leukemia 15,680 9,720 5,960 4,580 2,750 1,830 Acute myeloid leukemia 14,590 7,820 6,770 10,370 5,930 4,440 Chronic myeloid leukemia 5,920 3,420 2,500 610 340 270 Other leukemia ‡ 6,350 3,570 2,780 6,730 3,820 2,910 Other & unspecified primary sites ‡ 31,860 15,450 16,410 45,420 25,020 20,400 * Rounded to the nearest 10; estimated new cases exclude basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 64,640 carcinoma in situ of the female breast and 61,300 melanoma in situ will be newly diagnosed in 2013. † 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 and/or an undercount in the case estimate. 2 Incidence Rates for All Cancers Combined (2005‐2009) and Estimated New Cases * for Selected Cancers (2013) by State STATE INCIDENCE RATE † ALL SITES FEMALE BREAST UTERINE CERVIX COLORECTUM UTERINE CORPUS LEUKEMIA LUNG & BRONCHUS MELANOMA OF THE SKIN NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER Alabama 473.2 27,080 3,720 200 2,390 610 640 4,550 1,300 990 3,940 960 Alaska 474.6 3,290 510 ‡ 310 90 100 470 90 140 440 140 Arizona 394.9 34,010 4,660 220 2,630 860 920 4,250 1,400 1,360 4,340 1,400 Arkansas § 461.8 16,330 2,280 150 1,540 370 450 2,700 530 680 2,370 610 California 444.1 171,330 25,360 1,480 14,690 5,160 5,210 18,720 8,530 7,280 23,740 6,920 Colorado 436.6 23,410 3,300 160 1,880 690 840 2,550 1,310 1,050 3,870 990 Connecticut 515.0 21,180 3,050 110 1,670 740 570 2,780 1,080 890 2,940 1,090 Delaware 519.7 5,370 770 ‡ 430 170 140 760 300 220 860 250 Dist. of Columbia § 468.5 2,920 450 ‡ 240 90 70 320 90 100 500 90 Florida 458.1 118,320 15,710 940 10,290 3,110 3,490 17,960 5,330 5,060 17,330 5,720 Georgia 467.3 49,280 7,310 420 3,970 1,230 1,290 6,690 2,360 1,810 7,930 1,610 Hawaii 443.4 6,650 960 50 730 240 180 900 380 240 800 200 Idaho 463.2 7,670 1,010 50 670 220 270 930 420 360 1,330 380 Illinois 491.4 66,090 9,350 500 6,140 2,150 2,020 9,270 2,480 2,840 9,230 2,990 Indiana 467.8 35,550 4,540 260 3,250 1,040 1,000 5,500 1,470 1,460 4,310 1,560 Iowa 489.9 17,480 2,310 90 1,640 580 590 2,350 980 790 2,270 810 Kansas 480.3 14,370 2,160 90 1,250 440 450 1,930 800 650 2,020 600 Kentucky 523.1 25,100 3,300 190 2,300 700 720 4,560 1,540 1,100 3,130 1,060 Louisiana 496.6 24,930 3,630 220 2,400 550 660 3,740 770 950 4,040 930 Maine 522.3 9,190 1,150 50 730 310 280 1,380 440 390 1,290 530 Maryland 460.6 30,680 4,760 220 2,410 950 780 4,040 1,530 1,180 4,880 1,220 Massachusetts 506.8 38,250 5,820 210 2,910 1,280 990 4,880 1,840 1,590 5,700 2,060 Michigan 492.7 57,560 8,140 330 4,730 1,920 1,750 8,250 2,900 2,530 9,490 2,860 Minnesota 483.8 28,410 4,260 120 2,220 890 950 3,860 1,020 1,210 4,090 1,190 Mississippi 485.2 15,830 2,080 130 1,580 340 390 2,630 550 560 2,490 540 Missouri 474.6 33,950 4,680 250 3,110 1,040 980 5,410 1,500 1,480 4,170 1,480 Montana 468.8 5,450 740 ‡ 510 160 180 700 250 260 870 280 Nebraska 475.9 9,060 1,230 50 910 290 310 1,220 460 430 1,290 420 Nevada 454.6 13,830 1,760 120 1,350 330 400 1,970 440 520 1,900 660 New Hampshire 507.6 8,470 1,180 50 640 290 240 1,150 410 350 1,180 460 New Jersey 509.0 49,440 6,960 460 4,640 1,740 1,430 5,960 2,520 2,190 7,190 2,450 New Mexico 418.8 10,090 1,360 80 860 270 330 1,050 460 400 1,610 380 New York 498.5 108,760 14,950 850 9,210 3,850 3,270 13,480 4,200 4,740 16,720 5,510 North Carolina 484.1 53,200 7,430 360 4,260 1,430 1,470 8,040 2,620 2,080 8,150 2,070 North Dakota 478.4 3,510 450 ‡ 370 100 120 460 150 150 550 170 Ohio 470.8 66,610 9,060 440 5,890 2,230 1,770 10,230 2,960 2,840 8,530 3,020 Oklahoma 484.2 20,160 2,690 170 1,780 500 610 3,370 770 840 2,500 790 Oregon 469.3 21,720 3,310 120 1,610 670 620 2,860 1,410 950 3,380 1,030 Pennsylvania 505.3 79,560 10,490 480 7,390 2,720 2,240 10,980 3,890 3,440 9,450 3,980 Rhode Island 514.1 6,280 900 ‡ 530 210 180 870 270 250 820 340 South Carolina 465.6 27,620 3,580 220 2,340 710 760 4,390 1,320 1,040 4,160 1,070 South Dakota 433.9 4,570 600 ‡ 430 140 150 620 200 200 730 220 Tennessee 475.7 36,580 5,070 280 3,180 900 990 6,200 1,900 1,450 4,990 1,440 Texas 452.1 112,230 14,980 1,110 9,750 2,870 3,740 15,000 3,930 4,830 15,730 4,030 Utah 400.1 10,810 1,550 70 740 320 380 800 720 490 1,960 420 Vermont 496.3 4,200 550 ‡ 320 130 110 590 220 170 560 210 Virginia § 460.3 40,870 6,280 300 3,270 1,240 990 5,380 2,380 1,590 6,840 1,590 Washington 486.4 37,290 5,610 230 2,730 1,140 1,160 4,700 2,350 1,650 5,690 1,690 West Virginia 496.8 11,450 1,460 80 1,180 350 330 2,100 540 470 1,470 530 Wisconsin § 463.2 31,590 4,490 190 2,610 1,080 1,050 4,310 1,250 1,400 4,370 1,530 Wyoming 444.7 2,700 380 ‡ 240 80 80 320 130 120 430 130 United States 473.4 1,660,290 232,340 12,340 142,820 49,560 48,610 228,190 76,690 69,740 238,590 72,570 * Rounded to the nearest 10; excludes basal cell 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. § Rate is for cases diagnosed during 2005 to 2008. Note: These model‐based estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusion of states with fewer than 50 cases. Figure 1 indicates the most common cancers expected to occur in men and women in 2013. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about 50% of all newly diagnosed cancers; prostate cancer alone will account for 28% (238,590) of incident cases in men. The 3 most commonly diagnosed types of cancer among women in 2013 will be breast, lung and bronchus, and colorectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 29% (232,340) of all new cancer cases among women. 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2013. *Estimates are rounded to the nearest 10 and exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Expected Numbers of Cancer Deaths Table 1 also shows the expected numbers of deaths from cancer projected for 2013. It is estimated that about 580,350 Americans will die from cancer this year, corresponding to almost 1600 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 causes of cancer death. These 4 cancers account for almost half (48%) of the total cancer deaths among men and women (Fig. 1 ). In 2013, lung cancer is expected to account for 26% of all female cancer deaths and 28% of all male cancer deaths. Table 3 provides the estimated numbers of cancer deaths in 2013 by state for selected cancer sites. 3 Death Rates for All Cancers Combined (2005‐2009) and Estimated Deaths * for Selected Cancers (2013) by State STATE DEATH RATE † ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLORECTUM LEUKEMIA LIVER & INTRAHEPATIC BILE DUCT LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama 198.2 10,430 250 690 970 400 330 3,290 320 270 630 550 Alaska 181.3 980 ‡ 70 80 ‡ ‡ 270 ‡ ‡ 60 50 Arizona 152.8 11,210 310 790 990 480 460 2,850 400 310 740 630 Arkansas 199.7 6,650 150 420 610 270 200 2,170 200 150 390 320 California 163.1 57,290 1,590 4,220 5,150 2,460 2,980 12,700 2,000 1,540 4,010 3,390 Colorado 154.6 7,350 230 510 680 320 290 1,710 250 230 500 440 Connecticut 173.4 6,890 170 460 470 290 230 1,740 230 170 530 400 Delaware 190.4 1,940 50 120 170 70 80 580 60 50 120 100 Dist. of Columbia 196.5 1,030 ‡ 80 100 ‡ 50 240 ‡ ‡ 80 80 Florida 170.0 42,370 880 2,660 3,640 1,770 1,550 12,070 1,400 930 2,770 2,200 Georgia 179.2 16,010 360 1,200 1,450 600 530 4,670 460 410 1,010 790 Hawaii 147.8 2,400 ‡ 140 230 80 120 580 80 50 210 110 Idaho 165.8 2,660 90 180 220 120 80 670 100 60 200 180 Illinois 186.6 24,000 530 1,610 2,230 1,010 750 6,560 780 550 1,620 1,230 Indiana 195.4 13,250 320 850 1,120 550 370 4,110 440 300 820 590 Iowa 178.3 6,420 190 400 580 280 200 1,780 230 170 390 350 Kansas 178.8 5,430 150 360 490 250 170 1,590 210 140 350 240 Kentucky 211.3 9,970 200 590 880 340 270 3,510 300 200 540 390 Louisiana 204.0 9,040 210 650 860 330 380 2,670 260 190 580 420 Maine 192.8 3,240 90 190 250 130 90 950 110 60 200 160 Maryland 184.1 10,480 230 800 930 410 380 2,810 310 250 730 560 Massachusetts 180.0 12,840 310 810 1,020 500 500 3,530 400 340 910 650 Michigan 187.5 20,570 540 1,360 1,700 910 670 5,940 730 490 1,460 890 Minnesota 169.9 9,610 250 610 770 440 330 2,500 340 240 630 520 Mississippi 204.7 6,300 140 420 630 250 210 2,010 170 110 380 330 Missouri 191.4 12,730 310 890 1,100 540 420 3,940 380 240 820 560 Montana 172.5 2,000 50 120 180 90 50 550 70 50 130 140 Nebraska 174.0 3,440 100 210 340 140 90 900 130 80 230 210 Nevada 183.0 4,760 140 360 450 180 210 1,480 140 100 350 290 New Hampshire 179.5 2,680 70 170 200 100 80 750 80 60 200 140 New Jersey 179.0 16,410 340 1,330 1,560 630 570 4,060 530 440 1,180 750 New Mexico 158.2 3,540 90 240 350 140 170 770 110 90 240 230 New York 166.7 34,240 780 2,390 3,020 1,450 1,410 8,790 1,090 900 2,500 1,770 North Carolina 186.3 18,620 390 1,260 1,510 710 620 5,660 550 420 1,150 910 North Dakota 171.1 1,280 ‡ 90 130 60 ‡ 310 ‡ ‡ 90 80 Ohio 194.9 25,130 590 1,720 2,170 980 750 7,350 800 560 1,620 1,240 Oklahoma 194.8 7,850 190 490 720 300 270 2,440 260 170 440 380 Oregon 179.8 7,820 230 490 660 320 310 2,110 280 220 520 460 Pennsylvania 187.5 28,680 600 1,950 2,540 1,190 930 7,640 1,020 730 1,950 1,430 Rhode Island 180.4 2,140 50 130 170 100 80 600 60 50 130 100 South Carolina 187.9 9,800 220 660 820 360 340 2,990 280 210 600 500 South Dakota 168.2 1,590 50 110 150 60 ‡ 440 50 ‡ 110 90 Tennessee 200.6 14,080 360 910 1,220 520 460 4,600 440 280 800 630 Texas 171.3 37,180 940 2,650 3,390 1,490 1,950 9,670 1,210 850 2,340 1,650 Utah 128.4 2,790 110 260 240 150 90 450 120 80 220 210 Vermont 176.2 1,300 ‡ 80 100 50 50 380 ‡ ‡ 90 60 Virginia 183.2 14,720 320 1,110 1,270 580 480 4,130 460 370 1,020 740 Washington 176.7 12,390 350 800 980 520 530 3,260 440 360 850 730 West Virginia 206.6 4,660 100 280 440 170 120 1,480 160 100 230 190 Wisconsin 178.6 11,220 310 700 880 520 370 2,980 400 300 770 630 Wyoming 169.8 950 ‡ 60 80 ‡ ‡ 240 ‡ ‡ 70 50 United States 178.7 580,350 14,080 39,620 50,830 23,720 21,670 159,480 19,020 14,030 38,460 29,720 * 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 the exclusion of states with fewer than 50 deaths. Lifetime Probability of Developing Cancer The lifetime probability of being diagnosed with an invasive cancer is higher for men (45%) than for women (38%) (Table 4 ). However, because of the earlier median age at 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 over‐ or underestimate individual risk because of differences in exposure (eg, smoking history) and/or genetic susceptibility. 4 Probability (%) of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2007 to 2009 * BIRTH TO 39 40 TO 59 60 TO 69 70 AND OLDER BIRTH TO DEATH All sites † Male 1.46 (1 in 69) 8.79 (1 in 11) 16.03 (1 in 6) 38.07 (1 in 3) 44.81 (1 in 2) Female 2.20 (1 in 46) 9.19 (1 in 11) 10.39 (1 in 10) 26.69 (1 in 4) 38.17 (1 in 3) Urinary bladder ‡ Male 0.02 (1 in 4,924) 0.37 (1 in 272) 0.92 (1 in 109) 3.69 (1 in 27) 3.81 (1 in 26) Female 0.01 (1 in 12,663) 0.12 (1 in 864) 0.24 (1 in 410) 0.98 (1 in 106) 1.15 (1 in 90) Breast Female 0.50 (1 in 202) 3.78 (1 in 26) 3.56 (1 in 28) 6.65 (1 in 15) 12.38 (1 in 8) Colorectum Male 0.08 (1 in 1,212) 0.94 (1 in 106) 1.40 (1 in 71) 4.19 (1 in 24) 5.17 (1 in 19) Female 0.08 (1 in 1,236) 0.75 (1 in 134) 0.98 (1 in 102) 3.80 (1 in 26) 4.78 (1 in 21) Leukemia Male 0.16 (1 in 612) 0.23 (1 in 440) 0.35 (1 in 288) 1.26 (1 in 80) 1.59 (1 in 63) Female 0.13 (1 in 746) 0.15 (1 in 655) 0.21 (1 in 481) 0.81 (1 in 123) 1.14 (1 in 88) Lung & bronchus Male 0.03 (1 in 3,552) 0.92 (1 in 109) 2.27 (1 in 44) 6.82 (1 in 15) 7.77 (1 in 13) Female 0.03 (1 in 3,287) 0.76 (1 in 131) 1.72 (1 in 58) 4.93 (1 in 20) 6.35 (1 in 16) Melanoma of the skin § Male 0.15 (1 in 691) 0.63 (1 in 160) 0.77 (1 in 130) 2.02 (1 in 50) 2.87 (1 in 35) Female 0.26 (1 in 391) 0.55 (1 in 181) 0.40 (1 in 248) 0.84 (1 in 120) 1.85 (1 in 54) Non‐Hodgkin lymphoma Male 0.13 (1 in 753) 0.44 (1 in 225) 0.60 (1 in 167) 1.77 (1 in 57) 2.34 (1 in 43) Female 0.09 (1 in 1,147) 0.31 (1 in 322) 0.44 (1 in 229) 1.40 (1 in 72) 1.93 (1 in 52) Prostate Male 0.01 (1 in 7,964) 2.68 (1 in 37) 6.78 (1 in 15) 12.06 (1 in 8) 16.15 (1 in 6) Uterine cervix Female 0.16 (1 in 641) 0.27 (1 in 374) 0.13 (1 in 795) 0.18 (1 in 551) 0.68 (1 in 147) Uterine corpus Female 0.07 (1 in 1,348) 0.77 (1 in 129) 0.89 (1 in 112) 1.25 (1 in 80) 2.64 (1 in 38) * For people free of cancer at beginning of age interval. † All sites excludes basal cell and squamous cell skin cancers and in situ cancers except urinary bladder. ‡ Includes in situ cancer cases. § Statistics for whites only. Trends in Cancer Incidence 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. While incidence rates are declining for most cancer sites, they are increasing among both men and women for melanoma of the skin and cancers of the liver and thyroid (Fig. 3 , Table 5 ). Table 5 shows incidence (delay‐adjusted) and mortality trends for all cancers combined and for selected cancer sites based on joinpoint regression analysis. Joinpoint is a tool used to describe and quantify trends by fitting observed rates to lines connected at “joinpoints” where trends change in direction or magnitude. 13 , 15 According to data from the SEER 13 cancer registries, incidence rates in the most recent 5 years (2005‐2009) decreased in males by 0.6% per year and were stable in females (Table 5 ). Incidence rates are decreasing for all 4 major cancer sites except female breast, for which rates remained relatively stable from 2005 to 2009 after decreasing by 2% per year from 1999 to 2005. Lung cancer incidence rates in women began declining in the late 1990s, more than a decade after the decline began in men. 6 Differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use; cigarette smoking prevalence peaked about 20 years later in women than in men. 16 Recent rapid declines in colorectal cancer incidence rates have largely been attributed to increases in screening that can detect and allow the removal of precancerous polyps. 17‐19 Although joinpoint trend analysis shows that the incidence rate for prostate cancer declined steadily by 1.9% per year from 2000 to 2009, it is important to realize that annual rates fluctuate widely (Fig. 3 ), likely reflecting variation in the prevalence of prostate‐specific antigen testing for the detection of prostate cancer. For example, in the SEER 13 areas, the delay‐adjusted prostate cancer incidence rate increased from 154 (per 100,000) to 164 from 2005 to 2006, then dropped from 168 to 153 from 2007 to 2008. 2 Trends in Cancer Incidence and Death Rates by Sex, United States, 1975 to 2009. Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. 3 Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2009. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Liver includes intrahepatic bile duct. 4 Trends in Death Rates Among Males for Selected Cancers, United States, 1930 to 2009. 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, colorectum, and liver are affected by these changes. 5 Trends in Death Rates Among Females for Selected Cancers, United States, 1930 to 2009. 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 uterus, ovary, lung and bronchus, and colorectum are affected by these changes. *Uterus includes uterine cervix and uterine corpus. 5 Trends in Cancer Incidence (Delay‐Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1992 to 2009 TREND 1 TREND 2 TREND 3 YEARS APC YEARS APC YEARS APC 2005‐2009 AAPC All sites Incidence Male 1992‐1994 −5.6 * 1994‐2009 −0.6 * −0.6 * Female 1992‐1998 0.8 * 1998‐2006 −0.5 * 2006‐2009 1.0 0.6 Death Male 1992‐2001 −1.4 * 2001‐2009 −1.8 * −1.8 * Female 1992‐1994 −0.2 1994‐2002 −0.8 * 2002‐2009 −1.5 * −1.5 * Lung & bronchus Incidence Male 1992‐2009 −1.9 * −1.9 * Female 1992‐1997 0.7 1997‐2009 −0.3 * −0.3 * Death Male 1992‐2005 −1.9 * 2005‐2009 −2.8 * −2.8 * Female 1992‐2002 0.6 * 2002‐2009 −1.0 * −1.0 * Colorectum Incidence Male 1992‐1995 −2.6 * 1995‐1998 1.5 1998‐2009 −2.6 * −2.6 * Female 1992‐1995 −1.8 * 1995‐1998 1.9 1998‐2009 −2.1 * −2.1 * Death Male 1992‐2002 −2.0 * 2002‐2005 −4.0 * 2005‐2009 −2.4 * −2.4 * Female 1992‐2001 −1.7 * 2001‐2009 −3.1 * −3.1 * Liver & intrahepatic bile duct Incidence Male 1992‐2009 3.7 * 3.7 * Female 1992‐2009 3.0 * 3.0 * Death Male 1992‐2009 2.3 * 2.3 * Female 1992‐2009 1.3 * 1.3 * Melanoma of skin Incidence Male 1992‐2009 2.5 * 2.5 * Female 1992‐1997 3.9 * 1997‐2009 1.7 * 1.7 * Death Male 1992‐2009 0.4 * 0.4 * Female 1992‐2009 −0.5 * −0.5 * Thyroid Incidence Male 1992‐1996 −1.4 1996‐2009 5.6 * 5.6 * Female 1992‐1999 4.1 * 1999‐2009 7.0 * 7.0 * Death Male 1992‐2009 1.6 * 1.6 * Female 1992‐1994 −6.4 1994‐2009 0.8 * 0.8 * Female breast Incidence 1992‐1999 1.3 * 1999‐2005 −2.0 * 2005‐2009 1.1 1.1 Death 1992‐1995 −1.3 * 1995‐1998 −3.4 * 1998‐2009 −1.9 * −1.9 * Prostate Incidence 1992‐1995 −11.1 * 1995‐2000 2.0 2000‐2009 −1.9 * −1.9 * Death 1992‐1994 −1.3 1994‐2009 −3.7 * −3.7 * APC indicates annual percent change based on incidence (delay‐adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change. * The APC or AAPC is significantly different from 0 ( P < .05). Note: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 3 joinpoints. Incidence trends based on Surveillance, Epidemiology, and End Results (SEER) 13 areas. Trends in Cancer Mortality Cancer death rates decreased by 1.8% per year in males and by 1.5% per year in females during the most recent 5 years of data (2005‐2009). These declines have been consistent since 2001 and 2002 in men and women, respectively, and are larger in magnitude than those occurring in the previous decade (Table 5 ). Death rates peaked in men in 1990 (279.8 per 100,000), in women in 1991 (175.3 per 100,000), and overall in 1991 (215.1 per 100,000). Between 1990/1991 and 2009, cancer death rates decreased 24% in men, 16% in women, and 20% overall. Figure 6 shows that as a result of almost two decades of consistent declines in cancer death rates, about 1,177,300 cancer deaths were averted, 152,900 of these in 2009 alone. Death rates continue to decrease for the 4 major cancer sites (Figs. 4 and 5 ). Over the past two decades of data, death rates have decreased from their peak by more than 30% for cancers of the colorectum, female breast, and male lung, and by more than 40% for prostate cancer. The decrease in lung cancer death rates—among men since 1990 and among women since 2002—is due to the reduction in tobacco use, 20 while the decrease in death rates for female breast, colorectal, and prostate cancers largely reflects improvements in early detection and/or treatment. 17 , 21 , 22 Over the past 10 years of data (2000‐2009), the largest annual declines in death rates were for chronic myeloid leukemia (8.4%), cancers of the stomach (3.1%) and colorectum (3.0%), and non‐Hodgkin lymphoma (3.0%). 6 Total Number of Cancer Deaths Averted From 1991 to 2009 in Men and From 1992 to 2009 in Women. The blue line represents the actual number of cancer deaths recorded in each year, and the red line represents the number of cancer deaths that would have been expected if cancer death rates had remained at their peak. Recorded Number of Deaths From Cancer in 2009 A total of 2,437,163 deaths were recorded in the United States in 2009, 567,628 of these from cancer. 23 Cancer is the second leading cause of death, following heart disease, accounting for 23% of all deaths. However, within 20‐year age groups, cancer is the leading cause of death among both men and women aged 40 to 79 years (Table 6 ). 6 Ten Leading Causes of Death by Age and Sex, United States, 2009 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 All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes 1,217,379 1,219,784 13,919 7,702 62,116 28,792 227,801 142,628 467,962 373,658 430,581 655,337 1 Heart Heart Accidents Accidents Accidents Accidents Cancer Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional 54,483 50,579 154,168 127,506 diseases diseases 307,225 292,188 injuries) injuries) injuries) injuries) 130,332 193,676 5,317 2,645 21,388 7,228 2 Cancer Cancer Assault Cancer Intentional Cancer Heart Heart Heart Heart Cancer Cancer 296,763 270,865 (homicide) 848 self‐harm 4,629 diseases diseases diseases diseases 82,765 87,264 2,031 (suicide) 52,826 21,353 118,163 74,294 8,977 3 Accidents Cerebro‐ Intentional Assault Assault Heart Accidents Accidents Chronic Chronic Chronic Cerebro‐ (unintentional vascular self‐harm (homicide) (homicide) diseases (unintentional (unintentional lower lower lower vascular injuries) disease (suicide) 569 7,214 2,393 injuries) injuries) respiratory respiratory respiratory disease 75,022 76,769 1,500 24,265 11,333 diseases diseases diseases 51,445 31,425 31,457 27,930 4 Chronic Chronic Cancer Congenital Heart Intentional Intentional Cerebro‐ Cerebro‐ Cerebro‐ Cerebro‐ Alzheimer lower lower 1,042 anomalies diseases self‐harm self‐harm vascular vascular vascular vascular disease respiratory respiratory 495 5,256 (suicide) (suicide) disease disease disease disease 47,856 diseases diseases 2,140 11,858 5,283 19,751 19,317 24,649 65,119 72,234 5 Cerebro‐ Alzheimer Congenital Intentional Cancer Assault Chronic liver Chronic Diabetes Diabetes Alzheimer Chronic vascular disease anomalies self‐harm 4,256 (homicide) disease & lower mellitus mellitus disease lower disease 55,103 563 (suicide) 1,443 cirrhosis respiratory 16,646 13,572 18,689 respiratory 52,073 434 10,562 diseases diseases 5,134 35,212 6 Diabetes Accidents Heart Heart HIV Pregnancy, Diabetes Chronic liver Accidents Nephritis, Influenza & Influenza & mellitus (unintentional diseases diseases disease childbirth mellitus disease & (unintentional nephrotic pneumonia pneumonia 35,054 injuries) 411 295 1,295 & puerperium 7,346 cirrhosis injuries) syndrome & 13,134 18,559 42,999 721 4,654 12,728 nephrosis 8,254 7 Intentional Diabetes Influenza & Influenza & Influenza & Influenza & Cerebro‐ Diabetes Nephritis, Accidents Nephritis, Diabetes self‐harm mellitus pneumonia pneumonia pneumonia pneumonia vascular mellitus nephrotic (unintentional nephrotic mellitus (suicide) 33,651 265 272 847 718 disease 4,477 syndrome & injuries) syndrome & 15,002 29,089 6,730 nephrosis 7,431 nephrosis 9,174 11,482 8 Influenza & Influenza & Chronic Chronic Chronic liver HIV Chronic Intentional Influenza & Alzheimer Accidents Nephritis, pneumonia pneumonia lower lower disease & disease lower self‐harm pneumonia disease (unintentional nephrotic 25,128 28,564 respiratory respiratory cirrhosis 686 respiratory (suicide) 7,616 7,060 injuries) syndrome & diseases diseases 825 diseases 3,813 10,590 nephrosis 157 118 5,265 14,302 9 Nephritis, Nephritis, Cerebro‐ Septicemia Diabetes Cerebro‐ HIV Influenza & Chronic liver Septicemia Diabetes Accidents nephrotic nephrotic vascular 99 mellitus vascular disease pneumonia disease & 6,919 mellitus (unintentional syndrome & syndrome & disease 812 disease 4,462 2,564 cirrhosis 10,209 injuries) nephrosis nephrosis 109 591 7,183 13,870 23,930 25,005 10 Alzheimer Septicemia Septicemia Cerebro‐ Cerebro‐ Diabetes Viral Septicemia Septicemia Influenza & Parkinson Hypertension disease 19,268 103 vascular vascular mellitus hepatitis 2,384 6,955 pneumonia disease & hypertensive 23,900 disease disease 564 3,456 6,350 7,864 renal disease * 72 744 10,444 HIV indicates human immunodeficiency virus. * 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, 2009, National Center for Health Statistics, Centers for Disease Control and Prevention, 2012. Table 7 presents the numbers of deaths for all cancers combined and for the 5 most common sites for each 20‐year age group. Among males, leukemia is the leading cause of cancer death among those aged younger than 40 years, while lung cancer ranks first among men aged 40 years and older. Among females, tumors of the brain and other nervous system are the leading cause of cancer death among children and adolescents (aged younger than 20 years), breast cancer ranks first among women aged 20 to 59 years, and lung cancer causes the most cancer deaths in those aged 60 years and older. 7 Five Leading Types of Cancer Death by Age and Sex, United States, 2009 ALL AGES < 20 20 TO 39 40 TO 59 60 TO 79 ≥ 80 MALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 296,758 1,086 4,256 54,483 154,168 82,765 Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus 87,697 330 590 14,960 52,272 20,171 Prostate Brain & ONS Brain & ONS Colorectum Colorectum Prostate 28,088 281 556 5,495 13,200 15,099 Colorectum Other endocrine system Colorectum Liver & intrahepatic bile duct Prostate Colorectum 26,807 99 456 4,553 11,717 7,652 Pancreas Bones & joints Non‐Hodgkin lymphoma Pancreas Pancreas Urinary bladder 17,870 93 305 3,662 9,871 4,579 Liver & intrahepatic bile duct Soft tissue Lung & bronchus Esophagus Liver & intrahepatic bile duct Pancreas 13,035 83 279 2,615 6,309 4,215 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 270,856 878 4,629 50,579 127,506 87,264 Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus 70,389 241 1,056 11,572 39,782 19,188 Breast Leukemia Uterine cervix Lung & bronchus Breast Breast 40,678 231 438 11,174 17,165 10,882 Colorectum Bones & joints Leukemia Colorectum Colorectum Colorectum 25,042 86 388 4,139 9,968 10,600 Pancreas Soft tissue Brain & ONS Ovary Pancreas Pancreas 17,758 81 333 3,189 8,782 6,371 Ovary Other endocrine system Colorectum Pancreas Ovary Non‐Hodgkin lymphoma 14,436 63 331 2,523 7,171 4,129 ONS indicates other nervous system. Note: Ranking order excludes “Miscellaneous malignant cancer” and “In situ, benign, or unknown behavior neoplasm.” Regional Variations in Cancer Rates Tables 8 and 9 depict cancer incidence and death rates for selected cancers by state. Lung cancer shows the largest geographic variation in cancer occurrence by far, reflecting the large historical and continuing differences in smoking prevalence among states. 20 For example, lung cancer incidence rates in Kentucky, which has historically had the highest smoking prevalence, are almost 4‐fold higher than those in Utah, which has the lowest smoking prevalence (128 vs 34 cases per 100,000 men). In contrast, state variations for other cancer sites are smaller in both absolute and proportionate terms. For example, the breast cancer incidence rate in Connecticut, which has the highest rate (137 per 100,000 women), is only 28% higher than that in Arizona, which has the lowest rate (107 per 100,000 women). For cancers that can be detected by screening or other testing practices, such as those of the prostate, female breast, and colorectum, state variation in incidence rates reflects differences in the utilization of these tests as well as differences in disease occurrence. 8 Incidence Rates for Selected Cancers by State, United States, 2005 to 2009 ALL CANCERS BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PROSTATE URINARY BLADDER STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama * 582.4 395.4 119.4 59.7 41.3 104.8 54.6 19.5 13.4 162.1 33.2 7.4 Alaska 523.7 435.7 130.0 55.4 44.2 83.8 63.0 22.0 18.3 139.9 38.2 9.5 Arizona 439.6 361.0 106.7 41.9 31.8 62.5 48.2 17.6 13.3 118.1 31.5 8.3 Arkansas † 551.6 381.6 109.2 54.7 39.8 107.4 59.6 21.9 15.0 153.4 32.5 7.9 California 510.5 398.9 123.3 50.7 38.1 62.4 45.2 23.0 15.6 143.0 33.9 8.0 Colorado 493.9 396.4 125.4 46.0 35.1 57.2 44.6 22.2 15.8 152.3 31.8 8.3 Connecticut 594.1 462.5 137.3 55.3 41.1 78.5 61.0 25.9 17.9 165.2 47.9 12.5 Delaware 613.1 448.2 127.9 56.4 41.4 90.6 68.8 24.0 17.1 182.8 44.2 11.3 Dist. of Columbia † 562.6 399.0 128.3 53.0 42.2 77.2 45.9 21.3 13.5 185.1 24.6 8.0 Florida 528.3 403.1 114.9 49.6 37.9 82.8 58.1 21.7 15.2 137.7 35.6 8.8 Georgia 569.8 397.2 119.7 53.4 38.8 95.6 54.7 21.6 14.2 167.8 33.0 7.8 Hawaii 504.3 401.6 125.1 59.6 38.7 68.7 40.4 20.9 13.0 128.4 26.2 6.4 Idaho 528.7 411.6 119.1 45.8 36.5 64.6 48.1 22.1 17.3 160.1 36.7 8.9 Illinois 573.5 437.8 125.4 61.3 44.8 88.9 60.6 23.8 16.3 157.9 40.2 10.3 Indiana 539.3 421.5 116.9 57.5 43.3 99.5 64.0 23.1 17.0 129.2 36.3 8.9 Iowa 568.2 436.5 123.5 59.6 45.9 87.6 56.3 26.5 18.5 142.2 43.0 8.7 Kansas 563.8 422.2 124.6 57.6 40.4 85.0 55.0 23.6 17.2 157.3 38.2 9.3 Kentucky 615.4 459.7 121.2 65.7 46.9 128.2 80.1 25.1 17.3 139.0 40.3 9.9 Louisiana * 614.5 410.9 118.9 64.6 43.7 101.9 58.2 24.2 16.8 173.7 34.4 8.2 Maine 600.1 467.3 128.5 55.8 43.9 95.5 67.6 25.6 18.4 153.6 48.1 13.5 Maryland 532.8 411.8 124.8 49.9 37.9 77.3 56.6 21.1 14.2 158.4 33.5 9.3 Massachusetts 581.1 459.2 132.8 53.3 40.3 81.0 64.0 25.1 16.3 157.5 45.0 12.3 Michigan 578.0 433.3 120.3 52.9 40.9 87.3 61.3 24.8 17.8 166.5 42.5 10.9 Minnesota 566.5 424.4 128.5 51.2 40.1 66.7 49.8 26.9 18.1 179.0 40.0 9.6 Mississippi * 612.1 395.5 114.3 62.7 44.7 116.4 56.3 21.8 14.4 174.2 31.4 7.2 Missouri 548.3 423.4 121.9 58.3 42.0 100.0 64.7 22.3 15.9 132.9 36.3 8.4 Montana 531.6 417.9 123.0 52.7 38.5 73.0 58.5 23.0 15.3 164.1 37.6 9.7 Nebraska 547.1 426.6 124.7 62.8 46.2 78.2 51.7 24.2 17.7 150.9 35.8 8.9 Nevada 514.4 405.1 114.3 52.1 39.3 76.8 65.5 20.9 15.4 138.4 38.4 11.0 New Hampshire 584.8 452.4 132.5 51.9 39.5 81.4 62.2 23.9 17.4 155.1 48.1 13.3 New Jersey 593.0 454.1 130.0 58.2 43.0 76.1 56.8 25.5 17.6 172.4 45.1 11.8 New Mexico 480.8 370.5 111.4 46.4 34.6 55.7 39.3 19.1 14.5 141.6 26.9 6.4 New York 583.3 442.7 125.8 54.6 41.5 77.1 55.1 25.9 17.8 167.2 42.5 10.9 North Carolina 579.2 418.1 125.0 54.5 38.7 100.1 58.2 23.0 15.6 158.3 37.5 9.1 North Dakota 555.6 421.0 126.4 62.9 44.1 71.5 46.2 22.0 17.8 169.4 40.9 10.1 Ohio 546.5 421.5 119.6 56.3 42.3 93.2 60.0 23.0 16.0 144.1 39.0 9.7 Oklahoma 567.8 426.7 123.9 56.1 42.1 101.9 64.7 22.6 17.6 153.2 35.5 8.7 Oregon 521.7 432.3 130.7 47.9 38.3 74.2 59.2 23.3 16.1 145.1 37.6 10.0 Pennsylvania 583.8 453.7 125.8 59.4 44.5 87.5 58.2 25.4 17.8 154.1 44.5 11.0 Rhode Island 590.8 466.7 133.2 55.2 43.0 88.2 64.7 23.9 17.6 152.6 52.4 13.8 South Carolina 559.9 397.7 121.4 52.2 38.7 96.7 53.7 20.6 13.6 159.0 30.4 8.0 South Dakota 494.3 389.8 118.4 54.2 41.0 72.2 47.1 20.5 16.0 149.1 34.2 8.0 Tennessee 565.6 413.7 119.6 56.2 41.3 106.1 61.5 23.0 16.2 145.6 34.9 8.4 Texas * 533.7 394.6 116.1 53.0 37.0 81.8 49.9 22.6 15.9 142.7 30.1 6.9 Utah 469.7 345.2 108.0 39.3 31.3 33.8 22.8 23.0 15.5 169.8 28.8 5.6 Vermont 554.3 455.5 129.4 45.8 40.4 82.0 64.6 24.0 17.7 150.9 43.6 12.6 Virginia † 537.0 396.9 124.0 49.8 37.9 85.2 54.5 21.4 14.3 157.7 33.8 8.1 Washington 552.6 438.4 131.8 48.6 37.2 73.3 57.7 26.6 17.5 155.3 39.5 9.5 West Virginia 576.5 441.6 112.2 61.8 45.4 112.7 73.6 24.0 16.8 138.4 39.3 11.4 Wisconsin † 513.8 404.6 118.8 48.2 37.4 70.6 51.2 22.5 16.5 144.4 36.4 9.3 Wyoming 513.8 388.8 113.2 49.5 38.7 59.7 47.9 20.9 15.5 162.6 42.6 10.4 United States 550.7 419.3 122.3 54.0 40.3 82.7 55.9 23.3 16.2 151.4 37.5 9.3 Rates are per 100,000 and age adjusted to the 2000 US standard population. * Data for 2005 are limited to cases diagnosed from January through June due to the effect of large migrations of populations on this state as a result of Hurricane Katrina in September 2005. † This state's incidence data are not included in overall US rates because registry data submitted for 2009 did not meet high‐quality standards according to the North American Association of Central Cancer Registries. 9 Death Rates for Selected Cancers by State, United States, 2005 to 2009 ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON‐HODGKIN LYMPHOMA PANCREAS PROSTATE STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE Alabama 259.0 157.4 24.0 22.9 15.1 89.4 41.1 8.3 5.3 13.3 9.5 28.7 Alaska 209.5 159.6 23.5 20.0 14.1 62.9 45.5 7.9 5.8 12.3 10.0 22.1 Arizona 182.1 130.0 20.5 16.8 11.6 50.2 33.2 7.5 4.8 10.9 7.9 19.7 Arkansas 253.7 161.2 23.6 22.5 15.2 92.5 46.3 8.8 5.2 13.6 9.4 25.3 California 194.9 141.7 22.3 18.1 12.9 49.2 33.1 8.1 5.0 11.8 9.4 23.2 Colorado 185.0 134.4 19.9 17.4 13.0 45.1 31.9 8.0 4.4 10.9 8.9 23.8 Connecticut 212.0 149.6 22.5 17.3 13.0 55.9 38.8 8.1 5.2 14.7 10.2 24.8 Delaware 229.6 162.8 23.0 20.3 14.3 69.2 48.5 8.4 5.0 12.3 9.7 24.9 Dist. of Columbia 256.3 160.4 28.0 23.1 17.7 64.7 34.8 9.4 3.5 16.3 10.7 41.3 Florida 206.0 141.9 21.5 18.3 13.0 63.5 39.3 7.8 4.9 12.0 8.7 19.6 Georgia 230.8 146.8 23.0 20.2 13.8 75.8 38.7 7.7 4.6 12.4 8.9 27.5 Hawaii 184.6 119.6 17.8 18.7 10.8 51.2 27.0 7.5 4.2 12.9 9.4 16.2 Idaho 195.9 143.5 21.3 15.9 13.4 51.3 35.6 8.1 5.4 11.5 9.8 26.7 Illinois 229.4 160.1 24.2 22.5 15.6 67.8 41.9 8.8 5.5 13.1 10.1 25.5 Indiana 244.9 163.2 23.9 22.5 15.0 82.0 47.2 9.7 5.6 13.1 9.4 23.8 Iowa 220.1 151.0 21.8 20.6 15.2 67.5 39.4 9.2 5.5 12.0 8.8 23.9 Kansas 221.5 149.9 22.9 21.2 14.0 70.6 41.0 9.6 5.2 12.5 9.4 21.4 Kentucky 267.2 173.6 23.4 24.3 16.6 99.7 55.5 9.2 5.9 12.5 9.4 24.6 Louisiana 260.8 165.8 26.3 25.1 15.7 84.4 44.1 9.0 5.2 13.8 11.0 27.1 Maine 240.0 161.6 21.4 20.5 14.4 73.1 46.4 9.2 5.5 12.2 9.8 24.4 Maryland 226.5 157.3 24.9 22.0 14.6 65.6 41.8 7.9 4.9 12.9 10.4 26.7 Massachusetts 222.6 154.0 21.9 19.6 13.8 62.6 42.5 8.3 5.1 13.1 10.3 23.4 Michigan 228.1 160.9 24.0 20.2 14.7 70.3 43.9 9.2 6.1 13.9 10.1 22.6 Minnesota 206.8 146.0 21.3 18.0 12.6 55.2 37.2 9.6 5.2 11.8 9.5 24.3 Mississippi 274.2 158.8 24.9 24.9 16.2 97.3 42.3 8.3 4.8 13.8 9.9 31.0 Missouri 237.6 160.4 24.9 21.6 14.6 79.8 46.0 8.4 5.3 13.1 9.7 22.7 Montana 203.4 150.5 20.5 17.8 14.7 57.1 41.3 8.1 5.4 12.4 8.7 27.2 Nebraska 215.2 145.7 21.2 22.5 15.1 62.4 36.0 9.0 5.7 12.2 9.4 24.7 Nevada 213.3 158.4 23.3 20.7 15.3 62.5 48.8 6.7 4.8 12.3 9.8 23.4 New Hampshire 218.2 154.7 21.4 19.3 13.2 62.0 43.0 7.7 5.0 13.4 10.6 23.2 New Jersey 213.8 157.7 26.1 22.0 15.5 57.9 38.3 8.1 5.5 13.3 10.0 22.4 New Mexico 190.1 134.3 21.1 18.7 13.5 44.4 29.1 6.7 4.4 11.6 8.9 24.3 New York 201.3 145.2 22.5 19.4 14.0 55.2 35.8 8.0 4.9 12.6 9.7 22.2 North Carolina 236.9 152.7 23.5 19.8 13.6 79.3 41.6 7.6 5.0 12.1 9.7 25.9 North Dakota 210.2 144.1 22.0 21.6 14.8 56.5 34.3 7.4 5.5 12.8 8.7 25.2 Ohio 243.4 163.4 25.2 22.5 15.5 77.4 44.5 9.4 5.6 13.1 9.9 25.4 Oklahoma 243.0 161.2 23.8 22.9 14.8 82.7 46.9 8.9 5.9 12.0 8.7 23.6 Oregon 214.4 155.5 21.5 18.5 13.9 61.2 43.6 8.6 5.7 12.2 10.0 25.7 Pennsylvania 232.4 158.5 24.1 22.3 15.2 68.5 40.0 9.2 5.6 13.4 10.0 23.7 Rhode Island 228.8 151.3 21.9 19.6 13.3 66.3 43.0 8.8 4.6 12.4 8.4 22.5 South Carolina 241.3 151.0 24.0 20.5 14.1 79.6 40.0 8.0 4.8 12.5 9.7 26.9 South Dakota 206.0 141.5 20.9 20.1 14.2 62.2 35.5 7.8 5.1 11.1 9.1 22.9 Tennessee 257.9 162.0 24.0 22.4 15.1 91.5 47.2 9.3 5.5 13.0 9.3 25.3 Texas 212.5 142.8 22.2 20.2 13.1 63.4 35.9 8.1 5.0 11.7 8.7 21.4 Utah 154.1 109.6 21.5 14.3 10.4 28.1 16.1 7.5 4.6 9.5 8.0 24.5 Vermont 211.9 152.8 20.7 18.8 14.2 61.6 44.3 8.1 5.0 12.5 9.6 22.0 Virginia 228.5 153.9 24.8 19.9 14.2 70.6 40.7 8.3 5.0 13.0 9.9 26.0 Washington 209.6 153.9 21.9 17.7 12.7 58.1 42.8 8.8 5.5 12.4 9.8 24.9 West Virginia 254.8 173.2 23.6 24.2 16.8 87.5 51.9 9.1 6.4 11.2 7.7 21.7 Wisconsin 218.8 152.0 21.6 18.7 13.1 59.9 38.7 9.4 5.7 12.9 9.8 25.6 Wyoming 199.5 148.3 21.4 18.9 14.2 52.8 38.5 8.1 5.9 13.2 9.7 20.9 United States 219.4 151.1 23.0 20.2 14.1 65.7 39.6 8.4 5.2 12.5 9.5 23.6 Rates are per 100,000 and age adjusted to the 2000 US standard population. Cancer Occurrence by Race/Ethnicity Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 10 ). For all cancer sites combined, African American men have a 14% higher incidence rate and a 33% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 16% higher death rate than white women. Cancer incidence and death rates are higher among African American men than white men for every cancer site listed in Table 10 . 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), access to high‐quality screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. 24 The higher breast cancer incidence rate among whites compared to women of other racial or ethnic groups is thought to reflect a combination of factors that affect both diagnosis (ie, more prevalent mammography among white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white women). 25 10 Incidence and Death Rates by Site, Race, and Ethnicity, United States, 2005 to 2009 WHITE AFRICAN AMERICAN ASIAN AMERICAN AND PACIFIC ISLANDER AMERICAN INDIAN AND ALASKA NATIVE * HISPANIC/LATINO Incidence All sites Male 543.1 619.7 327.5 423.2 418.7 Female 424.0 396.8 286.2 360.3 333.2 Breast (female ) 123.3 118.0 85.9 89.1 93.0 Colorectum Male 52.8 65.1 41.4 50.7 46.9 Female 39.2 48.0 32.1 41.1 33.3 Kidney & renal pelvis Male 21.2 23.3 10.1 29.0 19.8 Female 11.2 12.1 5.1 16.6 11.4 Liver & intrahepatic bile duct Male 9.1 15.0 21.6 16.4 17.5 Female 3.1 4.2 8.1 7.6 6.6 Lung & bronchus Male 82.3 99.3 49.4 67.4 45.4 Female 57.5 51.3 28.1 49.5 26.6 Prostate 141.0 228.7 77.2 98.8 124.9 Stomach Male 8.4 16.3 16.1 13.0 13.5 Female 4.0 8.2 9.3 6.4 8.1 Uterine cervix 7.8 10.4 7.2 10.1 11.8 Mortality All sites Male 216.7 288.3 132.6 184.9 146.4 Female 150.8 174.6 93.2 135.9 100.6 Breast (female ) 22.4 31.6 11.9 16.6 14.9 Colorectum Male 19.5 29.8 13.1 18.8 15.3 Female 13.6 19.8 9.6 14.6 10.2 Kidney & renal pelvis Male 5.9 6.0 2.9 8.8 5.0 Female 2.7 2.6 1.3 4.1 2.3 Liver & intrahepatic bile duct Male 7.4 11.9 14.5 11.9 11.8 Female 3.1 4.0 6.1 5.9 5.3 Lung & bronchus Male 65.3 82.6 35.9 48.3 30.8 Female 40.8 38.0 18.5 33.2 14.1 Prostate 21.7 53.1 10.0 19.7 17.8 Stomach Male 4.3 10.3 9.0 8.3 7.4 Female 2.2 4.8 5.3 3.8 4.3 Uterine cervix 2.2 4.3 2.0 3.5 3.0 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Race and ethnicity categories are not mutually exclusive of Hispanic origin. * Data based on Indian Health Service Contract Health Service Delivery Areas. 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 cancers related to infectious agents, such as 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 Americans/Pacific Islanders as in whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B virus in this population. 26 Kidney cancer incidence and death rates are the highest among American Indians/Alaskan Natives, which may reflect the high prevalence of obesity and smoking in this population. 27 Cancer incidence rates can only be adjusted for delayed reporting in whites and African Americans because the long‐term incidence data required for delay adjustment are not available for other racial and ethnic groups. During the past 10 years of data (2000‐2009), while incidence rates (unadjusted for delayed reporting) declined by 1% or more per year among men of all racial/ethnic groups except American Indians/Alaska Natives, among women only slight declines (0.2%‐0.3% per year) occurred among non‐Hispanic whites and Hispanics (Table 11 ). In contrast, cancer death rates declined by 1.5% or more per year among men and by 1.1% or more per year among women of all races/ethnicities except American Indians/Alaska Natives, among whom rates were stable. Notably, the largest declines in death rates occurred among men of African American (2.4% per year) and Hispanic (2.3% per year) heritage. 11 Ten‐Year Trends in Cancer Incidence and Mortality Rates by Race/Ethnicity, United States, 2000 to 2009 2000‐2009 AAPC INCIDENCE MORTALITY MALE FEMALE MALE FEMALE All races/ethnicities −1.1 * −0.3 * −1.8 * −1.4 * Non‐Hispanic white −1.0 * −0.2 * −1.5 * −1.3 * African American −1.4 * 0.0 −2.4 * −1.5 * Asian American/Pacific Islander −1.8 * 0.2 −1.5 * −1.1 * American Indian/Alaska Native † −0.7 0.0 −0.8 −0.8 Hispanic ‡ −1.7 * −0.3 * −2.3 * −1.4 * AAPC indicates average annual percent change. * AAPC is statistically significant ( P < .05). † Data based on Indian Health Service Contract Health Service Delivery Areas. ‡ Excludes deaths from the District of Columbia, Minnesota, New Hampshire, and North Dakota due to unreliable Hispanic origin data for some years. Notes: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 2 joinpoints. Incidence trends based on the North American Association of Central Cancer Registries (NAACCR) data. Race and ethnicity categories are not mutually exclusive of Hispanic origin. Cancer Survival African Americans are less likely to survive cancer than whites. The 5‐year relative survival is lower among African Americans for every stage of diagnosis for nearly every type of cancer (Fig. 7 ). 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 8 , African Americans are less likely than whites to be diagnosed with cancer at a localized stage, when treatment is usually less extensive and more successful. The extent to which factors other than stage at diagnosis contribute to the overall survival differential is unclear. 28 A study of Medicare‐insured patients showed that African Americans remain less likely than whites to receive standard cancer therapies for lung, breast, colorectal, and prostate cancers. 29 Some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes. 30 7 Five‐Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2002 to 2008. *The standard error of the survival rate is between 5 and 10 percentage points. The survival rate for carcinoma in situ of the urinary bladder is 96% for All Races, 97% for Whites, and 91% for African Americans. 8 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 2002 to 2008. *The proportions of carcinoma in situ of the urinary bladder are 51% for All Races, 52% for Whites, and 37% for African Americans. Stage categories do not sum to 100% because sufficient information is not available to assign a stage to all cancer cases. There have been notable improvements in survival over the past 3 decades for most cancers for both whites and African Americans (Table 12 ). Between 1975 to 1977 and 2002 to 2008, overall 5‐year relative survival rates increased 19% among whites and 21% among African Americans. The largest improvements in survival have been for leukemia and non‐Hodgkin lymphoma, while cancers of the lung and pancreas have shown the least improvement. 12 Trends in 5‐Year Relative Survival Rates * (%) by Race and Year of Diagnosis, United States, 1975 to 2008 ALL RACES WHITE AFRICAN AMERICAN 1975 TO 1977 1987 TO 1989 2002 TO 2008 1975 TO 1977 1987 TO 1989 2002 TO 2008 1975 TO 1977 1987 TO 1989 2002 TO 2008 All sites 49 56 68 † 50 57 69 † 39 43 60 † Brain & other nervous system 22 29 35 † 22 28 34 † 25 32 41 † Breast (female) 75 84 90 † 76 85 92 † 62 71 78 † Colon 51 61 65 † 51 61 66 † 45 53 55 † Esophagus 5 10 19 † 6 11 21 † 3 7 14 † Hodgkin lymphoma 72 79 87 † 72 80 88 † 70 72 83 † Kidney & renal pelvis 50 57 72 † 50 57 72 † 49 55 70 † Larynx 66 66 63 † 67 67 65 59 56 51 Leukemia 34 43 58 † 35 44 59 † 33 35 51 † Liver & intrahepatic bile duct 3 5 16 † 3 6 16 † 2 3 11 † Lung & bronchus 12 13 17 † 12 13 17 † 11 11 14 † Melanoma of the skin 82 88 93 † 82 88 93 † 57 ‡ 79 ‡ 70 ‡ Myeloma 25 28 43 † 25 27 43 † 30 30 43 † Non‐Hodgkin lymphoma 47 51 71 † 47 52 72 † 48 46 63 † Oral cavity & pharynx 53 54 65 † 54 56 67 † 36 34 45 † Ovary 36 38 43 † 35 38 43 † 42 34 36 Pancreas 2 4 6 † 3 3 6 † 2 6 5 † Prostate 68 83 100 † 69 85 100 † 61 72 98 † Rectum 48 58 68 † 48 59 69 † 45 52 61 † Stomach 15 20 28 † 14 19 27 † 16 19 28 † Testis 83 95 96 † 83 96 97 † 73 ‡ , § 88 ‡ 89 Thyroid 92 95 98 † 92 94 98 † 90 92 96 † Urinary bladder 73 79 80 † 74 80 81 † 50 63 62 † Uterine cervix 69 70 69 70 73 70 65 57 61 Uterine corpus 87 83 83 † 88 84 85 † 60 57 63 * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillance, Epidemiology, and End Results (SEER) 9 areas from 1975 to 1977, 1987 to 1989, and 2002 to 2008 and followed through 2009. † The difference in rates between 1975 to 1977 and 2002 to 2008 is statistically significant ( P < .05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. § Survival rate is for 1978 to 1980. Relative survival rates cannot be calculated for some minority populations because accurate life expectancies are not available. Comparison of cause‐specific survival rates of cancer patients diagnosed from 2002 to 2008 in SEER registry areas of the United States indicate that all minority male populations have a greater probability than whites of dying from cancer within 5 years of diagnosis, although the difference is small for Hispanic men. 6 In contrast, among women, Asian Americans/Pacific Islanders (69.1%) and Hispanics (67.2%) have the highest 5‐year cause‐specific survival, followed by whites (66.2%), American Indians/Alaska Natives (60.6%), and African Americans (57.6%). Minority populations are generally more likely than non‐Hispanic whites to be diagnosed at a distant stage of disease for all 4 major cancer sites. 31 Cancer in Children Cancer is the second most common cause of death among children ages 1 to 14 years in the United States, surpassed only by accidents; 1,320 children died from cancer in 2009. 1 Leukemia accounts for almost one‐third of all cancers (including benign brain tumors) diagnosed in children aged 0 to 14 years, 77% of which are acute lymphocytic leukemias. Cancers of the brain and other nervous system are the second most common cancer type (25%), followed by soft tissue sarcomas (7%, half of which are rhabdomyosarcoma), neuroblastoma (6%), renal (Wilms) tumors (5%), and Hodgkin and non‐Hodgkin lymphomas (4% each). 6 From 2005 to 2009, the overall incidence rate for cancer in children aged 14 years and younger increased slightly by 0.5% per year, a trend that has been consistent since 1975. The death rate for childhood cancer has decreased by more than half over the past 3 decades, from 4.9 (per 100,000) in 1975 to 2.1 in 2009. Table 13 provides trends in survival rates for the most common childhood cancers. The 5‐year relative survival rate for all cancer sites combined improved from 58% for children diagnosed between 1975 and 1977 to 83% for those diagnosed between 2002 and 2008. The substantial progress for all of the major childhood cancers reflects both improvements in treatment and high levels of participation in clinical trials. 13 Trends in 5‐Year Relative Survival Rates * (%) for Children (0 to 14 Years) by Year of Diagnosis, United States, 1975 to 2008 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 2001 2002 TO 2008 All sites 58 63 67 68 72 76 77 79 81 83 † Acute lymphocytic leukemia 58 66 71 73 78 83 84 87 88 91 † Acute myeloid leukemia 19 26 27 ‡ 31 ‡ 37 ‡ 42 42 ‡ 49 58 64 † Bone & joint 50 ‡ 48 57 ‡ 57 ‡ 67 ‡ 67 74 70 70 79 † Brain & other nervous system 57 58 56 62 64 65 71 75 74 75 Hodgkin lymphoma 81 87 88 91 87 97 95 96 94 97 † Neuroblastoma 53 57 55 52 63 76 67 66 73 74 † Non‐Hodgkin lymphoma 43 53 67 70 71 77 81 84 89 85 † Soft tissue 61 75 69 73 66 80 77 70 77 82 † Wilms tumor 73 79 87 91 92 92 92 92 94 90 † * Survival rates are adjusted for normal life expectancy and are based on follow‐up of patients through 2009. † The difference in rates between 1975 to 1977 and 2002 to 2008 is statistically significant ( P < .05). ‡ The standard error of the survival rate is between 5 and 10 percentage points. Limitations The projected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are model‐based and may vary considerably from year to year for reasons other than changes in cancer occurrence. For instance, estimates are affected by changes in method, which occur regularly as modeling techniques improve over time and cancer registration becomes more complete. In addition, not all changes in cancer trends can be captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year‐to‐year changes in cancer occurrence and death. The data used for tracking cancer trends are age‐standardized or age‐specific cancer death rates from the NCHS and cancer incidence rates from SEER and/or NPCR. Nevertheless, the American Cancer Society projections of the numbers of new cancer cases and deaths provide a reasonably accurate estimate of the current cancer burden in the United States. Errors in reporting race/ethnicity in medical records and on death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and non‐African American 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 important differences in the cancer burden within racial/ethnic subgroups are masked. Conclusions In 2009, Americans had a 20% lower risk of death from cancer than in 1991, when cancer death rates peaked. Despite this substantial progress, all demographic groups have not benefitted equally, particularly for cancers such as colorectal and breast, for which mortality declines have been attributed to earlier detection and improvements in treatment. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket as well as other disadvantaged populations.

Journal

CA: A Cancer Journal for CliniciansWiley

Published: Jan 1, 2013

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