Cancer Statistics, 2010 Ahmedin Jemal, Rebecca Siegel, Jiaquan Xu and Elizabeth Ward. DOI: /caac.20073

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1 Statistics, 21 Ahmedin Jemal, Rebecca Siegel, Jiaquan Xu and Elizabeth Ward CA J Clin 21;6;277-3; originally published online Jul 7, 21; DOI: /caac.273 This information is current as of February 3, 211 The online version of this article, along with updated information and services, is located on the World Wide Web at: To subscribe to the print issue of CA: A Journal for Clinicians, go to (US individuals only): CA: A Journal for Clinicians is published six times per year for the American Society by Wiley-Blackwell. A bimonthly publication, it has been published continuously since November 195. CA is owned, published, and trademarked by the American Society, 25 Williams Street NW, Atlanta GA 333. ( American Society, Inc.) All rights reserved. Print ISSN: Online ISSN: Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.)

2 CA CANCER J CLIN 21;6:277 3 Statistics, 21 Ahmedin Jemal, DVM, PhD 1 ; Rebecca Siegel, MPH 2 ; Jiaquan Xu, MD 3 ; Elizabeth Ward, PhD 4 Abstract Each year, the American Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data regarding cancer incidence, mortality, and survival based on incidence data from the National Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2 US standard million population. A total of 1,529,56 new cancer cases and 569,49 deaths from cancer are projected to occur in the United States in 21. Overall cancer incidence rates decreased in the most recent time period in both men (1.3% per year from 2 to 26) and women (.5% per year from 1998 to 26), largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and 2 major cancer sites in women (breast and colorectum). This decrease occurred in all racial/ethnic groups in both men and women with the exception of American Indian/Alaska Native women, in whom rates were stable. Among men, death rates for all races combined decreased by 21.% between 199 and 26, with decreases in lung, prostate, and colorectal cancer rates accounting for nearly 8% of the total decrease. Among women, overall cancer death rates between 1991 and 26 decreased by 12.3%, with decreases in breast and colorectal cancer rates accounting for 6% of the total decrease. The reduction in the overall cancer death rates translates to the avoidance of approximately 767, deaths from cancer over the 16-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart in persons younger than 85 years. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. CA J Clin 21;6: American Society, Inc. Introduction is a major public health problem in the United States and many other parts of the world. Currently, 1 in 4 deaths in the United States is due to cancer. In this article, we provide an overview of cancer statistics, including updated incidence, mortality, and survival rates, and expected numbers of new cancer cases and deaths in 21. Materials and Methods Data Sources Mortality data from 193 to 27 in the United States were obtained from the National Center for Health Statistics (NCHS). 1 Incidence data for long-term trends ( ), 5-year relative survival rates, and lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 1 Strategic Director, Surveillance, Surveillance and Health Policy Research, American Society, Atlanta, GA; 2 Manager, Surveillance Information Services, Surveillance and Health Policy Research, American Society, Atlanta, GA; 3 Epidemiologist, Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD; 4 Vice President, Surveillance and Health Policy Research, American Society, Atlanta, GA. Corresponding author: Ahmedin Jemal, DVM, PhD, Surveillance and Health Policy Research, American Society, 25 Williams Street, NW, Atlanta, GA ; ahmedin.jemal@cancer.org DISCLOSURES: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors report no conflicts of interest. 21 American Society, Inc. doi:1.12/caac.273. Available online at: and VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

3 Statistics 21 TABLE 1. Estimated New Cases and Deaths by Sex, United States, 21* ESTIMATED NEW CASES ESTIMATED DEATHS BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE All Sites 1,529,56 789,62 739,94 569,49 299,2 27,29 Oral cavity & pharynx 36,54 25,42 11,12 7,88 5,43 2,45 Tongue 1,99 7,69 3,3 1,99 1,3 69 Mouth 1,84 6,43 4,41 1,83 1,14 69 Pharynx 12,66 9,88 2,78 2,41 1,73 68 Other oral cavity 2,5 1, ,65 1,26 39 Digestive system 274,33 148,54 125,79 139,58 79,1 6,57 Esophagus 16,64 13,13 3,51 14,5 11,65 2,85 Stomach 21, 12,73 8,27 1,57 6,35 4,22 Small intestine 6,96 3,68 3,28 1, Colon 12,9 49,47 53,43 51,37 26,58 24,79 Rectum 39,67 22,62 17,5 Anus, anal canal, & anorectum 5,26 2, 3, Liver & intrahepatic bile duct 24,12 17,43 6,69 18,91 12,72 6,19 Gallbladder & other biliary 9,76 4,45 5,31 3,32 1,24 2,8 Pancreas 43,14 21,37 21,77 36,8 18,77 18,3 Other digestive organs 4,88 1,66 3,22 2, ,48 Respiratory system 24,61 13,6 11,1 161,67 89,55 72,12 Larynx 12,72 1,11 2,61 3,6 2,87 73 Lung & bronchus 222,52 116,75 15,77 157,3 86,22 71,8 Other respiratory organs 5,37 3,74 1, Bones & joints 2,65 1,53 1,12 1, Soft tissue (including heart) 1,52 5,68 4,84 3,92 2,2 1,9 Skin (excluding basal & squamous) 74,1 42,61 31,4 11,79 7,91 3,88 Melanoma-skin 68,13 38,87 29,26 8,7 5,67 3,3 Other nonepithelial skin 5,88 3,74 2,14 3,9 2,24 85 Breast 29,6 1,97 27,9 4, ,84 Genital system 311,21 227,46 83,75 6,42 32,71 27,71 Uterine cervix 12,2 12,2 4,21 4,21 Uterine corpus 43,47 43,47 7,95 7,95 Ovary 21,88 21,88 13,85 13,85 Vulva 3,9 3, Vagina & other genital, female 2,3 2, Prostate 217,73 217,73 32,5 32,5 Testis 8,48 8, Penis & other genital, male 1,25 1, Urinary system 131,26 89,62 41,64 28,55 19,11 9,44 Urinary bladder 7,53 52,76 17,77 14,68 1,41 4,27 Kidney & renal pelvis 58,24 35,37 22,87 13,4 8,21 4,83 Ureter & other urinary organs 2,49 1,49 1, Eye & orbit 2,48 1,24 1, Brain & other nervous system 22,2 11,98 1,4 13,14 7,42 5,72 Endocrine system 46,93 11,89 35,4 2,57 1,14 1,43 Thyroid 44,67 1,74 33,93 1, Other endocrine 2,26 1,15 1, Lymphoma 74,3 4,5 33,98 21,53 11,45 1,8 Hodgkin lymphoma 8,49 4,67 3,82 1, Non-Hodgkin lymphoma 65,54 35,38 3,16 2,21 1,71 9,5 Myeloma 2,18 11,17 9,1 1,65 5,76 4,89 Leukemia 43,5 24,69 18,36 21,84 12,66 9,18 Acute lymphocytic leukemia 5,33 3,15 2,18 1, Chronic lymphocytic leukemia 14,99 8,87 6,12 4,39 2,65 1,74 Acute myeloid leukemia 12,33 6,59 5,74 8,95 5,28 3,67 Chronic myeloid leukemia 4,87 2,8 2, Other leukemia 5,53 3,28 2,25 6,64 3,75 2,89 Other & unspecified primary sites 3,68 15,17 15,51 44,3 23,69 2,34 Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) *Rounded to the nearest 1; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 54,1 female carcinoma in situ of the breast and 46,77 melanoma in situ will be newly diagnosed in 21. Estimated deaths for colon and rectum cancers are combined. More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates or an undercount in the case estimate. Source: Estimated new cases are based on incidence rates from 41 states and the District of Columbia as reported by the North American Association of Central Registries(NAACCR),basedondatacollectedbycancerregistriesparticipatinginNCI sseerprogramandcdc snationalprogramofregistries,representingabout89% of the US population. Estimated deaths are based on US Mortality Data, 1969 to 27, National Center for Health Statistics, Centers for Disease Control and Prevention. 278 CA: A Journal for Clinicians

4 CA CANCER J CLIN 21;6:277 3 TABLE 2. Age-standardized Incidence Rates for All s Combined, 22-26, and Estimated New Cases* for Selected s by State, United States, 21 STATE INCIDENCE RATE ALL CASES FEMALE BREAST UTERINE CERVIX COLON & RECTUM UTERINE CORPUS LEUKEMIA LUNG & BRONCHUS MELANOMA OF THE SKIN NON- HODGKIN LYMPHOMA PROSTATE URINARY BLADDER Alabama ,64 3,45 2 2, ,16 1, ,3 92 Alaska , Arizona 29,78 3, , ,3 1,43 1,21 3,85 1,53 Arkansas ,32 1, , , ,33 61 California ,32 21,13 1,54 13,95 4,47 4,46 18,49 8,3 7,1 22,64 6,62 Colorado ,34 3,1 15 1, ,27 1, ,43 96 Connecticut ,75 2, , ,64 1,9 86 2,94 1,11 Delaware , Dist. of Columbia 2, Florida , 14,8 94 1,5 2,71 3,33 18,39 4,98 4,66 14,61 5,6 Georgia ,48 6, , ,4 6,28 2,2 1,6 6,38 1,47 Hawaii , ,6 2 Idaho , ,3 38 Illinois ,89 8, ,34 1,96 1,86 9,19 2,6 2,69 8,73 3,5 Indiana ,2 4, , ,43 1,2 1,37 4,16 1,51 Iowa ,26 2,2 1 1, , ,42 84 Kansas 13,55 1,78 9 1, , ,63 55 Kentucky ,24 3, , ,78 1,44 1,3 3,18 1,3 Louisiana ,95 2, , , ,41 85 Maine ,65 1, , ,41 53 Maryland 27,7 4,15 2 2, ,17 1,29 1,11 4,1 1,18 Massachusetts ,4 5,32 2 3,12 1, ,2 1,77 1,46 4,82 2, Michigan ,66 7, ,17 1,7 1,6 8,15 2,24 2,4 8,49 2,79 Minnesota ,8 3, , , ,1 3,87 1,16 Mississippi 14,33 1, , , ,26 51 Missouri ,16 3, , ,36 1,32 1,26 3,6 1,36 Montana , Nebraska ,23 1, , ,47 42 Nevada ,23 1, , , ,75 62 New Hampshire , , ,1 43 New Jersey ,1 6, ,43 1,58 1,33 6,26 2,65 2,13 6,79 2,51 New Mexico ,21 1, ,61 35 New York ,34 14, ,78 3,43 2,98 13,72 4,5 4,68 14,84 5,23 North Carolina ,12 6,5 36 4,22 1,19 1,15 7,52 2,13 1,8 6,91 1,89 North Dakota , Ohio 64,45 8, ,96 2,1 1,81 1,71 2,2 2,72 8,1 2,97 Oklahoma ,67 2,3 15 1, , ,44 77 Oregon ,75 2, , ,81 1,2 93 3,1 1,4 Pennsylvania ,26 1, 54 7,44 2,45 2,7 1,52 3,55 3,43 9,8 4,5 Rhode Island , South Carolina ,24 3, , ,97 1,6 95 3,6 95 South Dakota , Tennessee 33,7 4,7 27 3, ,98 1,72 1,36 4,6 1,35 Texas ,12 12,92 1,7 9,19 2,42 3,24 14,3 3,57 4,41 13,74 3,65 Utah ,97 1, ,73 39 Vermont 3, Virginia ,41 5, ,37 1,4 88 5,51 1,81 1,47 5,55 1,52 Washington ,5 4,9 22 2,74 1,1 1, 4,32 1,93 1,6 5,22 1,72 West Virginia ,61 1,31 8 1, , ,44 53 Wisconsin 29,61 4,12 2 2,76 1,4 94 3,99 1,5 1,34 4,67 1,51 Wyoming , United States ,529,56 27,9 12,2 142,57 43,47 43,5 222,52 68,13 65,54 217,73 7,53 Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) *Rounded to the nearest 1; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Rates are per 1, and age adjusted to the 2 US standard population. Estimate is fewer than 5 cases. Combined incidence rate is not available. Source: Data as of June 29 reported by the North American Association of Central Registries (NAACCR) as meeting high quality standards for and include data collected by cancer registries participating in NCI s SEER Program and CDC s National Program of Registries. To account for population anomalies caused by Hurricane Katrina in 25, statistics exclude data for AL, LA, and TX from July 25-December 25. Note: These model-based estimates are calculated using incidence rates from 41 states and the District of Columbia; they are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and exclusion of states with fewer than 5 cases. VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

5 Statistics 21 FIGURE 1. Ten Leading Types for the Estimated New Cases and Deaths by Sex, 21. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 1. National Institute (NCI), covering approximately 26% of the US population. 2-5 Incidence data ( ) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC) s National Program of Registries (NPCR), through the North American Association of Central Registries (NAACCR) covering approximately 89% of the US population. State-specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and the NPCR. 6 Population data were obtained from the US Census Bureau. 7 Causes of death were coded and classified according to the International Classification of Diseases (ICD-8, ICD-9, and ICD-1). 8-1 cases were classified according to the International Classification of Diseases for Oncology. 11 Estimated New Cases and Deaths The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer case reporting is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection and compilation. Therefore, we project the expected number of new cancer Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 28 CA: A Journal for Clinicians

6 CA CANCER J CLIN 21;6:277 3 TABLE 3. Age-standardized Death Rates for All s Combined, 22-26, and Estimated Deaths* for Selected s by State, United States, 21 STATE DEATH RATE ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER LUNG & BRONCHUS NON-HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE Alabama , , Alaska Arizona , , , Arkansas 25. 6, , California ,71 1,49 4,23 4,97 2,22 2,6 12,63 2,11 1,5 3,9 3,71 Colorado , , Connecticut , , Delaware , Dist. of Columbia Florida ,88 8 2,65 3,54 1,56 1,36 11,62 1, ,56 2,59 Georgia , ,1 1, , Hawaii , Idaho , Illinois , ,79 2, , ,58 1,42 Indiana , , , Iowa , , Kansas , , Kentucky , , Louisiana , , Maine , Maryland , , Massachusetts , , , Michigan ,74 5 1,32 1, , ,33 1,1 Minnesota , , Mississippi , , Missouri , , , Montana , Nebraska , Nevada , , New Hampshire , New Jersey , ,43 1, , ,13 94 New Mexico , New York ,54 8 2,49 3,12 1,38 1,27 8,72 1, ,44 1,69 North Carolina ,1 35 1,34 1, , ,16 98 North Dakota , Ohio , ,73 2, , ,53 1,44 Oklahoma , , Oregon , , Pennsylvania , ,98 2,61 1,1 84 7,96 1,1 73 2,1 1,66 Rhode Island , South Carolina , , South Dakota , Tennessee , , , Texas , ,78 3,34 1,41 1,66 9,6 1, ,2 1,82 Utah , Vermont , Virginia ,23 3 1,12 1, , Washington , , West Virginia , , Wisconsin , , Wyoming , United States ,49 13,14 39,84 51,37 21,84 18,91 157,3 2,21 13,85 36,8 32,5 Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) *Rounded to the nearest 1. Rates are per 1, and age adjusted to the 2 US standard population. Estimate is fewer than 5 deaths. Note: State estimates may not add to US total due to rounding and exclusion of states with fewer than 5 deaths. Source: US Mortality Data, 1969 to 27, National Center for Health Statistics, Centers for Disease Control and Prevention. VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

7 Statistics 21 TABLE 4. Incidence Rates* by Site and State, United States, 22 to 26 ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PROSTATE URINARY BLADDER STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming United States Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) *Per 1,, age adjusted to the 2 US standard population. Due to the displacement of populations after Hurricane Katrina in September 25, 25 statistics are based on cases diagnosed in January to June. This state s registry did not achieve high quality data standards for one or more years during according to the North American Association of Central Registry (NAACCR) data quality indicators. This state s registry did not submit incidence data to NAACCR for Case assertainment for this state s registry is incomplete for the years Source: NAACCR, 29. Data are collected by cancer registries participating in the National Institute s SEER program and the Centers for Disease Control and Prevention s National Program of Registries. 282 CA: A Journal for Clinicians

8 CA CANCER J CLIN 21;6: Male Incidence 6 Male and Female Incidence Rate per 1, Population cases and deaths in the United States in 21 to provide an estimate of the current cancer burden. Estimated new cancer cases in the current year (21) were projected using a spatiotemporal model based on incidence data from 1995 through 26 from 44 states and the District of Columbia that met the NAACCR s high-quality data standard for incidence, covering approximately 89% of the US population. 12 The method also considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening Female Incidence Male Mortality Male and Female Mortality Female Mortality Year of Diagnosis/Death FIGURE 2. Annual Age-Adjusted Incidence and Death Rates* by Sex, United States, 1975 to 26. *Rates are age adjusted to the 2 US standard population. Incidences rates are adjusted for delays in reporting. Sources: Incidence: Surveillance, Epidemiology, and End Results (SEER) program (available at: Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, Bethesda, MD: National Institute, Division of Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 29. Released April 29, based on the November 28 SEER data submission. Mortality: US Mortality Data, 1975 to 26. National Center for Health Statistics, Centers for Disease Control and Prevention. behaviors as predictors of incidence, and accounts for expected delays in case reporting. We used the state-space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year Projections are based on underlying cause-of-death from death certificates as reported to the NCHS. 1 This model projects the number of cancer deaths expected to occur in 21 based on the number that occurred each year from 1969 to 27 in the United States and in each state separately. VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.)

9 Statistics Male 26 Female Prostate Rate per 1, Population Non-Hodgkin Lymphoma Lung and Bronchus Colon and Rectum Urinary Bladder Melanoma of the Skin Other Statistics We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 27. Causes of death for 27 were coded and classified according to ICD-1. 1 This report also provides updated statistics regarding trends in cancer incidence and mortality rates, the probability of developing cancer, and 5-year relative survival rates for selected cancer sites based on data from 1975 through 26. 2,6 All age-adjusted incidence and death rates are standardized to the 2 US standard population and expressed per 1, population. The incidence rates (22-26) and long-term trends ( ) are adjusted for delays in reporting when possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 24-26), especially for cancers such as melanoma, Breast Colon and Rectum Non-Hodgkin Lymphoma Uterine Corpus Lung and Bronchus Melanoma of the Skin Year of Diagnosis Year of Diagnosis FIGURE 3. Annual Age-Adjusted Incidence Rates* for Selected s by Sex, United States, 1975 to 26. *Rates are age adjusted to the 2 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (available at: Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, Bethesda, MD: National Institute, Division of Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 29. Released April 29, based on the November 28 SEER data submission. leukemia, and prostate that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and many specific cancer sites. 14 Delay-adjusted rates provide a more accurate assessment of trends in the most recent years for which data are available. Long-term incidence and mortality trends for selected cancer sites were previously published in the 21 Annual Report to the Nation on the Status of. 15 We also provide the contribution of individual cancer sites to the total decrease in overall cancer death rates since 199 in men and 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age-standardized cancer death rates through 26. The total number of cancer deaths avoided was calculated by applying the age-specific Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 284 CA: A Journal for Clinicians

10 CA CANCER J CLIN 21;6: Lung and Bronchus 8 7 Rate per 1, Males Stomach cancer death rates in the peak year for the agestandardized cancer death rates (199 for males and 1991 for females) to the corresponding age-specific populations in the subsequent years through 26 to obtain the number of expected deaths in each calendar year if the death rates had not decreased. We then summed the difference between the number of expected and observed deaths in each age group and calendar year for men and women separately to obtain the total number of cancer deaths avoided over the 15-year (women) or 16-year (men) interval. Selected Findings Expected Numbers of New Cases in 21 Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in 1945 Leukemia Colon and Rectum Year of Death Pancreas Prostate FIGURE 4. Annual Age-Adjusted Death Rates*Among Males for Selected s, United States, 193 to 26. *Rates are age adjusted to the 2 US standard population. Due to changes in International Classification of Diseases (ICD) coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US Mortality Data, 196 to 26, US Mortality Vol. 193 to National Center for Health Statistics, Centers for Disease Control and Prevention. Liver the US in 21. The overall estimate of approximately 1.53 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. Greater than 2 million unreported cases of basal cell and squamous cell skin cancer, approximately 54,1 cases of breast carcinoma in situ, and 46,77 cases of melanoma in situ are expected to be newly diagnosed in 21. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2. Figure 1 indicates the most common cancers expected to occur in men and women in 21. Among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,73) of incident cases in men. Based on cases Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

11 Statistics Rate per 1, Females Stomach 194 Ovary diagnosed between 1999 and 25, an estimated 92% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which the 5-year relative survival approaches 1%. The 3 most commonly diagnosed types of cancer among women in 21 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (27,9) of all new cancer cases among women. Expected Number of Deaths in 21 Table 1 also shows the expected number of deaths from cancer projected for 21 for men, women, and both sexes combined. It is estimated that approximately 569,49 Americans will die from cancer, corresponding Uterus Year of Death 1975 Breast 198 Pancreas 1985 to greater than 15 deaths per day. s of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common fatal cancers. These 4 cancers account for approximately half of the total cancer deaths among men and women (Fig. 1). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987 and is expected to account for 26% of all female cancer deaths in 21. Table 3 provides the estimated number of cancer deaths in 21 by state for selected cancer sites. Variations in Rates Table 4 depicts cancer incidence rates for selected cancer sites by state. By far, the largest variation in incidence among the cancer sites listed in Table 4 is for 199 Lung and Bronchus Colon and Rectum FIGURE 5. Annual Age-Adjusted Death Rates* Among Females for Selected s, United States, 193 to 26. *Rates are age adjusted to the 2 US standard population. Uterus includes uterine cervix and uterine corpus. Due to changes in International Classification of Diseases (ICD) coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Source: US Mortality Data, 196 to 26, US Mortality Volumes 193 to National Center for Health Statistics, Centers for Disease Control and Prevention Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 286 CA: A Journal for Clinicians

12 CA CANCER J CLIN 21;6:277 3 TABLE 5. Trends in Incidence and Death Rates for Selected s by Sex, United States, 1975 to 26 TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 YEARS APC* YEARS APC* YEARS APC* YEARS APC* YEARS APC* All sites Incidence Male and female Male Female Death Male and female Male Female Lung & bronchus Incidence Male Female Death Male Female Incidence Male Female Death Male Female Female breast Incidence Death Prostate Incidence Death *Annual percent change (APC) based on incidence (delay-adjusted) and mortality rates age adjusted to the 2 US standard population. The APC is significantly different from zero (P.5). Note: Trends were analyzed by Joinpoint Regression Program, version 3.3.1, with a maximum of four joinpoints (ie, five line segments). Source: Edwards, et al. 15 lung cancer, for which rates (cases per 1, population) range from 37.8 in men and 23. in women in Utah to in men and 76.9 in women in Kentucky. This variation reflects the large and continuing differences in smoking prevalence among states. Utah ranks lowest in adult smoking prevalence and Kentucky highest. In contrast, state variation in the incidence rates of other cancer sites shown in Table 4 is smaller in both absolute and proportionate terms. For screenable cancers, such as those of the prostate and female breast, variation in incidence rates reflects differences in the use of screening tests in addition to differences in occurrence. Trends in Incidence and Mortality Figures 2 to 5 depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites and for the 4 most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates decreased by 1.3% per year from 2 through 26 in males and by.5% per year from 1998 through 26 in females. 15 Incidence trends decreased for all 4 major cancer sites except for lung cancer in women, in whom rates are still increasing, though at a much slower rate than in previous years. The lag in the temporal trend of lung cancer rates in women compared with men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked approximately 2 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 26 largely reflects increases in screening that can detect and remove precancerous polyps. 15 The decrease in prostate cancer incidence rates (by 2.4% per year from VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.)

13 Statistics 21 TABLE 6. The Contribution of Individual Sites to the Decrease in Death Rates, DEATH RATE (PER 1,) CHANGE MALE 199* 26 ABSOLUTE % % CONTRIBUTION All malignant cancers Decreasing Lung & bronchus Prostate Stomach Oral cavity & pharynx Non-Hodgkin lymphoma Leukemia Brain & other nervous system Larynx Myeloma Kidney & renal pelvis Urinary bladder Hodgkin lymphoma Other Total Increasing Esophagus Liver & Intrahepatic Bile Duct Melanoma of the Skin Total FEMALE DEATH RATE (PER 1,) CHANGE 1991* 26 ABSOLUTE % % CONTRIBUTION All malignant cancers Decreasing Breast Non-Hodgkin Lymphoma Stomach Cervix Uteri Ovary Leukemia Brain & Other Nervous System Oral Cavity & Pharynx Other Total Increasing Lung & bronchus Liver & intrahepatic bile duct Pancreas Total *Death rates for cancer peaked in 199 in men and in 1991 in women. This calculation is based on each cancer site s contribution to the increasing or decreasing portion of the total cancer death rate, depending on the individual site s trend; it does not represent the contribution to the net decrease in cancer death rates. Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 2-26) may reflect recent stabilization of prostate-specific antigen testing, resulting in decreased detection or a reduced number of undiagnosed cases The decrease in the breast cancer incidence rate since 1999 likely reflects the large discontinuity in the use of menopausal hormone therapy among postmenopausal women beginning in 21, and it may also reflect delayed diagnosis due to decreased mammography use However, close inspection of incidence data by individual year (Fig. 3) shows that after a 6% decrease from 22 to 23, incidence rates from 23 to 26 remained relatively unchanged. This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer CA: A Journal for Clinicians

14 CA CANCER J CLIN 21;6:277 3 TABLE 7. Fifteen Leading Causes of Death, United States, 27 RANK CAUSE OF DEATH NUMBER OF DEATHS PERCENT (%) OF TOTAL DEATHS DEATH RATE* All Causes 2,423, Heart 616, , Cerebrovascular 135, Chronic lower respiratory 127, Accidents (unintentional injuries) 123, Alzheimer 74, Diabetes mellitus 71, Influenza & pneumonia 52, Nephritis, nephrotic syndrome, & nephrosis 46, Septicemia 34, Intentional self-harm (suicide) 34, Chronic liver & cirrhosis 29, Essential hypertension & hypertensive renal 23, Parkinson 2, Assault (homicide) 18, All other & ill-defined causes 451, *Rates are per 1, population and age adjusted to the 2 US standard population. Includes primary and secondary hypertension. Note: Percentages may not total 1 due to rounding. In accordance with the National Center for Health Statistics cause-of-death ranking, Symptoms, signs, and abnormal clinical or laboratory findings and categories that begin with Other and All other were not ranked. Source: US Mortality Data, 27. National Center for Health Statistics, Centers for Disease Control and Prevention. TABLE 8. Trends in the Recorded Number of Deaths from Selected s by Sex, United States, 199 to 27 YEAR ALL SITES LUNG AND BRONCHUS COLORECTUM PROSTATE BREAST MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE , ,39 91,14 5,136 28,484 28,674 32,378 43, ,38 242,277 91,63 52,22 28,26 28,753 33,564 43, , ,74 91,322 54,485 28,28 28,714 34,24 43, ,375 25,529 92,493 56,234 28,199 29,26 34,865 43, , ,845 91,825 57,535 28,471 28,936 34,92 43, , ,844 91,8 59,34 28,49 29,237 34,475 43, , ,635 91,559 6,351 27,989 28,766 34,123 43, ,11 258,467 91,278 61,922 28,75 28,621 32,891 41, ,65 259,467 91,399 63,75 28,24 28,95 32,23 41, , ,6 89,41 62,662 28,313 28,99 31,729 41, ,82 267,9 9,415 65,16 28,484 28,95 31,78 41, ,75 266,693 9,367 65,66 28,229 28,579 3,719 41, , ,53 9,121 67,59 28,472 28,132 3,446 41, ,99 268,912 89,98 68,84 27,991 27,793 29,554 41, ,83 267,58 89,575 68,431 26,881 26,699 29,2 4, , ,89 9,141 69,79 26,783 26,224 28,95 41, ,69 269,819 89,243 69,357 26,83 26,396 28,372 4, ,857 27,18 88,331 7,355 27,5 26,216 29,93 4,599 Note: Effective with the mortality data for 1999, causes of death are classified by ICD-1, replacing ICD-9 used for 199 to 1998 data. Source: US Mortality Data, 199 to 27. National Center for Health Statistics, Centers for Disease Control and Prevention. Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) Death rates for all cancer sites combined decreased by 2.% per year in men from 21 through 26 and by 1.5% per year in women from 22 to 26, compared with declines of 1.5% per year in men from 1993 to 21 and.8% per year in women from 1994 through 22 (Table 5). Mortality rates have continued to decrease across all 4 major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 23 to 26 after increasing for many decades. Table 6 shows the contribution of individual cancer sites to the decreasing portion of the total cancer death rate for VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

15 Statistics 21 TABLE 9. Ten Leading Causes of Death by Age and Sex, United States, 27 ALL AGES AGES 1 TO 19 AGES 2 TO 39 AGES 4 TO 59 AGES 6 TO 79 AGES 8 MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE All Causes 1,23,968 All Causes 1,219,744 All Causes 15,777 All Causes 8,372 All Causes 65,35 All Causes 28,831 All Causes 226,396 All Causes 139,473 All Causes 46,41 All Causes 372,878 All Causes 42, All Causes 657,3 1 Heart 39, ,857 3 Accidents (unintentional injuries) 79,827 4 Chronic lower respiratory 61,235 5 Cerebrovascular 54,111 6 Diabetes mellitus 35,478 7 Intentional self-harm (suicide) 27,269 8 Influenza & pneumonia 24,71 9 Nephritis, nephrotic syndrome & nephrosis 22,616 1 Alzheimer 21,8 Heart 36,246 27,18 Cerebrovascular 81,841 Chronic lower respiratory 66,689 Alzheimer 52,832 Accidents (unintentional injuries) 43,879 Diabetes mellitus 35,94 Influenza & pneumonia 28,646 Nephritis, nephrotic syndrome & nephrosis 23,832 Septicemia 18,989 Accidents (unintentional injuries) 6,875 Assault (homicide) 2,355 Intentional self-harm (suicide) 1,352 1,85 Congenital anomalies 593 Heart 445 Chronic lower respiratory 151 Influenza & pneumonia 13 Septecemia 113 Cerebrovascular 97 Accidents (unintentional injuries) 3,4 911 Assault (homicide) 613 Congenital anomalies 518 Heart 315 Intentional self-harm (suicide) 313 Influenza & pneumonia 134 Cerebrovascular 19 Chronic lower respiratory 95 Septecemia 92 Accidents (unintentional injuries) 24,329 Intentional self-harm (suicide) 8,91 Assault (homicide) 8,17 Heart 5,351 4,41 HIV 1,65 Diabetes mellitus 95 Chronic liver & cirrhosis 765 Cerebrovascular 726 Congenital anomalies 49 Accidents (unintentional injuries) 7,789 4,639 Heart 2,58 Intentional self-harm (suicide) 2,58 Assault (homicide) 1,534 HIV 95 Cerebrovascular 636 Pregnancy, childbirth & puerperium 598 Diabetes mellitus 567 Chronic liver & cirrhosis ,54 Heart 53,779 Accidents (unintentional injuries) 25,41 Intentional self-harm (suicide) 1,828 Chronic liver & cirrhosis 1,296 Diabetes mellitus 7,34 Cerebrovascular 7,6 HIV 5,451 Chronic lower respiratory 4,887 Viral hepatitis 3,463 5,64 Heart 21,389 Accidents (unintentional injuries) 11,28 Cerebrovascular 5,524 Diabetes mellitus 4,769 Chronic lower respiratory 4,475 Chronic liver & cirrhosis 4,229 Intentional self-harm (suicide) 3,612 Septicemia 2,321 Nephritis, nephrotic syndrome & nephrosis 2,36 152,231 Heart 119,29 Chronic lower respiratory 3,237 Cerebrovascular 2,454 Diabetes mellitus 16,722 Accidents (unintentional injuries) 12,311 Nephritis, nephrotic syndrome & nephrosis 8,665 Influenza & pneumonia 7,46 Chronic liver & cirrhosis 6,859 Septicemia 6,68 126,918 Heart 77,73 Chronic lower respiratory 29,321 Cerebrovascular 2,281 Diabetes mellitus 14,621 Nephritis, nephrotic syndrome & nephrosis 7,935 Accidents (unintentional injuries) 7,457 Alzheimer 7,191 Septicemia 6,639 Influenza & pneumonia 5,997 Heart 13,779 81,43 Cerebrovascular 25,747 Chronic lower respiratory 25,616 Alzheimer 16,78 Influenza & pneumonia 14,99 Nephritis, nephrotic syndrome & nephrosis 1,868 Diabetes mellitus 1,495 Accidents (unintentional injuries) 1,164 Parkinson 7,422 Heart 24,138 86,873 Cerebrovascular 55,234 Alzheimer 45,458 Chronic lower respiratory 32,524 Influenza & pneumonia 2,555 Diabetes mellitus 15,99 Nephritis, nephrotic syndrome & nephrosis 13,479 Accidents (unintentional injuries) 13,453 Hypertension & hypertensive renal * 1,126 Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) *Includes primary and secondary hypertension. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. In accordance with the National Center for Health Statistics cause-of-death ranking, Symptoms, signs, and abnormal clinical or laboratory findings and categories that begin with Other and All other were not ranked. Source: US Mortality Data, 27, National Center for Health Statistics, Centers for Disease Control and Prevention. 29 CA: A Journal for Clinicians

16 CA CANCER J CLIN 21;6: Younger than 85 Years 8, 85 years and Older 32 Rate per 1, Population Heart Disease each sex. Death rates from all cancers combined peaked in 199 for men and in 1991 for women. Between and 26, death rates for cancer decreased by 21.% among men and by 12.3% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 8% of the total decrease in the cancer death rate, whereas reduction in death rates from breast and colorectal cancers accounted for 6% of the decrease noted among women. Lung cancer in men and breast cancer in women each account for nearly 4% of the sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to a reduction in tobacco use over the past 5 years, whereas the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment. Between and 26, death rates increased for liver cancer in both men and women, esophageal cancer and melanoma in 7, 6, 5, 4, 3, 2, 1, Heart Disease Year of Death Year of Death FIGURE 6. Death Rates* For and Heart Disease for Ages Younger Than 85 Years and 85 Years and Older, 1975 to 26. *Rates are age adjusted to the 2 US standard population. Source: US Mortality Data, 1975 to 26. National Center for Health Statistics, Centers for Disease Control and Prevention. men, and lung and pancreatic cancer in women. Figure 7 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. Approximately 767, cancer deaths (561,4 in men and 25,7 in women) were averted between and 26. Recorded Number of Deaths from in 27 A total of 562,875 cancer deaths were recorded in the United States in 27, the most recent year for which actual data are available, accounting for approximately 23% of all deaths (Table 7 ). Despite a decrease in age-standardized death rates, from 18.7 in 26 to in 27, there were 2987 more cancer deaths reported in 27 than in 26 due to the influence of the aging and growth of the population (Table 8). When causes of death are ranked within 2-year age groups, cancer is one of the 5 leading causes of death in Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) VOLUME 6 NUMBER 5 SEPTEMBER/OCTOBER

17 Statistics 21 TABLE 1. Reported Deaths for the Five Leading Sites by Age and Sex, United States, 27 ALL AGES <2 2 TO 39 4 TO 59 6 TO 79 > 8 MALE ALL SITES 292,857 Lung & bronchus 88,331 Prostate 29,93 27,5 Pancreas 17,132 Leukemia 12,435 ALL SITES 27,18 Lung & bronchus 7,355 Breast 4,599 26,216 Pancreas 16,985 Ovary 14,621 ALL SITES 1,124 Leukemia 365 Brain & ONS* 26 Bones & joints 92 Other endocrine system 92 Soft tissue 72 ALL SITES 944 Leukemia 278 Brain & ONS* 261 Other endocrine system 81 Bones & joints 8 Soft tissue 68 ALL SITES 4,41 Leukemia 522 Brain & ONS* Non-Hodgkin lymphoma 31 Lung & bronchus 268 ALL SITES 4,639 Breast 1,94 Uterine cervix 468 Leukemia Brain & ONS* 3 all age groups among both males and females; it is the leading cause of death among men and women ages 4 to 79 years (Table 9). is the leading cause of death among men and women aged younger than 85 years (Fig. 6). A total of 475,211 persons aged younger than 85 years died from cancer in the United States in 27, compared with 38,791 deaths from heart, which is the leading cause of death overall in the United States. 1 Table 1 presents the number of deaths from all cancers combined and from the 5 most common cancer sites for each 2-year age group. Among males aged younger than 4 years, leukemia is the most common fatal cancer, whereas cancer of the lung and bronchus predominates in men aged 4 years and older. FEMALE ALL SITES 54,54 Lung & bronchus 15,174 5,434 Liver & bile duct 3,944 Pancreas 3,638 Esophagus 2,695 ALL SITES 5,64 Breast 11,63 Lung & bronchus 11,412 4,15 Ovary 3,151 Pancreas 2,417 ALL SITES 152,231 Lung & bronchus 53,125 13,37 Prostate 12,187 Pancreas 9,293 Esophagus 5,958 ALL SITES 126,918 Lung & bronchus 4,187 Breast 16,9 1,459 Pancreas 8,211 Ovary 7,195 ALL SITES 81,43 Lung & bronchus 19,751 Prostate 15,67 7,795 Urinary bladder 4,216 Pancreas 4,84 ALL SITES 86,873 Lung & bronchus 18,519 11,298 Breast 1,973 Pancreas 6,283 Non-Hodgkin lymphoma 4,171 *ONS Other nervous system. Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. Other and unspecified malignant neoplasm is excluded from cause of death ranking order. Source: US Mortality Data, 27, National Center for Health Statistics, Centers for Disease Control and Prevention. Colorectal cancer is the second most common cause of cancer death among men ages 4 to 79 years, and prostate cancer among men aged 8 years and older. Among females, leukemia is the leading cause of cancer death before age 2 years, breast cancer ranks first at ages 2 to 59 years, and lung cancer ranks first at ages 6 years and older. Occurrence by Race/Ethnicity incidence and death rates vary considerably among racial and ethnic groups (Table 11), although the extent of variation may be affected by misclassification of race and ethnicity on medical records, including Downloaded from caonline.amcancersoc.org by on February 3, 211 ( American Society, Inc.) 292 CA: A Journal for Clinicians