CancerStatistics,2013
RebeccaSiegel,MPH1;DeepaNaishadham,MA,MS2;AhmedinJemal,DVM,PhD3Eachyear,theAmericanCancerSocietyestimatesthenumbersofnewcancercasesanddeathsexpectedintheUnitedStatesinthecurrentyearandcompilesthemostrecentdataoncancerincidence,mortality,andsurvivalbasedonincidencedatafromtheNationalCancerInstitute,theCentersforDiseaseControlandPrevention,andtheNorthAmericanAssociationofCentralCancerRegistriesandmortalitydatafromtheNationalCenterforHealthStatistics.Atotalof1,660,290newcancercasesand580,350cancerdeathsareprojectedtooccurintheUnitedStatesin2013.Duringthemostrecent5yearsforwhichtherearedata(2005-2009),delay-adjustedcancerincidenceratesdeclinedslightlyinmen(by0.6%peryear)andwerestableinwomen,whilecancerdeathratesdecreasedby1.8%peryearinmenandby1.5%peryearinwomen.Overall,cancerdeathrateshavedeclined20%fromtheirpeakin1991(215.1per100,000population)to2009(173.1per100,000population).Deathratescontinuetodeclineforall4majorcancersites(lung,colorectum,breast,andprostate).Overthepast10yearsofdata(2000-2009),thelargestannualdeclinesindeathrateswereforchronicmyeloidleukemia(8.4%),cancersofthestomach(3.1%)andcolorectum(3.0%),andnon-Hodgkinlymphoma(3.0%).Thereductioninoverallcancerdeathratessince1990inmenand1991inwomentranslatestotheavoidanceofapproximately1.18milliondeathsfromcancer,with152,900ofthesedeathsavertedin2009alone.Furtherprogresscanbeacceleratedbyapplyingexistingcancercontrolknowledgeacrossallsegmentsofthepopulation,withanemphasisonthosegroupsinthelowest
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socioeconomicbracketandotherunderservedpopulations.CACancerJClin2013;63:11-30.V2013AmericanCancerSociety.Keywords:cancer,incidence,mortality,survival,trends,deathsaverted
Introduction
CancerisamajorpublichealthproblemintheUnitedStatesandmanyotherpartsoftheworld.Onein4deathsintheUnitedStatesisduetocancer.Inthisarticle,weprovidetheexpectednumbersofnewcancercasesanddeathsin2013nationallyandbystate,aswellasanoverviewofcurrentcancerstatisticsusingdatathrough2009,includingincidence,mortality,andsurvivalratesandtrends.Wealsoestimatethetotalnumberofdeathsavertedasaresultofthedeclineincancerdeathratessincetheearly1990s,andprovidetheactualreportednumbersofdeathsin2009byageforthe10leadingcausesofdeathandthe5leadingcancertypes.
MaterialsandMethods
IncidenceandMortalityData
Mortalitydatafrom1930to2009intheUnitedStateswereobtainedfromtheNationalCenterforHealthStatistics(NCHS).1,2Thereareseveralsourcesforcancerincidencedata.TheSurveillance,Epidemiology,andEndResults(SEER)programoftheNationalCancerInstitutereportslong-term(beginningin1973),high-quality,population-basedincidencedatacoveringupto26%oftheUSpopulation.Cancerincidenceratesforlong-termtrends(1975-2009),5-yearrelativeandcause-specificsurvivalrates(2002-2008),andestimationsofthelifetimeprobabilityofdevelopingcancer(2007-2009)wereobtainedfromSEERregistries.3-6TheNorthAmericanAssociationofCentralCancerRegistries(NAACCR)compilesandreportsincidencedatafrom1995onwardforcancerregistriesthatparticipateintheSEERprogramortheCentersforDiseaseControlandPrevention’sNationalProgramofCancerRegistries(NPCR).Incidencedataforstate-levelrates(2005-2009),trendsbyrace/ethnicity(2000-2009),andestimatednewcancercasesin2013wereobtainedfromNAACCR.7Cancercaseswereclassi-fiedaccordingtotheInternationalClassificationofDiseasesforOncology.8Allincidenceanddeathratesareage-standardizedtothe2000USstandardpopulationandexpressedper100,000persons.
Cancerincidenceratesinthisreportaredelay-adjustedwheneverpossibleinordertoaccountforanticipatedfuturecorrectionstoregistrydataduetoinherentdelaysanderrorsincasereporting.Delay-adjustedratesprimarilyaffectthemostrecentyearsofdataforcancersthatarefrequentlydiagnosedinoutpatientsettings(eg,melanoma,leukemia,andprostate)andprovideamore
1Director,SurveillanceInformation,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;2Epidemiologist,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;3VicePresident,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA.
Correspondingauthor:RebeccaSiegel,MPH,SurveillanceandHealthServicesResearch,AmericanCancerSociety,250WilliamsSt,NW,Atlanta,GA30303-1002;Rebecca.siegel@cancer.org
DISCLOSURES:Theauthorsreportnoconflictsofinterest.
CV
2013AmericanCancerSociety,Inc.doi:10.3322/caac.21166.Availableonlineatcacancerjournal.com
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TABLE1.EstimatedNewCancerCasesandDeathsbySex,UnitedStates,2013*
ESTIMATEDNEWCASES
BOTHSEXES
MALE
FEMALE
BOTHSEXES
ESTIMATEDDEATHS
MALE
FEMALE
Allsites
Oralcavity&pharynxTongueMouthPharynx
OtheroralcavityDigestivesystemEsophagusStomach
SmallintestineColon†Rectum
Anus,analcanal,&anorectumLiver&intrahepaticbileductGallbladder&otherbiliaryPancreas
OtherdigestiveorgansRespiratorysystemLarynx
Lung&bronchus
OtherrespiratoryorgansBones&joints
Softtissue(includingheart)
Skin(excludingbasal&squamous)Melanoma-skin
OthernonepithelialskinBreast
GenitalsystemUterinecervixUterinecorpusOvaryVulva
Vagina&othergenital,femaleProstateTestis
Penis&othergenital,maleUrinarysystemUrinarybladder
Kidney&renalpelvis
Ureter&otherurinaryorgansEye&orbit
Brain&othernervoussystemEndocrinesystemThyroid
OtherendocrineLymphoma
HodgkinlymphomaNon-HodgkinlymphomaMyelomaLeukemia
AcutelymphocyticleukemiaChroniclymphocyticleukemiaAcutemyeloidleukemiaChronicmyeloidleukemiaOtherleukemia‡
Other&unspecifiedprimarysites‡1,660,29041,38013,59011,40013,9302,460290,20017,99021,6008,810102,48040,3407,06030,64010,31045,2205,750246,21012,260228,1905,7603,01011,41082,77076,6906,080234,580339,81012,34049,56022,2404,7002,890238,5907,9201,570140,43072,57065,1502,7102,80023,13062,71060,2202,49079,0309,29069,74022,35048,6106,07015,68014,5905,9206,35031,860
854,79029,6209,9006,73011,2001,790160,75014,44013,2304,67050,09023,5902,63022,7204,74022,7401,900131,7609,680118,0804,0001,6806,29048,66045,0603,6002,240248,080
805,50011,7603,6904,6702,730670129,4503,5508,3704,14052,39016,7504,4307,9205,57022,4803,850114,4502,580110,1101,7601,3305,12034,11031,6302,480232,34091,73012,34049,56022,2404,7002,890
580,3507,8902,0701,8002,4001,640144,57015,21010,9901,17050,83088021,6703,23038,4602,130163,8903,630159,480
7801,4404,39012,6509,4803,17040,03058,4804,0308,19014,03099084029,72037031029,79015,21013,68090032014,0802,7701,85092020,2001,18019,02010,71023,7201,4304,58010,3706106,73045,420
306,9205,5001,3801,0801,7901,26082,70012,2206,74061026,30033014,8901,26019,48087090,6002,86087,2604808102,5008,5606,2802,28041030,400
273,4302,39069072061038061,8702,9904,25056024,5305506,7801,97018,9801,26073,29077072,2203006301,8904,0903,20089039,62028,0804,0308,19014,030990840
238,5907,9201,57096,80054,61040,4301,7601,49012,77016,21014,9101,30042,6705,07037,60012,44027,8803,3509,7207,8203,4203,57015,450
43,63017,96024,7209501,31010,36046,50045,3101,19036,3604,22032,1409,91020,7302,7205,9606,7702,5002,78016,410
29,72037031020,12010,8208,7805201207,9301,27081046011,25066010,5906,07013,6608202,7505,9303403,82025,020
9,6704,3904,9003802006,1501,5001,0404608,9505208,4304,64010,0606101,8304,4402702,91020,400
*Roundedtothenearest10;estimatednewcasesexcludebasalcellandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.About64,640carcinomainsituofthefemalebreastand61,300melanomainsituwillbenewlydiagnosedin2013.†Estimateddeathsforcolonandrectumcancersarecombined.
‡Moredeathsthancasesmayreflectlackofspecificityinrecordingunderlyingcauseofdeathondeathcertificatesand/oranundercountinthecaseestimate.
accurateportrayalofthecancerburdeninthemostrecenttimeperiod.9Forexample,melanomaincidenceratesadjustedfordelaysinreportingare14%higherthanunadjustedratesinthemostrecentreportingyear.Delay-adjustedratesareavailable
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forSEERregistrydataandwereobtainedfromtheNationalCancerInstitute.Incidencetrendspresentedforthemostrecent5years(2005-2009)arebasedondelay-adjustedratesfromSEER13cancerregistries.4CACANCERJCLIN2013;63:11–30
TABLE2.IncidenceRatesforAllCancersCombined(2005-2009)andEstimatedNewCases*forSelectedCancers(2013)
byState
STATE
INCIDENCERATE†
ALLSITES
FEMALEBREAST
UTERINEUTERINELUNG&MELANOMANON-HODGKINURINARYCERVIXCOLORECTUMCORPUSLEUKEMIABRONCHUSOFTHESKINLYMPHOMAPROSTATEBLADDER
AlabamaAlaskaArizonaArkansas§CaliforniaColoradoConnecticutDelaware
Dist.ofColumbia§FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio
OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginia§WashingtonWestVirginiaWisconsin§Wyoming
UnitedStates473.2474.6394.9461.8444.1436.6515.0519.7468.5458.1467.3443.4463.2491.4467.8489.9480.3523.1496.6522.3460.6506.8492.7483.8485.2474.6468.8475.9454.6507.6509.0418.8498.5484.1478.4470.8484.2469.3505.3514.1465.6433.9475.7452.1400.1496.3460.3486.4496.8463.2444.7473.427,0803,7202003,290510‡34,0104,66022016,3302,280150171,33025,3601,48023,4103,30016021,1803,0501105,370770‡2,920450‡118,32015,71094049,2807,3104206,650960507,6701,0105066,0909,35050035,5504,54026017,4802,3109014,3702,1609025,1003,30019024,9303,6302209,1901,1505030,6804,76022038,2505,82021057,5608,14033028,4104,26012015,8302,08013033,9504,6802505,450740‡9,0601,2305013,8301,7601208,4701,1805049,4406,96046010,0901,36080108,76014,95085053,2007,4303603,510450‡66,6109,06044020,1602,69017021,7203,31012079,56010,4904806,280900‡27,6203,5802204,570600‡36,5805,070280112,23014,9801,11010,8101,550704,200550‡40,8706,28030037,2905,61023011,4501,4608031,5904,4901902,700380‡1,660,290232,34012,3402,3903102,6301,54014,6901,8801,67043024010,2903,9707306706,1403,2501,6401,2502,3002,4007302,4102,9104,7302,2201,5803,1105109101,3506404,6408609,2104,2603705,8901,7801,6107,3905302,3404303,1809,7507403203,2702,7301,1802,610240142,8206106404,550901004708609204,2503704502,7005,1605,21018,7206908402,5507405702,78017014076090703203,1103,49017,9601,2301,2906,6902401809002202709302,1502,0209,2701,0401,0005,5005805902,3504404501,9307007204,5605506603,7403102801,3809507804,0401,2809904,8801,9201,7508,2508909503,8603403902,6301,0409805,4101601807002903101,2203304001,9702902401,1501,7401,4305,9602703301,0503,8503,27013,4801,4301,4708,0401001204602,2301,77010,2305006103,3706706202,8602,7202,24010,9802101808707107604,3901401506209009906,2002,8703,74015,0003203808001301105901,2409905,3801,1401,1604,7003503302,1001,0801,0504,310808032049,56048,610228,1901,300901,4005308,5301,3101,080300905,3302,3603804202,4801,4709808001,5407704401,5301,8402,9001,0205501,5002504604404102,5204604,2002,6201502,9607701,4103,8902701,3202001,9003,9307202202,3802,3505401,25013076,6909901401,3606807,2801,0508902201005,0601,8102403602,8401,4607906501,1009503901,1801,5902,5301,2105601,4802604305203502,1904004,7402,0801502,8408409503,4402501,0402001,4504,8304901701,5901,6504701,40012069,7403,9409604401404,3401,4002,37061023,7406,9203,8709902,9401,0908602505009017,3305,7207,9301,6108002001,3303809,2302,9904,3101,5602,2708102,0206003,1301,0604,0409301,2905304,8801,2205,7002,0609,4902,8604,0901,1902,4905404,1701,4808702801,2904201,9006601,1804607,1902,4501,61038016,7205,5108,1502,0705501708,5303,0202,5007903,3801,0309,4503,9808203404,1601,0707302204,9901,44015,7304,0301,9604205602106,8401,5905,6901,6901,4705304,3701,530430130238,59072,570
*Roundedtothenearest10;excludesbasalcellandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.†Ratesareper100,000andageadjustedtothe2000USstandardpopulation.‡Estimateisfewerthan50cases.
§Rateisforcasesdiagnosedduring2005to2008.
Note:Thesemodel-basedestimatesareofferedasaroughguideandshouldbeinterpretedwithcaution.StateestimatesmaynotaddtoUStotalduetoroundingandtheexclusionofstateswithfewerthan50cases.
ProjectedCancerCasesandDeathsin2013
Theprecisenumberofcancercasesdiagnosedeachyearinthenationandineverystateisunknownbecausecancerregistrationisincompleteinsomestates.Furthermore,themostrecentyearforwhichincidenceandmortalitydataareavailablelags3to4yearsbehindthecurrentyearduetothetimerequiredfordatacollection,compilation,qualitycontrol,anddissemination.Therefore,weprojectthenumbersofnewcancercasesand
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CancerStatistics,2013
FIGURE1.TenLeadingCancerTypesfortheEstimatedNewCancerCasesandDeathsbySex,UnitedStates,2013.
*Estimatesareroundedtothenearest10andexcludebasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.
deathsintheUnitedStatesin2013inordertoprovideanestimateofthecontemporarycancerburden.Themethodsforprojectingbothnewcasesanddeathsinthecurrentyearwererecentlymodifiedsoestimatesshouldnotbecomparedfromyeartoyear.Weprojectedthenumberofnewinvasivecancercasesthatwillbediagnosedin2013(withtheexceptionofurinarybladder,forwhichinsitucasesareincluded)usinga2-stepprocessthatfirstestimatescompleteincidencecountsbystateduringyearsforwhichobserveddataareavailable,andthenprojectsthesecounts4yearsaheadfortheUnitedStatesoverallandeachstateindividually.10Toestimatecountsforeachstatethrough2009,weusedaspatiotemporalmodelbasedonincidencedatafor1995through2009from49statesandtheDistrictofColumbiathatmetNAACCR’shigh-qualitydatastandardforincidence,coveringabout98%oftheUSpopulation.11(Minnesotacancerregistrydatacouldnotbeincludedinthemodelbecausecounty-leveldatawereunavailable.)Thismethodaccountsforexpecteddelaysincasereportingandconsidersgeographicvariationsinsociodemographicandlifestylefactors,medicalsettings,
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andcancerscreeningbehaviorsaspredictorsofincidence.Atemporalprojectionmethod(thevectorautoregressivemodel)wasthenappliedtotheestimatedcountstoobtainprojectionsfor2013.Forthecompletedetailsofthismethodology,pleaserefertoZhuetal.10Toestimatethenumbersofnewbreastcarcinomainsitu(female)andmelanomainsitucasesin2013,wefirstestimatedthenumberofinsitucasesoccurringannuallyfrom2000through2009intheUnitedStatesbyapplyingtheage-specificincidenceratesinthe18SEERareastothecorrespondingUSpopulationestimatesprovidedinSEER*Stat.12Wethenprojectedthetotalnumberofcasesin2013basedontheannualpercentchangefrom2000through2009generatedbythejoinpointregressionmodel.13Weestimatedthenumberofcancerdeathsexpectedtooccurin2013intheUnitedStatesoverallandineachstateusingthejoinpointregressionmodelbasedontheactualnumbersofcancerdeathsfrom1995through2009atthestateandnationallevelsasreportedtotheNCHS.1Forthecompletedetailsofthismethodology,pleaserefertoChenetal.14CACANCERJCLIN2013;63:11–30
TABLE3.DeathRatesforAllCancersCombined(2005-2009)andEstimatedDeaths*forSelectedCancers(2013)by
State
STATE
DEATHRATE†
ALLSITES
BRAIN&OTHERLIVER&NERVOUSFEMALEINTRAHEPATICLUNG&NON-HODGKINSYSTEMBREASTCOLORECTUMLEUKEMIABILEDUCTBRONCHUSLYMPHOMAOVARYPANCREASPROSTATE
Alabama198.2
Alaska181.3Arizona152.8Arkansas199.7California163.1Colorado154.6Connecticut173.4Delaware190.4Dist.ofColumbia196.5Florida170.0Georgia179.2Hawaii147.8Idaho165.8Illinois186.6Indiana195.4Iowa178.3Kansas178.8Kentucky211.3Louisiana204.0Maine192.8Maryland184.1Massachusetts180.0Michigan187.5Minnesota169.9Mississippi204.7Missouri191.4Montana172.5Nebraska174.0Nevada183.0NewHampshire179.5NewJersey179.0NewMexico158.2NewYork166.7NorthCarolina186.3NorthDakota171.1Ohio194.9Oklahoma194.8Oregon179.8Pennsylvania187.5RhodeIsland180.4SouthCarolina187.9SouthDakota168.2Tennessee200.6Texas171.3Utah128.4Vermont176.2Virginia183.2Washington176.7WestVirginia206.6Wisconsin178.6Wyoming169.8UnitedStates178.710,430
98011,2106,65057,2907,3506,8901,9401,03042,37016,0102,4002,66024,00013,2506,4205,4309,9709,0403,24010,48012,84020,5709,6106,30012,7302,0003,4404,7602,68016,4103,54034,24018,6201,28025,1307,8507,82028,6802,1409,8001,59014,08037,1802,7901,30014,72012,3904,66011,220950580,350250‡3101501,59023017050‡880360‡9053032019015020021090230310540250140310501001407034090780390‡5901902306005022050360940110‡320350100310‡14,080690707904204,220510460120802,6601,2001401801,6108504003605906501908008101,3606104208901202103601701,3302402,3901,260901,7204904901,9501306601109102,650260801,1108002807006039,620970809906105,1506804701701003,6401,4502302202,2301,1205804908808602509301,0201,7007706301,1001803404502001,5603503,0201,5101302,1707206602,5401708201501,2203,3902401001,2709804408808050,830400‡4802702,46032029070‡1,770600801201,010550280250340330130410500910440250540901401801006301401,450710609803003201,190100360605201,49015050580520170520‡23,720330‡4602002,98029023080501,55053012080750370200170270380903805006703302104205090210805701701,410620‡75027031093080340‡4601,9509050480530120370‡21,6703,2902702,8502,17012,7001,7101,74058024012,0704,6705806706,5604,1101,7801,5903,5102,6709502,8103,5305,9402,5002,0103,9405509001,4807504,0607708,7905,6603107,3502,4402,1107,6406002,9904404,6009,6704503804,1303,2601,4802,980240159,480320‡4002002,00025023060‡1,4004608010078044023021030026011031040073034017038070130140805301101,090550‡8002602801,02060280504401,210120‡460440160400‡19,020270‡3101501,54023017050‡93041050605503001701402001906025034049024011024050801006044090900420‡56017022073050210‡28085080‡370360100300‡14,030630607403904,010500530120802,7701,0102102001,6208203903505405802007309101,4606303808201302303502001,1802402,5001,150901,6204405201,9501306001108002,340220901,0208502307707038,460550506303203,390440400100802,2007901101801,2305903502403904201605606508905203305601402102901407502301,770910801,2403804601,430100500906301,650210607407301906305029,720
*Roundedtothenearest10.
†Ratesareper100,000andageadjustedtothe2000USstandardpopulation.‡Estimateisfewerthan50deaths.
Note:StateestimatesmaynotaddtoUStotalduetoroundingandtheexclusionofstateswithfewerthan50deaths.
OtherStatistics
Theestimatednumbersofcancerdeathsavertedinmenandwomenduetothereductioninoverallcancerdeathrateswerecalculatedbyapplyingthe5-yearage-specificcancerdeathratesinthepeakyearforage-standardizedcancerdeathrates(1990inmenand1991inwomen)tothecorrespondingage-specificpopulationsinthesubsequentyearsthrough2009toobtainthenumberofexpecteddeathsineachcalendaryearifthedeathrateshadnotdecreased.Wethensummedthedifferencebetweenthenumberofexpectedandobserveddeathsineachagegroupandcalendaryearformenandwomenseparately.
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TABLE4.Probability(%)ofDevelopingInvasiveCancersWithinSelectedAgeIntervalsbySex,UnitedStates,2007to2009*
BIRTHTO39
40TO59
60TO69
70ANDOLDER
BIRTHTODEATH
Allsites†Urinarybladder‡Breast
ColorectumLeukemiaLung&bronchusMelanomaoftheskin§Non-HodgkinlymphomaProstate
UterinecervixUterinecorpusMaleFemaleMaleFemaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleFemale1.462.200.020.010.500.080.080.160.130.030.030.150.260.130.090.010.160.07(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininin69)46)4,924)12,663)202)1,212)1,236)612)746)3,552)3,287)691)391)753)1,147)7,964)641)1,348)8.799.190.370.123.780.940.750.230.150.920.760.630.550.440.312.680.270.77(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininin11)11)272)864)26)106)134)440)655)109)131)160)181)225)322)37)374)129)16.0310.390.920.243.561.400.980.350.212.271.720.770.400.600.446.780.130.89(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininin6)10)109)410)28)71)102)288)481)44)58)130)248)167)229)15)795)112)38.0726.693.690.986.654.193.801.260.816.824.932.020.841.771.4012.060.181.25(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininin3)4)27)106)15)24)26)80)123)15)20)50)120)57)72)8)551)80)44.8138.173.811.1512.385.174.781.591.147.776.352.871.852.341.9316.150.682.64(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininin2)3)26)90)8)19)21)63)88)13)16)35)54)43)52)6)147)38)
*Forpeoplefreeofcanceratbeginningofageinterval.
†Allsitesexcludesbasalcellandsquamouscellskincancersandinsitucancersexcepturinarybladder.‡Includesinsitucancercases.§Statisticsforwhitesonly.
SelectedFindings
ExpectedNumbersofNewCancerCases
Table1presentstheestimatednumbersofnewcasesofinvasivecancerexpectedamongmenandwomenintheUnitedStatesin2013.Theoverallestimateofmorethan1.6millionnewcasesdoesnotincludecarcinomainsituofanysiteexcepturinarybladder,nordoesitincludebasalcellorsquamouscellcancersoftheskin.About64,640casesofbreastcarcinomainsituand61,300casesofmelanomainsituareexpectedtobenewlydiagnosedin2013.TheestimatednumbersofnewcancercasesbystateforselectedcancersitesareshowninTable2.
Figure1indicatesthemostcommoncancersexpectedtooccurinmenandwomenin2013.Amongmen,cancersoftheprostate,lungandbronchus,andcolorectumwillaccountforabout50%ofallnewlydiagnosedcancers;prostatecanceralonewillaccountfor28%(238,590)ofincidentcasesinmen.The3mostcommonlydiagnosedtypesofcanceramongwomenin2013willbebreast,lungandbronchus,andcolorectum,accountingfor51%ofestimatedcancercasesinwomen.Breastcanceraloneisexpectedtoaccountfor29%(232,340)ofallnewcancercasesamongwomen.
inwomencontinuetobethemostcommoncausesofcancerdeath.These4cancersaccountforalmosthalf(48%)ofthetotalcancerdeathsamongmenandwomen(Fig.1).In2013,lungcancerisexpectedtoaccountfor26%ofallfemalecancerdeathsand28%ofallmalecancerdeaths.Table3providestheestimatednumbersofcancerdeathsin2013bystateforselectedcancersites.
ExpectedNumbersofCancerDeaths
Table1alsoshowstheexpectednumbersofdeathsfromcancerprojectedfor2013.Itisestimatedthatabout580,350Americanswilldiefromcancerthisyear,correspondingtoalmost1600deathsperday.Cancersofthelungandbronchus,prostate,andcolorectuminmenandcancersofthelungandbronchus,breast,andcolorectum
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FIGURE2.TrendsinCancerIncidenceandDeathRatesby
Sex,UnitedStates,1975to2009.
Ratesareageadjustedtothe2000USstandardpopulation.Incidenceratesareadjustedfordelaysinreporting.
CACANCERJCLIN2013;63:11–30
FIGURE3.TrendsinIncidenceRatesforSelectedCancersbySex,UnitedStates,1975to2009.
Ratesareageadjustedtothe2000USstandardpopulationandadjustedfordelaysinreporting.*Liverincludesintrahepaticbileduct.
LifetimeProbabilityofDevelopingCancer
Thelifetimeprobabilityofbeingdiagnosedwithaninvasivecancerishigherformen(45%)thanforwomen(38%)(Table4).However,becauseoftheearliermedianageatdiagnosisforbreastcancercomparedwithothermajorcancers,womenhaveaslightlyhigherprobabilityofdevelopingcancerbeforeage60years.Theseestimatesarebasedontheaverageexperienceofthegeneralpopulationandmayover-orunderestimateindividualriskbecauseofdifferencesinexposure(eg,smokinghistory)and/orgeneticsusceptibility.
TrendsinCancerIncidence
Figures2to5depictlong-termtrendsincancerincidenceanddeathratesforallcancerscombinedandforselectedcancersitesbysex.Whileincidenceratesaredecliningformostcancersites,theyareincreasingamongbothmenandwomenformelanomaoftheskinandcancersoftheliverandthyroid(Fig.3,Table5).Table5showsincidence(delay-adjusted)andmortalitytrendsforallcancerscom-binedandforselectedcancersitesbasedonjoinpointregres-sionanalysis.Joinpointisatoolusedtodescribeandquantifytrendsbyfittingobservedratestolinesconnectedat‘‘join-points’’wheretrendschangeindirectionormagnitude.13,15AccordingtodatafromtheSEER13cancerregistries,inci-denceratesinthemostrecent5years(2005-2009)decreasedinmalesby0.6%peryearandwerestableinfemales(Table5).Incidenceratesaredecreasingforall4majorcancersitesexceptfemalebreast,forwhichratesremainedrelativelystablefrom2005to2009afterdecreasingby2%peryearfrom1999to2005.Lungcancerincidenceratesinwomenbegandeclininginthelate1990s,morethanadecadeafterthedeclinebeganinmen.6Differencesinlungcancerinci-dencepatternsbetweenmenandwomenreflecthistoricaldifferencesintobaccouse;cigarettesmokingprevalencepeakedabout20yearslaterinwomenthaninmen.16Recentrapiddeclinesincolorectalcancerincidencerateshavelargelybeenattributedtoincreasesinscreeningthatcandetectandallowtheremovalofprecancerouspolyps.17-19Althoughjoinpointtrendanalysisshowsthattheincidencerateforprostatecancerdeclinedsteadilyby1.9%peryearfrom2000to2009,itisimportanttorealizethatannualratesfluctuatewidely(Fig.3),likelyreflectingvariationintheprevalenceofprostate-specificantigentestingforthedetectionofprostatecancer.Forexample,intheSEER13areas,thedelay-adjustedprostatecancerincidencerateincreasedfrom154(per100,000)to164from2005to2006,thendroppedfrom168to153from2007to2008.
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FIGURE4.TrendsinDeathRatesAmongMalesforSelectedCancers,UnitedStates,1930to2009.
Ratesareageadjustedtothe2000USstandardpopulation.DuetochangesinInternationalClassificationofDiseases(ICD)coding,numeratorinformationhaschangedovertime.Ratesforcancersofthelungandbronchus,colorectum,andliverareaffectedbythesechanges.
FIGURE5.TrendsinDeathRatesAmongFemalesforSelectedCancers,UnitedStates,1930to2009.
Ratesareageadjustedtothe2000USstandardpopulation.DuetochangesinInternationalClassificationofDiseases(ICD)coding,numeratorinformationhaschangedovertime.Ratesforcancersoftheuterus,ovary,lungandbronchus,andcolorectumareaffectedbythesechanges.*Uterusincludesuterinecervixanduterinecorpus.
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TABLE5.TrendsinCancerIncidence(Delay-Adjusted)andDeathRatesforSelectedCancersbySex,UnitedStates,
1992to2009
TREND1
YEARS
APC
YEARS
TREND2
APC
YEARS
TREND3
APC
2005-2009AAPC
AllsitesIncidenceMaleFemaleDeathMaleFemale
Lung&bronchusIncidenceMaleFemaleDeathMaleFemaleColorectumIncidenceMaleFemaleDeathMaleFemale
Liver&intrahepaticbileductIncidenceMaleFemaleDeathMaleFemale
MelanomaofskinIncidenceMaleFemaleDeathMaleFemaleThyroidIncidenceMaleFemaleDeathMaleFemaleFemalebreastIncidenceDeathProstateIncidenceDeath
1992-19941992-19981992-20011992-19941992-20091992-19971992-20051992-20021992-19951992-19951992-20021992-20011992-20091992-20091992-20091992-20091992-20091992-19971992-20091992-20091992-19961992-19991992-20091992-19941992-19991992-19951992-19951992-1994
À5.6*0.8*À1.4*À0.2À1.9*0.7À1.9*0.6*À2.6*À1.8*À2.0*À1.7*3.7*3.0*2.3*1.3*2.5*3.9*0.4*À0.5*À1.44.1*1.6*À6.41.3*À1.3*À11.1*À1.3
1994-20091998-20062001-20091994-2002
À0.6*À0.5*À1.8*À0.8*
2006-20092002-2009
1.0À1.5*
À0.6*0.6À1.8*À1.5*À1.9*À0.3*À2.8*À1.0*
1997-20092005-20092002-20091995-19981995-19982002-20052001-2009
À0.3*À2.8*À1.0*1.51.9À4.0*À3.1*
1998-20091998-20092005-2009
À2.6*À2.1*À2.4*
À2.6*À2.1*À2.4*À3.1*3.7*3.0*2.3*1.3*2.5*1.7*0.4*À0.5*
1997-20091.7*
1996-20091999-20091994-20091999-20051995-19981995-20001994-2009
5.6*7.0*0.8*À2.0*À3.4*2.0À3.7*
2005-20091998-20092000-2009
1.1À1.9*À1.9*
5.6*7.0*1.6*0.8*1.1À1.9*À1.9*À3.7*
APCindicatesannualpercentchangebasedonincidence(delay-adjusted)andmortalityratesageadjustedtothe2000USstandardpopulation;AAPC,averageannualpercentchange.
*TheAPCorAAPCissignificantlydifferentfrom0(P<.05).
Note:TrendsanalyzedbytheJoinpointRegressionProgram,version3.5.0,allowingupto3joinpoints.IncidencetrendsbasedonSurveillance,Epidemiology,andEndResults(SEER)13areas.
TrendsinCancerMortality
Cancerdeathratesdecreasedby1.8%peryearinmalesandby1.5%peryearinfemalesduringthemostrecent5yearsofdata(2005-2009).Thesedeclineshavebeenconsistentsince2001and2002inmenandwomen,respectively,andarelargerinmagnitudethanthoseoccurringinthepreviousdecade(Table5).Deathratespeakedinmenin1990(279.8per100,000),inwomenin1991(175.3per100,000),andoverallin1991(215.1per100,000).Between1990/1991and2009,cancerdeathratesdecreased24%inmen,16%inwomen,and20%overall.Figure6showsthatasaresultofalmosttwodecadesofconsistentdeclinesincancerdeathrates,about1,177,300cancerdeathswereaverted,152,900ofthesein2009alone.
Deathratescontinuetodecreaseforthe4majorcancersites(Figs.4and5).Overthepasttwodecadesofdata,deathrateshavedecreasedfromtheirpeakbymorethan30%forcancersofthecolorectum,femalebreast,andmale
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FIGURE6.TotalNumberofCancerDeathsAvertedFrom1991to2009inMenandFrom1992to2009inWomen.
Thebluelinerepresentstheactualnumberofcancerdeathsrecordedineachyear,andtheredlinerepresentsthenumberofcancerdeathsthatwouldhavebeenexpectedifcancerdeathrateshadremainedattheirpeak.
lung,andbymorethan40%forprostatecancer.Thedecreaseinlungcancerdeathrates—amongmensince1990andamongwomensince2002—isduetothereductionintobaccouse,20whilethedecreaseindeathratesforfemalebreast,colorectal,andprostatecancerslargelyreflectsimprovementsinearlydetectionand/ortreatment.17,21,22Overthepast10yearsofdata(2000-2009),thelargestannualdeclinesindeathrateswereforchronicmyeloidleukemia(8.4%),cancersofthestomach(3.1%)andcolorectum(3.0%),andnon-Hodgkinlymphoma(3.0%).
40years,whilelungcancerranksfirstamongmenaged40yearsandolder.Amongfemales,tumorsofthebrainandothernervoussystemaretheleadingcauseofcancerdeathamongchildrenandadolescents(agedyoungerthan20years),breastcancerranksfirstamongwomenaged20to59years,andlungcancercausesthemostcancerdeathsinthoseaged60yearsandolder.
RegionalVariationsinCancerRates
Tables8and9depictcancerincidenceanddeathratesforselectedcancersbystate.Lungcancershowsthelargestgeographicvariationincanceroccurrencebyfar,reflectingthelargehistoricalandcontinuingdifferencesinsmokingprevalenceamongstates.20Forexample,lungcancerincidenceratesinKentucky,whichhashistoricallyhadthehighestsmokingprevalence,arealmost4-foldhigherthanthoseinUtah,whichhasthelowestsmokingprevalence(128vs34casesper100,000men).Incon-trast,statevariationsforothercancersitesaresmallerinbothabsoluteandproportionateterms.Forexample,thebreastcancerincidencerateinConnecticut,whichhasthehighestrate(137per100,000women),isonly28%higherthanthatinArizona,whichhasthelowest
RecordedNumberofDeathsFromCancerin2009
Atotalof2,437,163deathswererecordedintheUnitedStatesin2009,567,628ofthesefromcancer.23Canceristhesecondleadingcauseofdeath,followingheartdisease,accountingfor23%ofalldeaths.However,within20-yearagegroups,canceristheleadingcauseofdeathamongbothmenandwomenaged40to79years(Table6).
Table7presentsthenumbersofdeathsforallcancerscombinedandforthe5mostcommonsitesforeach20-yearagegroup.Amongmales,leukemiaistheleadingcauseofcancerdeathamongthoseagedyoungerthan
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TABLE6.TenLeadingCausesofDeathbyAgeandSex,UnitedStates,2009
ALLAGESMALEAllCauses1,217,3791
Heartdiseases307,225Cancer296,763
FEMALEAllCauses1,219,784Heartdiseases292,188Cancer270,865
AGES1TO19MALEAllCauses13,919
FEMALEAllCauses7,702
AGES20TO39MALEAllCauses62,116
FEMALEAllCauses28,792
AGES40TO59MALEAllCauses227,801Cancer54,483
FEMALEAllCauses142,628Cancer50,579
AGES60TO79MALEAllCauses467,962Cancer154,168
FEMALEAllCauses373,658Cancer127,506
MALEAllCauses430,581Heartdiseases130,332Cancer82,765
AGES!80
FEMALEAllCauses655,337Heartdiseases193,676Cancer87,264
AccidentsAccidentsAccidentsAccidents(unintentional(unintentional(unintentional(unintentionalinjuries)injuries)injuries)injuries)5,3172,64521,3887,228Assault(homicide)2,031Intentionalself-harm(suicide)1,500Cancer1,042
Cancer848
Intentionalself-harm(suicide)8,977Assault(homicide)7,214
Cancer4,629
2
Heartdiseases52,826Heartdiseases21,353Heartdiseases118,163Chroniclowerrespiratorydiseases31,425Cerebro-vasculardisease19,751Diabetesmellitus16,646
Heartdiseases74,294Chroniclowerrespiratorydiseases31,457Cerebro-vasculardisease19,317Diabetesmellitus13,572
3
Accidents(unintentionalinjuries)75,022Chroniclowerrespiratorydiseases65,119Cerebro-vasculardisease52,073Diabetesmellitus35,054
Cerebro-vasculardisease76,769Chroniclowerrespiratorydiseases72,234Alzheimerdisease55,103
Assault(homicide)569Heartdiseases2,393
AccidentsAccidents(unintentional(unintentionalinjuries)injuries)24,26511,333Intentionalself-harm(suicide)11,858Chronicliverdisease&cirrhosis10,562Diabetesmellitus7,346
Cerebro-vasculardisease5,283Chroniclowerrespiratorydiseases5,134
Chroniclowerrespiratorydiseases27,930Cerebro-vasculardisease24,649Alzheimerdisease18,689
Cerebro-vasculardisease51,445Alzheimerdisease47,856
4
Congenitalanomalies495Heartdiseases5,256
Intentionalself-harm(suicide)2,140Assault(homicide)1,443
5
Congenitalanomalies563
Intentionalself-harm(suicide)434Heartdiseases295
Cancer4,256
Chroniclowerrespiratorydiseases35,212Influenza&pneumonia18,559
6
Accidents(unintentionalinjuries)42,999Diabetesmellitus33,651
Heartdiseases411HIVdisease1,295
Pregnancy,childbirth&puerperium
721Influenza&pneumonia718
ChronicliverAccidentsNephritis,disease&(unintentionalnephroticcirrhosisinjuries)syndrome&4,65412,728nephrosis
8,254Diabetesmellitus4,477
Influenza&pneumonia13,134
7
Intentionalself-harm(suicide)29,089Influenza&pneumonia25,128
Influenza&pneumonia265Influenza&pneumonia272Influenza&pneumonia847
Cerebro-vasculardisease6,730Chroniclowerrespiratorydiseases5,265HIVdisease4,462
Nephritis,AccidentsNephritis,nephrotic(unintentionalnephroticsyndrome&injuries)syndrome&nephrosis7,431nephrosis9,17411,482Influenza&pneumonia7,616
Alzheimerdisease7,060
Accidents(unintentionalinjuries)10,590Diabetesmellitus10,209
Diabetesmellitus15,002
8
Influenza&pneumonia28,564
Chroniclowerrespiratorydiseases157Cerebro-vasculardisease109Septicemia103
Chroniclowerrespiratorydiseases118Septicemia99
Chronicliverdisease&cirrhosis825Diabetesmellitus812
HIVdisease686
Intentionalself-harm(suicide)3,813Influenza&pneumonia2,564
Nephritis,nephroticsyndrome&nephrosis14,302Accidents(unintentionalinjuries)13,870Hypertension&hypertensiverenaldisease*10,444
9
Nephritis,nephroticsyndrome&nephrosis23,930Alzheimerdisease23,900
Nephritis,nephroticsyndrome&nephrosis25,005Septicemia19,268
Cerebro-vasculardisease591Diabetesmellitus564
Chronicliverdisease&cirrhosis7,183Septicemia6,955
Septicemia6,919
10
Cerebro-vasculardisease72Cerebro-vasculardisease744
Viralhepatitis3,456
Septicemia2,384
Influenza&pneumonia6,350Parkinsondisease7,864
HIVindicateshumanimmunodeficiencyvirus.
*Includesprimaryandsecondaryhypertension
Note:Deathswithineachagegroupdonotsumtoallagescombinedduetotheinclusionofunknownages.InaccordancewiththeNationalCenterforHealthStatistics’cause-of-deathranking,‘‘Symptoms,signs,andabnormalclinicalorlaboratoryfindings’’andcategoriesthatbeginwith‘‘Other’’and‘‘Allother’’werenotranked.Source:USMortalityData,2009,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention,2012.
rate(107per100,000women).Forcancersthatcanbedetectedbyscreeningorothertestingpractices,suchasthoseoftheprostate,femalebreast,andcolorectum,statevariationinincidenceratesreflectsdifferencesintheuti-lizationofthesetestsaswellasdifferencesindiseaseoccurrence.
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TABLE7.FiveLeadingTypesofCancerDeathbyAgeandSex,UnitedStates,2009
ALLAGES
<20
20TO39
MALE
ALLSITES296,758
ALLSITES1,086
ALLSITES4,256
ALLSITES54,483
ALLSITES154,168
ALLSITES82,765
40TO59
60TO79
!80
Lung&bronchusLeukemiaLeukemiaLung&bronchusLung&bronchus
87,69733059014,96052,272ProstateBrain&ONSBrain&ONSColorectumColorectum28,0882815565,49513,200ColorectumOtherendocrinesystemColorectumLiver&intrahepaticbileductProstate26,807994564,55311,717PancreasBones&jointsNon-HodgkinlymphomaPancreasPancreas17,870933053,6629,871
Liver&intrahepaticbileductSofttissueLung&bronchusEsophagusLiver&intrahepaticbileduct
13,035832792,6156,309
FEMALE
ALLSITES270,856
ALLSITES878
ALLSITES4,629
ALLSITES50,579
ALLSITES127,506
Lung&bronchus
20,171Prostate15,099Colorectum7,652Urinarybladder
4,579Pancreas4,215
ALLSITES87,264
Lung&bronchus
70,389Breast40,678Colorectum25,042Pancreas17,758Ovary14,436Brain&ONS
241Leukemia231Bones&joints
86Softtissue81
Otherendocrinesystem
63Breast1,056Uterinecervix
438Leukemia388Brain&ONS
333Colorectum331Breast11,572Lung&bronchus
11,174Colorectum4,139Ovary3,189Pancreas2,523Lung&bronchus
39,782Breast17,165Colorectum9,968Pancreas8,782Ovary7,171Lung&bronchus
19,188Breast10,882Colorectum10,600Pancreas6,371
Non-Hodgkinlymphoma
4,129
ONSindicatesothernervoussystem.
Note:Rankingorderexcludes‘‘Miscellaneousmalignantcancer’’and‘‘Insitu,benign,orunknownbehaviorneoplasm.’’
CancerOccurrencebyRace/Ethnicity
Cancerincidenceanddeathratesvaryconsiderablyamongracialandethnicgroups(Table10).Forallcancersitescom-bined,AfricanAmericanmenhavea14%higherincidencerateanda33%higherdeathratethanwhitemen,whereasAfricanAmericanwomenhavea6%lowerincidenceratebuta16%higherdeathratethanwhitewomen.Cancerinci-denceanddeathratesarehigheramongAfricanAmericanmenthanwhitemenforeverycancersitelistedinTable10.Factorsknowntocontributetoracialdisparitiesinmortalityvarybycancersiteandincludedifferencesinexposuretounderlyingriskfactors(eg,historicalsmokingprevalenceforlungcancer),accesstohigh-qualityscreening(breast,cervi-cal,andcolorectalcancers),andtimelydiagnosisandtreat-ment.24Thehigherbreastcancerincidencerateamongwhitescomparedtowomenofotherracialorethnicgroupsisthoughttoreflectacombinationoffactorsthataffectbothdiagnosis(ie,moreprevalentmammographyamongwhitewomen)andunderlyingdiseaseoccurrence(eg,laterageatfirstbirthandgreateruseofmenopausalhormonetherapyamongwhitewomen).2522
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CancerincidenceanddeathratesarelowerinotherracialandethnicgroupsthaninwhitesandAfricanAmericansforallcancersitescombinedandforthe4mostcommoncancersites.However,incidenceanddeathratesforcancersrelatedtoinfectiousagents,suchasuterinecervix,stomach,andliver,aregenerallyhigherinminoritypopulationsthaninwhites.StomachandlivercancerincidenceanddeathratesaretwiceashighinAsianAmericans/PacificIslandersasinwhites,reflectinganincreasedprevalenceofchronicinfectionwithHelicobacterpyloriandhepatitisBvirusinthispop-ulation.26KidneycancerincidenceanddeathratesarethehighestamongAmericanIndians/AlaskanNatives,whichmayreflectthehighprevalenceofobesityandsmokinginthispopulation.27CancerincidenceratescanonlybeadjustedfordelayedreportinginwhitesandAfricanAmericansbecausethelong-termincidencedatarequiredfordelayadjustmentarenotavailableforotherracialandethnicgroups.Duringthepast10yearsofdata(2000-2009),whileincidencerates(unadjustedfordelayedreporting)declinedby1%ormoreperyearamongmenofall
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TABLE8.IncidenceRatesforSelectedCancersbyState,UnitedStates,2005to2009
ALLCANCERS
STATE
MALE
FEMALE
BREASTFEMALE
COLORECTUMMALE
FEMALE
LUNG&BRONCHUSMALE
FEMALE
NON-HODGKINLYMPHOMAMALE
FEMALE
PROSTATEMALE
URINARYBLADDERMALE
FEMALE
Alabama*AlaskaArizonaArkansas†CaliforniaColoradoConnecticutDelaware
Dist.ofColumbia†FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana*MaineMarylandMassachusettsMichiganMinnesotaMississippi*MissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio
OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexas*UtahVermontVirginia†WashingtonWestVirginiaWisconsin†Wyoming
UnitedStates582.4523.7439.6551.6510.5493.9594.1613.1562.6528.3569.8504.3528.7573.5539.3568.2563.8615.4614.5600.1532.8581.1578.0566.5612.1548.3531.6547.1514.4584.8593.0480.8583.3579.2555.6546.5567.8521.7583.8590.8559.9494.3565.6533.7469.7554.3537.0552.6576.5513.8513.8550.7395.4435.7361.0381.6398.9396.4462.5448.2399.0403.1397.2401.6411.6437.8421.5436.5422.2459.7410.9467.3411.8459.2433.3424.4395.5423.4417.9426.6405.1452.4454.1370.5442.7418.1421.0421.5426.7432.3453.7466.7397.7389.8413.7394.6345.2455.5396.9438.4441.6404.6388.8419.3119.4130.0106.7109.2123.3125.4137.3127.9128.3114.9119.7125.1119.1125.4116.9123.5124.6121.2118.9128.5124.8132.8120.3128.5114.3121.9123.0124.7114.3132.5130.0111.4125.8125.0126.4119.6123.9130.7125.8133.2121.4118.4119.6116.1108.0129.4124.0131.8112.2118.8113.2122.359.755.441.954.750.746.055.356.453.049.653.459.645.861.357.559.657.665.764.655.849.953.352.951.262.758.352.762.852.151.958.246.454.654.562.956.356.147.959.455.252.254.256.253.039.345.849.848.661.848.249.554.041.344.231.839.838.135.141.141.442.237.938.838.736.544.843.345.940.446.943.743.937.940.340.940.144.742.038.546.239.339.543.034.641.538.744.142.342.138.344.543.038.741.041.337.031.340.437.937.245.437.438.740.3104.883.862.5107.462.457.278.590.677.282.895.668.764.688.999.587.685.0128.2101.995.577.381.087.366.7116.4100.073.078.276.881.476.155.777.1100.171.593.2101.974.287.588.296.772.2106.181.833.882.085.273.3112.770.659.782.754.663.048.259.645.244.661.068.845.958.154.740.448.160.664.056.355.080.158.267.656.664.061.349.856.364.758.551.765.562.256.839.355.158.246.260.064.759.258.264.753.747.161.549.922.864.654.557.773.651.247.955.919.522.017.621.923.022.225.924.021.321.721.620.922.123.823.126.523.625.124.225.621.125.124.826.921.822.323.024.220.923.925.519.125.923.022.023.022.623.325.423.920.620.523.022.623.024.021.426.624.022.520.923.313.418.313.315.015.615.817.917.113.515.214.213.017.316.317.018.517.217.316.818.414.216.317.818.114.415.915.317.715.417.417.614.517.815.617.816.017.616.117.817.613.616.016.215.915.517.714.317.516.816.515.516.2162.1139.9118.1153.4143.0152.3165.2182.8185.1137.7167.8128.4160.1157.9129.2142.2157.3139.0173.7153.6158.4157.5166.5179.0174.2132.9164.1150.9138.4155.1172.4141.6167.2158.3169.4144.1153.2145.1154.1152.6159.0149.1145.6142.7169.8150.9157.7155.3138.4144.4162.6151.433.238.231.532.533.931.847.944.224.635.633.026.236.740.236.343.038.240.334.448.133.545.042.540.031.436.337.635.838.448.145.126.942.537.540.939.035.537.644.552.430.434.234.930.128.843.633.839.539.336.442.637.57.49.58.37.98.08.312.511.38.08.87.86.48.910.38.98.79.39.98.213.59.312.310.99.67.28.49.78.911.013.311.86.410.99.110.19.78.710.011.013.88.08.08.46.95.612.68.19.511.49.310.49.3
Ratesareper100,000andageadjustedtothe2000USstandardpopulation.
*Datafor2005arelimitedtocasesdiagnosedfromJanuarythroughJuneduetotheeffectoflargemigrationsofpopulationsonthisstateasaresultofHurricaneKatrinainSeptember2005.
†Thisstate’sincidencedataarenotincludedinoverallUSratesbecauseregistrydatasubmittedfor2009didnotmeethigh-qualitystandardsaccordingtotheNorthAmericanAssociationofCentralCancerRegistries.
racial/ethnicgroupsexceptAmericanIndians/AlaskaNatives,amongwomenonlyslightdeclines(0.2%-0.3%peryear)occurredamongnon-HispanicwhitesandHispanics(Table11).Incontrast,cancerdeathratesdeclinedby1.5%ormoreperyearamongmenandby1.1%ormoreperyearamongwomenofallraces/ethnicitiesexceptAmericanIndians/AlaskaNatives,amongwhomrateswerestable.Notably,thelargest
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TABLE9.DeathRatesforSelectedCancersbyState,UnitedStates,2005to2009
ALLSITES
STATE
MALE
FEMALE
BREASTFEMALE
COLORECTUMMALE
FEMALE
LUNG&BRONCHUSMALE
FEMALE
NON-HODGKINLYMPHOMAMALE
FEMALE
PANCREASMALE
FEMALE
PROSTATEMALE
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelaware
Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio
OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming
UnitedStates259.0209.5182.1253.7194.9185.0212.0229.6256.3206.0230.8184.6195.9229.4244.9220.1221.5267.2260.8240.0226.5222.6228.1206.8274.2237.6203.4215.2213.3218.2213.8190.1201.3236.9210.2243.4243.0214.4232.4228.8241.3206.0257.9212.5154.1211.9228.5209.6254.8218.8199.5219.4157.4159.6130.0161.2141.7134.4149.6162.8160.4141.9146.8119.6143.5160.1163.2151.0149.9173.6165.8161.6157.3154.0160.9146.0158.8160.4150.5145.7158.4154.7157.7134.3145.2152.7144.1163.4161.2155.5158.5151.3151.0141.5162.0142.8109.6152.8153.9153.9173.2152.0148.3151.124.023.520.523.622.319.922.523.028.021.523.017.821.324.223.921.822.923.426.321.424.921.924.021.324.924.920.521.223.321.426.121.122.523.522.025.223.821.524.121.924.020.924.022.221.520.724.821.923.621.621.423.022.920.016.822.518.117.417.320.323.118.320.218.715.922.522.520.621.224.325.120.522.019.620.218.024.921.617.822.520.719.322.018.719.419.821.622.522.918.522.319.620.520.122.420.214.318.819.917.724.218.718.920.215.114.111.615.212.913.013.014.317.713.013.810.813.415.615.015.214.016.615.714.414.613.814.712.616.214.614.715.115.313.215.513.514.013.614.815.514.813.915.213.314.114.215.113.110.414.214.212.716.813.114.214.189.462.950.292.549.245.155.969.264.763.575.851.251.367.882.067.570.699.784.473.165.662.670.355.297.379.857.162.462.562.057.944.455.279.356.577.482.761.268.566.379.662.291.563.428.161.670.658.187.559.952.865.741.145.533.246.333.131.938.848.534.839.338.727.035.641.947.239.441.055.544.146.441.842.543.937.242.346.041.336.048.843.038.329.135.841.634.344.546.943.640.043.040.035.547.235.916.144.340.742.851.938.738.539.68.37.97.58.88.18.08.18.49.47.87.77.58.18.89.79.29.69.29.09.27.98.39.29.68.38.48.19.06.77.78.16.78.07.67.49.48.98.69.28.88.07.89.38.17.58.18.38.89.19.48.18.45.35.84.85.25.04.45.25.03.54.94.64.25.45.55.65.55.25.95.25.54.95.16.15.24.85.35.45.74.85.05.54.44.95.05.55.65.95.75.64.64.85.15.55.04.65.05.05.56.45.75.95.213.312.310.913.611.810.914.712.316.312.012.412.911.513.113.112.012.512.513.812.212.913.113.911.813.813.112.412.212.313.413.311.612.612.112.813.112.012.213.412.412.511.113.011.79.512.513.012.411.212.913.212.59.510.07.99.49.48.910.29.710.78.78.99.49.810.19.48.89.49.411.09.810.410.310.19.59.99.78.79.49.810.610.08.99.79.78.79.98.710.010.08.49.79.19.38.78.09.69.99.87.79.89.79.528.722.119.725.323.223.824.824.941.319.627.516.226.725.523.823.921.424.627.124.426.723.422.624.331.022.727.224.723.423.222.424.322.225.925.225.423.625.723.722.526.922.925.321.424.522.026.024.921.725.620.923.6
Ratesareper100,000andageadjustedtothe2000USstandardpopulation.
declinesindeathratesoccurredamongmenofAfricanAmerican(2.4%peryear)andHispanic(2.3%peryear)heritage.
CancerSurvival
AfricanAmericansarelesslikelytosurvivecancerthanwhites.The5-yearrelativesurvivalisloweramongAfricanAmericansforeverystageofdiagnosisfornearlyeverytype
24
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ofcancer(Fig.7).Thesedisparitiesmayresultfrominequal-itiesinaccesstoandreceiptofqualityhealthcareand/orfromdifferencesincomorbidities.AsshowninFigure8,AfricanAmericansarelesslikelythanwhitestobediagnosedwithcanceratalocalizedstage,whentreatmentisusuallylessextensiveandmoresuccessful.Theextenttowhichfactorsotherthanstageatdiagnosiscontributetotheoverallsurvivaldifferentialisunclear.28AstudyofMedicare-insuredpatients
TABLE10.IncidenceandDeathRatesbySite,Race,andEthnicity,UnitedStates,2005to2009
WHITE
AFRICANAMERICAN
ASIANAMERICANANDPACIFICISLANDER
AMERICANINDIANANDALASKANATIVE*
HISPANIC/LATINO
Incidence
AllsitesMaleFemale
Breast(female)ColorectumMaleFemale
Kidney&renalpelvisMaleFemale
Liver&intrahepaticbileductMaleFemale
Lung&bronchusMaleFemaleProstateStomachMaleFemale
Uterinecervix
543.1424.0123.352.839.221.211.29.13.182.357.5141.08.44.07.8
619.7396.8118.065.148.023.312.115.04.299.351.3228.716.38.210.4
Mortality
AllsitesMaleFemale
Breast(female)ColorectumMaleFemale
Kidney&renalpelvisMaleFemale
Liver&intrahepaticbileductMaleFemale
Lung&bronchusMaleFemaleProstateStomachMaleFemale
Uterinecervix
216.7150.822.419.513.65.92.77.43.165.340.821.74.32.22.2
288.3174.631.629.819.86.02.611.94.082.638.053.110.34.84.3
132.693.211.913.19.62.91.314.56.135.918.510.09.05.32.0
184.9135.916.618.814.68.84.111.95.948.333.219.78.33.83.5
146.4100.614.915.310.25.02.311.85.330.814.117.87.44.33.0
327.5286.285.941.432.110.15.121.68.149.428.177.216.19.37.2
423.2360.389.150.741.129.016.616.47.667.449.598.813.06.410.1
418.7333.293.046.933.319.811.417.56.645.426.6124.913.58.111.8
Ratesareper100,000populationandageadjustedtothe2000USstandardpopulation.RaceandethnicitycategoriesarenotmutuallyexclusiveofHispanicorigin.
*DatabasedonIndianHealthServiceContractHealthServiceDeliveryAreas.
TABLE11.Ten-YearTrendsinCancerIncidenceandMortalityRatesbyRace/Ethnicity,UnitedStates,2000to2009
2000-2009AAPC
INCIDENCE
MALE
FEMALE
MALE
MORTALITY
FEMALE
Allraces/ethnicitiesNon-HispanicwhiteAfricanAmerican
AsianAmerican/PacificIslanderAmericanIndian/AlaskaNative†Hispanic‡
AAPCindicatesaverageannualpercentchange.
À1.1*À1.0*À1.4*À1.8*À0.7À1.7*À0.3*À0.2*0.00.20.0À0.3*À1.8*À1.5*À2.4*À1.5*À0.8À2.3*À1.4*À1.3*À1.5*À1.1*À0.8À1.4*
*AAPCisstatisticallysignificant(P<.05).
†DatabasedonIndianHealthServiceContractHealthServiceDeliveryAreas.
‡ExcludesdeathsfromtheDistrictofColumbia,Minnesota,NewHampshire,andNorthDakotaduetounreliableHispanicorigindataforsomeyears.Notes:TrendsanalyzedbytheJoinpointRegressionProgram,version3.5.0,allowingupto2joinpoints.IncidencetrendsbasedontheNorthAmericanAssocia-tionofCentralCancerRegistries(NAACCR)data.RaceandethnicitycategoriesarenotmutuallyexclusiveofHispanicorigin.
CancerStatistics,2013
FIGURE7.Five-YearRelativeSurvivalRatesforSelectedCancersbyRaceandStageatDiagnosis,UnitedStates,2002to2008.
*Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.
†Thesurvivalrateforcarcinomainsituoftheurinarybladderis96%forAllRaces,97%forWhites,and91%forAfricanAmericans.
showedthatAfricanAmericansremainlesslikelythanwhitestoreceivestandardcancertherapiesforlung,breast,colorectal,andprostatecancers.29SomestudiessuggestthatAfricanAmericanswhoreceivecancertreatmentandmedicalcaresimilartothatofwhitesexperiencesimilaroutcomes.3026
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Therehavebeennotableimprovementsinsurvivaloverthepast3decadesformostcancersforbothwhitesandAfricanAmericans(Table12).Between1975to1977and2002to2008,overall5-yearrelativesurvivalratesincreased19%amongwhitesand21%amongAfricanAmericans.
CACANCERJCLIN2013;63:11–30
FIGURE8.DistributionofSelectedCancersbyRaceandStageatDiagnosis,UnitedStates,2002to2008.
*Theproportionsofcarcinomainsituoftheurinarybladderare51%forAllRaces,52%forWhites,and37%forAfricanAmericans.Stagecategoriesdonotsumto100%becausesufficientinformationisnotavailabletoassignastagetoallcancercases.
Thelargestimprovementsinsurvivalhavebeenforleukemiaandnon-Hodgkinlymphoma,whilecancersofthelungandpancreashaveshowntheleastimprovement.Relativesurvivalratescannotbecalculatedforsomeminoritypopulationsbecauseaccuratelifeexpectanciesarenotavailable.Comparisonofcause-specificsurvivalratesofcancerpatientsdiagnosedfrom2002to2008inSEERregistryareasoftheUnitedStatesindicatethatallminoritymalepopulationshaveagreaterprobabilitythanwhitesofdyingfromcancerwithin5yearsofdiagnosis,althoughthedifferenceissmallforHispanicmen.6Incontrast,amongwomen,AsianAmericans/PacificIslanders(69.1%)and
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TABLE12.Trendsin5-YearRelativeSurvivalRates*(%)byRaceandYearofDiagnosis,UnitedStates,1975to2008
ALLRACES
1975TO1977
1987TO1989
2002TO2008
1975TO1977
WHITE1987TO1989
2002TO2008
1975TO1977
AFRICANAMERICAN
1987TO1989
2002TO2008
Allsites
Brain&othernervoussystemBreast(female)ColonEsophagus
HodgkinlymphomaKidney&renalpelvisLarynxLeukemia
Liver&intrahepaticbileductLung&bronchusMelanomaoftheskinMyeloma
Non-HodgkinlymphomaOralcavity&pharynxOvaryPancreasProstateRectumStomachTestisThyroid
UrinarybladderUterinecervixUterinecorpus4922755157250663431282254753362684815839273698756298461107957664351388285154384835820959579708368†35†90†65†19†87†72†63†58†16†17†93†43†71†65†43†6†100†68†28†96†98†80†6983†5022765167250673531282254754353694814839274708857288561118057674461388275256383855919969480738469†34†92†66†21†88†72†6559†16†17†93†43†72†67†43†6†100†69†27†97†98†81†7085†3925624537049593321157‡30483642261451673‡,§905065604332715377255563531179‡30463434672521988‡9263575760†41†78†55†14†83†70†5151†11†14†70‡43†63†45†365†98†61†28†8996†62†6163
*SurvivalratesareadjustedfornormallifeexpectancyandarebasedoncasesdiagnosedintheSurveillance,Epidemiology,andEndResults(SEER)9areasfrom1975to1977,1987to1989,and2002to2008andfollowedthrough2009.
†Thedifferenceinratesbetween1975to1977and2002to2008isstatisticallysignificant(P<.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.§Survivalrateisfor1978to1980.
Hispanics(67.2%)havethehighest5-yearcause-specificsurvival,followedbywhites(66.2%),AmericanIndians/AlaskaNatives(60.6%),andAfricanAmericans(57.6%).Minoritypopulationsaregenerallymorelikelythannon-Hispanicwhitestobediagnosedatadistantstageofdiseaseforall4majorcancersites.31CancerinChildren
Canceristhesecondmostcommoncauseofdeathamongchildrenages1to14yearsintheUnitedStates,surpassedonlybyaccidents;1,320childrendiedfromcancerin2009.1Leukemiaaccountsforalmostone-thirdofallcancers(includingbenignbraintumors)diagnosedin
TABLE13.Trendsin5-YearRelativeSurvivalRates*(%)forChildren(0to14Years)byYearofDiagnosis,
UnitedStates,1975to2008
1975TO1977
1978TO1980
1981TO1983
1984TO1986
1987TO1989
1990TO1992
1993TO1995
1996TO1998
1999TO2001
2002TO2008
Allsites
AcutelymphocyticleukemiaAcutemyeloidleukemiaBone&joint
Brain&othernervoussystemHodgkinlymphomaNeuroblastoma
Non-HodgkinlymphomaSofttissueWilmstumor58581950‡57815343617363662648588757537579677127‡57‡568855676987687331‡57‡629152707391727837‡67‡64876371669276834267659776778092778442‡74719567817792798749707596668470928188587074947389779483†91†64†79†7597†74†85†82†90†
*Survivalratesareadjustedfornormallifeexpectancyandarebasedonfollow-upofpatientsthrough2009.†Thedifferenceinratesbetween1975to1977and2002to2008isstatisticallysignificant(P<.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.
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childrenaged0to14years,77%ofwhichareacutelymphocyticleukemias.Cancersofthebrainandothernervoussystemarethesecondmostcommoncancertype(25%),followedbysofttissuesarcomas(7%,halfofwhicharerhabdomyosarcoma),neuroblastoma(6%),renal(Wilms)tumors(5%),andHodgkinandnon-Hodgkinlymphomas(4%each).6From2005to2009,theoverallincidencerateforcancerinchildrenaged14yearsandyoungerincreasedslightlyby0.5%peryear,atrendthathasbeenconsistentsince1975.Thedeathrateforchild-hoodcancerhasdecreasedbymorethanhalfoverthepast3decades,from4.9(per100,000)in1975to2.1in2009.Table13providestrendsinsurvivalratesforthemostcommonchildhoodcancers.The5-yearrelativesurvivalrateforallcancersitescombinedimprovedfrom58%forchildrendiagnosedbetween1975and1977to83%forthosediagnosedbetween2002and2008.Thesubstantialprogressforallofthemajorchildhoodcancersreflectsbothimprovementsintreatmentandhighlevelsofparticipationinclinicaltrials.
discouragetheuseoftheseestimatestotrackyear-to-yearchangesincanceroccurrenceanddeath.Thedatausedfortrackingcancertrendsareage-standardizedorage-specificcancerdeathratesfromtheNCHSandcancerincidenceratesfromSEERand/orNPCR.Nevertheless,theAmericanCancerSocietyprojectionsofthenumbersofnewcancercasesanddeathsprovideareasonablyaccurateestimateofthecurrentcancerburdenintheUnitedStates.Errorsinreportingrace/ethnicityinmedicalrecordsandondeathcertificatesmayresultinunderestimatesofcancerincidenceandmortalityratesinnonwhiteandnon-AfricanAmericanpopulations.ItisalsoimportanttonotethatcancerdataintheUnitedStatesareprimarilyreportedforbroadracialandethnicminoritygroupsthatarenothomogenous,andthusimportantdifferencesinthecancerburdenwithinracial/ethnicsubgroupsaremasked.
Conclusions
In2009,Americanshada20%lowerriskofdeathfromcancerthanin1991,whencancerdeathratespeaked.Despitethissubstantialprogress,alldemographicgroupshavenotbenefittedequally,particularlyforcancerssuchascolorectalandbreast,forwhichmortalitydeclineshavebeenattributedtoearlierdetectionandimprovementsintreatment.Furtherprogresscanbeacceleratedbyapplyingexistingcancercontrolknowledgeacrossallsegmentsofthepopulation,withanemphasisonthosegroupsinthelowestsocioeconomicbracketaswellasotherdisadvantagedpopulations.n
Limitations
Theprojectednumbersofnewcancercasesandcancerdeathsshouldbeinterpretedcautiouslybecausetheseestimatesaremodel-basedandmayvaryconsiderablyfromyeartoyearforreasonsotherthanchangesincanceroccurrence.Forinstance,estimatesareaffectedbychangesinmethod,whichoccurregularlyasmodelingtechniquesimproveovertimeandcancerregistrationbecomesmorecomplete.Inaddition,notallchangesincancertrendscanbecapturedbymodelingtechniques.Forthesereasons,we
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