Get 20M+ Full-Text Papers For Less Than $1.50/day. Subscribe now for You or Your Team.

Learn More →

Cancer statistics, 2017

Cancer statistics, 2017 CA CANCER J CLIN 2017;67:7–30 1 2 3 Rebecca L. Siegel, MPH ; Kimberly D. Miller, MPH ; Ahmedin Jemal, DVM, PhD Strategic Director, Surveillance Information Services, Surveillance and Health Services Abstract: Each year, the American Cancer Society estimates the numbers of new can- Research, American Cancer Society, Atlanta, cer cases and deaths that will occur in the United States in the current year and com- GA; Epidemiologist, Surveillance and Health piles the most recent data on cancer incidence, mortality, and survival. Incidence data Services Research, American Cancer Society, were collected by the Surveillance, Epidemiology, and End Results Program; the National Atlanta, GA; Vice President, Surveillance and Program of Cancer Registries; and the NorthAmericanAssociationofCentral Cancer Health Services Research, American Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In Society, Atlanta, GA 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur Corresponding author: Rebecca L. Siegel, in the United States. For all sites combined, the cancer incidence rate is 20% higher in MPH, Surveillance Information Services, Sur- veillance and Health Services Research, Amer- men than in women, while the cancer death rate is 40% higher. However, sex disparities ican Cancer Society, 250 Williams St, NW, vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in Atlanta, GA 30303-1002; Rebecca.siegel@can- women than in men (21 vs 7 per 100,000 population), despite equivalent death rates cer.org (0.5 per 100,000 population), largely reflecting sex differences in the “epidemic of diag- DISCLOSURES: The authors report no con- nosis.” Over the past decade of available data, the overall cancer incidence rate (2004- flicts of interest. 2013) was stable in women and declined by approximately 2% annually in men, while the doi: 10.3322/caac.21387. Available online cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. at cacancerjournal.com From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approxi- mately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7–30. V 2017 American Cancer Society. Keywords: cancer cases, cancer statistics, death rates, incidence, mortality Introduction Cancer is amajor publichealth problem worldwideand is thesecondleading causeof death in the United States. In this article, we provide the expected numbers of new cancer cases and deaths in 2017 in the United States nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using population-based data. The most current cancer data are available through 2013 for incidence and through 2014 for mortality. We also estimate the total number of deaths averted as a result of the continual decline in cancer death rates since the early 1990s. In addition, we present the actual number of deaths reported in 2014 by age for the 10 leading causes of death and for the 5 leading causes of cancer death. Materials and Methods Incidence and Mortality Data Mortality data from 1930 to 2014 were provided by the National Center for 1-3 Health Statistics (NCHS). Forty-seven states and the District of Columbia met data quality requirements for reporting to the national vital statistics system in 1930. Texas, Alaska, and Hawaii began reporting mortality data in 1933, 1959, and 1960, respectively. The methods for abstraction and age adjustment of mortal- 3,4 ity data are described elsewhere. Population-based cancer incidence data in the United States have been collected by the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 7 Cancer Statistics, 2017 TABLE 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2017* ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,688,780 836,150 852,630 600,920 318,420 282,500 Oral cavity & pharynx 49,670 35,720 13,950 9,700 7,000 2,700 Tongue 16,400 11,880 4,520 2,400 1,670 730 Mouth 13,210 7,800 5,410 2,580 1,680 900 Pharynx 17,000 13,780 3,220 3,050 2,340 710 Other oral cavity 3,060 2,260 800 1,670 1,310 360 Digestive system 310,440 175,650 134,790 157,700 92,350 65,350 Esophagus 16,940 13,360 3,580 15,690 12,720 2,970 Stomach 28,000 17,750 10,250 10,960 6,720 4,240 Small intestine 10,190 5,380 4,810 1,390 770 620 Colon† 95,520 47,700 47,820 50,260 27,150 23,110 Rectum 39,910 23,720 16,190 Anus, anal canal, & anorectum 8,200 2,950 5,250 1,100 450 650 Liver & intrahepatic bile duct 40,710 29,200 11,510 28,920 19,610 9,310 Gallbladder & other biliary 11,740 5,320 6,420 3,830 1,630 2,200 Pancreas 53,670 27,970 25,700 43,090 22,300 20,790 Other digestive organs 5,560 2,300 3,260 2,460 1,000 1,460 Respiratory system 243,170 133,050 110,120 160,420 88,100 72,320 Larynx 13,360 10,570 2,790 3,660 2,940 720 Lung & bronchus 222,500 116,990 105,510 155,870 84,590 71,280 Other respiratory organs 7,310 5,490 1,820 890 570 320 Bones & joints 3,260 1,820 1,440 1,550 890 660 Soft tissue (including heart) 12,390 6,890 5,500 4,990 2,670 2,320 Skin (excluding basal & squamous) 95,360 57,140 38,220 13,590 9,250 4,340 Melanoma of the skin 87,110 52,170 34,940 9,730 6,380 3,350 Other nonepithelial skin 8,250 4,970 3,280 3,860 2,870 990 Breast 255,180 2,470 252,710 41,070 460 40,610 Genital system 279,800 172,330 107,470 59,100 27,500 31,600 Uterine cervix 12,820 12,820 4,210 4,210 Uterine corpus 61,380 61,380 10,920 10,920 Ovary 22,440 22,440 14,080 14,080 Vulva 6,020 6,020 1,150 1,150 Vagina & other genital, female 4,810 4,810 1,240 1,240 Prostate 161,360 161,360 26,730 26,730 Testis 8,850 8,850 410 410 Penis & other genital, male 2,120 2,120 360 360 Urinary system 146,650 103,480 43,170 32,190 22,260 9,930 Urinary bladder 79,030 60,490 18,540 16,870 12,240 4,630 Kidney & renal pelvis 63,990 40,610 23,380 14,400 9,470 4,930 Ureter & other urinary organs 3,630 2,380 1,250 920 550 370 Eye & orbit 3,130 1,800 1,330 330 180 150 Brain & other nervous system 23,800 13,450 10,350 16,700 9,620 7,080 Endocrine system 59,250 15,610 43,640 3,010 1,440 1,570 Thyroid 56,870 14,400 42,470 2,010 920 1,090 Other endocrine 2,380 1,210 1,170 1,000 520 480 Lymphoma 80,500 44,730 35,770 21,210 12,080 9,130 Hodgkin lymphoma 8,260 4,650 3,610 1,070 630 440 Non-Hodgkin lymphoma 72,240 40,080 32,160 20,140 11,450 8,690 Myeloma 30,280 17,490 12,790 12,590 6,660 5,930 Leukemia 62,130 36,290 25,840 24,500 14,300 10,200 Acute lymphocytic leukemia 5,970 3,350 2,620 1,440 800 640 Chronic lymphocytic leukemia 20,110 12,310 7,800 4,660 2,880 1,780 Acute myeloid leukemia 21,380 11,960 9,420 10,590 6,110 4,480 Chronic myeloid leukemia 8,950 5,230 3,720 1,080 610 470 Other leukemia‡ 5,720 3,440 2,280 6,730 3,900 2,830 Other & unspecified primary sites‡ 33,770 18,230 15,540 42,270 23,660 18,610 *Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. About 63,410 cases of carcinoma in situ of the female breast and 74,680 cases of melanoma in situ will be newly diagnosed in 2017. †Deaths for colon and rectum cancers are combined because a large number of deaths from rectal cancer are misclassified as colon. ‡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. 8 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 2. Estimated New Cases for Selected Cancers by State, 2017* ALL FEMALE UTERINE COLON & UTERINE LUNG & MELANOMA NON-HODGKIN URINARY STATE CASES BREAST CERVIX RECTUM CORPUS LEUKEMIA BRONCHUS OF THE SKIN LYMPHOMA PROSTATE BLADDER Alabama 26,160 3,960 210 2,210 720 770 3,880 1,320 960 2,410 1,090 Alaska 3,600 500 † 280 120 100 450 130 140 320 150 Arizona 35,810 4,870 240 2,630 1,110 1,170 3,940 2,050 1,410 2,990 1,670 Arkansas 16,040 2,100 150 1,390 480 580 2,620 610 660 1,440 710 California 176,140 27,980 1,490 13,890 6,280 6,740 18,270 9,180 7,880 14,520 7,500 Colorado 24,330 3,840 170 1,770 890 960 2,420 1,590 1,090 2,880 1,120 Connecticut 21,900 3,420 120 1,600 890 800 2,540 970 950 2,140 1,220 Delaware 5,660 840 † 440 200 180 850 340 250 590 270 Dist. of Columbia 3,070 520 † 210 110 90 310 120 110 380 90 Florida 124,740 18,170 1,040 9,930 4,230 5,070 19,000 7,610 5,410 12,830 6,430 Georgia 48,850 7,820 410 4,040 1,510 1,550 6,610 2,930 1,890 5,410 1,880 Hawaii 6,540 1,120 50 660 290 210 700 460 260 500 240 Idaho 7,310 1,080 50 610 290 310 980 550 370 870 480 Illinois 64,720 10,210 520 5,580 2,740 2,350 8,600 2,810 2,750 6,410 3,070 Indiana 36,440 5,140 290 3,080 1,370 1,280 5,540 1,730 1,560 3,410 1,710 Iowa 17,230 2,400 100 1,510 700 760 2,410 1,020 800 1,430 870 Kansas 14,400 2,180 110 1,170 540 560 1,880 830 630 1,320 640 Kentucky 26,220 3,590 210 2,250 830 1,050 4,830 1,410 1,070 2,050 1,190 Louisiana 24,220 3,320 230 2,150 630 770 3,510 960 990 2,620 980 Maine 8,750 1,350 † 710 380 310 1,380 450 380 720 570 Maryland 31,820 5,250 220 2,430 1,200 1,000 4,020 1,700 1,260 3,400 1,390 Massachusetts 37,130 5,940 200 2,760 1,600 1,220 4,890 1,890 1,630 3,930 2,050 Michigan 57,600 8,160 370 4,660 2,320 2,010 8,190 2,780 2,480 5,350 3,050 Minnesota 30,000 4,230 140 2,170 1,080 1,290 3,620 1,330 1,370 2,750 1,320 Mississippi 17,290 2,340 140 1,520 410 530 2,570 560 560 1,380 620 Missouri 34,400 4,930 240 2,860 1,250 1,210 5,620 1,690 1,420 2,990 1,610 Montana 6,140 900 † 500 220 260 750 400 280 750 350 Nebraska 9,520 1,450 60 840 380 380 1,220 490 440 840 450 Nevada 13,840 2,010 110 1,160 400 460 1,680 560 560 1,190 700 New Hampshire 8,670 1,260 † 620 350 290 1,150 470 340 770 520 New Jersey 51,680 7,890 360 4,000 2,100 1,990 5,540 2,790 2,380 5,180 2,560 New Mexico 10,040 1,410 80 800 350 370 1,010 490 400 960 390 New York 107,530 16,310 810 8,490 4,420 4,320 12,700 4,900 4,760 10,060 5,410 North Carolina 56,900 8,580 400 4,290 1,810 1,970 7,940 3,060 2,180 5,560 2,500 North Dakota 4,180 550 † 330 140 150 480 210 170 360 200 Ohio 68,180 9,430 460 5,510 2,670 2,270 10,660 3,140 2,860 5,840 3,360 Oklahoma 18,710 2,690 170 1,610 590 760 3,050 790 840 1,700 860 Oregon 21,780 3,450 140 1,620 870 730 2,900 1,580 970 2,060 1,070 Pennsylvania 77,710 11,300 520 6,300 3,270 2,800 9,930 4,140 3,310 7,320 4,190 Rhode Island 5,870 930 † 480 250 190 860 270 260 780 350 South Carolina 28,680 4,250 210 2,270 890 990 4,320 1,740 1,120 3,250 1,260 South Dakota 4,920 690 † 410 180 200 590 240 210 430 240 Tennessee 37,080 5,510 290 3,080 1,090 1,300 5,830 1,840 1,490 2,830 1,620 Texas 116,200 17,060 1,300 9,690 3,890 4,550 14,560 4,240 5,250 12,550 4,270 Utah 10,990 1,460 70 740 400 460 850 950 490 1,240 430 Vermont 4,000 580 † 280 160 110 510 220 170 380 240 Virginia 42,770 7,020 280 3,260 1,490 1,380 5,400 2,500 1,720 3,950 1,870 Washington 35,560 5,950 250 2,720 1,380 1,390 4,390 2,590 1,740 3,580 1,830 West Virginia 11,690 1,520 80 1,050 450 410 1,980 700 480 840 610 Wisconsin 32,990 4,850 180 2,650 1,360 1,460 4,280 1,590 1,380 3,570 1,670 Wyoming 2,780 410 † 220 100 100 320 190 120 320 150 United States 1,688,780 252,710 12,820 135,430 61,380 62,130 222,500 87,110 72,240 161,360 79,030 *Rounded to the nearest 10; excludes basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Estimate is fewer than 50 cases. Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusionof states with fewer than 50 cases. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 9 Cancer Statistics, 2017 FIGURE 1. Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2017. Estimates are rounded to the nearest 10 and cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Results (SEER) Program since 1973 and by the Centers for presented herein was adapted from data previously published Disease Control and Prevention’s (CDC’s) National Pro- in the SEER Cancer Statistics Review 1975-2013. gram of Cancer Registries (NPCR) since 1995. The SEER NAACCR compiles and reports incidence data from program is the only source for long-term population-based 1995 onward for cancer registries that participate in the SEER program and/or the NPCR. These data approach incidence data. Long-term incidence and survival trends (1975-2013) were based on data from the 9 oldest SEER 100% coverage of the US population in the most recent time areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and period and were the source for the projected new cancer cases 10,11 the metropolitan areas of Atlanta, Detroit, San Francisco- in 2017 and incidence rates by state and race/ethnicity. Oakland, and Seattle-Puget Sound), representing approxi- Some of the incidence data presented herein were previously 5,6 mately 9% of the US population. The lifetime probability published in volumes 1 and 2 of Cancer in North America: 12,13 of developing cancer, stage distribution, and survival by stage 2009-2013. and for children and adolescents were based on data from all All cancer cases were classified according to the Interna- 18 SEER registries (the SEER 9 registries plus Alaska tional Classification of Diseases for Oncology except childhood Natives, California, Georgia, Kentucky, Louisiana, and New and adolescent cancers, which were classified according to Jersey), covering 28% of the US population. The probability the International Classification of Childhood Cancer 14,15 of developing cancer was calculated using NCI’s DevCan (ICCC). Causes of death were classified according to 8 16 software (version 6.7.4). Some of the statistical information the International Classification of Diseases. All incidence 10 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 3. Estimated Deaths for Selected Cancers by State, 2017* BRAIN & OTHER LIVER & ALL NERVOUS FEMALE COLON & INTRAHEPATIC LUNG & NON-HODGKIN STATE SITES SYSTEM BREAST RECTUM LEUKEMIA BILE DUCT BRONCHUS LYMPHOMA OVARY PANCREAS PROSTATE Alabama 10,530 320 650 940 420 470 3,200 320 250 710 450 Alaska 1,070 † 70 100 † 60 280 † † 80 50 Arizona 12,050 380 810 1,020 550 660 2,820 430 310 930 600 Arkansas 6,800 180 420 600 250 280 2,160 210 150 430 260 California 59,400 1,830 4,440 5,240 2,610 3,750 12,000 2,140 1,530 4,510 3,130 Colorado 7,840 270 570 660 340 380 1,640 260 240 580 450 Connecticut 6,610 190 430 450 300 300 1,630 230 170 490 310 Delaware 2,050 50 130 150 70 110 590 70 50 150 90 Dist. of Columbia 1,060 † 100 90 † 90 220 † † 100 70 Florida 43,870 1,250 2,910 3,620 1,800 2,020 11,790 1,510 970 3,170 2,050 Georgia 17,280 490 1,320 1,540 620 850 4,720 510 420 1,160 780 Hawaii 2,520 50 140 240 90 170 590 100 50 220 100 Idaho 2,900 100 190 250 110 120 680 110 70 230 170 Illinois 24,040 610 1,680 2,030 990 1,040 6,470 790 570 1,650 1,040 Indiana 13,590 350 860 1,110 550 520 4,030 450 300 900 550 Iowa 6,460 190 380 570 260 240 1,740 240 150 440 280 Kansas 5,440 170 330 470 260 230 1,500 180 120 400 230 Kentucky 10,400 250 590 830 390 400 3,560 330 200 640 340 Louisiana 9,240 220 620 830 320 520 2,610 300 170 700 370 Maine 3,260 100 170 220 130 120 960 110 60 220 140 Maryland 10,650 280 820 860 410 560 2,630 340 260 840 470 Massachusetts 12,620 350 760 910 540 670 3,270 410 320 950 550 Michigan 21,050 570 1,410 1,680 830 860 5,650 760 500 1,560 830 Minnesota 9,860 280 610 760 480 390 2,450 390 230 710 470 Mississippi 6,560 220 420 650 230 300 1,940 170 110 460 280 Missouri 14,380 330 860 1,070 550 580 4,030 390 250 910 500 Montana 2,030 60 130 170 80 80 510 70 50 140 120 Nebraska 3,520 110 230 330 150 130 900 120 70 250 180 Nevada 5,200 150 380 500 200 230 1,400 160 120 360 270 New Hampshire 2,710 80 170 200 110 90 760 80 60 200 120 New Jersey 15,880 420 1,250 1,420 640 700 3,760 510 410 1,270 700 New Mexico 3,630 90 250 340 150 220 760 110 100 250 200 New York 35,960 910 2,410 2,870 1,460 1,680 8,660 1,210 910 2,750 1,560 North Carolina 20,020 600 1,360 1,530 760 940 5,830 620 440 1,350 840 North Dakota 1,290 † 70 120 60 † 340 † † 90 70 Ohio 25,430 640 1,690 2,130 990 990 7,300 860 570 1,810 1,020 Oklahoma 8,200 200 530 710 340 360 2,450 270 200 520 350 Oregon 8,140 260 520 660 320 440 2,030 290 230 580 410 Pennsylvania 28,510 700 1,900 2,390 1,210 1,220 7,420 1,010 690 2,110 1,200 Rhode Island 2,160 50 120 170 90 110 610 60 50 140 90 South Carolina 10,320 260 700 830 380 440 2,920 300 230 710 460 South Dakota 1,660 60 110 160 90 60 450 50 † 110 70 Tennessee 14,830 380 920 1,220 570 670 4,590 470 310 950 550 Texas 40,260 1,100 2,830 3,700 1,690 2,620 9,540 1,380 920 2,780 1,650 Utah 3,180 130 270 260 170 150 460 120 100 270 210 Vermont 1,400 50 70 100 50 50 400 † † 110 70 Virginia 14,870 390 1,060 1,190 550 670 3,810 490 370 1,080 650 Washington 12,720 410 850 970 520 680 3,100 460 330 920 620 West Virginia 4,780 110 280 430 190 170 1,450 160 90 280 160 Wisconsin 11,710 360 740 880 540 440 3,070 420 220 870 570 Wyoming 960 † 60 80 60 † 220 † † 70 † United States 600,920 16,700 40,610 50,260 24,500 28,920 155,870 20,140 14,080 43,090 26,730 *Rounded to the nearest 10. †Estimate is fewer than 50 deaths. Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusionof states with fewer than 50 deaths. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 11 Cancer Statistics, 2017 from 1999 through 2013 using geographic variations in soci- odemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. Then these counts were adjusted for delays in cancer reporting using registry-specific or combined NAACCR delay ratios and aggregated to obtain national- and state-level counts for each year. Finally, a temporal projection method (the vector autoregressive model) was applied to all 15 years of data to estimate counts for 2017. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are not required to be reported to cancer registries. For complete details of the case projection methodology, please refer to Zhu et al. New cases of female breast carcinoma in situ and melano- ma in situ diagnosed in 2017 were estimated by first approxi- mating the number of cases occurring annually from 2004 through 2013 based on age-specific NAACCR incidence rates (data from 46 states and the District of Columbia with FIGURE 2. Trends in Cancer Incidence (1975 to 2013) and high-quality data every year) and US population estimates Death Rates (1975 to 2014) by Sex, United States. provided in SEER*Stat. The average annual percent change Rates are age adjusted to the 2000 US standard population. Incidence rates also are adjusted for delays in reporting. in case counts from 2004 through 2013 generated by the joinpoint regression model was then used to project cases to 2017. The estimates for in situ cases were not adjusted for and death rates were age-standardized to the 2000 US stan- reporting delays. dard population and expressed per 100,000 population, as The number of cancer deaths expected to occur in 2017 calculated by NCI’s SEER*Stat software (version 8.3.2). was estimated based on the most recent joinpoint- The annual percent change in rates was quantified using generated annual percent change in reported numbers of NCI’s Joinpoint Regression Program (version 4.3.1.0). cancer deaths from 2000 through 2014 at the state and Whenever possible, cancer incidence rates presented in this national levels as reported to the NCHS. For the complete report were adjusted for delays in reporting, which occur details of this methodology, please refer to Chen et al. becauseofa lag incasecapture or data corrections. Delay adjustment has the largest effect on the most recent years of Other Statistics data for cancers that are frequently diagnosed in outpatient The number of cancer deaths averted in men and women settings (eg, melanoma, leukemia, and prostate cancer) and due to the reduction in overall cancer death rates was provides a more accurate portrayal of the cancer burden in the 19 estimated by subtracting the number of recorded deaths most recent time period. For example, the leukemia incidence from the number that would have been expected if cancer rate for 2013 is 14% higher after adjusting for reporting 20 death rates had remained at their peak. The expected delays. number of deaths was estimated by applying the 5-year age-specific cancer death rates in the peak year for age- Projected Cancer Cases and Deaths in 2017 standardized cancer death rates (1990 in men and 1991 The most recent year for which incidence and mortality data in women) to the corresponding age-specific populations are available lags 2 to 4 years behind the current year due to in subsequent years through 2014. The difference the time required for data collection, compilation, quality between the number of expected and recorded cancer control, and dissemination. Therefore, we projected the deaths in each age group and calendar year was then numbers of new cancer cases and deaths in the United States summed. in 2017 to provide an estimate of the contemporary cancer burden. The number of invasive cancer cases was estimated Selected Findings using a 3-step spatio-temporal model based on high-quality Expected Numbers of New Cancer Cases incidence data from 49 states and the District of Columbia representing approximately 95% population coverage (data Table 1 presents the estimated numbers of new cases of were lacking for all years for Minnesota and for some years invasive cancer expected in the United States in 2017 by for other states). First, complete incidence counts were esti- sex. The overall estimate of 1,688,780 cases is the equiva- mated for each county (or health service area for rare cancers) lent of more than 4,600 new cancer diagnoses each day. 12 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 3. Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2013. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Includes intrahepatic bile duct. In addition, about 63,410 cases of female breast carcinoma Trends in Cancer Incidence in situ and 74,680 cases of melanoma in situ are expected Figure 2 illustrates long-term trends in cancer incidence to be diagnosed in 2017. The estimated numbers of rates for all cancers combined by sex. Cancer incidence pat- new cases by state for selected cancer sites are shown in terns reflect trends in behaviors associated with cancer risk Table 2. and changes in medical practice, such as the introduction of Figure 1 depicts the most common cancers expected to screening. The volatility in incidence for males compared occur in men and women in 2017. Prostate, lung and bron- with females reflects rapid changes in prostate cancer inci- chus, and colorectal cancers account for 42% of all cases in dence, which spiked in the late 1980s and early 1990s men, with prostate cancer alone accounting for almost 1 in (Fig. 3) due to a surge in the detection of asymptomatic 5 new diagnoses. For women, the 3 most commonly diag- disease as a result of widespread prostate-specific antigen nosed cancers are breast, lung and bronchus, and colorec- (PSA) testing. Over the past decade of data, the overall tum, which collectively represent one-half of all cases; cancer incidence rate in men declined by about 2% per year, breast cancer alone is expected to account for 30% of all with the pace accelerating in more recent years (Table 4). new cancer diagnoses in women. This trend reflects large continuing declines for cancers of the lung and colorectum, in addition to a sharp reduction Expected Numbers of Cancer Deaths in prostate cancer incidence of more than 10% annually An estimated 600,920 Americans will die from cancer in from 2010 to 2013. This drop is attributed to decreased 2017, corresponding to about 1,650 deaths per day PSA testing in the wake of US Preventive Services Task (Table 1). The most common causes of cancer death are Force recommendations against routine use of the test to cancers of the lung and bronchus, colorectum, and pros- screen for prostate cancer because of growing concerns 25,26 tate in men and lung and bronchus, breast, and colorec- about overdiagnosis and overtreatment. The effect of tum in women (Fig. 1). These 4 cancers account for 46% reduced screening on the occurrence of advanced disease is of all cancer deaths, with more than one-quarter (26%) being watched closely. Incidence rates for distant stage dis- due to lung cancer. Table 3 provides the estimated ease, which accounted for 4% of diagnoses during 2006 to numbers of cancer deaths in 2017 by state for selected 2012 (Fig. 4), have been stable since the mid-2000s follow- cancer sites. ing at least a decade of decline. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 13 Cancer Statistics, 2017 TABLE 4. Trends in Delay-Adjusted Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2013 2004- 2009- TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2013 2013 YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC All sites Overall 1975-1989 1.2* 1989-1992 2.8 1992-1995 22.4 1995-1998 1.0 1998-2009 20.3* 2009-2013 21.5* 20.8* 21.5* Male 1975-1989 1.3* 1989-1992 5.2* 1992-1995 24.9* 1995-1999 0.6 1999-2009 20.6* 2009-2013 22.9* 21.6* 22.9* Female 1975-1979 20.3 1979-1987 1.6* 1987-1995 0.1 1995-1998 1.5 1998-2003 20.6 2003-2013 0.1 0.1 0.1 Female breast 1975-1980 20.5 1980-1987 4.0* 1987-1994 20.2 1994-1999 1.8* 1999-2004 22.3* 2004-2013 0.4* 0.4* 0.4* Colorectum Male 1975-1985 1.1* 1985-1991 21.2* 1991-1995 23.2* 1995-1998 2.3 1998-2013 23.0* 23.0* 23.0* Female 1975-1985 0.3 1985-1995 21.9* 1995-1998 1.8 1998-2008 22.0* 2008-2013 23.8* 23.0* 23.8* Liver & intrahepatic bile duct Male 1975-1980 0.7 1980-2013 3.8* 3.8* 3.8* Female 1975-1983 0.6 1983-1996 4.1* 1996-2013 2.8* 2.8* 2.8* Lung & bronchus Male 1975-1982 1.5* 1982-1991 20.5* 1991-2008 21.7* 2008-2013 22.9* 22.4* 22.9* Female 1975-1982 5.6* 1982-1991 3.4* 1991-2006 0.5* 2006-2013 21.4* 21.0* 21.4* Melanoma of skin Male 1975-1985 5.6* 1985-2005 3.2* 2005-2013 1.7* 1.8* 1.7* Female 1975-1980 5.5* 1980-2008 2.4* 2008-2013 0.4 1.3* 0.4 Pancreas Male 1975-1993 20.8* 1993-2003 0.2 2003-2006 3.0 2006-2013 0.4 0.9 0.4 Female 1975-1984 1.3* 1984-1999 20.3 1999-2013 1.3* 1.3* 1.3* Prostate 1975-1988 2.6* 1988-1992 16.5* 1992-1995 211.5* 1995-2000 2.3 2000-2010 21.7* 2010-2013 210.7* 24.8* 28.6* Thyroid Male 1975-1980 24.7 1980-1997 1.9* 1997-2013 5.4* 5.4* 5.4* Female 1975-1977 6.5 1977-1980 25.2 1980-1993 2.3* 1993-1999 4.5* 1999-2009 7.1* 2009-2013 1.5 4.6* 1.5 Uterine corpus 1975-1979 26.0* 1979-1988 21.7* 1988-1997 0.7* 1997-2006 20.4* 2006-2009 3.7* 2009-2013 0.0 1.1 0.0 APC indicates annual percent change based on incidence (delay adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, aver- age annual percent change. *The APC or AAPC is significantly different from zero (P <.05). Note: Trends analyzed by the Joinpoint Regression Program, version 4.3.0.0, allowing up to 5 joinpoints. Trends are based on Surveillance, Epidemiology, and End Results (SEER) 9 areas. The overall incidence rate in women has remained gen- among adults aged 50 years and older has tripled, from 21% erally stable since 1987 because declines in lung and colo- in 2000 to 60% in 2015. In contrast to the rapid declines in rectal cancers are being offset by increasing or stable rates colorectal cancer incidence among screening aged adults, rates for breast, uterine corpus, and thyroid cancers and for increased by about 2% per year from 1993 to 2013 in individ- melanoma (Table 4). The slight increase in breast cancer uals aged younger than 50 years. incidence from 2004 to 2013 is driven wholly by nonwhite Incidence rates continue to increase rapidly for liver women; rates increased by about 2% per year among wom- cancer, by about 3% per year in women and 4% per year in en other than white or black and by 0.5% per year among men, although rates have begun to decline in adults aged black women, while remaining stable among white younger than 50 years. Similarly, the long-term, rapid women. rise in melanoma incidence appears to be slowing, partic- Lung cancer incidence rates continue to decline about ularly among younger age groups. Incidence rates for thy- twice as fast in men as in women (Table 4). Sex differences in roid cancer also appear to have begun stabilizing in recent lung cancer trends reflect historical differences in tobacco use. years after changes in clinical practice guidelines were ini- Women took up smoking in large numbers later and at older tiated in 2009, including moreconservativeindications ages than men, but were also slower to quit, including recent for biopsy, following increased awareness of the 27,28 33 upturns in smoking prevalence in some birth cohorts. In “epidemic in diagnosis.” In an effort to further reduce contrast, incidence patterns for colorectal cancer are very sim- overdiagnosis and overtreatment, an international panel ilar in men and women, with rates declining by 3% per year of experts convened by the NCI recently proposed down- from 2004 through 2013 (Table 4). While declines in colo- grading the terminology for a common subtype of thyroid rectal cancer incidence rates prior to 2000 are attributed cancer from encapsulated follicular variant of papillary equally to changes in risk factors and the introduction of thyroid carcinoma to noninvasive follicular thyroid neo- 29 34 screening, recent rapid declines are thought to primarily plasm with papillary-like nuclear features. These indo- reflect the increased uptake of colonoscopy and the removal lent tumors, which represent approximately 20% of 30,31 of precancerous adenomatous polyps. Colonoscopy use thyroid cancer diagnoses in the United States, have a 14 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 4. Stage Distribution by Race, United States, 2006 to 2012. Stage categories do not sum to 100% because sufficient information is not available to stage all cases. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 15 Cancer Statistics, 2017 FIGURE 5. Five-Year Relative Survival Rates by Stage at Diagnosis and Race, United States, 2006 to 2012. *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% in all races, 96% in whites, and 90% in blacks. 16 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 6. Total Number Of Cancer Deaths Averted From 1991 to 2014inMen andFrom1992to2014inWomen,UnitedStates. 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. recurrence rate of <1% at 15 years when removed with normal life expectancy, particularly those diagnosed before limited surgery (ie, thyroid lobectomy). age 65 years, based on a recent review of clinical trial data. Although historical groupings of lymphoid malig- Trends in Cancer Survival nancies are still used to track progress, they do not reflect Over the past 3 decades, the 5-year relative survival rate for the substantial biologic variation by subtype that is cap- all cancers combined has increased 20 percentage points tured by the more contemporary World Health Organiza- among whites and 24 percentage points among blacks. tion classification system. Improvements in survival for the most common cancers In contrast to the steady increase in survival for most can- have been similar by sex, but are much more pronounced cers, advances have been slow for lung and pancreatic cancers, among patients aged 50 to 64 years than among those aged for which the 5-year relative survival is currently 18% and 8%, older than 65 years, likely reflecting lower efficacy or use respectively (Fig. 5). These low rates are partly because more of new therapies in the elderly population. Progress has than one-half of cases are diagnosed at a distant stage (Fig. 4), been most rapid for hematopoietic and lymphoid malignan- for which the 5-year survival is 4% and 3%, respectively. cies due to improvements in treatment protocols, including There is potential for lung cancer to be diagnosed at an earlier the discovery of targeted therapies. For example, compar- stage through the use of screening with low-dose computed ing patients diagnosed in the mid-1970s with those diag- tomography, which has been shown to reduce lung cancer nosed during 2006 to 2012, the 5-year relative survival mortality by up to 20% among current and former smokers 38,39 rate has increased from 41% to 71% for acute lymphocytic with a smoking history of 30 or more pack-years. Howev- leukemia and from 22% to 66% for chronic myeloid leuke- er, only 2% to 4% of the 8.7 million Americans eligible for mia. Most patients with chronic myeloid leukemia who screening reported undergoing a computed tomography scan are treated with tyrosine kinase inhibitors experience near of the chest to check for lung cancer in 2010. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 17 Cancer Statistics, 2017 FIGURE 7. Trends in Death Rates by Sex Overall and for Select Cancers, United States, 1930 to 2014. Rates are age adjusted to the 2000 US standard population. Due to improvements in International Classification of Diseases (ICD) coding over time, numerator data for cancers of the lung and bronchus, colon and rectum, liver, and uterus differ from the contemporary time period. For example, rates for lung and bron- chus include pleura, trachea, mediastinum, and other respiratory organs. The decline in cancer mortality over the past 2 decades is Trends in Cancer Mortality the result of steady reductions in smoking and advances in The overall cancer death rate rose during most of the 20th early detection and treatment, reflected in considerable century, largely driven by rapid increases in lung cancer decreases for the 4 major cancers (lung, breast, prostate, and deaths among men as a consequence of the tobacco epi- colorectum) (Fig. 7). Specifically, the death rate dropped 38% demic, but has declined by about 1.5% per year since the from 1989 to 2014 for female breast cancer, 51% from 1993 early 1990s. From its peak of 215.1 (per 100,000 popula- to 2014 for prostate cancer, and 51% from 1976 to 2014 for tion) in 1991, the cancer death rate dropped 25% to 161.2 colorectal cancer. Lung cancer death rates declined 43% from in 2014. This decline, which is larger in men (31% since 1990 to 2014 among males and 17% from 2002 to 2014 1990) than in women (21% since 1991), translates into approximately 2,143,200 fewer cancer deaths (1,484,000 in among females due to reduced tobacco use because of men and 659,200 in women) than what would have increased awareness of the health hazards of smoking and occurred if peak rates had persisted (Fig. 6). the implementation of comprehensive tobacco control. 18 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 5. Trends in Death Rates for Selected Cancers by Sex, United States, 1975 to 2014 2005- 2010- TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2014 2014 YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC All sites Overall 1975-1984 0.5* 1984-1991 0.3* 1991-1994 20.5 1994-1998 21.3* 1998-2001 20.8 2001-2014 21.5* 21.5* 21.5* Male 1975-1979 1.0* 1979-1990 0.3* 1990-1993 20.5 1993-2001 21.5* 2001-2014 21.8* 21.8* 21.8* Female 1975-1990 0.6* 1990-1994 20.2 1994-2002 20.8* 2002-2014 21.4* 21.4* 21.4* Female breast 1975-1990 0.4* 1990-1995 21.8* 1995-1998 23.3* 1998-2014 21.8* 21.8* 21.8* Colorectum Male 1975-1978 0.8 1978-1984 20.3 1984-1990 21.3* 1990-2002 22.0* 2002-2005 23.9* 2005-2014 22.5* 22.5* 22.5* Female 1975-1984 21.0* 1984-2001 21.8* 2001-2014 22.8* 22.8* 22.8* Liver & intrahepatic bile duct Male 1975-1985 1.5* 1985-1996 3.8* 1996-1999 0.5 1999-2014 2.6* 2.6* 2.6* Female 1975-1978 21.5 1978-1988 1.4* 1988-1995 3.9* 1995-2000 0.4 2000-2008 1.5* 2008-2014 2.8* 2.4* 2.8* Lung & bronchus Male 1975-1978 2.4* 1978-1984 1.2* 1984-1991 0.3* 1991-2005 21.9* 2005-2012 23.0* 2012-2014 24.0* 23.2* 23.5* Female 1975-1982 6.0* 1982-1990 4.2* 1990-1995 1.7* 1995-2003 0.3* 2003-2007 20.8 2007-2014 22.0* 21.7* 22.0* Melanoma of skin Male 1975-1990 2.2* 1990-2002 0.0 2002-2009 0.9* 2009-2014 21.3* 20.3 21.3* Female 1975-1988 0.8* 1988-2014 20.6* 20.6* 20.6* Pancreas Male 1975-1986 20.8* 1986-2000 20.3* 2000-2014 0.3* 0.3* 0.3* Female 1975-1984 0.8* 1984-2002 0.1 2002-2008 0.6* 2008-2014 20.2 0.1 20.2 Prostate 1975-1987 0.9* 1987-1991 3.0* 1991-1994 20.5 1994-1999 24.1* 1999-2014 23.4* 23.4* 23.4* Uterine corpus 1975-1993 21.5* 1993-2008 0.2 2008-2014 2.1* 1.4* 2.1* APC indicates annual percent change based mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change. *The APC or AAPC is significantly different from zero (P <.05). Note: Trends analyzed by the Joinpoint Regression Program, version 4.3.1.0, allowing up to 5 joinpoints. Tobacco control efforts adopted in the wake of the first Sur- the leading cause of cancer death among women aged 40 to geon General’s report on smoking and health in 1964 have 59 years. Cervical cancer is the second leading cause of cancer death in women aged 20 to 39 years, underscoring the need to resulted in an estimated 8 million fewer premature smoking- 42,43 improve screening rates in this age group, as well as increase related deaths, one-third of which are due to cancer. acceptance of and access to human papillomavirus vaccination. Despite this progress, in much of the Southern United States, In 2014, only 40% of females aged 13 to 17 years had com- 40% of cancer deaths in men in 2014 were caused by pleted the 3-dose series, up slightly from 37% in 2013. smoking. In contrast to declining trends for the 4 major cancers, Cancer Disparities by Sex death rates rose from 2010 to 2014 by almost 3% per year for The lifetime probability of being diagnosed with invasive liver cancer and by about 2% per year for uterine cancer (Table 5). Pancreatic cancer death rates continued to increase slightly cancer is slightly higher for men (40.8%) than for women (by 0.3% per year) in men but have leveled off in women. (37.5%) (Table 8). Reasons for the increased susceptibility in men are not well understood, but to some extent reflect differ- Recorded Number of Deaths in 2014 ences in environmental exposures, endogenous hormones, A total of 2,626,418 deaths were recorded in the United and probably complex interactions between these influences. States in 2014, 23% of which were from cancer (Table 6). Adult height, which is determined by genetics and childhood Cancer is the second leading cause of death following heart nutrition, is positively associated with cancer incidence and disease. However, it is the leading cause of death in 22 death in both men and women, and has been estimated to 45 46,47 50 states, and in Hispanic and Asian Americans. Cancer account for one-third of the gender disparity in cancer risk. is also the leading cause of death among women aged 40 to Table 9 shows sex differences in cancer-specific incidence and mortality. Overall, incidence rates are about 20% 79 years and among men aged 45 to 79 years when data are analyzed by 5-year age group. higher in men while mortality rates are about 40% higher. Table 7 presents the number of deaths in 2014 for the 5 The larger disparity for mortality reflects differences in the leading cancer types by age and sex. The leading causes of composition and distribution of cancers. For example, rates cancer death are brain cancer, leukemia, and female breast of liver cancer, which is highly fatal, are 3 times higher in cancer before age 40 years and lung cancer in those aged 40 men than in women. The largest sex disparities are for can- years or older. In 2013, lung cancer surpassed breast cancer as cers of the esophagus, larynx, and bladder, for which _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 19 Cancer Statistics, 2017 TABLE 6. Ten Leading Causes of Death by Age and Sex, United States, 2014 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 1,328,241 1,298,177 12,128 6,538 65,486 30,221 227,562 147,196 534,113 411,138 475,956 692,702 1 Heart Heart Accidents Accidents Accidents Accidents Cancer Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional 52,478 49,683 167,075 136,649 diseases diseases 325,077 289,271 injuries) injuries) injuries) injuries) 137,360 187,680 4,409 2,023 24,467 8,850 2 Cancer Cancer Intentional Cancer Intentional Cancer Heart Heart Heart Heart Cancer Cancer 311,296 280,403 self-harm 757 self-harm 4,440 diseases diseases diseases diseases 86,662 88,842 (suicide) (suicide) 52,140 22,465 129,926 76,242 1,681 10,353 3 Accidents Chronic Assault Intentional Assault Intentional Accidents Accidents Chronic Chronic Chronic Alzheimer (unintentional lower (homicide) self-harm (homicide) self-harm (unintentional (unintentional lower lower lower disease injuries) respiratory 1,563 (suicide) 7,040 (suicide) injuries) injuries) respiratory respiratory respiratory 56,533 85,448 diseases 581 2,649 26,259 12,789 diseases diseases diseases 77,645 34,508 33,872 28,801 4 Chronic Cerebro- Cancer Assault Heart Heart Intentional Chronic Cerebro- Cerebro- Cerebro- Cerebro- lower vascular 1,028 (homicide) diseases diseases self-harm lower vascular vascular vascular vascular respiratory disease 477 5,077 2,459 (suicide) respiratory disease disease disease disease diseases 77,632 12,196 diseases 21,645 19,932 26,324 52,068 69,456 5,960 5 Cerebro- Alzheimer Congenital Congenital Cancer Assault Chronic liver Chronic liver Diabetes Diabetes Alzheimer Chronic vascular disease anomalies anomalies 4,020 (homicide) disease & disease & mellitus mellitus disease lower disease 65,179 498 428 1,287 cirrhosis cirrhosis 20,335 14,965 22,353 respiratory 55,471 11,443 5,646 diseases 37,397 6 Diabetes Accidents Heart Heart Chronic liver Pregnancy, Diabetes Cerebro- Accidents Accidents Influenza & Influenza & mellitus (unintentional diseases diseases disease & childbirth mellitus vascular (unintentional (unintentional pneumonia pneumonia 41,111 injuries) 373 266 cirrhosis & puerperium 8,118 disease injuries) injuries) 13,482 17,954 50,605 971 748 4,959 16,588 9,714 7 Intentional Diabetes Chronic Influenza & Diabetes Chronic liver Cerebro- Diabetes Chronic liver Alzheimer Accidents Accidents self-harm mellitus lower pneumonia mellitus disease & vascular mellitus disease & disease (unintentional (unintentional (suicide) 35,377 respiratory 126 970 cirrhosis disease 4,947 cirrhosis 8,462 injuries) injuries) 33,113 diseases 628 6,585 10,620 13,047 16,726 8 Alzheimer Influenza & Influenza & Chronic HIV Diabetes Chronic Intentional Nephritis, Nephritis, Nephritis, Diabetes disease pneumonia pneumonia lower disease mellitus lower self-harm nephrotic nephrotic nephrotic mellitus 28,362 28,641 145 respiratory 784 624 respiratory (suicide) syndrome & syndrome & syndrome & 14,817 diseases diseases 4,389 nephrosis nephrosis nephrosis 89 5,550 9,698 8,352 11,665 9 Influenza & Nephritis, Cerebro- Cerebro- Cerebro- Cerebro- Influenza & Septicemia Influenza & Septicemia Diabetes Nephritis, pneumonia nephrotic vascular vascular vascular vascular pneumonia 2,664 pneumonia 7,854 mellitus nephrotic 26,586 syndrome & disease disease disease disease 3,236 9,030 11,644 syndrome & nephrosis 96 83 766 548 nephrosis 23,710 13,234 10 Chronic liver Septicemia Septicemia Septicemia Influenza & Influenza & HIV Influenza & Septicemia Influenza & Parkinson Hypertension disease & 20,607 77 78 pneumonia pneumonia disease pneumonia 8,227 pneumonia disease & hypertensive cirrhosis 602 511 2,943 2,592 7,359 10,059 renal disease* 24,584 11,724 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 Final Mortality Data, 2014, National Center for Health Statistics, Centers for Disease Control and Prevention, 2016. 20 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 7. Five Leading Types of Cancer Death by Age and Sex, United States, 2014 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 311,296 1,050 4,020 52,478 167,075 86,662 Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus 84,861 314 529 13,078 51,714 19,821 Prostate Leukemia Leukemia Colorectum Colorectum Prostate 28,344 272 507 5,947 13,317 14,529 Colorectum Bones & joints Colorectum Liver* Prostate Colorectum 27,134 100 446 4,461 12,489 7,422 Pancreas Soft tissue Non-Hodgkin Pancreas Pancreas Urinary bladder (including heart) lymphoma 20,755 3,830 11,997 5,269 78 246 Liver* Non-Hodgkin Lung & bronchus Esophagus Liver* Pancreas lymphoma 16,623 236 2,581 9,503 4,815 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 280,403 787 4,440 49,683 136,649 88,842 Lung & bronchus Brain & ONS Breast Lung & bronchus Lung & bronchus Lung & bronchus 70,667 245 1,051 10,812 40,256 19,415 Breast Leukemia Uterine cervix Breast Breast Breast 41,213 184 446 10,708 18,461 10,991 Colorectum Bone & joints Colorectum Colorectum Colorectum Colorectum 24,517 81 376 4,214 10,060 9,864 Pancreas Soft tissue Leukemia Ovary Pancreas Pancreas (including heart) 19,664 363 2,869 10,019 6,914 Ovary Non-Hodgkin Brain & ONS Pancreas Ovary Leukemia lymphoma 14,195 307 2,660 7,419 4,190 ONS indicates other nervous system. *Includes intrahepatic bile duct. Note: Ranking order excludes category titles that begin with the word “Other.” 54,55 incidence and death rates are about 4-fold higher in men. observed in Europe and Australia, partly reflect more unfa- However, incidence rates are higher in women for cancers vorable prognostic indicators (eg, thick tumors, ulceration, and of the anus, gallbladder, and thyroid. Notably, thyroid can- trunk loci) and an older age at diagnosis in men compared with women. However, sex is a predictor of survival indepen- cer incidence rates are 3 times higher in women than in dent of clinicopathologic factors for reasons that remain men (21 vs 7 per 100,000 population), despite equivalent unclear. While hormonal influences are thought to play a death rates (0.5 per 100,000 population). This pattern is role, survival is higher and disease progression less likely in indicative of a preponderance of nonfatal thyroid tumors in women, regardless of menopausal status, even for patients with women, which is consistent with more prominent and pro- advanced disease. A recent study found a survival advantage longed overdiagnosis in women than in men. However, for women when melanoma arose de novo (70%–80% of consistency in the gender disparity for thyroid cancer glob- tumors), but no difference in survival for nevi-associated ally and across racial/ethnic groups in the United States tumors, which are associated with better outcomes. suggests a higher underlying disease burden in women, despite unknown etiologic mechanisms. Melanoma incidence rates are about 60% higher in men Cancer Disparities by Race/Ethnicity and Socioeconomic Status than in women, while death rates are more than double. The larger disparity for mortality reflects an earlier stage at diagno- Cancer incidence and death rates vary considerably between sis and better stage-specific survival in women than in men. racial and ethnic groups, with rates generally highest among Sex disparities in melanoma survival, which have also been blacks and lowest among Asian/Pacific Islanders (APIs) _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 21 Cancer Statistics, 2017 TABLE 8. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2011 to 2013* BIRTH TO 49 50 TO 59 60 TO 69 70 BIRTH TO DEATH All sites† Male 3.4 (1 in 30) 6.3 (1 in 16) 14.0 (1 in 7) 33.3 (1 in 3) 40.8 (1 in 2) Female 5.4 (1 in 18) 6.0 (1 in 17) 10.0 (1 in 10) 25.9 (1 in 4) 37.5 (1 in 3) Breast Female 1.9 (1 in 52) 2.3 (1 in 44) 3.5 (1 in 29) 6.8 (1 in 15) 12.4 (1 in 8) Colorectum Male 0.3 (1 in 294) 0.7 (1 in 149) 1.2 (1 in 84) 3.5 (1 in 28) 4.6 (1 in 22) Female 0.3 (1 in 318) 0.5 (1 in 198) 0.8 (1 in 120) 3.2 (1 in 31) 4.2 (1 in 24) Kidney & renal pelvis Male 0.2 (1 in 457) 0.3 (1 in 289) 0.6 (1 in 157) 1.3 (1 in 75) 2.1 (1 in 48) Female 0.1 (1 in 729) 0.2 (1 in 582) 0.3 (1 in 315) 0.7 (1 in 135) 1.2 (1 in 83) Leukemia Male 0.2 (1 in 410) 0.2 (1 in 574) 0.6 (1 in 259) 1.4 (1 in 72) 1.8 (1 in 57) Female 0.2 (1 in 509) 0.1 (1 in 901) 0.4 (1 in 447) 0.9 (1 in 113) 1.2 (1 in 81) Lung & bronchus Male 0.2 (1 in 643) 0.7 (1 in 149) 1.9 (1 in 53) 6.2 (1 in 16) 7.0 (1 in 14) Female 0.2 (1 in 598) 0.6 (1 in 178) 1.5 (1 in 68) 4.8 (1 in 21) 6.0 (1 in 17) Melanoma of the skin‡ Male 0.5 (1 in 220) 0.5 (1 in 198) 0.9 (1 in 111) 2.5 (1 in 40) 3.5 (1 in 28) Female 0.6 (1 in 155) 0.4 (1 in 273) 0.5 (1 in 212) 1.0 (1 in 97) 2.3 (1 in 44) Non-Hodgkin lymphoma Male 0.3 (1 in 385) 0.3 (1 in 353) 0.4 (1 in 175) 1.8 (1 in 55) 2.4 (1 in 42) Female 0.2 (1 in 547) 0.2 (1 in 483) 0.2 (1 in 245) 1.3 (1 in 74) 1.9 (1 in 54) Prostate Male 0.3 (1 in 354) 1.9 (1 in 52) 5.4 (1 in 19) 9.1 (1 in 11) 12.9 (1 in 8) Thyroid Male 0.2 (1 in 533) 0.1 (1 in 799) 0.2 (1 in 620) 0.2 (1 in 429) 0.6 (1 in 163) Female 0.8 (1 in 127) 0.4 (1 in 275) 0.3 (1 in 292) 0.4 (1 in 258) 1.8 (1 in 57) Uterine cervix Female 0.3 (1 in 371) 0.1 (1 in 868) 0.1 (1 in 899) 0.2 (1 in 594) 0.6 (1 in 161) Uterine corpus Female 0.3 (1 in 352) 0.6 (1 in 169) 1.0 (1 in 105) 1.3 (1 in 76) 2.8 (1 in 36) *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. ‡Probabilities for non-Hispanic whites only. (Tables 10 and 11). Importantly, there are considerable dif- Education Reconciliation Act of 2010, together referred to as ferences within all of the broadly defined population groups the Affordable Care Act or ACA, 11% of blacks and 7% of described here, despite scant data. For example, while overall non-Hispanic whites were uninsured in 2015, down from 64,65 cancer incidence rates are 40% lower for API men than non- 21% and 12%, respectively, in 2010. Progress for His- Hispanic white men based on aggregated data, rates in panics is similar, with the uninsured rate dropping from 31% Hawaiians and Samoans are similar to those in non- in 2010 to 16% in 2015. If maintained, these shifts should Hispanic whites. The same is true for Puerto Ricans with- help to expedite progress in reducing socioeconomic dispar- in the lower risk Hispanic population. ities in cancer, as well as other health conditions. In 2014, the cancer death rate was 15% higher in blacks Cancer incidence and death rates among APIs, American than in whites. The racial disparity has been most striking for Indians/Alaska Natives (AI/ANs), and Hispanics are lower men, with the excess risk growing from 20% in 1970 to 47% than among non-Hispanic whites for the 4 most common in 1990. However, that gap had narrowed to 21% in 2014, cancers, but higher for cancers associated with infectious due in part to more rapid declines in smoking-related cancers agents (eg, those of the stomach and liver). For example, in blacks driven by sharper reductions in smoking initiation in liver cancer incidence rates in these populations are double 59,60 the 1970s and early 1980s. The racial disparity has those in non-Hispanic whites, reflecting a higher preva- declined similarly in women, from a peak of 20% in 1998 to lence of risk factors such as chronic infection with hepatitis 13% in 2014. Other than behavioral differences, racial dispar- B and/or hepatitis C viruses, obesity, diabetes, and binge ities are caused by unequal access to and use of high-quality drinking. AI/ANs have the highest rates of kidney cancer, health care, including cancer prevention and early detection, although there is striking geographic variation, most likely 61,62 timely diagnosis, and optimal treatment. Blacks are more reflecting differences in the prevalence of renal cancer risk likely than whites to be diagnosed with cancer at an advanced factors such as obesity, smoking, and hypertension. stage (Fig. 4), but also have lower stage-specific survival for Regional Variations in Cancer Rates most cancer types (Fig. 5). Both stage at diagnosis and survival are closely aligned with health insurance coverage, which is Tables 12 and 13 depict average annual cancer incidence and lower among minorities than non-Hispanic whites. However, death rates for selected cancers by state. State variation in can- this gap is also narrowing rapidly. As a result of the Patient cer occurrence reflects differences in medical practice and the Protection and Affordable Care Act and the Health Care and prevalence of risk factors, such as smoking and obesity. 22 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 9. Sex Differences in Cancer Incidence and Mortality Rates, 2009 to 2013 INCIDENCE MORTALITY RATE RATE RATIO (M/F) (95% CI) RATE RATE RATIO (M/F) (95% CI) All sites Female 418.5 143.4 Male 512.1 1.2 (1.22-1.23) 204.0 1.4 (1.42-1.43) Oral cavity and pharynx Female 6.3 1.3 Male 17.2 2.7 (2.69-2.75) 3.8 2.8 (2.77-2.89) Esophagus Female 1.8 1.5 Male 8.1 4.5 (4.44-4.60) 7.4 4.8 (4.75-4.93) Stomach Female 4.6 2.4 Male 9.2 2.0 (1.97-2.02) 4.5 1.9 (1.85-1.91) Colon and rectum Female 35.6 12.7 Male 46.9 1.3 (1.31-1.32) 18.1 1.4 (1.42-1.44) Colon excluding rectum Female 26.6 Male 32.4 1.2 (1.21-1.22) Rectum and rectosigmoid junction Female 8.9 Male 14.5 1.6 (1.61-1.64) Anus, anal canal, and anorectum Female 2.1 0.3 Male 1.5 0.7 (0.68-0.72) 0.2 0.8 (0.77-0.87) Liver and intrahepatic bile duct Female 4.0 3.6 Male 11.8 2.9 (2.89-2.96) 9.1 2.5 (2.45-2.52) Gallbladder Female 1.4 0.7 Male 0.8 0.6 (0.59-0.62) 0.5 0.7 (0.62-0.68) Pancreas Female 10.9 9.5 Male 14.1 1.3 (1.28-1.30) 12.5 1.3 (1.30-1.33) Larynx Female 1.4 0.4 Male 6.2 4.5 (4.39-4.57) 1.9 4.8 (4.62-4.97) Lung and bronchus Female 53.5 37.0 Male 75.0 1.4 (1.40-1.41) 57.8 1.6 (1.55-1.57) Melanoma of the skin Female 16.1 1.7 Male 25.9 1.6 (1.60-1.62) 4.1 2.4 (2.35-2.45) Urinary bladder Female 8.9 2.2 Male 36.2 4.1 (4.02-4.08) 7.7 3.5 (3.47-3.59) Kidney and renal pelvis Female 11.3 2.5 Male 21.7 1.9 (1.90-1.93) 5.7 2.3 (2.25-2.32) Brain and ONS Female 5.6 3.5 Male 7.8 1.4 (1.37-1.40) 5.3 1.5 (1.48-1.52) Thyroid Female 20.8 0.5 Male 7.0 0.3 (0.34-0.34) 0.5 1.0 (0.99-1.08) Hodgkin lymphoma Female 2.4 0.3 Male 3.1 1.3 (1.27-1.32) 0.5 1.6 (1.53-1.70) Non-Hodgkin lymphoma Female 15.9 4.7 Male 23.0 1.4 (1.44-1.46) 7.7 1.7 (1.63-1.67) Myeloma Female 5.2 2.7 Male 8.0 1.5 (1.51-1.54) 4.2 1.6 (1.54-1.59) Leukemia Female 10.6 5.2 Male 17.3 1.6 (1.62-1.65) 9.3 1.8 (1.78-1.82) Acute lymphocytic leukemia Female 1.4 0.4 Male 1.8 1.3 (1.27-1.33) 0.5 1.4 (1.36-1.50) Chronic lymphocytic leukemia Female 3.1 0.9 Male 6.1 1.9 (1.90-1.95) 2.0 2.2 (2.15-2.27) Acute myeloid leukemia Female 3.4 2.2 Male 5.0 1.5 (1.44-1.49) 3.7 1.7 (1.65-1.72) Chronic myeloid leukemia Female 1.4 0.2 Male 2.2 1.6 (1.57-1.65) 0.4 1.7 (1.64-1.83) 95% CI indicates 95% confidence interval; F, female, M, male, ONS, other nervous system. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 23 Cancer Statistics, 2017 TABLE 10. Incidence Rates by Site, Race, and Ethnicity, United States, 2009 to 2013 ALL RACES NON-HISPANIC NON-HISPANIC ASIAN/PACIFIC AMERICAN INDIAN/ COMBINED WHITE BLACK ISLANDER ALASKA NATIVE* HISPANIC All sites Male 512.1 519.3 577.3 310.2 426.7 398.1 Female 418.5 436.0 408.5 287.1 387.3 329.6 Breast (female) 123.3 128.3 125.1 89.3 98.1 91.7 Colorectum Male 46.9 46.1 58.3 37.8 51.4 42.8 Female 35.6 35.2 42.7 27.8 41.2 29.8 Kidney & renal pelvis Male 21.7 21.9 24.4 10.8 29.9 20.7 Female 11.3 11.3 13.0 4.8 17.6 11.9 Liver & intrahepatic bile duct Male 11.8 9.7 16.9 20.4 18.5 19.4 Female 4.0 3.3 5.0 7.6 8.9 7.5 Lung & bronchus Male 75.0 77.7 90.8 46.6 71.3 42.2 Female 53.5 58.2 51.0 28.3 56.2 25.6 Prostate 123.2 114.8 198.4 63.5 85.1 104.9 Stomach Male 9.2 7.8 14.7 14.4 11.2 13.1 Female 4.6 3.5 7.9 8.4 6.5 7.8 Uterine cervix 7.6 7.0 9.8 6.1 9.7 9.9 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite and nonblack race categories are not mutually exclusive of Hispanic origin. *Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties and exclude data from Kansas. Geographic disparities often reflect the national distribution smoking prevalence among states. For example, lung cancer of poverty and access to health care, which have increased incidence rates in Kentucky (118 per 100,000 population in over time and may continue to exacerbate because of differen- men and 80 per 100,000 population in women), which has 68-70 tial state expansion of Medicaid facilitated by the ACA. historically had the highest smoking prevalence, are about 3.5 The largest geographic variation by far is for lung cancer, times higher than those in Utah (34 per 100,000 population reflecting the large historical and continuing differences in in men and 24 per 100,000 population in women), which TABLE 11. Death Rates by Site, Race, and Ethnicity, United States, 2010 to 2014 ALL RACES NON-HISPANIC NON-HISPANIC ASIAN/PACIFIC AMERICAN INDIAN/ COMBINED WHITE BLACK ISLANDER ALASKA NATIVE* HISPANIC All sites Male 200.4 204.0 253.4 122.7 183.6 142.5 Female 141.5 145.5 165.9 88.8 129.1 97.7 Breast (female) 21.2 21.1 30.0 11.3 14.1 14.4 Colorectum Male 17.7 17.3 25.9 12.4 19.5 15.0 Female 12.4 12.3 16.9 8.8 14.0 9.2 Kidney & renal pelvis Male 5.6 5.8 5.7 2.7 8.9 4.9 Female 2.4 2.5 2.5 1.1 4.2 2.3 Liver & intrahepatic bile duct Male 9.2 8.0 13.3 14.3 14.9 13.1 Female 3.7 3.3 4.6 6.1 6.8 5.8 Lung & bronchus Male 55.9 58.3 69.8 31.7 46.2 27.3 Female 36.3 39.8 35.5 18.0 30.8 13.4 Prostate 20.0 18.7 42.8 8.8 19.4 16.5 Stomach Male 4.4 3.4 8.7 7.1 7.5 6.9 Female 2.3 1.7 4.2 4.3 3.8 4.1 Uterine cervix 2.3 2.1 3.9 1.7 2.8 2.6 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite and nonblack race categories are not mutually exclusive of Hispanic origin. *Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties. 24 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 12. Incidence Rates for Selected Cancers by State, United States, 2009 to 2013 LUNG & NON-HODGKIN URINARY ALL CANCERS BREAST COLORECTUM BRONCHUS LYMPHOMA PROSTATE BLADDER STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama 548.1 395.6 119.3 52.8 37.3 95.3 53.4 19.8 13.9 139.1 34.0 7.7 Alaska 459.7 411.9 123.5 49.2 40.4 71.6 55.6 21.4 14.3 100.3 34.7 10.8 Arizona 418.1 375.1 111.0 39.6 30.5 58.0 46.4 18.6 13.5 84.1 32.1 8.0 Arkansas 531.2 390.7 111.5 50.1 37.0 99.6 59.4 20.8 14.8 128.4 35.7 7.2 California 473.0 390.9 121.4 43.8 33.7 53.6 41.2 22.8 15.3 118.7 32.0 7.6 Colorado 458.0 393.8 124.8 38.7 31.0 49.8 42.4 21.5 14.9 122.1 32.7 8.3 Connecticut 541.8 459.1 137.8 46.5 35.1 70.9 57.7 25.3 17.7 130.3 47.4 12.5 Delaware 581.7 451.2 130.0 44.3 33.3 83.4 62.3 25.0 17.3 151.1 41.8 11.1 Dist. of Columbia 543.1 444.8 143.0 47.9 41.1 72.0 49.7 22.1 13.9 169.1 24.4 9.3 Florida 490.1 398.5 115.3 43.4 33.1 73.6 54.4 21.3 14.8 111.2 34.1 8.3 Georgia 542.5 409.6 123.4 48.8 36.2 86.7 53.2 21.7 14.6 139.8 33.6 7.7 Hawaii 454.0 408.7 134.4 53.1 36.4 58.0 38.7 21.8 14.9 96.5 23.3 6.1 Idaho 496.0 408.7 119.4 42.2 32.2 56.4 46.9 20.7 16.1 131.8 39.0 8.7 Illinois 531.6 437.6 128.5 53.4 38.9 81.0 58.5 23.5 16.2 128.8 38.2 9.5 Indiana 503.2 425.9 120.0 49.5 39.4 91.1 61.7 23.3 16.4 102.0 36.4 8.9 Iowa 536.5 438.8 122.6 52.2 39.7 80.2 52.7 26.7 18.5 119.2 39.7 8.8 Kansas 529.0 426.8 122.0 48.8 36.0 73.6 53.5 23.6 16.6 133.5 38.8 9.2 Kentucky 593.8 470.2 122.0 59.6 43.7 118.3 80.2 25.4 17.1 118.1 40.0 9.7 Louisiana 585.0 420.0 123.4 57.3 41.8 92.1 55.5 24.0 16.6 154.4 34.2 8.0 Maine 529.7 450.8 124.5 44.8 35.6 86.0 66.1 24.0 17.6 106.5 46.6 12.5 Maryland 506.0 421.0 130.2 42.5 33.8 67.9 52.9 21.2 15.1 135.0 36.0 9.2 Massachusetts 522.5 454.4 136.0 43.8 35.0 72.7 61.9 23.8 16.7 124.9 41.5 11.4 Michigan 530.2 428.3 123.0 45.2 34.9 78.9 59.1 24.5 17.2 137.0 39.5 10.2 Minnesota* 518.7 431.8 130.1 44.6 35.3 62.9 50.1 27.2 18.5 130.3 38.3 9.5 Mississippi 567.0 405.4 116.1 58.9 42.6 103.1 56.5 20.8 14.4 142.7 30.9 7.3 Missouri 504.9 427.6 124.8 50.5 37.3 90.8 64.7 22.3 15.3 106.3 33.6 8.5 Montana 500.4 425.5 122.7 45.7 34.5 62.6 54.9 23.3 15.8 127.3 37.0 10.5 Nebraska 493.8 414.0 120.7 49.5 38.9 70.4 49.9 24.0 17.8 119.2 34.8 8.4 Nevada* † 496.9 397.1 113.9 50.7 35.1 67.9 58.6 20.5 14.2 135.4 38.0 11.1 New Hampshire 544.2 460.9 138.1 41.4 34.7 73.5 64.4 26.2 17.9 133.5 50.1 12.8 New Jersey 555.2 452.9 131.4 49.5 38.8 67.7 53.1 25.4 17.8 148.7 41.6 11.0 New Mexico* ‡ 424.2 365.8 112.9 41.1 30.6 49.6 36.8 17.8 13.8 106.1 25.5 6.0 New York 557.3 450.6 128.4 47.9 36.6 72.0 54.7 26.3 18.0 145.2 41.4 10.6 North Carolina 534.8 419.5 128.4 44.8 33.4 90.5 55.9 21.7 15.0 130.2 36.1 8.8 North Dakota 515.5 415.5 124.6 54.5 40.2 69.8 47.5 22.7 18.3 130.9 38.5 8.7 Ohio 513.8 423.8 122.0 48.9 36.2 85.6 59.7 22.9 15.7 119.7 38.8 9.3 Oklahoma 511.4 409.8 117.7 49.9 38.1 87.7 58.5 21.7 14.9 120.6 33.8 8.1 Oregon 478.5 424.0 128.1 42.2 32.5 65.3 54.9 22.5 15.4 110.6 37.5 9.2 Pennsylvania 550.8 460.4 129.0 51.3 38.6 80.0 56.5 26.1 17.8 125.4 44.1 11.0 Rhode Island 528.3 459.2 130.4 42.7 35.3 78.3 64.0 25.0 17.8 117.4 46.3 13.3 South Carolina 530.6 409.6 125.6 45.5 34.4 87.8 54.3 20.4 13.4 129.0 34.2 8.7 South Dakota 487.0 428.6 130.6 50.9 39.8 67.4 50.9 23.6 16.3 119.6 33.8 9.4 Tennessee 540.5 420.6 121.7 47.6 36.6 97.6 61.2 22.0 15.1 126.3 35.1 8.1 Texas 474.1 381.1 112.3 47.0 32.8 70.1 45.5 21.5 15.2 106.4 27.9 6.5 Utah 468.6 369.8 112.7 36.1 28.2 34.4 24.2 23.4 15.1 144.4 30.2 5.8 Vermont 505.6 439.3 128.3 41.2 33.4 74.2 61.2 25.4 18.2 109.8 40.0 9.8 Virginia 473.3 399.3 125.5 42.2 33.5 75.2 52.2 21.1 14.4 116.5 31.7 8.3 Washington 513.3 442.2 135.6 41.7 34.0 67.1 54.7 25.6 17.0 125.7 37.8 9.5 West Virginia 533.4 440.0 114.4 54.3 40.8 101.0 65.9 22.1 16.1 106.6 39.9 10.9 Wisconsin 517.9 433.5 127.2 44.6 34.3 70.3 54.5 25.0 17.3 122.0 40.0 10.0 Wyoming 458.1 380.7 109.6 44.0 31.6 52.6 43.1 18.4 14.4 116.0 36.7 10.5 United States 512.1 418.5 123.3 46.9 35.6 75.0 53.5 23.0 15.9 123.2 36.2 8.9 Rates are per 100,000 and age adjusted to the 2000 US standard population. *This state’s data are not included in the US combined rates because they did not meet high-quality standards for one or more years during 2009 to 2013 according to the North American Association of Central Cancer Registries (NAACCR). †Rates are based on incidence data for 2009 to 2010. ‡Rates are based on incidence data for 2009 to 2012. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 25 Cancer Statistics, 2017 TABLE 13. Death Rates for Selected Cancers by State, United States, 2010 to 2014 LUNG & NON-HODGKIN ALL SITES BREAST COLORECTUM BRONCHUS LYMPHOMA PANCREAS PROSTATE STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE Alabama 235.7 148.2 22.0 20.6 13.3 77.1 39.5 7.5 4.8 13.2 9.7 23.8 Alaska 203.5 146.7 20.4 18.5 13.5 54.7 41.7 7.1 3.7 11.9 9.9 20.5 Arizona 174.2 126.2 19.5 15.6 11.2 42.9 30.4 6.8 4.3 11.5 9.0 18.2 Arkansas 237.0 153.8 22.1 21.8 14.6 81.0 43.9 7.6 5.2 12.7 9.4 20.8 California 176.7 130.4 20.4 15.9 11.5 39.8 28.5 7.1 4.4 11.8 9.2 20.0 Colorado 166.4 125.1 19.2 14.5 11.1 36.4 28.1 6.6 4.0 10.9 8.6 21.7 Connecticut 182.5 133.5 19.1 13.8 10.4 46.3 34.4 7.1 4.3 12.5 9.8 18.6 Delaware 208.3 150.5 21.9 17.1 10.8 62.3 42.6 7.8 4.6 14.1 9.6 19.2 Dist. of Columbia 210.0 160.0 29.3 18.6 15.5 49.6 33.5 6.1 3.3 15.5 12.1 33.6 Florida 189.4 132.7 20.2 16.3 11.3 54.1 35.5 7.2 4.2 12.0 8.9 17.6 Georgia 212.3 140.5 22.5 19.4 12.6 64.1 35.6 7.1 4.1 12.3 9.1 23.4 Hawaii 167.3 114.9 15.0 17.5 10.7 40.8 25.1 6.7 4.0 12.4 9.8 13.7 Idaho 185.4 132.6 20.4 15.9 11.1 43.7 31.4 7.9 5.1 12.8 9.7 23.3 Illinois 208.3 150.3 22.5 19.1 13.2 59.0 39.4 7.8 4.6 12.8 9.8 20.9 Indiana 224.8 153.7 21.8 19.3 13.4 71.2 42.9 8.6 5.1 13.1 9.6 21.0 Iowa 206.5 142.2 19.4 19.2 13.9 59.1 36.0 8.7 5.1 12.7 9.3 19.8 Kansas 200.9 143.0 20.1 18.4 12.6 57.3 38.4 7.7 4.9 13.0 9.9 19.1 Kentucky 249.4 167.1 21.9 20.9 14.2 89.6 54.7 9.0 5.1 13.3 9.6 19.8 Louisiana 237.7 157.1 24.2 21.7 14.9 72.9 41.5 8.6 5.0 15.1 11.3 22.4 Maine 215.7 150.4 18.0 16.5 11.8 64.4 43.3 7.6 5.3 11.8 10.6 19.8 Maryland 198.1 143.3 22.8 17.6 12.1 52.2 36.6 7.1 4.2 13.9 9.9 20.3 Massachusetts 196.6 140.2 18.8 15.9 11.3 51.8 38.0 7.1 4.4 12.6 9.9 19.4 Michigan 209.2 151.6 22.4 17.7 12.7 60.8 41.5 8.8 5.2 13.3 10.1 19.5 Minnesota 188.7 135.8 18.8 15.2 11.5 47.6 33.9 8.6 5.2 12.4 8.8 20.6 Mississippi 252.2 158.5 23.9 23.7 16.1 82.7 41.0 7.2 4.2 14.3 11.0 26.2 Missouri 216.6 154.5 22.5 19.1 13.2 69.3 44.7 7.5 4.7 13.0 9.9 18.2 Montana 182.5 138.2 20.2 16.2 11.1 46.2 37.2 7.5 4.1 10.5 9.0 21.4 Nebraska 197.1 138.3 20.1 18.5 14.2 54.3 34.6 7.2 5.1 12.5 8.9 20.8 Nevada 194.1 145.4 22.7 20.2 13.8 52.8 41.4 6.9 4.0 12.2 9.0 21.1 New Hampshire 197.7 143.4 20.3 14.0 13.3 53.9 40.7 6.8 4.1 12.9 9.5 19.9 New Jersey 191.3 141.6 22.9 18.2 12.8 48.4 33.7 7.3 4.4 13.2 10.2 19.4 New Mexico 176.2 123.8 19.3 17.3 11.3 38.1 26.4 6.0 4.1 10.9 8.1 20.7 New York 187.1 138.0 20.6 16.9 12.1 49.0 33.8 7.3 4.4 13.0 9.9 19.5 North Carolina 215.1 142.1 21.6 17.3 11.6 67.9 37.9 7.4 4.5 12.6 9.2 21.6 North Dakota 189.6 128.0 17.8 17.9 13.1 52.0 31.4 6.9 4.5 12.1 7.9 19.8 Ohio 219.6 155.0 23.1 19.8 13.6 66.5 42.7 8.5 5.1 13.3 10.0 19.9 Oklahoma 227.2 157.4 23.4 20.6 13.8 71.5 44.9 8.3 5.0 12.4 9.9 20.8 Oregon 196.2 145.9 20.8 16.6 12.2 50.5 39.1 8.2 4.9 12.5 9.5 21.2 Pennsylvania 210.5 149.4 22.2 18.9 13.5 59.0 37.1 8.3 4.9 13.6 10.0 19.7 Rhode Island 209.2 143.5 18.8 16.4 12.9 59.1 41.8 6.8 4.7 12.6 9.1 19.8 South Carolina 223.0 145.7 22.7 18.7 12.9 67.0 37.8 7.2 4.4 13.1 9.7 23.4 South Dakota 196.9 138.5 20.2 19.8 12.8 55.5 35.2 7.5 4.3 11.6 9.1 19.5 Tennessee 236.2 153.9 22.1 20.1 14.0 78.4 43.7 8.3 4.8 12.6 10.0 20.7 Texas 195.1 133.2 20.4 18.3 11.9 52.2 31.7 7.4 4.4 11.7 9.0 18.7 Utah 151.0 111.2 20.8 13.0 9.7 24.6 16.2 6.8 4.7 11.4 8.6 22.1 Vermont 202.5 147.0 18.6 15.8 12.7 54.3 41.5 8.0 4.4 12.7 10.0 21.1 Virginia 201.9 141.3 21.9 17.0 12.0 57.4 36.5 7.5 4.4 12.9 9.4 21.0 Washington 191.4 140.1 20.1 15.2 11.2 49.9 36.3 7.9 4.8 12.3 9.8 20.4 West Virginia 236.7 163.3 22.1 22.1 15.0 77.2 47.2 8.1 5.3 12.2 8.7 18.2 Wisconsin 202.0 144.0 20.5 16.4 12.1 53.4 37.5 8.1 4.9 13.2 10.0 21.8 Wyoming 177.9 134.9 18.9 17.1 10.6 41.9 32.5 6.6 4.6 10.8 8.4 18.5 United States 200.4 141.5 21.2 17.7 12.4 55.9 36.3 7.6 4.6 12.6 9.5 20.0 Rates are per 100,000 and age adjusted to the 2000 US standard population. 26 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 Leukemias (76% of which are lymphoid leukemias) account TABLE 14. Five-Year Relative Survival Rate (%) by Age for 29% of all childhood cancers (including benign and bor- and ICCC Type, Ages Birth to 19 Years, United States, 2006 to 2012 derline malignant brain tumors). Cancers of the brain and other nervous system are the second most common cancer BIRTH TO 14 15 TO 19 type (26%). The third most common category is lymphomas All ICCC groups combined 83.0 83.9 and reticuloendothelial neoplasms (11%), almost one-half of Lymphoid leukemia 90.2 74.7 which are non-Hodgkin lymphoma (including Burkitt lym- Acute myeloid leukemia 64.2 59.7 phoma) and more than one-quarter of which are Hodgkin Hodgkin lymphoma 97.7 96.4 Non-Hodgkin lymphoma 90.7 86.0 lymphoma. Soft tissue sarcomas (almost one-half of which are Central nervous system neoplasms 72.6 79.1 rhabdomyosarcoma) and neuroblastoma each account for 6% Neuroblastoma & other 79.7 74.2* of childhood cancers, followed by renal (Wilms) tumors peripheral nervous cell tumors (5%). Retinoblasoma 95.3 † Cancers in adolescents (aged 15 to 19 years) differ some- Renal tumors 90.6 68.1* what from those in children in terms of type and distribu- Hepatic tumors 77.1 47.4* tion. For example, the most common cancer type in Osteosarcoma 69.5 63.4 Ewing tumor & related bone sarcomas 78.7 59.2 adolescents is lymphoma (21%), almost two-thirds of which Soft tissue and other extraosseous 74.0 69.1 is Hodgkin lymphoma. Cancers of the brain and other ner- sarcomas vous system account for 17% of cases, followed by leukemia Rhabdomyosarcoma 69.6 48.9 (14%), germ cell and gonadal tumors (12%), and thyroid car- Germ cell and gonadal tumors 93.3 91.9 cinoma (11%). Melanoma accounts for 5% of the cancers Thyroid carcinoma 99.7 99.7 diagnosed in this age group. Malignant melanoma 93.7 94.0 Although overall cancer incidence in children and adoles- ICCC indicates International Classification of Childhood Cancer. cents has been increasing slightly (by 0.6% per year) since Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2013. 1975, rates appear to have stabilized during the most recent *The standard error of the survival rate is between 5 and 10 percentage points. data years. In contrast, death rates among those aged birth to †Statistic could not be calculated due to fewer than 25 cases during 2006 19 years have declined continuously, from 6.5 (per 100,000 to 2012. population) in 1970 to 2.2 in 2014, an overall reduction of 66% (68% in children and 60% in adolescents). The 5-year relative survival rate for all cancers combined improved from continues to have the lowest smoking prevalence. Smoking 58% during the mid-1970s to 83% during 2006-2012 for history similarly predicts state disparities in smoking- children and from 68% to 84% for adolescents. However, sur- attributable mortality; the proportion of total cancer deaths vival varies substantially by cancer type and age at diagnosis caused by smoking is 38% in men and 29% in women in (Table 14). Kentucky, compared with 22% and 11%, respectively, in Utah. The 2-fold difference for prostate cancer incidence Limitations rates, which range from 84 (per 100,000 population) in Although the estimated numbers of new cancer cases and Arizona to 169 in the District of Columbia, reflect state dif- deaths expected to occur in 2017 provide a reasonably accu- ferences in PSA testing prevalence and racial composition. rate portrayal of the contemporary cancer burden, they are State variations are smaller for cancers without particularly model-based, 3-year- or 4-year-ahead projections that strong risk factors or early detection tests (eg, pancreas). should be interpreted with caution and not be used to track trends over time. First, the estimates may be affect- Cancer in Children and Adolescents ed by changes in methodology as we take advantage of Cancer is the second most common cause of death among improvements in modeling techniques and cancer sur- children aged 1 to 14 years in the United States, surpassed veillance coverage. Second, although the model is robust, only by accidents. In 2017, an estimated 10,270 children it can only account for trends through the most recent (birth to 14 years) will be diagnosed with cancer (excluding year of data (currently 2013 for incidence and 2014 for benign/borderline malignant brain tumors) and 1,190 will die mortality) and cannot anticipate abrupt fluctuations for from the disease. Benign and borderline malignant brain cancers affected by changes in detection practice, such as tumors are not included in the 2017 case estimates because prostate cancer. Third, the model can be oversensitive to the calculation method requires historical data and these sudden or large changes in observed data. The most tumors were not required to be reported to cancer registries informative metrics for tracking cancer trends are age- until 2004. standardized or age-specific cancer death rates from the _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 27 Cancer Statistics, 2017 NCHS and cancer incidence rates from SEER, NPCR, 2.1 million fewer cancer deaths during this time period. and/or NAACCR. Moreover, racial disparities in cancer death rates are con- Errors in reporting race/ethnicity in medical records and tinuing to decline and the proportion of blacks who are on death certificates may result in underestimates of cancer uninsured has halved since 2010, potentially expediting incidence and mortality rates in nonwhite and nonblack further progress. Despite these successes, death rates are populations. This is particularly relevant for AI/AN popu- increasing rapidly for cancers of the liver (one of the most lations. It is also important to note that cancer data in the fatal cancers) and uterine corpus, both of which are United States are primarily reported for broad, heteroge- strongly associated with obesity. Advancing the fight neous racial and ethnic groups, masking substantial and against cancer requires continued clinical and basic important differences in the cancer burden within these research to improve detection practices, as well as treat- subpopulations. For example, among API men, lung cancer ment. In addition, creative new strategies are also needed incidence rates in Hawaiian men are just as high as those in to increase healthy behaviors nationwide and to more non-Hispanic white men and 3-fold higher than those in broadly apply existing cancer control knowledge across all Asian Indian/Pakistani men based on limited data available segments of the population, with an emphasis on disad- by population subgroups. Thus, the high burden of lung vantaged groups. and other cancers among Hawaiians is completely con- cealed with the presentation of aggregated API data. Author Contributions: Rebecca L. Siegel: Conceptualization, formal analysis, investigation, writing–original draft, writing–review and editing, Conclusions and visualization. Kimberly D. Miller: Software, formal analysis, investigation, writing–review and editing, and visualization. Ahmedin Jemal: The continuous decline in cancer death rates over 2 deca- Conceptualization, methodology, writing–review and editing, visualization, des has resulted in an overall drop of 25%, resulting in and supervision. Sciences, Surveillance Research Program, Epidemiology and End Results [SEER] Reg- References Surveillance Systems Branch; 2016. istries). Bethesda, MD: National Cancer Institute, Division of Cancer Control and 1. Surveillance, Epidemiology, and End 6. Surveillance, Epidemiology, and End Results Population Sciences, Surveillance Research Results (SEER) Program. SEER*Stat Data- (SEER) Program. SEER*Stat Database: Program, Surveillance Systems Branch; base: Mortality-All COD, Total US (1969- Incidence-SEER 9 Regs Research Data with 2014) <Early Release with Vintage 2014 Delay-Adjustment, Malignant Only, Nov. Katrina/Rita Population Adjustment>- 2015 Sub (1975-2013) <Katrina/Rita Popula- 11. Surveillance, Epidemiology, and End Linked To County Attributes-Total US, tion Adjustment>-Linked To County Results (SEER) Program. SEER*Stat Data- 1969-2014 Counties. Bethesda, MD: Nation- Attributes-Total US, 1969-2014 Counties. base: North American Association of Cen- al Cancer Institute, Division of Cancer Con- Bethesda, MD: National Cancer Institute, tral Cancer Registries (NAACCR) Incidence trol and Population Sciences, Surveillance Division of Cancer Control and Population Data-CiNA Analytic File, 1995-2013, for Research Program, Surveillance Systems Sciences, Surveillance Research Program, NHIAv2 Origin, Custom File With County, Branch; 2016; underlying mortality data Surveillance Systems Branch; 2016. ACS Facts and Figures Projection Project provided by National Center for Health Sta- (Which Includes Data From CDC’s National 7. Surveillance, Epidemiology, and End Results tistics 2016. Program of Cancer Registries [NPCR], (SEER) Program. SEER*Stat Database: CCCR’s Provincial and Territorial Regis- 2. Surveillance, Epidemiology, and End Incidence-SEER 18 Regs Research Data 1 tries, and the NCI’s Surveillance, Epidemi- Results (SEER) Program. SEER*Stat Data- Hurricane Katrina Impacted Louisiana Cases, ology and End Results [SEER] Registries). base: Mortality-All COD, Total US (1990- Nov. 2015 Sub (2000-2013) <Katrina/Rita Bethesda, MD: National Cancer Institute, 2014) <Early Release with Vintage 2014 Population Adjustment>-Linked To County Division of Cancer Control and Population Katrina/Rita Population Adjustment>- Attributes-Total US, 1969-2014 Counties. Sciences, Surveillance Research Program, Linked To County Attributes-Total US, Bethesda, MD: National Cancer Institute, Surveillance Systems Branch; 2016. 1969-2014 Counties. Bethesda, MD: Nation- Division of Cancer Control and Population al Cancer Institute, Division of Cancer Con- Sciences, Surveillance Research Program, 12. Copeland G, Lake A, Firth R, et al. Cancer trol and Population Sciences, Surveillance Surveillance Systems Branch; 2016. in North America: 2009-2013. Vol 1. Com- Research Program, Surveillance Systems bined Cancer Incidence for the United 8. Statistical Research and Applications Branch; 2016; underlying mortality data States, Canada and North America. Spring- Branch. DevCan: Probability of Developing provided by National Center for Health Sta- field, IL: North American Association of or Dying of Cancer Software. Version 6.7.4. tistics 2016. Central Cancer Registries Inc; 2016. Bethesda, MD: Surveillance Research Pro- 3. Wingo PA, Cardinez CJ, Landis SH, et al. gram, Statistical Methodology and Applica- 13. Copeland G, Lake A, Firth R, et al. Cancer Long-term trends in cancer mortality in the tions, National Cancer Institute; 2012. in North America: 2009-2013. Vol 2. United States, 1930-1998. Cancer. 2003; Registry-Specific Cancer Incidence in the 9. Howlader N, Noone AM, Krapcho M, et al. 97(suppl 12):3133-3275. United States and Canada. Springfield, IL: SEER Cancer Statistics Review, 1975-2013. North American Association of Central Can- 4. Murphy SL, Kochanek KD, Xu J, Heron M. Bethesda, MD: National Cancer Institute; cer Registries Inc; 2016. Deaths: Final Data for 2012. National Vital Statistics Reports. Vol 63. No. 9. Hyattsville, 14. Steliarova-Foucher E, Stiller C, Lacour B, 10. Surveillance, Epidemiology, and End MD: National Center for Health Statistics; Kaatsch P. International Classification of Results (SEER) Program. SEER*Stat Data- Childhood Cancer, Third Edition. Cancer. base: North American Association of Cen- 2005;103:1457–1467. 5. Surveillance, Epidemiology, and End Results tral Cancer Registries (NAACCR) Incidence (SEER) Program. SEER*Stat Database: Data-CiNA Analytic File, 1995-2013, for 15. Fritz A, Percy C, Jack A, et al. International Incidence-SEER 9 Regs Research Data, Nov. Expanded Races, Custom File With County, Classification of Diseases for Oncology. 3rd 2015 Sub (1973-2013) <Katrina/Rita Popula- ACS Facts and Figures Projection Project ed. Geneva: World Health Organization; tion Adjustment>-Linked To County (Which Includes Data From CDC’s National Attributes-Total US, 1969-2014 Counties. Program of Cancer Registries [NPCR], Bethesda, MD: National Cancer Institute, CCCR’s Provincial and Territorial Regis- 16. World Health Organization. International Division of Cancer Control and Population tries, and the NCI’s Surveillance, Statistical Classification of Diseases and 28 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 Related Health Problems. 10th Rev. Vols I- and race/ethnicity, 1992-2001. Cancer. 44. Lortet-Tieulent J, Sauer AG, Siegel RL, et al. III. Geneva: World Health Organization; 2006;107(suppl 5):1142-1152. State-level cancer mortality attributable 2011. to cigarette smoking in the United 31. Siegel RL, Ward EM, Jemal A. Trends in States. JAMA Intern Med. 2016; Published 17. Surveillance Research Program, National colorectal cancer incidence rates in the online October 24, 2016. doi:10.1001/jama Cancer Institute. SEER*Stat Software. Ver- United States by tumor location and stage, internmed.2016.6530. sion 8.3.2. Bethesda, MD: Surveillance 1992-2008. Cancer Epidemiol Biomarkers Research Program, National Cancer Insti- Prev. 2012;21:411-416. 45. Heron M, Anderson RN. Changes in the tute; 2016. Leading Cause of Death: Recent Patterns in 32. Centers for Disease Control and Prevention, Heart Disease and Cancer Mortality. NCHS 18. Joinpoint Regression Program, Version National Center for Health Statistics. Data Brief No. 254. Hyattsville, MD: 4.3.1.0. Bethesda, MD: Statistical Research National Health Interview Surveys, 2000 National Center for Health Statistics; 2016. and 2015. Public use data files, 2001, 2016. and Applications Branch, National Cancer 46. Siegel R, Naishadham D, Jemal A. Cancer Institute; 2016. 33. Morris LG, Tuttle RM, Davies L. Changing statistics for Hispanics/Latinos, 2012. CA trends in the incidence of thyroid cancer in 19. Clegg LX, Feuer EJ, Midthune DN, Fay MP, Cancer J Clin. 2012;62:283-298. the United States. JAMA Otolaryngol Head Hankey BF. Impact of reporting delay and Neck Surg. 2016;142:709-711. 47. Torre LA, Sauer AM, Chen MS Jr, Kagawa- reporting error on cancer incidence rates Singer M, Jemal A, Siegel RL. Cancer statis- and trends. J Natl Cancer Inst. 2002;94: 34. Nikiforov YE, Seethala RR, Tallini G, et al. tics for Asian Americans, Native Hawai- 1537-1545. Nomenclature revision for encapsulated ians, and Pacific Islanders, 2016: follicular variant of papillary thyroid carci- 20. Surveillance, Epidemiology, and End converging incidence in males and females. Results (SEER) Program. SEER*Stat Data- noma: a paradigm shift to reduce overtreat- CA Cancer J Clin. 2016;66:182-202. base: Incidence-SEER 18 Regs Research ment of indolent tumors. JAMA Oncol. 48. Reagan-Steiner S, Yankey D, Jeyarajah J, 2016;2:1023-1029. Data with Delay-Adjustment, Malignant et al. National, regional, state, and selected Only, Nov. 2015 Sub (2000-2013) 35. Zeng C, Wen W, Morgans AK, Pao W, Shu local area vaccination coverage among ado- <Katrina/Rita Population Adjustment>- XO, Zheng W. Disparities by race, age, and lescents aged 13-17 years-United States, Linked To County Attributes-Total US, sex in the improvement of survival for 2014. MMWR Morb Mortal Wkly Rep. 2015; 1969-2014 Counties. Bethesda, MD: Nation- major cancers: results from the National 64:784-792. al Cancer Institute, Division of Cancer Con- Cancer Institute Surveillance, Epidemiolo- trol and Population Sciences, Surveillance 49. Wiren S, Haggstrom C, Ulmer H, et al. gy, and End Results (SEER) Program in the Research Program, Surveillance Systems Pooled cohort study on height and risk of United States, 1990 to 2010. JAMA Oncol. Branch; 2016. cancer and cancer death. Cancer Causes 2015;1:88-96. Control. 2014;25:151-159. 21. Pickle LW, Hao Y, Jemal A, et al. A new 36. Sasaki K, Strom SS, O’Brien S, et al. Rela- method of estimating United States and 50. Walter RB, Brasky TM, Buckley SA, tive survival in patients with chronic-phase state-level cancer incidence counts for the Potter JD, White E. Height as an explana- chronic myeloid leukaemia in the tyrosine- current calendar year. CA Cancer J Clin. kinase inhibitor era: analysis of patient data tory factor for sex differences in human 2007;57:30-42. from six prospective clinical trials. Lancet cancer. JNatl Cancer Inst. 2013;105:860- Haematol. 2015;2:e186-e193. 868. 22. Zhu L, Pickle LW, Ghosh K, et al. Predicting US- and state-level cancer counts for the 37. Teras LR, DeSantis CE, Cerhan JR, Morton 51. O’Grady TJ, Gates MA, Boscoe FP. Thyroid current calendar year: Part II: evaluation of cancer incidence attributable to overdiag- LM, Jemal A, Flowers CR. 2016 US lym- spatiotemporal projection methods for inci- nosis in the United States 1981-2011. Int J phoid malignancy statistics by World dence. Cancer. 2012;118:1100-1109. Cancer. 2015;137:2664-2673. Health Organization subtypes [published online ahead of print September 12, 2016]. 23. Chen HS, Portier K, Ghosh K, et al. Predict- 52. Aschebrook-Kilfoy B, Ward MH, Sabra CA Cancer J Clin. doi: 10.3322/caac.21357. ing US- and state-level cancer counts for the MM, Devesa SS. Thyroid cancer incidence current calendar year: Part I: evaluation of patterns in the United States by histologic 38. National Lung Screening Trial Research temporal projection methods for mortality. type, 1992-2006. Thyroid. 2011;21:125- Team, Aberle DR, Adams AM, et al. Cancer. 2012;118:1091-1099. Reduced lung-cancer mortality with low- dose computed tomographic screening. N 24. Potosky AL, Miller BA, Albertsen PC, 53. Rahbari R, Zhang L, Kebebew E. Thyroid Engl J Med. 2011;365:395-409. Kramer BS. The role of increasing detection cancer gender disparity. Future Oncol. in the rising incidence of prostate cancer. 2010;6:1771-1779. 39. Marcus PM, Doria-Rose VP, Gareen IF, JAMA. 1995;273:548-552. et al. Did death certificates and a death 54. Joosse A, de Vries E, Eckel R, et al; Munich review process agree on lung cancer cause 25. Siegel RL, Miller KD, Jemal A. Cancer sta- Melanoma Group. Gender differences in of death in the National Lung Screening Tri- tistics, 2016. CA Cancer J Clin. 2016;66: melanoma survival: female patients have a al? Clin Trials. 2016;13:434-438. 7-30. decreased risk of metastasis. J Invest Der- matol. 2011;131:719-726. 40. Doria-Rose VP, White MC, Klabunde CN, 26. Moyer VA; US Preventive Services Task et al. Use of lung cancer screening tests in Force. Screening for prostate cancer: U.S. 55. Crocetti E, Fancelli L, Manneschi G, et al. the United States: results from the 2010 Preventive Services Task Force recommen- Melanoma survival: sex does matter, but National Health Interview Survey. Cancer dation statement. Ann Intern Med. 2012; we do not know how. Eur J Cancer Prev. Epidemiol Biomarkers Prev. 2012;21:1049- 157:120-134. 2016;25:404-409. 27. Harris JE. Cigarette smoking among succes- 56. Scoggins CR, Ross MI, Reintgen DS, et al; Sun- 41. Jemal A, Thun MJ, Ries LA, et al. Annual sive birth cohorts of men and women in the belt Melanoma Trial. Gender-related differ- report to the nation on the status of cancer, United States during 1900-80. J Natl Cancer ences in outcome for melanoma patients. Ann 1975-2005, featuring trends in lung cancer, Inst. 1983;71:473-479. Surg. 2006;243:693-698; discussion 698-700. tobacco use, and tobacco control. J Natl 28. Jemal A, Ma J, Rosenberg PS, Siegel R, Cancer Inst. 2008;100:1672-1694. 57. Joosse A, Collette S, Suciu S, et al. Sex is an Anderson WF. Increasing lung cancer death independent prognostic indicator for sur- 42. Holford TR, Meza R, Warner KE, et al. rates among young women in southern and vival and relapse/progression-free survival Tobacco control and the reduction in midwestern states. J Clin Oncol. 2012;30: in metastasized stage III to IV melanoma: a smoking-related premature deaths in the 2739-2744. pooled analysis of five European Organisa- United States, 1964-2012. JAMA. 2014;311: tion for Research and Treatment of Cancer 29. Edwards BK, Ward E, Kohler BA, et al. 164-171. randomized controlled trials. J Clin Oncol. Annual report to the nation on the status 2013;31:2337-2346. 43. US Department of Health and Human Serv- of cancer, 1975-2006, featuring colorectal ices. The Health Consequences of Smoking- cancer trends and impact of interventions 58. Cymerman RM, Shao Y, Wang K, et al. De 50 Years of Progress. A Report of the Sur- (risk factors, screening, and treatment) to Novo vs Nevus-Associated Melanomas: Dif- geon General. Atlanta, GA: US Department reduce future rates. Cancer. 2010;116:544- ferences in Associations With Prognostic of Health and Human Services, Centers for Indicators and Survival. J Natl Cancer Inst. Disease Control and Prevention, National 2016;108. 30. Cress RD, Morris C, Ellison GL, Goodman Center for Chronic Disease Prevention and MT. Secular changes in colorectal cancer Health Promotion, Office on Smoking and 59. Jemal A, Center MM, Ward E. The conver- incidence by subsite, stage at diagnosis, Health; 2014. gence of lung cancer rates between blacks _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 29 Cancer Statistics, 2017 and whites under the age of 40, United 64. Barnett J, Vornovitsky M. Health Insur- Indians and Alaska Natives in the United States. Cancer Epidemiol Biomarkers Prev. ance Coverage in the United States: 2015. States. Am J Public Health. 2014;104(suppl 2009;18:3349-3352. Current Population Reports P60-257. 3):S377-S387. Washington, DC: US Census Bureau; 60. Anderson C, Burns DM. Patterns of adoles- 68. Ezzati M, Friedman AB, Kulkarni SC, cent smoking initiation rates by ethnicity and Murray CJ. The reversal of fortunes: trends sex. Tob Control. 2000;9(suppl 2):II4-II8. 65. DeNavas-Walt C, Proctor B, Smith J. in county mortality and cross-county mor- Income, Poverty, and Health Insurance tality disparities in the United States. PLoS 61. Ward E, Jemal A, Cokkinides V, et al. Can- Coverage in the United States: 2010. Cur- Med. 2008;5:e66. cer disparities by race/ethnicity and socio- rent Population Reports P60-239. Washing- 69. Grauman DJ, Tarone RE, Devesa SS, economic status. CA Cancer J Clin. 2004;54: ton, DC: US Census Bureau; 2011. Fraumeni JF Jr. Alternate ranging methods 78-93. 66. Welzel TM, Graubard BI, Quraishi S, et al. for cancer mortality maps. J Natl Cancer 62. Bach PB, Schrag D, Brawley OW, Galaznik Population-attributable fractions of risk fac- Inst. 2000;92:534-543. A, Yakren S, Begg CB. Survival of blacks tors for hepatocellular carcinoma in the 70. Nguyen BT, Han X, Jemal A, Drope J. Diet and whites after a cancer diagnosis. JAMA. United States. Am J Gastroenterol. 2013; quality, risk factors and access to care 2002;287:2106-2113. 108:1314-1321. among low-income uninsured American 63. Ward E, Halpern M, Schrag N, et al. Associ- 67. White MC, Espey DK, Swan J, Wiggins CL, adults in states expanding Medicaid vs. ation of insurance with cancer care utiliza- Eheman C, Kaur JS. Disparities in cancer states not expanding under the Affordable tion and outcomes. CA Cancer J Clin. 2008; mortality and incidence among American Care Act. Prev Med. 2016;91:169-171. 58:9-31. 30 CA: A Cancer Journal for Clinicians http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CA: A Cancer Journal for Clinicians Wiley

Loading next page...
 
/lp/wiley/cancer-statistics-2017-OwkI09TuSs

References (70)

Publisher
Wiley
Copyright
"© 2017 American Cancer Society"
ISSN
0007-9235
eISSN
1542-4863
DOI
10.3322/caac.21387
pmid
28055103
Publisher site
See Article on Publisher Site

Abstract

CA CANCER J CLIN 2017;67:7–30 1 2 3 Rebecca L. Siegel, MPH ; Kimberly D. Miller, MPH ; Ahmedin Jemal, DVM, PhD Strategic Director, Surveillance Information Services, Surveillance and Health Services Abstract: Each year, the American Cancer Society estimates the numbers of new can- Research, American Cancer Society, Atlanta, cer cases and deaths that will occur in the United States in the current year and com- GA; Epidemiologist, Surveillance and Health piles the most recent data on cancer incidence, mortality, and survival. Incidence data Services Research, American Cancer Society, were collected by the Surveillance, Epidemiology, and End Results Program; the National Atlanta, GA; Vice President, Surveillance and Program of Cancer Registries; and the NorthAmericanAssociationofCentral Cancer Health Services Research, American Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In Society, Atlanta, GA 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur Corresponding author: Rebecca L. Siegel, in the United States. For all sites combined, the cancer incidence rate is 20% higher in MPH, Surveillance Information Services, Sur- veillance and Health Services Research, Amer- men than in women, while the cancer death rate is 40% higher. However, sex disparities ican Cancer Society, 250 Williams St, NW, vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in Atlanta, GA 30303-1002; Rebecca.siegel@can- women than in men (21 vs 7 per 100,000 population), despite equivalent death rates cer.org (0.5 per 100,000 population), largely reflecting sex differences in the “epidemic of diag- DISCLOSURES: The authors report no con- nosis.” Over the past decade of available data, the overall cancer incidence rate (2004- flicts of interest. 2013) was stable in women and declined by approximately 2% annually in men, while the doi: 10.3322/caac.21387. Available online cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. at cacancerjournal.com From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approxi- mately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7–30. V 2017 American Cancer Society. Keywords: cancer cases, cancer statistics, death rates, incidence, mortality Introduction Cancer is amajor publichealth problem worldwideand is thesecondleading causeof death in the United States. In this article, we provide the expected numbers of new cancer cases and deaths in 2017 in the United States nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using population-based data. The most current cancer data are available through 2013 for incidence and through 2014 for mortality. We also estimate the total number of deaths averted as a result of the continual decline in cancer death rates since the early 1990s. In addition, we present the actual number of deaths reported in 2014 by age for the 10 leading causes of death and for the 5 leading causes of cancer death. Materials and Methods Incidence and Mortality Data Mortality data from 1930 to 2014 were provided by the National Center for 1-3 Health Statistics (NCHS). Forty-seven states and the District of Columbia met data quality requirements for reporting to the national vital statistics system in 1930. Texas, Alaska, and Hawaii began reporting mortality data in 1933, 1959, and 1960, respectively. The methods for abstraction and age adjustment of mortal- 3,4 ity data are described elsewhere. Population-based cancer incidence data in the United States have been collected by the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 7 Cancer Statistics, 2017 TABLE 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2017* ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,688,780 836,150 852,630 600,920 318,420 282,500 Oral cavity & pharynx 49,670 35,720 13,950 9,700 7,000 2,700 Tongue 16,400 11,880 4,520 2,400 1,670 730 Mouth 13,210 7,800 5,410 2,580 1,680 900 Pharynx 17,000 13,780 3,220 3,050 2,340 710 Other oral cavity 3,060 2,260 800 1,670 1,310 360 Digestive system 310,440 175,650 134,790 157,700 92,350 65,350 Esophagus 16,940 13,360 3,580 15,690 12,720 2,970 Stomach 28,000 17,750 10,250 10,960 6,720 4,240 Small intestine 10,190 5,380 4,810 1,390 770 620 Colon† 95,520 47,700 47,820 50,260 27,150 23,110 Rectum 39,910 23,720 16,190 Anus, anal canal, & anorectum 8,200 2,950 5,250 1,100 450 650 Liver & intrahepatic bile duct 40,710 29,200 11,510 28,920 19,610 9,310 Gallbladder & other biliary 11,740 5,320 6,420 3,830 1,630 2,200 Pancreas 53,670 27,970 25,700 43,090 22,300 20,790 Other digestive organs 5,560 2,300 3,260 2,460 1,000 1,460 Respiratory system 243,170 133,050 110,120 160,420 88,100 72,320 Larynx 13,360 10,570 2,790 3,660 2,940 720 Lung & bronchus 222,500 116,990 105,510 155,870 84,590 71,280 Other respiratory organs 7,310 5,490 1,820 890 570 320 Bones & joints 3,260 1,820 1,440 1,550 890 660 Soft tissue (including heart) 12,390 6,890 5,500 4,990 2,670 2,320 Skin (excluding basal & squamous) 95,360 57,140 38,220 13,590 9,250 4,340 Melanoma of the skin 87,110 52,170 34,940 9,730 6,380 3,350 Other nonepithelial skin 8,250 4,970 3,280 3,860 2,870 990 Breast 255,180 2,470 252,710 41,070 460 40,610 Genital system 279,800 172,330 107,470 59,100 27,500 31,600 Uterine cervix 12,820 12,820 4,210 4,210 Uterine corpus 61,380 61,380 10,920 10,920 Ovary 22,440 22,440 14,080 14,080 Vulva 6,020 6,020 1,150 1,150 Vagina & other genital, female 4,810 4,810 1,240 1,240 Prostate 161,360 161,360 26,730 26,730 Testis 8,850 8,850 410 410 Penis & other genital, male 2,120 2,120 360 360 Urinary system 146,650 103,480 43,170 32,190 22,260 9,930 Urinary bladder 79,030 60,490 18,540 16,870 12,240 4,630 Kidney & renal pelvis 63,990 40,610 23,380 14,400 9,470 4,930 Ureter & other urinary organs 3,630 2,380 1,250 920 550 370 Eye & orbit 3,130 1,800 1,330 330 180 150 Brain & other nervous system 23,800 13,450 10,350 16,700 9,620 7,080 Endocrine system 59,250 15,610 43,640 3,010 1,440 1,570 Thyroid 56,870 14,400 42,470 2,010 920 1,090 Other endocrine 2,380 1,210 1,170 1,000 520 480 Lymphoma 80,500 44,730 35,770 21,210 12,080 9,130 Hodgkin lymphoma 8,260 4,650 3,610 1,070 630 440 Non-Hodgkin lymphoma 72,240 40,080 32,160 20,140 11,450 8,690 Myeloma 30,280 17,490 12,790 12,590 6,660 5,930 Leukemia 62,130 36,290 25,840 24,500 14,300 10,200 Acute lymphocytic leukemia 5,970 3,350 2,620 1,440 800 640 Chronic lymphocytic leukemia 20,110 12,310 7,800 4,660 2,880 1,780 Acute myeloid leukemia 21,380 11,960 9,420 10,590 6,110 4,480 Chronic myeloid leukemia 8,950 5,230 3,720 1,080 610 470 Other leukemia‡ 5,720 3,440 2,280 6,730 3,900 2,830 Other & unspecified primary sites‡ 33,770 18,230 15,540 42,270 23,660 18,610 *Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. About 63,410 cases of carcinoma in situ of the female breast and 74,680 cases of melanoma in situ will be newly diagnosed in 2017. †Deaths for colon and rectum cancers are combined because a large number of deaths from rectal cancer are misclassified as colon. ‡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. 8 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 2. Estimated New Cases for Selected Cancers by State, 2017* ALL FEMALE UTERINE COLON & UTERINE LUNG & MELANOMA NON-HODGKIN URINARY STATE CASES BREAST CERVIX RECTUM CORPUS LEUKEMIA BRONCHUS OF THE SKIN LYMPHOMA PROSTATE BLADDER Alabama 26,160 3,960 210 2,210 720 770 3,880 1,320 960 2,410 1,090 Alaska 3,600 500 † 280 120 100 450 130 140 320 150 Arizona 35,810 4,870 240 2,630 1,110 1,170 3,940 2,050 1,410 2,990 1,670 Arkansas 16,040 2,100 150 1,390 480 580 2,620 610 660 1,440 710 California 176,140 27,980 1,490 13,890 6,280 6,740 18,270 9,180 7,880 14,520 7,500 Colorado 24,330 3,840 170 1,770 890 960 2,420 1,590 1,090 2,880 1,120 Connecticut 21,900 3,420 120 1,600 890 800 2,540 970 950 2,140 1,220 Delaware 5,660 840 † 440 200 180 850 340 250 590 270 Dist. of Columbia 3,070 520 † 210 110 90 310 120 110 380 90 Florida 124,740 18,170 1,040 9,930 4,230 5,070 19,000 7,610 5,410 12,830 6,430 Georgia 48,850 7,820 410 4,040 1,510 1,550 6,610 2,930 1,890 5,410 1,880 Hawaii 6,540 1,120 50 660 290 210 700 460 260 500 240 Idaho 7,310 1,080 50 610 290 310 980 550 370 870 480 Illinois 64,720 10,210 520 5,580 2,740 2,350 8,600 2,810 2,750 6,410 3,070 Indiana 36,440 5,140 290 3,080 1,370 1,280 5,540 1,730 1,560 3,410 1,710 Iowa 17,230 2,400 100 1,510 700 760 2,410 1,020 800 1,430 870 Kansas 14,400 2,180 110 1,170 540 560 1,880 830 630 1,320 640 Kentucky 26,220 3,590 210 2,250 830 1,050 4,830 1,410 1,070 2,050 1,190 Louisiana 24,220 3,320 230 2,150 630 770 3,510 960 990 2,620 980 Maine 8,750 1,350 † 710 380 310 1,380 450 380 720 570 Maryland 31,820 5,250 220 2,430 1,200 1,000 4,020 1,700 1,260 3,400 1,390 Massachusetts 37,130 5,940 200 2,760 1,600 1,220 4,890 1,890 1,630 3,930 2,050 Michigan 57,600 8,160 370 4,660 2,320 2,010 8,190 2,780 2,480 5,350 3,050 Minnesota 30,000 4,230 140 2,170 1,080 1,290 3,620 1,330 1,370 2,750 1,320 Mississippi 17,290 2,340 140 1,520 410 530 2,570 560 560 1,380 620 Missouri 34,400 4,930 240 2,860 1,250 1,210 5,620 1,690 1,420 2,990 1,610 Montana 6,140 900 † 500 220 260 750 400 280 750 350 Nebraska 9,520 1,450 60 840 380 380 1,220 490 440 840 450 Nevada 13,840 2,010 110 1,160 400 460 1,680 560 560 1,190 700 New Hampshire 8,670 1,260 † 620 350 290 1,150 470 340 770 520 New Jersey 51,680 7,890 360 4,000 2,100 1,990 5,540 2,790 2,380 5,180 2,560 New Mexico 10,040 1,410 80 800 350 370 1,010 490 400 960 390 New York 107,530 16,310 810 8,490 4,420 4,320 12,700 4,900 4,760 10,060 5,410 North Carolina 56,900 8,580 400 4,290 1,810 1,970 7,940 3,060 2,180 5,560 2,500 North Dakota 4,180 550 † 330 140 150 480 210 170 360 200 Ohio 68,180 9,430 460 5,510 2,670 2,270 10,660 3,140 2,860 5,840 3,360 Oklahoma 18,710 2,690 170 1,610 590 760 3,050 790 840 1,700 860 Oregon 21,780 3,450 140 1,620 870 730 2,900 1,580 970 2,060 1,070 Pennsylvania 77,710 11,300 520 6,300 3,270 2,800 9,930 4,140 3,310 7,320 4,190 Rhode Island 5,870 930 † 480 250 190 860 270 260 780 350 South Carolina 28,680 4,250 210 2,270 890 990 4,320 1,740 1,120 3,250 1,260 South Dakota 4,920 690 † 410 180 200 590 240 210 430 240 Tennessee 37,080 5,510 290 3,080 1,090 1,300 5,830 1,840 1,490 2,830 1,620 Texas 116,200 17,060 1,300 9,690 3,890 4,550 14,560 4,240 5,250 12,550 4,270 Utah 10,990 1,460 70 740 400 460 850 950 490 1,240 430 Vermont 4,000 580 † 280 160 110 510 220 170 380 240 Virginia 42,770 7,020 280 3,260 1,490 1,380 5,400 2,500 1,720 3,950 1,870 Washington 35,560 5,950 250 2,720 1,380 1,390 4,390 2,590 1,740 3,580 1,830 West Virginia 11,690 1,520 80 1,050 450 410 1,980 700 480 840 610 Wisconsin 32,990 4,850 180 2,650 1,360 1,460 4,280 1,590 1,380 3,570 1,670 Wyoming 2,780 410 † 220 100 100 320 190 120 320 150 United States 1,688,780 252,710 12,820 135,430 61,380 62,130 222,500 87,110 72,240 161,360 79,030 *Rounded to the nearest 10; excludes basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. †Estimate is fewer than 50 cases. Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusionof states with fewer than 50 cases. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 9 Cancer Statistics, 2017 FIGURE 1. Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2017. Estimates are rounded to the nearest 10 and cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Results (SEER) Program since 1973 and by the Centers for presented herein was adapted from data previously published Disease Control and Prevention’s (CDC’s) National Pro- in the SEER Cancer Statistics Review 1975-2013. gram of Cancer Registries (NPCR) since 1995. The SEER NAACCR compiles and reports incidence data from program is the only source for long-term population-based 1995 onward for cancer registries that participate in the SEER program and/or the NPCR. These data approach incidence data. Long-term incidence and survival trends (1975-2013) were based on data from the 9 oldest SEER 100% coverage of the US population in the most recent time areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and period and were the source for the projected new cancer cases 10,11 the metropolitan areas of Atlanta, Detroit, San Francisco- in 2017 and incidence rates by state and race/ethnicity. Oakland, and Seattle-Puget Sound), representing approxi- Some of the incidence data presented herein were previously 5,6 mately 9% of the US population. The lifetime probability published in volumes 1 and 2 of Cancer in North America: 12,13 of developing cancer, stage distribution, and survival by stage 2009-2013. and for children and adolescents were based on data from all All cancer cases were classified according to the Interna- 18 SEER registries (the SEER 9 registries plus Alaska tional Classification of Diseases for Oncology except childhood Natives, California, Georgia, Kentucky, Louisiana, and New and adolescent cancers, which were classified according to Jersey), covering 28% of the US population. The probability the International Classification of Childhood Cancer 14,15 of developing cancer was calculated using NCI’s DevCan (ICCC). Causes of death were classified according to 8 16 software (version 6.7.4). Some of the statistical information the International Classification of Diseases. All incidence 10 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 3. Estimated Deaths for Selected Cancers by State, 2017* BRAIN & OTHER LIVER & ALL NERVOUS FEMALE COLON & INTRAHEPATIC LUNG & NON-HODGKIN STATE SITES SYSTEM BREAST RECTUM LEUKEMIA BILE DUCT BRONCHUS LYMPHOMA OVARY PANCREAS PROSTATE Alabama 10,530 320 650 940 420 470 3,200 320 250 710 450 Alaska 1,070 † 70 100 † 60 280 † † 80 50 Arizona 12,050 380 810 1,020 550 660 2,820 430 310 930 600 Arkansas 6,800 180 420 600 250 280 2,160 210 150 430 260 California 59,400 1,830 4,440 5,240 2,610 3,750 12,000 2,140 1,530 4,510 3,130 Colorado 7,840 270 570 660 340 380 1,640 260 240 580 450 Connecticut 6,610 190 430 450 300 300 1,630 230 170 490 310 Delaware 2,050 50 130 150 70 110 590 70 50 150 90 Dist. of Columbia 1,060 † 100 90 † 90 220 † † 100 70 Florida 43,870 1,250 2,910 3,620 1,800 2,020 11,790 1,510 970 3,170 2,050 Georgia 17,280 490 1,320 1,540 620 850 4,720 510 420 1,160 780 Hawaii 2,520 50 140 240 90 170 590 100 50 220 100 Idaho 2,900 100 190 250 110 120 680 110 70 230 170 Illinois 24,040 610 1,680 2,030 990 1,040 6,470 790 570 1,650 1,040 Indiana 13,590 350 860 1,110 550 520 4,030 450 300 900 550 Iowa 6,460 190 380 570 260 240 1,740 240 150 440 280 Kansas 5,440 170 330 470 260 230 1,500 180 120 400 230 Kentucky 10,400 250 590 830 390 400 3,560 330 200 640 340 Louisiana 9,240 220 620 830 320 520 2,610 300 170 700 370 Maine 3,260 100 170 220 130 120 960 110 60 220 140 Maryland 10,650 280 820 860 410 560 2,630 340 260 840 470 Massachusetts 12,620 350 760 910 540 670 3,270 410 320 950 550 Michigan 21,050 570 1,410 1,680 830 860 5,650 760 500 1,560 830 Minnesota 9,860 280 610 760 480 390 2,450 390 230 710 470 Mississippi 6,560 220 420 650 230 300 1,940 170 110 460 280 Missouri 14,380 330 860 1,070 550 580 4,030 390 250 910 500 Montana 2,030 60 130 170 80 80 510 70 50 140 120 Nebraska 3,520 110 230 330 150 130 900 120 70 250 180 Nevada 5,200 150 380 500 200 230 1,400 160 120 360 270 New Hampshire 2,710 80 170 200 110 90 760 80 60 200 120 New Jersey 15,880 420 1,250 1,420 640 700 3,760 510 410 1,270 700 New Mexico 3,630 90 250 340 150 220 760 110 100 250 200 New York 35,960 910 2,410 2,870 1,460 1,680 8,660 1,210 910 2,750 1,560 North Carolina 20,020 600 1,360 1,530 760 940 5,830 620 440 1,350 840 North Dakota 1,290 † 70 120 60 † 340 † † 90 70 Ohio 25,430 640 1,690 2,130 990 990 7,300 860 570 1,810 1,020 Oklahoma 8,200 200 530 710 340 360 2,450 270 200 520 350 Oregon 8,140 260 520 660 320 440 2,030 290 230 580 410 Pennsylvania 28,510 700 1,900 2,390 1,210 1,220 7,420 1,010 690 2,110 1,200 Rhode Island 2,160 50 120 170 90 110 610 60 50 140 90 South Carolina 10,320 260 700 830 380 440 2,920 300 230 710 460 South Dakota 1,660 60 110 160 90 60 450 50 † 110 70 Tennessee 14,830 380 920 1,220 570 670 4,590 470 310 950 550 Texas 40,260 1,100 2,830 3,700 1,690 2,620 9,540 1,380 920 2,780 1,650 Utah 3,180 130 270 260 170 150 460 120 100 270 210 Vermont 1,400 50 70 100 50 50 400 † † 110 70 Virginia 14,870 390 1,060 1,190 550 670 3,810 490 370 1,080 650 Washington 12,720 410 850 970 520 680 3,100 460 330 920 620 West Virginia 4,780 110 280 430 190 170 1,450 160 90 280 160 Wisconsin 11,710 360 740 880 540 440 3,070 420 220 870 570 Wyoming 960 † 60 80 60 † 220 † † 70 † United States 600,920 16,700 40,610 50,260 24,500 28,920 155,870 20,140 14,080 43,090 26,730 *Rounded to the nearest 10. †Estimate is fewer than 50 deaths. Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusionof states with fewer than 50 deaths. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 11 Cancer Statistics, 2017 from 1999 through 2013 using geographic variations in soci- odemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. Then these counts were adjusted for delays in cancer reporting using registry-specific or combined NAACCR delay ratios and aggregated to obtain national- and state-level counts for each year. Finally, a temporal projection method (the vector autoregressive model) was applied to all 15 years of data to estimate counts for 2017. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are not required to be reported to cancer registries. For complete details of the case projection methodology, please refer to Zhu et al. New cases of female breast carcinoma in situ and melano- ma in situ diagnosed in 2017 were estimated by first approxi- mating the number of cases occurring annually from 2004 through 2013 based on age-specific NAACCR incidence rates (data from 46 states and the District of Columbia with FIGURE 2. Trends in Cancer Incidence (1975 to 2013) and high-quality data every year) and US population estimates Death Rates (1975 to 2014) by Sex, United States. provided in SEER*Stat. The average annual percent change Rates are age adjusted to the 2000 US standard population. Incidence rates also are adjusted for delays in reporting. in case counts from 2004 through 2013 generated by the joinpoint regression model was then used to project cases to 2017. The estimates for in situ cases were not adjusted for and death rates were age-standardized to the 2000 US stan- reporting delays. dard population and expressed per 100,000 population, as The number of cancer deaths expected to occur in 2017 calculated by NCI’s SEER*Stat software (version 8.3.2). was estimated based on the most recent joinpoint- The annual percent change in rates was quantified using generated annual percent change in reported numbers of NCI’s Joinpoint Regression Program (version 4.3.1.0). cancer deaths from 2000 through 2014 at the state and Whenever possible, cancer incidence rates presented in this national levels as reported to the NCHS. For the complete report were adjusted for delays in reporting, which occur details of this methodology, please refer to Chen et al. becauseofa lag incasecapture or data corrections. Delay adjustment has the largest effect on the most recent years of Other Statistics data for cancers that are frequently diagnosed in outpatient The number of cancer deaths averted in men and women settings (eg, melanoma, leukemia, and prostate cancer) and due to the reduction in overall cancer death rates was provides a more accurate portrayal of the cancer burden in the 19 estimated by subtracting the number of recorded deaths most recent time period. For example, the leukemia incidence from the number that would have been expected if cancer rate for 2013 is 14% higher after adjusting for reporting 20 death rates had remained at their peak. The expected delays. number of deaths was estimated by applying the 5-year age-specific cancer death rates in the peak year for age- Projected Cancer Cases and Deaths in 2017 standardized cancer death rates (1990 in men and 1991 The most recent year for which incidence and mortality data in women) to the corresponding age-specific populations are available lags 2 to 4 years behind the current year due to in subsequent years through 2014. The difference the time required for data collection, compilation, quality between the number of expected and recorded cancer control, and dissemination. Therefore, we projected the deaths in each age group and calendar year was then numbers of new cancer cases and deaths in the United States summed. in 2017 to provide an estimate of the contemporary cancer burden. The number of invasive cancer cases was estimated Selected Findings using a 3-step spatio-temporal model based on high-quality Expected Numbers of New Cancer Cases incidence data from 49 states and the District of Columbia representing approximately 95% population coverage (data Table 1 presents the estimated numbers of new cases of were lacking for all years for Minnesota and for some years invasive cancer expected in the United States in 2017 by for other states). First, complete incidence counts were esti- sex. The overall estimate of 1,688,780 cases is the equiva- mated for each county (or health service area for rare cancers) lent of more than 4,600 new cancer diagnoses each day. 12 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 3. Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2013. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Includes intrahepatic bile duct. In addition, about 63,410 cases of female breast carcinoma Trends in Cancer Incidence in situ and 74,680 cases of melanoma in situ are expected Figure 2 illustrates long-term trends in cancer incidence to be diagnosed in 2017. The estimated numbers of rates for all cancers combined by sex. Cancer incidence pat- new cases by state for selected cancer sites are shown in terns reflect trends in behaviors associated with cancer risk Table 2. and changes in medical practice, such as the introduction of Figure 1 depicts the most common cancers expected to screening. The volatility in incidence for males compared occur in men and women in 2017. Prostate, lung and bron- with females reflects rapid changes in prostate cancer inci- chus, and colorectal cancers account for 42% of all cases in dence, which spiked in the late 1980s and early 1990s men, with prostate cancer alone accounting for almost 1 in (Fig. 3) due to a surge in the detection of asymptomatic 5 new diagnoses. For women, the 3 most commonly diag- disease as a result of widespread prostate-specific antigen nosed cancers are breast, lung and bronchus, and colorec- (PSA) testing. Over the past decade of data, the overall tum, which collectively represent one-half of all cases; cancer incidence rate in men declined by about 2% per year, breast cancer alone is expected to account for 30% of all with the pace accelerating in more recent years (Table 4). new cancer diagnoses in women. This trend reflects large continuing declines for cancers of the lung and colorectum, in addition to a sharp reduction Expected Numbers of Cancer Deaths in prostate cancer incidence of more than 10% annually An estimated 600,920 Americans will die from cancer in from 2010 to 2013. This drop is attributed to decreased 2017, corresponding to about 1,650 deaths per day PSA testing in the wake of US Preventive Services Task (Table 1). The most common causes of cancer death are Force recommendations against routine use of the test to cancers of the lung and bronchus, colorectum, and pros- screen for prostate cancer because of growing concerns 25,26 tate in men and lung and bronchus, breast, and colorec- about overdiagnosis and overtreatment. The effect of tum in women (Fig. 1). These 4 cancers account for 46% reduced screening on the occurrence of advanced disease is of all cancer deaths, with more than one-quarter (26%) being watched closely. Incidence rates for distant stage dis- due to lung cancer. Table 3 provides the estimated ease, which accounted for 4% of diagnoses during 2006 to numbers of cancer deaths in 2017 by state for selected 2012 (Fig. 4), have been stable since the mid-2000s follow- cancer sites. ing at least a decade of decline. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 13 Cancer Statistics, 2017 TABLE 4. Trends in Delay-Adjusted Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2013 2004- 2009- TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2013 2013 YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC All sites Overall 1975-1989 1.2* 1989-1992 2.8 1992-1995 22.4 1995-1998 1.0 1998-2009 20.3* 2009-2013 21.5* 20.8* 21.5* Male 1975-1989 1.3* 1989-1992 5.2* 1992-1995 24.9* 1995-1999 0.6 1999-2009 20.6* 2009-2013 22.9* 21.6* 22.9* Female 1975-1979 20.3 1979-1987 1.6* 1987-1995 0.1 1995-1998 1.5 1998-2003 20.6 2003-2013 0.1 0.1 0.1 Female breast 1975-1980 20.5 1980-1987 4.0* 1987-1994 20.2 1994-1999 1.8* 1999-2004 22.3* 2004-2013 0.4* 0.4* 0.4* Colorectum Male 1975-1985 1.1* 1985-1991 21.2* 1991-1995 23.2* 1995-1998 2.3 1998-2013 23.0* 23.0* 23.0* Female 1975-1985 0.3 1985-1995 21.9* 1995-1998 1.8 1998-2008 22.0* 2008-2013 23.8* 23.0* 23.8* Liver & intrahepatic bile duct Male 1975-1980 0.7 1980-2013 3.8* 3.8* 3.8* Female 1975-1983 0.6 1983-1996 4.1* 1996-2013 2.8* 2.8* 2.8* Lung & bronchus Male 1975-1982 1.5* 1982-1991 20.5* 1991-2008 21.7* 2008-2013 22.9* 22.4* 22.9* Female 1975-1982 5.6* 1982-1991 3.4* 1991-2006 0.5* 2006-2013 21.4* 21.0* 21.4* Melanoma of skin Male 1975-1985 5.6* 1985-2005 3.2* 2005-2013 1.7* 1.8* 1.7* Female 1975-1980 5.5* 1980-2008 2.4* 2008-2013 0.4 1.3* 0.4 Pancreas Male 1975-1993 20.8* 1993-2003 0.2 2003-2006 3.0 2006-2013 0.4 0.9 0.4 Female 1975-1984 1.3* 1984-1999 20.3 1999-2013 1.3* 1.3* 1.3* Prostate 1975-1988 2.6* 1988-1992 16.5* 1992-1995 211.5* 1995-2000 2.3 2000-2010 21.7* 2010-2013 210.7* 24.8* 28.6* Thyroid Male 1975-1980 24.7 1980-1997 1.9* 1997-2013 5.4* 5.4* 5.4* Female 1975-1977 6.5 1977-1980 25.2 1980-1993 2.3* 1993-1999 4.5* 1999-2009 7.1* 2009-2013 1.5 4.6* 1.5 Uterine corpus 1975-1979 26.0* 1979-1988 21.7* 1988-1997 0.7* 1997-2006 20.4* 2006-2009 3.7* 2009-2013 0.0 1.1 0.0 APC indicates annual percent change based on incidence (delay adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, aver- age annual percent change. *The APC or AAPC is significantly different from zero (P <.05). Note: Trends analyzed by the Joinpoint Regression Program, version 4.3.0.0, allowing up to 5 joinpoints. Trends are based on Surveillance, Epidemiology, and End Results (SEER) 9 areas. The overall incidence rate in women has remained gen- among adults aged 50 years and older has tripled, from 21% erally stable since 1987 because declines in lung and colo- in 2000 to 60% in 2015. In contrast to the rapid declines in rectal cancers are being offset by increasing or stable rates colorectal cancer incidence among screening aged adults, rates for breast, uterine corpus, and thyroid cancers and for increased by about 2% per year from 1993 to 2013 in individ- melanoma (Table 4). The slight increase in breast cancer uals aged younger than 50 years. incidence from 2004 to 2013 is driven wholly by nonwhite Incidence rates continue to increase rapidly for liver women; rates increased by about 2% per year among wom- cancer, by about 3% per year in women and 4% per year in en other than white or black and by 0.5% per year among men, although rates have begun to decline in adults aged black women, while remaining stable among white younger than 50 years. Similarly, the long-term, rapid women. rise in melanoma incidence appears to be slowing, partic- Lung cancer incidence rates continue to decline about ularly among younger age groups. Incidence rates for thy- twice as fast in men as in women (Table 4). Sex differences in roid cancer also appear to have begun stabilizing in recent lung cancer trends reflect historical differences in tobacco use. years after changes in clinical practice guidelines were ini- Women took up smoking in large numbers later and at older tiated in 2009, including moreconservativeindications ages than men, but were also slower to quit, including recent for biopsy, following increased awareness of the 27,28 33 upturns in smoking prevalence in some birth cohorts. In “epidemic in diagnosis.” In an effort to further reduce contrast, incidence patterns for colorectal cancer are very sim- overdiagnosis and overtreatment, an international panel ilar in men and women, with rates declining by 3% per year of experts convened by the NCI recently proposed down- from 2004 through 2013 (Table 4). While declines in colo- grading the terminology for a common subtype of thyroid rectal cancer incidence rates prior to 2000 are attributed cancer from encapsulated follicular variant of papillary equally to changes in risk factors and the introduction of thyroid carcinoma to noninvasive follicular thyroid neo- 29 34 screening, recent rapid declines are thought to primarily plasm with papillary-like nuclear features. These indo- reflect the increased uptake of colonoscopy and the removal lent tumors, which represent approximately 20% of 30,31 of precancerous adenomatous polyps. Colonoscopy use thyroid cancer diagnoses in the United States, have a 14 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 4. Stage Distribution by Race, United States, 2006 to 2012. Stage categories do not sum to 100% because sufficient information is not available to stage all cases. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 15 Cancer Statistics, 2017 FIGURE 5. Five-Year Relative Survival Rates by Stage at Diagnosis and Race, United States, 2006 to 2012. *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% in all races, 96% in whites, and 90% in blacks. 16 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 FIGURE 6. Total Number Of Cancer Deaths Averted From 1991 to 2014inMen andFrom1992to2014inWomen,UnitedStates. 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. recurrence rate of <1% at 15 years when removed with normal life expectancy, particularly those diagnosed before limited surgery (ie, thyroid lobectomy). age 65 years, based on a recent review of clinical trial data. Although historical groupings of lymphoid malig- Trends in Cancer Survival nancies are still used to track progress, they do not reflect Over the past 3 decades, the 5-year relative survival rate for the substantial biologic variation by subtype that is cap- all cancers combined has increased 20 percentage points tured by the more contemporary World Health Organiza- among whites and 24 percentage points among blacks. tion classification system. Improvements in survival for the most common cancers In contrast to the steady increase in survival for most can- have been similar by sex, but are much more pronounced cers, advances have been slow for lung and pancreatic cancers, among patients aged 50 to 64 years than among those aged for which the 5-year relative survival is currently 18% and 8%, older than 65 years, likely reflecting lower efficacy or use respectively (Fig. 5). These low rates are partly because more of new therapies in the elderly population. Progress has than one-half of cases are diagnosed at a distant stage (Fig. 4), been most rapid for hematopoietic and lymphoid malignan- for which the 5-year survival is 4% and 3%, respectively. cies due to improvements in treatment protocols, including There is potential for lung cancer to be diagnosed at an earlier the discovery of targeted therapies. For example, compar- stage through the use of screening with low-dose computed ing patients diagnosed in the mid-1970s with those diag- tomography, which has been shown to reduce lung cancer nosed during 2006 to 2012, the 5-year relative survival mortality by up to 20% among current and former smokers 38,39 rate has increased from 41% to 71% for acute lymphocytic with a smoking history of 30 or more pack-years. Howev- leukemia and from 22% to 66% for chronic myeloid leuke- er, only 2% to 4% of the 8.7 million Americans eligible for mia. Most patients with chronic myeloid leukemia who screening reported undergoing a computed tomography scan are treated with tyrosine kinase inhibitors experience near of the chest to check for lung cancer in 2010. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 17 Cancer Statistics, 2017 FIGURE 7. Trends in Death Rates by Sex Overall and for Select Cancers, United States, 1930 to 2014. Rates are age adjusted to the 2000 US standard population. Due to improvements in International Classification of Diseases (ICD) coding over time, numerator data for cancers of the lung and bronchus, colon and rectum, liver, and uterus differ from the contemporary time period. For example, rates for lung and bron- chus include pleura, trachea, mediastinum, and other respiratory organs. The decline in cancer mortality over the past 2 decades is Trends in Cancer Mortality the result of steady reductions in smoking and advances in The overall cancer death rate rose during most of the 20th early detection and treatment, reflected in considerable century, largely driven by rapid increases in lung cancer decreases for the 4 major cancers (lung, breast, prostate, and deaths among men as a consequence of the tobacco epi- colorectum) (Fig. 7). Specifically, the death rate dropped 38% demic, but has declined by about 1.5% per year since the from 1989 to 2014 for female breast cancer, 51% from 1993 early 1990s. From its peak of 215.1 (per 100,000 popula- to 2014 for prostate cancer, and 51% from 1976 to 2014 for tion) in 1991, the cancer death rate dropped 25% to 161.2 colorectal cancer. Lung cancer death rates declined 43% from in 2014. This decline, which is larger in men (31% since 1990 to 2014 among males and 17% from 2002 to 2014 1990) than in women (21% since 1991), translates into approximately 2,143,200 fewer cancer deaths (1,484,000 in among females due to reduced tobacco use because of men and 659,200 in women) than what would have increased awareness of the health hazards of smoking and occurred if peak rates had persisted (Fig. 6). the implementation of comprehensive tobacco control. 18 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 5. Trends in Death Rates for Selected Cancers by Sex, United States, 1975 to 2014 2005- 2010- TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2014 2014 YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC All sites Overall 1975-1984 0.5* 1984-1991 0.3* 1991-1994 20.5 1994-1998 21.3* 1998-2001 20.8 2001-2014 21.5* 21.5* 21.5* Male 1975-1979 1.0* 1979-1990 0.3* 1990-1993 20.5 1993-2001 21.5* 2001-2014 21.8* 21.8* 21.8* Female 1975-1990 0.6* 1990-1994 20.2 1994-2002 20.8* 2002-2014 21.4* 21.4* 21.4* Female breast 1975-1990 0.4* 1990-1995 21.8* 1995-1998 23.3* 1998-2014 21.8* 21.8* 21.8* Colorectum Male 1975-1978 0.8 1978-1984 20.3 1984-1990 21.3* 1990-2002 22.0* 2002-2005 23.9* 2005-2014 22.5* 22.5* 22.5* Female 1975-1984 21.0* 1984-2001 21.8* 2001-2014 22.8* 22.8* 22.8* Liver & intrahepatic bile duct Male 1975-1985 1.5* 1985-1996 3.8* 1996-1999 0.5 1999-2014 2.6* 2.6* 2.6* Female 1975-1978 21.5 1978-1988 1.4* 1988-1995 3.9* 1995-2000 0.4 2000-2008 1.5* 2008-2014 2.8* 2.4* 2.8* Lung & bronchus Male 1975-1978 2.4* 1978-1984 1.2* 1984-1991 0.3* 1991-2005 21.9* 2005-2012 23.0* 2012-2014 24.0* 23.2* 23.5* Female 1975-1982 6.0* 1982-1990 4.2* 1990-1995 1.7* 1995-2003 0.3* 2003-2007 20.8 2007-2014 22.0* 21.7* 22.0* Melanoma of skin Male 1975-1990 2.2* 1990-2002 0.0 2002-2009 0.9* 2009-2014 21.3* 20.3 21.3* Female 1975-1988 0.8* 1988-2014 20.6* 20.6* 20.6* Pancreas Male 1975-1986 20.8* 1986-2000 20.3* 2000-2014 0.3* 0.3* 0.3* Female 1975-1984 0.8* 1984-2002 0.1 2002-2008 0.6* 2008-2014 20.2 0.1 20.2 Prostate 1975-1987 0.9* 1987-1991 3.0* 1991-1994 20.5 1994-1999 24.1* 1999-2014 23.4* 23.4* 23.4* Uterine corpus 1975-1993 21.5* 1993-2008 0.2 2008-2014 2.1* 1.4* 2.1* APC indicates annual percent change based mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change. *The APC or AAPC is significantly different from zero (P <.05). Note: Trends analyzed by the Joinpoint Regression Program, version 4.3.1.0, allowing up to 5 joinpoints. Tobacco control efforts adopted in the wake of the first Sur- the leading cause of cancer death among women aged 40 to geon General’s report on smoking and health in 1964 have 59 years. Cervical cancer is the second leading cause of cancer death in women aged 20 to 39 years, underscoring the need to resulted in an estimated 8 million fewer premature smoking- 42,43 improve screening rates in this age group, as well as increase related deaths, one-third of which are due to cancer. acceptance of and access to human papillomavirus vaccination. Despite this progress, in much of the Southern United States, In 2014, only 40% of females aged 13 to 17 years had com- 40% of cancer deaths in men in 2014 were caused by pleted the 3-dose series, up slightly from 37% in 2013. smoking. In contrast to declining trends for the 4 major cancers, Cancer Disparities by Sex death rates rose from 2010 to 2014 by almost 3% per year for The lifetime probability of being diagnosed with invasive liver cancer and by about 2% per year for uterine cancer (Table 5). Pancreatic cancer death rates continued to increase slightly cancer is slightly higher for men (40.8%) than for women (by 0.3% per year) in men but have leveled off in women. (37.5%) (Table 8). Reasons for the increased susceptibility in men are not well understood, but to some extent reflect differ- Recorded Number of Deaths in 2014 ences in environmental exposures, endogenous hormones, A total of 2,626,418 deaths were recorded in the United and probably complex interactions between these influences. States in 2014, 23% of which were from cancer (Table 6). Adult height, which is determined by genetics and childhood Cancer is the second leading cause of death following heart nutrition, is positively associated with cancer incidence and disease. However, it is the leading cause of death in 22 death in both men and women, and has been estimated to 45 46,47 50 states, and in Hispanic and Asian Americans. Cancer account for one-third of the gender disparity in cancer risk. is also the leading cause of death among women aged 40 to Table 9 shows sex differences in cancer-specific incidence and mortality. Overall, incidence rates are about 20% 79 years and among men aged 45 to 79 years when data are analyzed by 5-year age group. higher in men while mortality rates are about 40% higher. Table 7 presents the number of deaths in 2014 for the 5 The larger disparity for mortality reflects differences in the leading cancer types by age and sex. The leading causes of composition and distribution of cancers. For example, rates cancer death are brain cancer, leukemia, and female breast of liver cancer, which is highly fatal, are 3 times higher in cancer before age 40 years and lung cancer in those aged 40 men than in women. The largest sex disparities are for can- years or older. In 2013, lung cancer surpassed breast cancer as cers of the esophagus, larynx, and bladder, for which _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 19 Cancer Statistics, 2017 TABLE 6. Ten Leading Causes of Death by Age and Sex, United States, 2014 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 1,328,241 1,298,177 12,128 6,538 65,486 30,221 227,562 147,196 534,113 411,138 475,956 692,702 1 Heart Heart Accidents Accidents Accidents Accidents Cancer Cancer Cancer Cancer Heart Heart diseases diseases (unintentional (unintentional (unintentional (unintentional 52,478 49,683 167,075 136,649 diseases diseases 325,077 289,271 injuries) injuries) injuries) injuries) 137,360 187,680 4,409 2,023 24,467 8,850 2 Cancer Cancer Intentional Cancer Intentional Cancer Heart Heart Heart Heart Cancer Cancer 311,296 280,403 self-harm 757 self-harm 4,440 diseases diseases diseases diseases 86,662 88,842 (suicide) (suicide) 52,140 22,465 129,926 76,242 1,681 10,353 3 Accidents Chronic Assault Intentional Assault Intentional Accidents Accidents Chronic Chronic Chronic Alzheimer (unintentional lower (homicide) self-harm (homicide) self-harm (unintentional (unintentional lower lower lower disease injuries) respiratory 1,563 (suicide) 7,040 (suicide) injuries) injuries) respiratory respiratory respiratory 56,533 85,448 diseases 581 2,649 26,259 12,789 diseases diseases diseases 77,645 34,508 33,872 28,801 4 Chronic Cerebro- Cancer Assault Heart Heart Intentional Chronic Cerebro- Cerebro- Cerebro- Cerebro- lower vascular 1,028 (homicide) diseases diseases self-harm lower vascular vascular vascular vascular respiratory disease 477 5,077 2,459 (suicide) respiratory disease disease disease disease diseases 77,632 12,196 diseases 21,645 19,932 26,324 52,068 69,456 5,960 5 Cerebro- Alzheimer Congenital Congenital Cancer Assault Chronic liver Chronic liver Diabetes Diabetes Alzheimer Chronic vascular disease anomalies anomalies 4,020 (homicide) disease & disease & mellitus mellitus disease lower disease 65,179 498 428 1,287 cirrhosis cirrhosis 20,335 14,965 22,353 respiratory 55,471 11,443 5,646 diseases 37,397 6 Diabetes Accidents Heart Heart Chronic liver Pregnancy, Diabetes Cerebro- Accidents Accidents Influenza & Influenza & mellitus (unintentional diseases diseases disease & childbirth mellitus vascular (unintentional (unintentional pneumonia pneumonia 41,111 injuries) 373 266 cirrhosis & puerperium 8,118 disease injuries) injuries) 13,482 17,954 50,605 971 748 4,959 16,588 9,714 7 Intentional Diabetes Chronic Influenza & Diabetes Chronic liver Cerebro- Diabetes Chronic liver Alzheimer Accidents Accidents self-harm mellitus lower pneumonia mellitus disease & vascular mellitus disease & disease (unintentional (unintentional (suicide) 35,377 respiratory 126 970 cirrhosis disease 4,947 cirrhosis 8,462 injuries) injuries) 33,113 diseases 628 6,585 10,620 13,047 16,726 8 Alzheimer Influenza & Influenza & Chronic HIV Diabetes Chronic Intentional Nephritis, Nephritis, Nephritis, Diabetes disease pneumonia pneumonia lower disease mellitus lower self-harm nephrotic nephrotic nephrotic mellitus 28,362 28,641 145 respiratory 784 624 respiratory (suicide) syndrome & syndrome & syndrome & 14,817 diseases diseases 4,389 nephrosis nephrosis nephrosis 89 5,550 9,698 8,352 11,665 9 Influenza & Nephritis, Cerebro- Cerebro- Cerebro- Cerebro- Influenza & Septicemia Influenza & Septicemia Diabetes Nephritis, pneumonia nephrotic vascular vascular vascular vascular pneumonia 2,664 pneumonia 7,854 mellitus nephrotic 26,586 syndrome & disease disease disease disease 3,236 9,030 11,644 syndrome & nephrosis 96 83 766 548 nephrosis 23,710 13,234 10 Chronic liver Septicemia Septicemia Septicemia Influenza & Influenza & HIV Influenza & Septicemia Influenza & Parkinson Hypertension disease & 20,607 77 78 pneumonia pneumonia disease pneumonia 8,227 pneumonia disease & hypertensive cirrhosis 602 511 2,943 2,592 7,359 10,059 renal disease* 24,584 11,724 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 Final Mortality Data, 2014, National Center for Health Statistics, Centers for Disease Control and Prevention, 2016. 20 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 7. Five Leading Types of Cancer Death by Age and Sex, United States, 2014 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 311,296 1,050 4,020 52,478 167,075 86,662 Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus 84,861 314 529 13,078 51,714 19,821 Prostate Leukemia Leukemia Colorectum Colorectum Prostate 28,344 272 507 5,947 13,317 14,529 Colorectum Bones & joints Colorectum Liver* Prostate Colorectum 27,134 100 446 4,461 12,489 7,422 Pancreas Soft tissue Non-Hodgkin Pancreas Pancreas Urinary bladder (including heart) lymphoma 20,755 3,830 11,997 5,269 78 246 Liver* Non-Hodgkin Lung & bronchus Esophagus Liver* Pancreas lymphoma 16,623 236 2,581 9,503 4,815 FEMALE ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES 280,403 787 4,440 49,683 136,649 88,842 Lung & bronchus Brain & ONS Breast Lung & bronchus Lung & bronchus Lung & bronchus 70,667 245 1,051 10,812 40,256 19,415 Breast Leukemia Uterine cervix Breast Breast Breast 41,213 184 446 10,708 18,461 10,991 Colorectum Bone & joints Colorectum Colorectum Colorectum Colorectum 24,517 81 376 4,214 10,060 9,864 Pancreas Soft tissue Leukemia Ovary Pancreas Pancreas (including heart) 19,664 363 2,869 10,019 6,914 Ovary Non-Hodgkin Brain & ONS Pancreas Ovary Leukemia lymphoma 14,195 307 2,660 7,419 4,190 ONS indicates other nervous system. *Includes intrahepatic bile duct. Note: Ranking order excludes category titles that begin with the word “Other.” 54,55 incidence and death rates are about 4-fold higher in men. observed in Europe and Australia, partly reflect more unfa- However, incidence rates are higher in women for cancers vorable prognostic indicators (eg, thick tumors, ulceration, and of the anus, gallbladder, and thyroid. Notably, thyroid can- trunk loci) and an older age at diagnosis in men compared with women. However, sex is a predictor of survival indepen- cer incidence rates are 3 times higher in women than in dent of clinicopathologic factors for reasons that remain men (21 vs 7 per 100,000 population), despite equivalent unclear. While hormonal influences are thought to play a death rates (0.5 per 100,000 population). This pattern is role, survival is higher and disease progression less likely in indicative of a preponderance of nonfatal thyroid tumors in women, regardless of menopausal status, even for patients with women, which is consistent with more prominent and pro- advanced disease. A recent study found a survival advantage longed overdiagnosis in women than in men. However, for women when melanoma arose de novo (70%–80% of consistency in the gender disparity for thyroid cancer glob- tumors), but no difference in survival for nevi-associated ally and across racial/ethnic groups in the United States tumors, which are associated with better outcomes. suggests a higher underlying disease burden in women, despite unknown etiologic mechanisms. Melanoma incidence rates are about 60% higher in men Cancer Disparities by Race/Ethnicity and Socioeconomic Status than in women, while death rates are more than double. The larger disparity for mortality reflects an earlier stage at diagno- Cancer incidence and death rates vary considerably between sis and better stage-specific survival in women than in men. racial and ethnic groups, with rates generally highest among Sex disparities in melanoma survival, which have also been blacks and lowest among Asian/Pacific Islanders (APIs) _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 21 Cancer Statistics, 2017 TABLE 8. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2011 to 2013* BIRTH TO 49 50 TO 59 60 TO 69 70 BIRTH TO DEATH All sites† Male 3.4 (1 in 30) 6.3 (1 in 16) 14.0 (1 in 7) 33.3 (1 in 3) 40.8 (1 in 2) Female 5.4 (1 in 18) 6.0 (1 in 17) 10.0 (1 in 10) 25.9 (1 in 4) 37.5 (1 in 3) Breast Female 1.9 (1 in 52) 2.3 (1 in 44) 3.5 (1 in 29) 6.8 (1 in 15) 12.4 (1 in 8) Colorectum Male 0.3 (1 in 294) 0.7 (1 in 149) 1.2 (1 in 84) 3.5 (1 in 28) 4.6 (1 in 22) Female 0.3 (1 in 318) 0.5 (1 in 198) 0.8 (1 in 120) 3.2 (1 in 31) 4.2 (1 in 24) Kidney & renal pelvis Male 0.2 (1 in 457) 0.3 (1 in 289) 0.6 (1 in 157) 1.3 (1 in 75) 2.1 (1 in 48) Female 0.1 (1 in 729) 0.2 (1 in 582) 0.3 (1 in 315) 0.7 (1 in 135) 1.2 (1 in 83) Leukemia Male 0.2 (1 in 410) 0.2 (1 in 574) 0.6 (1 in 259) 1.4 (1 in 72) 1.8 (1 in 57) Female 0.2 (1 in 509) 0.1 (1 in 901) 0.4 (1 in 447) 0.9 (1 in 113) 1.2 (1 in 81) Lung & bronchus Male 0.2 (1 in 643) 0.7 (1 in 149) 1.9 (1 in 53) 6.2 (1 in 16) 7.0 (1 in 14) Female 0.2 (1 in 598) 0.6 (1 in 178) 1.5 (1 in 68) 4.8 (1 in 21) 6.0 (1 in 17) Melanoma of the skin‡ Male 0.5 (1 in 220) 0.5 (1 in 198) 0.9 (1 in 111) 2.5 (1 in 40) 3.5 (1 in 28) Female 0.6 (1 in 155) 0.4 (1 in 273) 0.5 (1 in 212) 1.0 (1 in 97) 2.3 (1 in 44) Non-Hodgkin lymphoma Male 0.3 (1 in 385) 0.3 (1 in 353) 0.4 (1 in 175) 1.8 (1 in 55) 2.4 (1 in 42) Female 0.2 (1 in 547) 0.2 (1 in 483) 0.2 (1 in 245) 1.3 (1 in 74) 1.9 (1 in 54) Prostate Male 0.3 (1 in 354) 1.9 (1 in 52) 5.4 (1 in 19) 9.1 (1 in 11) 12.9 (1 in 8) Thyroid Male 0.2 (1 in 533) 0.1 (1 in 799) 0.2 (1 in 620) 0.2 (1 in 429) 0.6 (1 in 163) Female 0.8 (1 in 127) 0.4 (1 in 275) 0.3 (1 in 292) 0.4 (1 in 258) 1.8 (1 in 57) Uterine cervix Female 0.3 (1 in 371) 0.1 (1 in 868) 0.1 (1 in 899) 0.2 (1 in 594) 0.6 (1 in 161) Uterine corpus Female 0.3 (1 in 352) 0.6 (1 in 169) 1.0 (1 in 105) 1.3 (1 in 76) 2.8 (1 in 36) *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. ‡Probabilities for non-Hispanic whites only. (Tables 10 and 11). Importantly, there are considerable dif- Education Reconciliation Act of 2010, together referred to as ferences within all of the broadly defined population groups the Affordable Care Act or ACA, 11% of blacks and 7% of described here, despite scant data. For example, while overall non-Hispanic whites were uninsured in 2015, down from 64,65 cancer incidence rates are 40% lower for API men than non- 21% and 12%, respectively, in 2010. Progress for His- Hispanic white men based on aggregated data, rates in panics is similar, with the uninsured rate dropping from 31% Hawaiians and Samoans are similar to those in non- in 2010 to 16% in 2015. If maintained, these shifts should Hispanic whites. The same is true for Puerto Ricans with- help to expedite progress in reducing socioeconomic dispar- in the lower risk Hispanic population. ities in cancer, as well as other health conditions. In 2014, the cancer death rate was 15% higher in blacks Cancer incidence and death rates among APIs, American than in whites. The racial disparity has been most striking for Indians/Alaska Natives (AI/ANs), and Hispanics are lower men, with the excess risk growing from 20% in 1970 to 47% than among non-Hispanic whites for the 4 most common in 1990. However, that gap had narrowed to 21% in 2014, cancers, but higher for cancers associated with infectious due in part to more rapid declines in smoking-related cancers agents (eg, those of the stomach and liver). For example, in blacks driven by sharper reductions in smoking initiation in liver cancer incidence rates in these populations are double 59,60 the 1970s and early 1980s. The racial disparity has those in non-Hispanic whites, reflecting a higher preva- declined similarly in women, from a peak of 20% in 1998 to lence of risk factors such as chronic infection with hepatitis 13% in 2014. Other than behavioral differences, racial dispar- B and/or hepatitis C viruses, obesity, diabetes, and binge ities are caused by unequal access to and use of high-quality drinking. AI/ANs have the highest rates of kidney cancer, health care, including cancer prevention and early detection, although there is striking geographic variation, most likely 61,62 timely diagnosis, and optimal treatment. Blacks are more reflecting differences in the prevalence of renal cancer risk likely than whites to be diagnosed with cancer at an advanced factors such as obesity, smoking, and hypertension. stage (Fig. 4), but also have lower stage-specific survival for Regional Variations in Cancer Rates most cancer types (Fig. 5). Both stage at diagnosis and survival are closely aligned with health insurance coverage, which is Tables 12 and 13 depict average annual cancer incidence and lower among minorities than non-Hispanic whites. However, death rates for selected cancers by state. State variation in can- this gap is also narrowing rapidly. As a result of the Patient cer occurrence reflects differences in medical practice and the Protection and Affordable Care Act and the Health Care and prevalence of risk factors, such as smoking and obesity. 22 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 9. Sex Differences in Cancer Incidence and Mortality Rates, 2009 to 2013 INCIDENCE MORTALITY RATE RATE RATIO (M/F) (95% CI) RATE RATE RATIO (M/F) (95% CI) All sites Female 418.5 143.4 Male 512.1 1.2 (1.22-1.23) 204.0 1.4 (1.42-1.43) Oral cavity and pharynx Female 6.3 1.3 Male 17.2 2.7 (2.69-2.75) 3.8 2.8 (2.77-2.89) Esophagus Female 1.8 1.5 Male 8.1 4.5 (4.44-4.60) 7.4 4.8 (4.75-4.93) Stomach Female 4.6 2.4 Male 9.2 2.0 (1.97-2.02) 4.5 1.9 (1.85-1.91) Colon and rectum Female 35.6 12.7 Male 46.9 1.3 (1.31-1.32) 18.1 1.4 (1.42-1.44) Colon excluding rectum Female 26.6 Male 32.4 1.2 (1.21-1.22) Rectum and rectosigmoid junction Female 8.9 Male 14.5 1.6 (1.61-1.64) Anus, anal canal, and anorectum Female 2.1 0.3 Male 1.5 0.7 (0.68-0.72) 0.2 0.8 (0.77-0.87) Liver and intrahepatic bile duct Female 4.0 3.6 Male 11.8 2.9 (2.89-2.96) 9.1 2.5 (2.45-2.52) Gallbladder Female 1.4 0.7 Male 0.8 0.6 (0.59-0.62) 0.5 0.7 (0.62-0.68) Pancreas Female 10.9 9.5 Male 14.1 1.3 (1.28-1.30) 12.5 1.3 (1.30-1.33) Larynx Female 1.4 0.4 Male 6.2 4.5 (4.39-4.57) 1.9 4.8 (4.62-4.97) Lung and bronchus Female 53.5 37.0 Male 75.0 1.4 (1.40-1.41) 57.8 1.6 (1.55-1.57) Melanoma of the skin Female 16.1 1.7 Male 25.9 1.6 (1.60-1.62) 4.1 2.4 (2.35-2.45) Urinary bladder Female 8.9 2.2 Male 36.2 4.1 (4.02-4.08) 7.7 3.5 (3.47-3.59) Kidney and renal pelvis Female 11.3 2.5 Male 21.7 1.9 (1.90-1.93) 5.7 2.3 (2.25-2.32) Brain and ONS Female 5.6 3.5 Male 7.8 1.4 (1.37-1.40) 5.3 1.5 (1.48-1.52) Thyroid Female 20.8 0.5 Male 7.0 0.3 (0.34-0.34) 0.5 1.0 (0.99-1.08) Hodgkin lymphoma Female 2.4 0.3 Male 3.1 1.3 (1.27-1.32) 0.5 1.6 (1.53-1.70) Non-Hodgkin lymphoma Female 15.9 4.7 Male 23.0 1.4 (1.44-1.46) 7.7 1.7 (1.63-1.67) Myeloma Female 5.2 2.7 Male 8.0 1.5 (1.51-1.54) 4.2 1.6 (1.54-1.59) Leukemia Female 10.6 5.2 Male 17.3 1.6 (1.62-1.65) 9.3 1.8 (1.78-1.82) Acute lymphocytic leukemia Female 1.4 0.4 Male 1.8 1.3 (1.27-1.33) 0.5 1.4 (1.36-1.50) Chronic lymphocytic leukemia Female 3.1 0.9 Male 6.1 1.9 (1.90-1.95) 2.0 2.2 (2.15-2.27) Acute myeloid leukemia Female 3.4 2.2 Male 5.0 1.5 (1.44-1.49) 3.7 1.7 (1.65-1.72) Chronic myeloid leukemia Female 1.4 0.2 Male 2.2 1.6 (1.57-1.65) 0.4 1.7 (1.64-1.83) 95% CI indicates 95% confidence interval; F, female, M, male, ONS, other nervous system. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 23 Cancer Statistics, 2017 TABLE 10. Incidence Rates by Site, Race, and Ethnicity, United States, 2009 to 2013 ALL RACES NON-HISPANIC NON-HISPANIC ASIAN/PACIFIC AMERICAN INDIAN/ COMBINED WHITE BLACK ISLANDER ALASKA NATIVE* HISPANIC All sites Male 512.1 519.3 577.3 310.2 426.7 398.1 Female 418.5 436.0 408.5 287.1 387.3 329.6 Breast (female) 123.3 128.3 125.1 89.3 98.1 91.7 Colorectum Male 46.9 46.1 58.3 37.8 51.4 42.8 Female 35.6 35.2 42.7 27.8 41.2 29.8 Kidney & renal pelvis Male 21.7 21.9 24.4 10.8 29.9 20.7 Female 11.3 11.3 13.0 4.8 17.6 11.9 Liver & intrahepatic bile duct Male 11.8 9.7 16.9 20.4 18.5 19.4 Female 4.0 3.3 5.0 7.6 8.9 7.5 Lung & bronchus Male 75.0 77.7 90.8 46.6 71.3 42.2 Female 53.5 58.2 51.0 28.3 56.2 25.6 Prostate 123.2 114.8 198.4 63.5 85.1 104.9 Stomach Male 9.2 7.8 14.7 14.4 11.2 13.1 Female 4.6 3.5 7.9 8.4 6.5 7.8 Uterine cervix 7.6 7.0 9.8 6.1 9.7 9.9 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite and nonblack race categories are not mutually exclusive of Hispanic origin. *Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties and exclude data from Kansas. Geographic disparities often reflect the national distribution smoking prevalence among states. For example, lung cancer of poverty and access to health care, which have increased incidence rates in Kentucky (118 per 100,000 population in over time and may continue to exacerbate because of differen- men and 80 per 100,000 population in women), which has 68-70 tial state expansion of Medicaid facilitated by the ACA. historically had the highest smoking prevalence, are about 3.5 The largest geographic variation by far is for lung cancer, times higher than those in Utah (34 per 100,000 population reflecting the large historical and continuing differences in in men and 24 per 100,000 population in women), which TABLE 11. Death Rates by Site, Race, and Ethnicity, United States, 2010 to 2014 ALL RACES NON-HISPANIC NON-HISPANIC ASIAN/PACIFIC AMERICAN INDIAN/ COMBINED WHITE BLACK ISLANDER ALASKA NATIVE* HISPANIC All sites Male 200.4 204.0 253.4 122.7 183.6 142.5 Female 141.5 145.5 165.9 88.8 129.1 97.7 Breast (female) 21.2 21.1 30.0 11.3 14.1 14.4 Colorectum Male 17.7 17.3 25.9 12.4 19.5 15.0 Female 12.4 12.3 16.9 8.8 14.0 9.2 Kidney & renal pelvis Male 5.6 5.8 5.7 2.7 8.9 4.9 Female 2.4 2.5 2.5 1.1 4.2 2.3 Liver & intrahepatic bile duct Male 9.2 8.0 13.3 14.3 14.9 13.1 Female 3.7 3.3 4.6 6.1 6.8 5.8 Lung & bronchus Male 55.9 58.3 69.8 31.7 46.2 27.3 Female 36.3 39.8 35.5 18.0 30.8 13.4 Prostate 20.0 18.7 42.8 8.8 19.4 16.5 Stomach Male 4.4 3.4 8.7 7.1 7.5 6.9 Female 2.3 1.7 4.2 4.3 3.8 4.1 Uterine cervix 2.3 2.1 3.9 1.7 2.8 2.6 Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite and nonblack race categories are not mutually exclusive of Hispanic origin. *Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties. 24 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 TABLE 12. Incidence Rates for Selected Cancers by State, United States, 2009 to 2013 LUNG & NON-HODGKIN URINARY ALL CANCERS BREAST COLORECTUM BRONCHUS LYMPHOMA PROSTATE BLADDER STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama 548.1 395.6 119.3 52.8 37.3 95.3 53.4 19.8 13.9 139.1 34.0 7.7 Alaska 459.7 411.9 123.5 49.2 40.4 71.6 55.6 21.4 14.3 100.3 34.7 10.8 Arizona 418.1 375.1 111.0 39.6 30.5 58.0 46.4 18.6 13.5 84.1 32.1 8.0 Arkansas 531.2 390.7 111.5 50.1 37.0 99.6 59.4 20.8 14.8 128.4 35.7 7.2 California 473.0 390.9 121.4 43.8 33.7 53.6 41.2 22.8 15.3 118.7 32.0 7.6 Colorado 458.0 393.8 124.8 38.7 31.0 49.8 42.4 21.5 14.9 122.1 32.7 8.3 Connecticut 541.8 459.1 137.8 46.5 35.1 70.9 57.7 25.3 17.7 130.3 47.4 12.5 Delaware 581.7 451.2 130.0 44.3 33.3 83.4 62.3 25.0 17.3 151.1 41.8 11.1 Dist. of Columbia 543.1 444.8 143.0 47.9 41.1 72.0 49.7 22.1 13.9 169.1 24.4 9.3 Florida 490.1 398.5 115.3 43.4 33.1 73.6 54.4 21.3 14.8 111.2 34.1 8.3 Georgia 542.5 409.6 123.4 48.8 36.2 86.7 53.2 21.7 14.6 139.8 33.6 7.7 Hawaii 454.0 408.7 134.4 53.1 36.4 58.0 38.7 21.8 14.9 96.5 23.3 6.1 Idaho 496.0 408.7 119.4 42.2 32.2 56.4 46.9 20.7 16.1 131.8 39.0 8.7 Illinois 531.6 437.6 128.5 53.4 38.9 81.0 58.5 23.5 16.2 128.8 38.2 9.5 Indiana 503.2 425.9 120.0 49.5 39.4 91.1 61.7 23.3 16.4 102.0 36.4 8.9 Iowa 536.5 438.8 122.6 52.2 39.7 80.2 52.7 26.7 18.5 119.2 39.7 8.8 Kansas 529.0 426.8 122.0 48.8 36.0 73.6 53.5 23.6 16.6 133.5 38.8 9.2 Kentucky 593.8 470.2 122.0 59.6 43.7 118.3 80.2 25.4 17.1 118.1 40.0 9.7 Louisiana 585.0 420.0 123.4 57.3 41.8 92.1 55.5 24.0 16.6 154.4 34.2 8.0 Maine 529.7 450.8 124.5 44.8 35.6 86.0 66.1 24.0 17.6 106.5 46.6 12.5 Maryland 506.0 421.0 130.2 42.5 33.8 67.9 52.9 21.2 15.1 135.0 36.0 9.2 Massachusetts 522.5 454.4 136.0 43.8 35.0 72.7 61.9 23.8 16.7 124.9 41.5 11.4 Michigan 530.2 428.3 123.0 45.2 34.9 78.9 59.1 24.5 17.2 137.0 39.5 10.2 Minnesota* 518.7 431.8 130.1 44.6 35.3 62.9 50.1 27.2 18.5 130.3 38.3 9.5 Mississippi 567.0 405.4 116.1 58.9 42.6 103.1 56.5 20.8 14.4 142.7 30.9 7.3 Missouri 504.9 427.6 124.8 50.5 37.3 90.8 64.7 22.3 15.3 106.3 33.6 8.5 Montana 500.4 425.5 122.7 45.7 34.5 62.6 54.9 23.3 15.8 127.3 37.0 10.5 Nebraska 493.8 414.0 120.7 49.5 38.9 70.4 49.9 24.0 17.8 119.2 34.8 8.4 Nevada* † 496.9 397.1 113.9 50.7 35.1 67.9 58.6 20.5 14.2 135.4 38.0 11.1 New Hampshire 544.2 460.9 138.1 41.4 34.7 73.5 64.4 26.2 17.9 133.5 50.1 12.8 New Jersey 555.2 452.9 131.4 49.5 38.8 67.7 53.1 25.4 17.8 148.7 41.6 11.0 New Mexico* ‡ 424.2 365.8 112.9 41.1 30.6 49.6 36.8 17.8 13.8 106.1 25.5 6.0 New York 557.3 450.6 128.4 47.9 36.6 72.0 54.7 26.3 18.0 145.2 41.4 10.6 North Carolina 534.8 419.5 128.4 44.8 33.4 90.5 55.9 21.7 15.0 130.2 36.1 8.8 North Dakota 515.5 415.5 124.6 54.5 40.2 69.8 47.5 22.7 18.3 130.9 38.5 8.7 Ohio 513.8 423.8 122.0 48.9 36.2 85.6 59.7 22.9 15.7 119.7 38.8 9.3 Oklahoma 511.4 409.8 117.7 49.9 38.1 87.7 58.5 21.7 14.9 120.6 33.8 8.1 Oregon 478.5 424.0 128.1 42.2 32.5 65.3 54.9 22.5 15.4 110.6 37.5 9.2 Pennsylvania 550.8 460.4 129.0 51.3 38.6 80.0 56.5 26.1 17.8 125.4 44.1 11.0 Rhode Island 528.3 459.2 130.4 42.7 35.3 78.3 64.0 25.0 17.8 117.4 46.3 13.3 South Carolina 530.6 409.6 125.6 45.5 34.4 87.8 54.3 20.4 13.4 129.0 34.2 8.7 South Dakota 487.0 428.6 130.6 50.9 39.8 67.4 50.9 23.6 16.3 119.6 33.8 9.4 Tennessee 540.5 420.6 121.7 47.6 36.6 97.6 61.2 22.0 15.1 126.3 35.1 8.1 Texas 474.1 381.1 112.3 47.0 32.8 70.1 45.5 21.5 15.2 106.4 27.9 6.5 Utah 468.6 369.8 112.7 36.1 28.2 34.4 24.2 23.4 15.1 144.4 30.2 5.8 Vermont 505.6 439.3 128.3 41.2 33.4 74.2 61.2 25.4 18.2 109.8 40.0 9.8 Virginia 473.3 399.3 125.5 42.2 33.5 75.2 52.2 21.1 14.4 116.5 31.7 8.3 Washington 513.3 442.2 135.6 41.7 34.0 67.1 54.7 25.6 17.0 125.7 37.8 9.5 West Virginia 533.4 440.0 114.4 54.3 40.8 101.0 65.9 22.1 16.1 106.6 39.9 10.9 Wisconsin 517.9 433.5 127.2 44.6 34.3 70.3 54.5 25.0 17.3 122.0 40.0 10.0 Wyoming 458.1 380.7 109.6 44.0 31.6 52.6 43.1 18.4 14.4 116.0 36.7 10.5 United States 512.1 418.5 123.3 46.9 35.6 75.0 53.5 23.0 15.9 123.2 36.2 8.9 Rates are per 100,000 and age adjusted to the 2000 US standard population. *This state’s data are not included in the US combined rates because they did not meet high-quality standards for one or more years during 2009 to 2013 according to the North American Association of Central Cancer Registries (NAACCR). †Rates are based on incidence data for 2009 to 2010. ‡Rates are based on incidence data for 2009 to 2012. _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 25 Cancer Statistics, 2017 TABLE 13. Death Rates for Selected Cancers by State, United States, 2010 to 2014 LUNG & NON-HODGKIN ALL SITES BREAST COLORECTUM BRONCHUS LYMPHOMA PANCREAS PROSTATE STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE Alabama 235.7 148.2 22.0 20.6 13.3 77.1 39.5 7.5 4.8 13.2 9.7 23.8 Alaska 203.5 146.7 20.4 18.5 13.5 54.7 41.7 7.1 3.7 11.9 9.9 20.5 Arizona 174.2 126.2 19.5 15.6 11.2 42.9 30.4 6.8 4.3 11.5 9.0 18.2 Arkansas 237.0 153.8 22.1 21.8 14.6 81.0 43.9 7.6 5.2 12.7 9.4 20.8 California 176.7 130.4 20.4 15.9 11.5 39.8 28.5 7.1 4.4 11.8 9.2 20.0 Colorado 166.4 125.1 19.2 14.5 11.1 36.4 28.1 6.6 4.0 10.9 8.6 21.7 Connecticut 182.5 133.5 19.1 13.8 10.4 46.3 34.4 7.1 4.3 12.5 9.8 18.6 Delaware 208.3 150.5 21.9 17.1 10.8 62.3 42.6 7.8 4.6 14.1 9.6 19.2 Dist. of Columbia 210.0 160.0 29.3 18.6 15.5 49.6 33.5 6.1 3.3 15.5 12.1 33.6 Florida 189.4 132.7 20.2 16.3 11.3 54.1 35.5 7.2 4.2 12.0 8.9 17.6 Georgia 212.3 140.5 22.5 19.4 12.6 64.1 35.6 7.1 4.1 12.3 9.1 23.4 Hawaii 167.3 114.9 15.0 17.5 10.7 40.8 25.1 6.7 4.0 12.4 9.8 13.7 Idaho 185.4 132.6 20.4 15.9 11.1 43.7 31.4 7.9 5.1 12.8 9.7 23.3 Illinois 208.3 150.3 22.5 19.1 13.2 59.0 39.4 7.8 4.6 12.8 9.8 20.9 Indiana 224.8 153.7 21.8 19.3 13.4 71.2 42.9 8.6 5.1 13.1 9.6 21.0 Iowa 206.5 142.2 19.4 19.2 13.9 59.1 36.0 8.7 5.1 12.7 9.3 19.8 Kansas 200.9 143.0 20.1 18.4 12.6 57.3 38.4 7.7 4.9 13.0 9.9 19.1 Kentucky 249.4 167.1 21.9 20.9 14.2 89.6 54.7 9.0 5.1 13.3 9.6 19.8 Louisiana 237.7 157.1 24.2 21.7 14.9 72.9 41.5 8.6 5.0 15.1 11.3 22.4 Maine 215.7 150.4 18.0 16.5 11.8 64.4 43.3 7.6 5.3 11.8 10.6 19.8 Maryland 198.1 143.3 22.8 17.6 12.1 52.2 36.6 7.1 4.2 13.9 9.9 20.3 Massachusetts 196.6 140.2 18.8 15.9 11.3 51.8 38.0 7.1 4.4 12.6 9.9 19.4 Michigan 209.2 151.6 22.4 17.7 12.7 60.8 41.5 8.8 5.2 13.3 10.1 19.5 Minnesota 188.7 135.8 18.8 15.2 11.5 47.6 33.9 8.6 5.2 12.4 8.8 20.6 Mississippi 252.2 158.5 23.9 23.7 16.1 82.7 41.0 7.2 4.2 14.3 11.0 26.2 Missouri 216.6 154.5 22.5 19.1 13.2 69.3 44.7 7.5 4.7 13.0 9.9 18.2 Montana 182.5 138.2 20.2 16.2 11.1 46.2 37.2 7.5 4.1 10.5 9.0 21.4 Nebraska 197.1 138.3 20.1 18.5 14.2 54.3 34.6 7.2 5.1 12.5 8.9 20.8 Nevada 194.1 145.4 22.7 20.2 13.8 52.8 41.4 6.9 4.0 12.2 9.0 21.1 New Hampshire 197.7 143.4 20.3 14.0 13.3 53.9 40.7 6.8 4.1 12.9 9.5 19.9 New Jersey 191.3 141.6 22.9 18.2 12.8 48.4 33.7 7.3 4.4 13.2 10.2 19.4 New Mexico 176.2 123.8 19.3 17.3 11.3 38.1 26.4 6.0 4.1 10.9 8.1 20.7 New York 187.1 138.0 20.6 16.9 12.1 49.0 33.8 7.3 4.4 13.0 9.9 19.5 North Carolina 215.1 142.1 21.6 17.3 11.6 67.9 37.9 7.4 4.5 12.6 9.2 21.6 North Dakota 189.6 128.0 17.8 17.9 13.1 52.0 31.4 6.9 4.5 12.1 7.9 19.8 Ohio 219.6 155.0 23.1 19.8 13.6 66.5 42.7 8.5 5.1 13.3 10.0 19.9 Oklahoma 227.2 157.4 23.4 20.6 13.8 71.5 44.9 8.3 5.0 12.4 9.9 20.8 Oregon 196.2 145.9 20.8 16.6 12.2 50.5 39.1 8.2 4.9 12.5 9.5 21.2 Pennsylvania 210.5 149.4 22.2 18.9 13.5 59.0 37.1 8.3 4.9 13.6 10.0 19.7 Rhode Island 209.2 143.5 18.8 16.4 12.9 59.1 41.8 6.8 4.7 12.6 9.1 19.8 South Carolina 223.0 145.7 22.7 18.7 12.9 67.0 37.8 7.2 4.4 13.1 9.7 23.4 South Dakota 196.9 138.5 20.2 19.8 12.8 55.5 35.2 7.5 4.3 11.6 9.1 19.5 Tennessee 236.2 153.9 22.1 20.1 14.0 78.4 43.7 8.3 4.8 12.6 10.0 20.7 Texas 195.1 133.2 20.4 18.3 11.9 52.2 31.7 7.4 4.4 11.7 9.0 18.7 Utah 151.0 111.2 20.8 13.0 9.7 24.6 16.2 6.8 4.7 11.4 8.6 22.1 Vermont 202.5 147.0 18.6 15.8 12.7 54.3 41.5 8.0 4.4 12.7 10.0 21.1 Virginia 201.9 141.3 21.9 17.0 12.0 57.4 36.5 7.5 4.4 12.9 9.4 21.0 Washington 191.4 140.1 20.1 15.2 11.2 49.9 36.3 7.9 4.8 12.3 9.8 20.4 West Virginia 236.7 163.3 22.1 22.1 15.0 77.2 47.2 8.1 5.3 12.2 8.7 18.2 Wisconsin 202.0 144.0 20.5 16.4 12.1 53.4 37.5 8.1 4.9 13.2 10.0 21.8 Wyoming 177.9 134.9 18.9 17.1 10.6 41.9 32.5 6.6 4.6 10.8 8.4 18.5 United States 200.4 141.5 21.2 17.7 12.4 55.9 36.3 7.6 4.6 12.6 9.5 20.0 Rates are per 100,000 and age adjusted to the 2000 US standard population. 26 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 Leukemias (76% of which are lymphoid leukemias) account TABLE 14. Five-Year Relative Survival Rate (%) by Age for 29% of all childhood cancers (including benign and bor- and ICCC Type, Ages Birth to 19 Years, United States, 2006 to 2012 derline malignant brain tumors). Cancers of the brain and other nervous system are the second most common cancer BIRTH TO 14 15 TO 19 type (26%). The third most common category is lymphomas All ICCC groups combined 83.0 83.9 and reticuloendothelial neoplasms (11%), almost one-half of Lymphoid leukemia 90.2 74.7 which are non-Hodgkin lymphoma (including Burkitt lym- Acute myeloid leukemia 64.2 59.7 phoma) and more than one-quarter of which are Hodgkin Hodgkin lymphoma 97.7 96.4 Non-Hodgkin lymphoma 90.7 86.0 lymphoma. Soft tissue sarcomas (almost one-half of which are Central nervous system neoplasms 72.6 79.1 rhabdomyosarcoma) and neuroblastoma each account for 6% Neuroblastoma & other 79.7 74.2* of childhood cancers, followed by renal (Wilms) tumors peripheral nervous cell tumors (5%). Retinoblasoma 95.3 † Cancers in adolescents (aged 15 to 19 years) differ some- Renal tumors 90.6 68.1* what from those in children in terms of type and distribu- Hepatic tumors 77.1 47.4* tion. For example, the most common cancer type in Osteosarcoma 69.5 63.4 Ewing tumor & related bone sarcomas 78.7 59.2 adolescents is lymphoma (21%), almost two-thirds of which Soft tissue and other extraosseous 74.0 69.1 is Hodgkin lymphoma. Cancers of the brain and other ner- sarcomas vous system account for 17% of cases, followed by leukemia Rhabdomyosarcoma 69.6 48.9 (14%), germ cell and gonadal tumors (12%), and thyroid car- Germ cell and gonadal tumors 93.3 91.9 cinoma (11%). Melanoma accounts for 5% of the cancers Thyroid carcinoma 99.7 99.7 diagnosed in this age group. Malignant melanoma 93.7 94.0 Although overall cancer incidence in children and adoles- ICCC indicates International Classification of Childhood Cancer. cents has been increasing slightly (by 0.6% per year) since Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2013. 1975, rates appear to have stabilized during the most recent *The standard error of the survival rate is between 5 and 10 percentage points. data years. In contrast, death rates among those aged birth to †Statistic could not be calculated due to fewer than 25 cases during 2006 19 years have declined continuously, from 6.5 (per 100,000 to 2012. population) in 1970 to 2.2 in 2014, an overall reduction of 66% (68% in children and 60% in adolescents). The 5-year relative survival rate for all cancers combined improved from continues to have the lowest smoking prevalence. Smoking 58% during the mid-1970s to 83% during 2006-2012 for history similarly predicts state disparities in smoking- children and from 68% to 84% for adolescents. However, sur- attributable mortality; the proportion of total cancer deaths vival varies substantially by cancer type and age at diagnosis caused by smoking is 38% in men and 29% in women in (Table 14). Kentucky, compared with 22% and 11%, respectively, in Utah. The 2-fold difference for prostate cancer incidence Limitations rates, which range from 84 (per 100,000 population) in Although the estimated numbers of new cancer cases and Arizona to 169 in the District of Columbia, reflect state dif- deaths expected to occur in 2017 provide a reasonably accu- ferences in PSA testing prevalence and racial composition. rate portrayal of the contemporary cancer burden, they are State variations are smaller for cancers without particularly model-based, 3-year- or 4-year-ahead projections that strong risk factors or early detection tests (eg, pancreas). should be interpreted with caution and not be used to track trends over time. First, the estimates may be affect- Cancer in Children and Adolescents ed by changes in methodology as we take advantage of Cancer is the second most common cause of death among improvements in modeling techniques and cancer sur- children aged 1 to 14 years in the United States, surpassed veillance coverage. Second, although the model is robust, only by accidents. In 2017, an estimated 10,270 children it can only account for trends through the most recent (birth to 14 years) will be diagnosed with cancer (excluding year of data (currently 2013 for incidence and 2014 for benign/borderline malignant brain tumors) and 1,190 will die mortality) and cannot anticipate abrupt fluctuations for from the disease. Benign and borderline malignant brain cancers affected by changes in detection practice, such as tumors are not included in the 2017 case estimates because prostate cancer. Third, the model can be oversensitive to the calculation method requires historical data and these sudden or large changes in observed data. The most tumors were not required to be reported to cancer registries informative metrics for tracking cancer trends are age- until 2004. standardized or age-specific cancer death rates from the _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 27 Cancer Statistics, 2017 NCHS and cancer incidence rates from SEER, NPCR, 2.1 million fewer cancer deaths during this time period. and/or NAACCR. Moreover, racial disparities in cancer death rates are con- Errors in reporting race/ethnicity in medical records and tinuing to decline and the proportion of blacks who are on death certificates may result in underestimates of cancer uninsured has halved since 2010, potentially expediting incidence and mortality rates in nonwhite and nonblack further progress. Despite these successes, death rates are populations. This is particularly relevant for AI/AN popu- increasing rapidly for cancers of the liver (one of the most lations. It is also important to note that cancer data in the fatal cancers) and uterine corpus, both of which are United States are primarily reported for broad, heteroge- strongly associated with obesity. Advancing the fight neous racial and ethnic groups, masking substantial and against cancer requires continued clinical and basic important differences in the cancer burden within these research to improve detection practices, as well as treat- subpopulations. For example, among API men, lung cancer ment. In addition, creative new strategies are also needed incidence rates in Hawaiian men are just as high as those in to increase healthy behaviors nationwide and to more non-Hispanic white men and 3-fold higher than those in broadly apply existing cancer control knowledge across all Asian Indian/Pakistani men based on limited data available segments of the population, with an emphasis on disad- by population subgroups. Thus, the high burden of lung vantaged groups. and other cancers among Hawaiians is completely con- cealed with the presentation of aggregated API data. Author Contributions: Rebecca L. Siegel: Conceptualization, formal analysis, investigation, writing–original draft, writing–review and editing, Conclusions and visualization. Kimberly D. Miller: Software, formal analysis, investigation, writing–review and editing, and visualization. Ahmedin Jemal: The continuous decline in cancer death rates over 2 deca- Conceptualization, methodology, writing–review and editing, visualization, des has resulted in an overall drop of 25%, resulting in and supervision. Sciences, Surveillance Research Program, Epidemiology and End Results [SEER] Reg- References Surveillance Systems Branch; 2016. istries). Bethesda, MD: National Cancer Institute, Division of Cancer Control and 1. Surveillance, Epidemiology, and End 6. Surveillance, Epidemiology, and End Results Population Sciences, Surveillance Research Results (SEER) Program. SEER*Stat Data- (SEER) Program. SEER*Stat Database: Program, Surveillance Systems Branch; base: Mortality-All COD, Total US (1969- Incidence-SEER 9 Regs Research Data with 2014) <Early Release with Vintage 2014 Delay-Adjustment, Malignant Only, Nov. Katrina/Rita Population Adjustment>- 2015 Sub (1975-2013) <Katrina/Rita Popula- 11. Surveillance, Epidemiology, and End Linked To County Attributes-Total US, tion Adjustment>-Linked To County Results (SEER) Program. SEER*Stat Data- 1969-2014 Counties. Bethesda, MD: Nation- Attributes-Total US, 1969-2014 Counties. base: North American Association of Cen- al Cancer Institute, Division of Cancer Con- Bethesda, MD: National Cancer Institute, tral Cancer Registries (NAACCR) Incidence trol and Population Sciences, Surveillance Division of Cancer Control and Population Data-CiNA Analytic File, 1995-2013, for Research Program, Surveillance Systems Sciences, Surveillance Research Program, NHIAv2 Origin, Custom File With County, Branch; 2016; underlying mortality data Surveillance Systems Branch; 2016. ACS Facts and Figures Projection Project provided by National Center for Health Sta- (Which Includes Data From CDC’s National 7. Surveillance, Epidemiology, and End Results tistics 2016. Program of Cancer Registries [NPCR], (SEER) Program. SEER*Stat Database: CCCR’s Provincial and Territorial Regis- 2. Surveillance, Epidemiology, and End Incidence-SEER 18 Regs Research Data 1 tries, and the NCI’s Surveillance, Epidemi- Results (SEER) Program. SEER*Stat Data- Hurricane Katrina Impacted Louisiana Cases, ology and End Results [SEER] Registries). base: Mortality-All COD, Total US (1990- Nov. 2015 Sub (2000-2013) <Katrina/Rita Bethesda, MD: National Cancer Institute, 2014) <Early Release with Vintage 2014 Population Adjustment>-Linked To County Division of Cancer Control and Population Katrina/Rita Population Adjustment>- Attributes-Total US, 1969-2014 Counties. Sciences, Surveillance Research Program, Linked To County Attributes-Total US, Bethesda, MD: National Cancer Institute, Surveillance Systems Branch; 2016. 1969-2014 Counties. Bethesda, MD: Nation- Division of Cancer Control and Population al Cancer Institute, Division of Cancer Con- Sciences, Surveillance Research Program, 12. Copeland G, Lake A, Firth R, et al. Cancer trol and Population Sciences, Surveillance Surveillance Systems Branch; 2016. in North America: 2009-2013. Vol 1. Com- Research Program, Surveillance Systems bined Cancer Incidence for the United 8. Statistical Research and Applications Branch; 2016; underlying mortality data States, Canada and North America. Spring- Branch. DevCan: Probability of Developing provided by National Center for Health Sta- field, IL: North American Association of or Dying of Cancer Software. Version 6.7.4. tistics 2016. Central Cancer Registries Inc; 2016. Bethesda, MD: Surveillance Research Pro- 3. Wingo PA, Cardinez CJ, Landis SH, et al. gram, Statistical Methodology and Applica- 13. Copeland G, Lake A, Firth R, et al. Cancer Long-term trends in cancer mortality in the tions, National Cancer Institute; 2012. in North America: 2009-2013. Vol 2. United States, 1930-1998. Cancer. 2003; Registry-Specific Cancer Incidence in the 9. Howlader N, Noone AM, Krapcho M, et al. 97(suppl 12):3133-3275. United States and Canada. Springfield, IL: SEER Cancer Statistics Review, 1975-2013. North American Association of Central Can- 4. Murphy SL, Kochanek KD, Xu J, Heron M. Bethesda, MD: National Cancer Institute; cer Registries Inc; 2016. Deaths: Final Data for 2012. National Vital Statistics Reports. Vol 63. No. 9. Hyattsville, 14. Steliarova-Foucher E, Stiller C, Lacour B, 10. Surveillance, Epidemiology, and End MD: National Center for Health Statistics; Kaatsch P. International Classification of Results (SEER) Program. SEER*Stat Data- Childhood Cancer, Third Edition. Cancer. base: North American Association of Cen- 2005;103:1457–1467. 5. Surveillance, Epidemiology, and End Results tral Cancer Registries (NAACCR) Incidence (SEER) Program. SEER*Stat Database: Data-CiNA Analytic File, 1995-2013, for 15. Fritz A, Percy C, Jack A, et al. International Incidence-SEER 9 Regs Research Data, Nov. Expanded Races, Custom File With County, Classification of Diseases for Oncology. 3rd 2015 Sub (1973-2013) <Katrina/Rita Popula- ACS Facts and Figures Projection Project ed. Geneva: World Health Organization; tion Adjustment>-Linked To County (Which Includes Data From CDC’s National Attributes-Total US, 1969-2014 Counties. Program of Cancer Registries [NPCR], Bethesda, MD: National Cancer Institute, CCCR’s Provincial and Territorial Regis- 16. World Health Organization. International Division of Cancer Control and Population tries, and the NCI’s Surveillance, Statistical Classification of Diseases and 28 CA: A Cancer Journal for Clinicians CA CANCER J CLIN 2017;67:7–30 Related Health Problems. 10th Rev. Vols I- and race/ethnicity, 1992-2001. Cancer. 44. Lortet-Tieulent J, Sauer AG, Siegel RL, et al. III. Geneva: World Health Organization; 2006;107(suppl 5):1142-1152. State-level cancer mortality attributable 2011. to cigarette smoking in the United 31. Siegel RL, Ward EM, Jemal A. Trends in States. JAMA Intern Med. 2016; Published 17. Surveillance Research Program, National colorectal cancer incidence rates in the online October 24, 2016. doi:10.1001/jama Cancer Institute. SEER*Stat Software. Ver- United States by tumor location and stage, internmed.2016.6530. sion 8.3.2. Bethesda, MD: Surveillance 1992-2008. Cancer Epidemiol Biomarkers Research Program, National Cancer Insti- Prev. 2012;21:411-416. 45. Heron M, Anderson RN. Changes in the tute; 2016. Leading Cause of Death: Recent Patterns in 32. Centers for Disease Control and Prevention, Heart Disease and Cancer Mortality. NCHS 18. Joinpoint Regression Program, Version National Center for Health Statistics. Data Brief No. 254. Hyattsville, MD: 4.3.1.0. Bethesda, MD: Statistical Research National Health Interview Surveys, 2000 National Center for Health Statistics; 2016. and 2015. Public use data files, 2001, 2016. and Applications Branch, National Cancer 46. Siegel R, Naishadham D, Jemal A. Cancer Institute; 2016. 33. Morris LG, Tuttle RM, Davies L. Changing statistics for Hispanics/Latinos, 2012. CA trends in the incidence of thyroid cancer in 19. Clegg LX, Feuer EJ, Midthune DN, Fay MP, Cancer J Clin. 2012;62:283-298. the United States. JAMA Otolaryngol Head Hankey BF. Impact of reporting delay and Neck Surg. 2016;142:709-711. 47. Torre LA, Sauer AM, Chen MS Jr, Kagawa- reporting error on cancer incidence rates Singer M, Jemal A, Siegel RL. Cancer statis- and trends. J Natl Cancer Inst. 2002;94: 34. Nikiforov YE, Seethala RR, Tallini G, et al. tics for Asian Americans, Native Hawai- 1537-1545. Nomenclature revision for encapsulated ians, and Pacific Islanders, 2016: follicular variant of papillary thyroid carci- 20. Surveillance, Epidemiology, and End converging incidence in males and females. Results (SEER) Program. SEER*Stat Data- noma: a paradigm shift to reduce overtreat- CA Cancer J Clin. 2016;66:182-202. base: Incidence-SEER 18 Regs Research ment of indolent tumors. JAMA Oncol. 48. Reagan-Steiner S, Yankey D, Jeyarajah J, 2016;2:1023-1029. Data with Delay-Adjustment, Malignant et al. National, regional, state, and selected Only, Nov. 2015 Sub (2000-2013) 35. Zeng C, Wen W, Morgans AK, Pao W, Shu local area vaccination coverage among ado- <Katrina/Rita Population Adjustment>- XO, Zheng W. Disparities by race, age, and lescents aged 13-17 years-United States, Linked To County Attributes-Total US, sex in the improvement of survival for 2014. MMWR Morb Mortal Wkly Rep. 2015; 1969-2014 Counties. Bethesda, MD: Nation- major cancers: results from the National 64:784-792. al Cancer Institute, Division of Cancer Con- Cancer Institute Surveillance, Epidemiolo- trol and Population Sciences, Surveillance 49. Wiren S, Haggstrom C, Ulmer H, et al. gy, and End Results (SEER) Program in the Research Program, Surveillance Systems Pooled cohort study on height and risk of United States, 1990 to 2010. JAMA Oncol. Branch; 2016. cancer and cancer death. Cancer Causes 2015;1:88-96. Control. 2014;25:151-159. 21. Pickle LW, Hao Y, Jemal A, et al. A new 36. Sasaki K, Strom SS, O’Brien S, et al. Rela- method of estimating United States and 50. Walter RB, Brasky TM, Buckley SA, tive survival in patients with chronic-phase state-level cancer incidence counts for the Potter JD, White E. Height as an explana- chronic myeloid leukaemia in the tyrosine- current calendar year. CA Cancer J Clin. kinase inhibitor era: analysis of patient data tory factor for sex differences in human 2007;57:30-42. from six prospective clinical trials. Lancet cancer. JNatl Cancer Inst. 2013;105:860- Haematol. 2015;2:e186-e193. 868. 22. Zhu L, Pickle LW, Ghosh K, et al. Predicting US- and state-level cancer counts for the 37. Teras LR, DeSantis CE, Cerhan JR, Morton 51. O’Grady TJ, Gates MA, Boscoe FP. Thyroid current calendar year: Part II: evaluation of cancer incidence attributable to overdiag- LM, Jemal A, Flowers CR. 2016 US lym- spatiotemporal projection methods for inci- nosis in the United States 1981-2011. Int J phoid malignancy statistics by World dence. Cancer. 2012;118:1100-1109. Cancer. 2015;137:2664-2673. Health Organization subtypes [published online ahead of print September 12, 2016]. 23. Chen HS, Portier K, Ghosh K, et al. Predict- 52. Aschebrook-Kilfoy B, Ward MH, Sabra CA Cancer J Clin. doi: 10.3322/caac.21357. ing US- and state-level cancer counts for the MM, Devesa SS. Thyroid cancer incidence current calendar year: Part I: evaluation of patterns in the United States by histologic 38. National Lung Screening Trial Research temporal projection methods for mortality. type, 1992-2006. Thyroid. 2011;21:125- Team, Aberle DR, Adams AM, et al. Cancer. 2012;118:1091-1099. Reduced lung-cancer mortality with low- dose computed tomographic screening. N 24. Potosky AL, Miller BA, Albertsen PC, 53. Rahbari R, Zhang L, Kebebew E. Thyroid Engl J Med. 2011;365:395-409. Kramer BS. The role of increasing detection cancer gender disparity. Future Oncol. in the rising incidence of prostate cancer. 2010;6:1771-1779. 39. Marcus PM, Doria-Rose VP, Gareen IF, JAMA. 1995;273:548-552. et al. Did death certificates and a death 54. Joosse A, de Vries E, Eckel R, et al; Munich review process agree on lung cancer cause 25. Siegel RL, Miller KD, Jemal A. Cancer sta- Melanoma Group. Gender differences in of death in the National Lung Screening Tri- tistics, 2016. CA Cancer J Clin. 2016;66: melanoma survival: female patients have a al? Clin Trials. 2016;13:434-438. 7-30. decreased risk of metastasis. J Invest Der- matol. 2011;131:719-726. 40. Doria-Rose VP, White MC, Klabunde CN, 26. Moyer VA; US Preventive Services Task et al. Use of lung cancer screening tests in Force. Screening for prostate cancer: U.S. 55. Crocetti E, Fancelli L, Manneschi G, et al. the United States: results from the 2010 Preventive Services Task Force recommen- Melanoma survival: sex does matter, but National Health Interview Survey. Cancer dation statement. Ann Intern Med. 2012; we do not know how. Eur J Cancer Prev. Epidemiol Biomarkers Prev. 2012;21:1049- 157:120-134. 2016;25:404-409. 27. Harris JE. Cigarette smoking among succes- 56. Scoggins CR, Ross MI, Reintgen DS, et al; Sun- 41. Jemal A, Thun MJ, Ries LA, et al. Annual sive birth cohorts of men and women in the belt Melanoma Trial. Gender-related differ- report to the nation on the status of cancer, United States during 1900-80. J Natl Cancer ences in outcome for melanoma patients. Ann 1975-2005, featuring trends in lung cancer, Inst. 1983;71:473-479. Surg. 2006;243:693-698; discussion 698-700. tobacco use, and tobacco control. J Natl 28. Jemal A, Ma J, Rosenberg PS, Siegel R, Cancer Inst. 2008;100:1672-1694. 57. Joosse A, Collette S, Suciu S, et al. Sex is an Anderson WF. Increasing lung cancer death independent prognostic indicator for sur- 42. Holford TR, Meza R, Warner KE, et al. rates among young women in southern and vival and relapse/progression-free survival Tobacco control and the reduction in midwestern states. J Clin Oncol. 2012;30: in metastasized stage III to IV melanoma: a smoking-related premature deaths in the 2739-2744. pooled analysis of five European Organisa- United States, 1964-2012. JAMA. 2014;311: tion for Research and Treatment of Cancer 29. Edwards BK, Ward E, Kohler BA, et al. 164-171. randomized controlled trials. J Clin Oncol. Annual report to the nation on the status 2013;31:2337-2346. 43. US Department of Health and Human Serv- of cancer, 1975-2006, featuring colorectal ices. The Health Consequences of Smoking- cancer trends and impact of interventions 58. Cymerman RM, Shao Y, Wang K, et al. De 50 Years of Progress. A Report of the Sur- (risk factors, screening, and treatment) to Novo vs Nevus-Associated Melanomas: Dif- geon General. Atlanta, GA: US Department reduce future rates. Cancer. 2010;116:544- ferences in Associations With Prognostic of Health and Human Services, Centers for Indicators and Survival. J Natl Cancer Inst. Disease Control and Prevention, National 2016;108. 30. Cress RD, Morris C, Ellison GL, Goodman Center for Chronic Disease Prevention and MT. Secular changes in colorectal cancer Health Promotion, Office on Smoking and 59. Jemal A, Center MM, Ward E. The conver- incidence by subsite, stage at diagnosis, Health; 2014. gence of lung cancer rates between blacks _ _ VOLUME 67 NUMBER 1 JANUARY/FEBRUARY 2017 29 Cancer Statistics, 2017 and whites under the age of 40, United 64. Barnett J, Vornovitsky M. Health Insur- Indians and Alaska Natives in the United States. Cancer Epidemiol Biomarkers Prev. ance Coverage in the United States: 2015. States. Am J Public Health. 2014;104(suppl 2009;18:3349-3352. Current Population Reports P60-257. 3):S377-S387. Washington, DC: US Census Bureau; 60. Anderson C, Burns DM. Patterns of adoles- 68. Ezzati M, Friedman AB, Kulkarni SC, cent smoking initiation rates by ethnicity and Murray CJ. The reversal of fortunes: trends sex. Tob Control. 2000;9(suppl 2):II4-II8. 65. DeNavas-Walt C, Proctor B, Smith J. in county mortality and cross-county mor- Income, Poverty, and Health Insurance tality disparities in the United States. PLoS 61. Ward E, Jemal A, Cokkinides V, et al. Can- Coverage in the United States: 2010. Cur- Med. 2008;5:e66. cer disparities by race/ethnicity and socio- rent Population Reports P60-239. Washing- 69. Grauman DJ, Tarone RE, Devesa SS, economic status. CA Cancer J Clin. 2004;54: ton, DC: US Census Bureau; 2011. Fraumeni JF Jr. Alternate ranging methods 78-93. 66. Welzel TM, Graubard BI, Quraishi S, et al. for cancer mortality maps. J Natl Cancer 62. Bach PB, Schrag D, Brawley OW, Galaznik Population-attributable fractions of risk fac- Inst. 2000;92:534-543. A, Yakren S, Begg CB. Survival of blacks tors for hepatocellular carcinoma in the 70. Nguyen BT, Han X, Jemal A, Drope J. Diet and whites after a cancer diagnosis. JAMA. United States. Am J Gastroenterol. 2013; quality, risk factors and access to care 2002;287:2106-2113. 108:1314-1321. among low-income uninsured American 63. Ward E, Halpern M, Schrag N, et al. Associ- 67. White MC, Espey DK, Swan J, Wiggins CL, adults in states expanding Medicaid vs. ation of insurance with cancer care utiliza- Eheman C, Kaur JS. Disparities in cancer states not expanding under the Affordable tion and outcomes. CA Cancer J Clin. 2008; mortality and incidence among American Care Act. Prev Med. 2016;91:169-171. 58:9-31. 30 CA: A Cancer Journal for Clinicians

Journal

CA: A Cancer Journal for CliniciansWiley

Published: Jan 1, 2017

Keywords: ; ; ; ;

There are no references for this article.