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Cancer Statistics, 2015

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CACANCERJCLIN2015;00:00–00

CancerStatistics,2015

RebeccaL.Siegel,MPH1*;KimberlyD.Miller,MPH2;AhmedinJemal,DVM,PhD3EachyeartheAmericanCancerSocietyestimatesthenumbersofnewcancercasesanddeathsthatwilloccurintheUnitedStatesinthecurrentyearandcompilesthemostrecentdataoncancerincidence,mortality,andsurvival.IncidencedatawerecollectedbytheNationalCancerInstitute(Surveillance,Epidemiology,andEndResults[SEER]Program),theCentersforDis-easeControlandPrevention(NationalProgramofCancerRegistries),andtheNorthAmericanAssociationofCentralCancerRegistries.MortalitydatawerecollectedbytheNationalCenterforHealthStatistics.Atotalof1,658,370newcancercasesand5,430cancerdeathsareprojectedtooccurintheUnitedStatesin2015.Duringthemostrecent5yearsforwhichtherearedata(2007-2011),delay-adjustedcancerincidencerates(13oldestSEERregistries)declinedby1.8%peryearinmenandwerestableinwomen,whilecancerdeathratesnationwidedecreasedby1.8%peryearinmenandby1.4%peryearinwomen.Theoverallcancerdeathratedecreasedfrom215.1(per100,000population)in1991to168.7in2011,atotalrelativedeclineof22%.However,themagnitudeofthedeclinevariedbystate,andwasgenerallylowestintheSouth(󰀂15%)andhighestintheNortheast(󰀃20%).Forexample,thereweredeclinesof25%to30%inMaryland,NewJersey,Massachusetts,NewYork,andDelaware,whichcollectivelyaverted29,000cancerdeathsin2011asaresultofthisprogress.Furthergainscanbeacceler-atedbyapplyingexistingcancercontrolknowledgeacrossallsegmentsofthepopulation.CACancerJClin2015;000:000-C2015AmericanCancerSociety.000.V

Keywords:cancerstatistics,incidence,trends,survival,mortality,deathrates,cancercases

Introduction

CancerisamajorpublichealthproblemintheUnitedStatesandmanyotherpartsoftheworld.ItiscurrentlythesecondleadingcauseofdeathintheUnitedStates,andisexpectedtosurpassheartdiseasesastheleadingcauseofdeathinthenextfewyears.Inthisarticle,weprovidetheexpectednumbersofnewcancercasesanddeathsin2015intheUnitedStatesnationallyandforeachstate,aswellasacomprehensiveoverviewofcancerincidence,mortality,andsurvivalratesandtrendsusingthemostcurrentpopulation-baseddata.Inaddition,weestimatethetotalnumberofdeathsavertednationallyduringthepast2decadesandbystatein2011asaresultofthecontinualdeclineincancerdeathrates.Wealsopresenttheactualnumberofdeathsreportedin2011byageforthe10leadingcausesofdeathandforthe5leadingcausesofcancerdeath.

MaterialsandMethods

IncidenceandMortalityData

Mortalitydatafrom1930to2011wereobtainedfromtheNationalCenterforHealthStatistics(NCHS).1Forty-sevenstatesandtheDistrictofColumbiametdataqualityrequirementsforreportingtothenationalvitalstatisticssystemin1930.Texas,Alaska,andHawaiibeganreportingmortalitydatain1933,1959,and1960,respectively.Themethodsforabstractionandageadjustmentofmortalitydataaredescribedelsewhere.2,3Population-basedcancerincidencedataintheUnitedStateshavebeencollectedbytheNationalCancerInstitute’s(NCI’s)Surveillance,Epidemiology,andEndResults(SEER)Programsince1973andbytheCentersforDiseaseControlandPrevention’sNationalProgramofCancerRegistries(NPCR)since1995.TheSEERprogramistheonlysourceforlong-term,delay-adjusted,population-basedincidencedata.Long-termincidenceandsurvivaltrends(1975-2011)werebasedondatafromthe9oldestSEERareas(Connecticut,Hawaii,Iowa,NewMexico,Utah,andthemetropolitanareasofAtlanta,Detroit,SanFrancisco-Oakland,andSeattle-PugetSound),representingapproximately9%oftheUSpopulation.41Director,SurveillanceInformation,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;2Epidemiologist,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;3VicePresident,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA

Correspondingauthor:RebeccaL.Siegel,MPH,SurveillanceandHealthServicesResearch,AmericanCancerSociety,250WilliamsSt,NW,Atlanta,GA30303-1002;Rebecca.siegel@cancer.org

DISCLOSURES:Theauthorsreportnoconflictsofinterest.doi:10.3322/caac.212.Availableonlineatcacancerjournal.com

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TABLE1.EstimatedNewCancerCasesandDeathsbySex,UnitedStates,2015*

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)MelanomaoftheskinOthernonepithelialskinBreast

GenitalsystemUterinecervixUterinecorpusOvaryVulva

Vagina&othergenital,femaleProstateTestis

Penis&othergenital,maleUrinarysystemUrinarybladder

Kidney&renalpelvis

Ureter&otherurinaryorgansEye&orbit

Brain&othernervoussystemEndocrinesystemThyroid

OtherendocrineLymphoma

HodgkinlymphomaNon-HodgkinlymphomaMyelomaLeukemia

AcutelymphocyticleukemiaChroniclymphocyticleukemiaAcutemyeloidleukemiaChronicmyeloidleukemiaOtherleukemia‡

Other&unspecifiedprimarysites‡1,658,37045,78014,32012,92015,5203,020291,15016,98024,5909,41093,09039,6107,27035,66010,91048,9604,670240,39013,560221,2005,6302,97011,93080,10073,8706,230234,190329,33012,900,87021,2905,1504,070220,8008,4301,820138,71074,00061,5603,1502,58022,850,86062,4502,41080,9009,05071,85026,850,2706,25014,62020,8306,6605,91031,510

848,20032,67010,3107,75012,3802,230163,05013,57015,04,96045,023,2002,025,5104,99024,8401,910130,26010,720115,6103,9301,06,61046,61042,6703,9402,350231,050

810,17013,1104,0105,1703,140790128,1003,4109,0504,45047,20016,4104,63010,1505,92024,1202,760110,1302,840105,5901,7001,3305,32033,49031,2002,290231,84098,28012,900,87021,2905,1504,070

5,4308,6502,1902,1202,6601,680149,30015,59010,7201,26049,7001,01024,5503,70040,5602,210162,4603,0158,040

7801,4904,87013,3409,9403,40040,73058,6704,10010,17014,1801,08091027,038031030,97016,00014,080027015,3202,01,95094020,9401,15019,79011,24024,4501,4504,65010,4601,1406,75043,840

312,1506,0101,5001,2002,0101,30086,012,6006,50067026,10040017,0301,66020,710870,7502,086,3804808502,6009,1206,02,48044028,230

277,2802,069092065038062,7602,9904,22059023,6006107,5202,04019,8501,34072,71075071,66030002,2704,2203,30092040,29030,4404,10010,17014,1801,080910

220,8008,4301,82096,58056,32038,2701,9901,36012,90016,52015,2201,30044,9505,10039,85014,09030,9003,1008,14012,7303,5303,40016,660

42,13017,68023,2901,1601,2209,95048,34047,2301,11035,9503,95032,00012,76023,3703,1506,4808,1003,1302,51014,850

27,038031021,11011,5109,0705301408,9401,35087048012,14066011,4806,24014,2108002,8306,1105903,88024,480

9,8604,4905,0103601306,3801,01,0804608,8004908,3105,00010,2406501,8204,3505502,87019,360

*Roundedtothenearest10;estimatednewcasesexcludebasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.About60,290casesofcarcinomainsituofthefemalebreastand63,440casesofmelanomainsituwillbenewlydiagnosedin2015.†Estimateddeathsforcolonandrectumcancersarecombinedduetoahighpercentageofmisclassification.

‡Moredeathsthancasesmayreflectlackofspecificityinrecordingunderlyingcauseofdeathondeathcertificatesand/oranundercountinthecaseestimate.

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CACANCERJCLIN2015;00:00–00

TABLE2.

STATE

EstimatedNewCasesforSelectedCancersbyState,2015*

ALLCASES

FEMALEBREAST

UTERINECERVIX

COLON&RECTUM

UTERINE

CORPUSLEUKEMIA

LUNG&MELANOMANON-HODGKINBRONCHUSOFTHESKINLYMPHOMAPROSTATE

URINARY

BLADDER

Alabama26,1503,6802302,150660730Alaska3,700470†290100110Arizona32,4404,7502002,440940950Arkansas15,8302,0901501,420420480California172,09025,2701,49014,5105,8005,970Colorado24,03,01701,800740870Connecticut21,9703,1901301,580810660Delaware5,280780†400180160Dist.ofColumbia2,800430†23010070Florida114,04015,4709809,3303,5503,930Georgia48,0707,1704303,8201,3301,430Hawaii6,7301,14050720280230Idaho8,0801,070†620240300Illinois65,4609,5705505,7202,4702,200Indiana35,6204,6002802,01,1801,100Iowa17,1402,3901001,49000Kansas14,4402,130901,080500480Kentucky26,4903,3002202,090730820Louisiana24,1002,9002202,150570690Maine8,8101,01050610340320Maryland30,0504,7302302,3601,080780Massachusetts37,7905,02102,5501,4601,130Michigan57,4207,7803504,1902,0901,870Minnesota29,7303,9001302,1409901,120Mississippi16,2602,0501401,460390450Missouri34,6804,6102602,8401,1201,100Montana5,950830†500190200Nebraska9,01,23060850340320Nevada13,01,6901201,110350440NewHampshire8,0901,120†0310260NewJersey51,4107,3104104,2601,8501,610NewMexico9,9701,32080820300360NewYork107,84014,9008708,0104,2503,630NorthCarolina50,4207,8203903,9801,6301,660NorthDakota3,840510†350110140Ohio65,0108,9504505,4302,4101,930Oklahoma19,2802,7701701,6900670Oregon22,4103,2801301,510740720Pennsylvania81,09,99006,3003,0002,560RhodeIsland6,040730†470230180SouthCarolina25,5503,8202202,130780820SouthDakota4,520600†360150170Tennessee38,3004,7703203,0601,0001,110Texas113,63016,5101,24010,0503,2404,360Utah11,0501,46070670360390Vermont4,020530†280150110Virginia41,1706,0903202,9701,3401,100Washington38,1805,4802302,7001,2501,300WestVirginia11,7301,430901,080400380Wisconsin32,7004,3101902,4601,1601,190Wyoming2,860390†23090100UnitedStates1,658,370231,84012,900132,700,870,270

†Estimateisfewerthan50cases.

4,1504203,7402,62018,4302,5602,87086031016,8106,46009108,9205,5102,4401,9304,6803,3801,3603,9805,1508,3503,2502,3405,3807601,2001,7701,1405,83099013,1807,75044010,0003,2202,83010,08804,0405706,20013,6506605705,7404,7902,0804,370320221,2001,3801001,4003608,5601,400780280805,4802,3504204702,3801,4601,0708501,53003201,4101,3102,6301,19001,5103005004702802,5204804,2702,6001802,7904801,4803,8801801,4202101,9402,4108001502,2302,4605501,33016073,8701,0201401,3006707,8701,0909202201005,3401,8703103802,01,49083001,0309503901,2301,6202,5001,3305501,4502704505303502,3104104,8002,1501702,7908409603,4102501,0702101,5005,0805101701,6801,7704801,46012071,8503,5901,0004901804,0901,5802,05063021,0607,1503,6001,0803,1701,1407402504908015,4805,6707,4501,7207102201,2704108,1402,9704,0401,5902,1708001,8606203,0401,0703,9809101,10004,6201,2505,4202,0008,1102,8703,7401,2702,1505003,9001,5001,0003101,1904401,06601,0804507,2702,5301,29039014,8505,2007,2102,1704901908,1503,0402,4808303,1101,09010,0504,0807603303,8701,0905502204,4101,51015,0204,0801,7504304702106,1201,6705,4301,7901,3705504,3101,610460140220,80074,000

*Roundedtothenearest10;excludesbasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.

Note:Thesearemodel-basedestimatesthatshouldbeinterpretedwithcaution.StateestimatesmaynotaddtoUStotalduetoroundingandtheexclusionofstateswithfewerthan50cases.

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FIGURE1.TenLeadingCancerTypesfortheEstimatedNewCancerCasesandDeathsbySex,UnitedStates,2015.

Estimatesareroundedtothenearest10andcasesexcludebasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.

Asof1992,SEERdatahavebeenavailablefor4additionalpopulations(AlaskaNatives,LosAngelescounty,SanJose-Monterey,andruralGeorgia)thatincreasethecover-ageofminoritygroups,allowingforstratiﬁcationbyraceandethnicity.5Delay-adjusteddatafromthese(SEER13)registries,whichrepresent14%oftheUSpopulation,werethesourcefortheannualpercentchangeinincidencefrom1992to2011.TheSEERprogramadded5additionalcatchmentareasbeginningwithcasesdiagnosedin2000(greaterCalifornia,greaterGeorgia,Kentucky,Louisiana,andNewJersey),achieving28%populationcoverage.Datafromall18SEERareaswerethesourceforcancerstagedistribution,stage-speciﬁcsurvival,andthelifetimeproba-bilityofdevelopingcancer.6Muchofthestatisticalinfor-mationpresentedhereinwasadaptedfromdatapreviouslypublishedintheSEERCancerStatisticsReview,1975-2011.74

CA:ACancerJournalforClinicians

TheNorthAmericanAssociationofCentralCancerRegistries(NAACCR)compilesandreportsincidencedatafrom1995onwardforcancerregistriesthatparticipateintheSEERprogramand/ortheNPCR.(Fivestatesreceivefundingfrombothprograms).Thesedataapproach100%coverageoftheUSpopulationinthemostrecenttimeperiodandwerethesourcefortheprojectednewcancercasesin2015,incidenceratesbystateandrace/ethnicity,andthe5-yearaverageannualpercentchangeinincidenceratesbyrace/ethnicityandforchildhoodandadolescentcancers.8,9Someofthedatapresentedhereinwereprevi-ouslypublishedinvolumes1and2ofCancerinNorthAmerica:2007-2011.10,11AllcancercaseswereclassiﬁedaccordingtotheInterna-tionalClassiﬁcationofDiseasesforOncologyexceptchildhoodandadolescentcancers,forwhichtheInternationalClassiﬁca-tionofChildhoodCancer(ICCC)wasused.12Thelifetime

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TABLE3.EstimatedDeathsforSelectedCancersbyState,2015*

BRAIN&OTHERNERVOUSSYSTEM

LIVER&INTRAHEPATICBILEDUCT

STATE

ALLSITESFEMALEBREASTCOLON&RECTUM

LEUKEMIA

LUNG&BRONCHUSNON-HODGKINLYMPHOMA

OVARYPANCREASPROSTATE

Alabama10,560Alaska1,040Arizona11,0Arkansas6,760California58,180Colorado7,590Connecticut6,840Delaware2,010Dist.ofColumbia990Florida43,050Georgia16,460Hawaii2,470Idaho2,790Illinois23,940Indiana13,420Iowa6,440Kansas5,510Kentucky10,200Louisiana9,040Maine3,300Maryland10,470Massachusetts12,710Michigan20,920Minnesota9,820Mississippi6,360Missouri12,830Montana2,020Nebraska3,480Nevada4,880NewHampshire2,730NewJersey16,250NewMexico3,620NewYork34,600NorthCarolina19,310NorthDakota1,280Ohio25,400Oklahoma8,100Oregon8,040Pennsylvania28,0RhodeIsland2,120SouthCarolina10,130SouthDakota1,630Tennessee14,370Texas38,520Utah2,900Vermont1,360Virginia14,830Washington12,700WestVirginia4,710Wisconsin11,550Wyoming1,000UnitedStates5,430

*Roundedtothenearest10.

290

†3301601,69026019050†1,000430†90570340190170230210902603305802701403106011015080380100840460†62022024065050240503601,010120†370400110350†15,32068093070907709904106204,3205,1800650460440120150801002,8303,5201,2401,5001302301902201,02,0908701,0803905703504805908506308101802408108607709301,4101,67062076041009001,0501301702103403804701702001,2901,4802703502,4202,01,3401,490801301,7402,0905206805106701,9502,40013016069084011014001,2202,7103,470270240801001,0901,180830990270410720850708040,29049,700420†5102602,55033030080†1,79063010013099057027026037033014040053004902505309014019011001501,470750601,0103203301,240903508001,62014050580019006024,450360505302703,25035027090601,7106601409086040021019031044010044058073037026048060120220806301801,520730†8503103701,02090380505502,26012060570590130400†24,5503,2802902,8002,18012,3701,7101,73060021011,9204,05806706,5504,0601,7701,03,5502,6109702,7003,4206,0102,4501,9503,910001,4107703,9007608,7405,7803207,3702,4602,0707,5205702,9704504,6009,5804604004,0703,2201,4603,050240158,040330†4102102,07025022060†1,4404709010081045025020032028011032041074038017040070130150805101201,300590†8502602801,03060300504501,260120†480440160410†19,790270†3101401,530240170††940430606056030017014020018070250330470240110240607011070450110900430†560180220700†230†29093090†380350100300†14,180660708304104,2405300140802,9801,0402202101,08504103806006202107809301,4806603908601402403702001,2402502,5901,200901,7204905602,05012001008402,550240901,0409002508307040,560580506002903,180430360100702,0307501101701,08003002403503801505005708105103005001201802601207202101,0860701,1303504201,280100460905801,57020070670690170590†27,0

†Estimateisfewerthan50deaths.

Note:Thesearemodel-basedestimatesthatshouldbeinterpretedwithcaution.StateestimatesmaynotaddtoUStotalduetoroundingandtheexclusionofstateswithfewerthan50deaths.

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TABLE4.

Probability(%)ofDevelopingInvasiveCancerWithinSelectedAgeIntervalsbySex,UnitedStates,2009to2011*

BIRTHTO49

50TO59

60TO69

󰀃70

BIRTHTODEATH

Allsites†Breast

Colorectum

Kidney&renalpelvisLeukemiaLung&bronchusMelanomaoftheskin‡Non-HodgkinlymphomaProstateThyroidUterinecervixUterinecorpusMaleFemaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleMaleFemaleFemaleFemale3.45.41.90.30.30.20.10.20.20.20.20.30.50.30.20.30.20.70.30.3(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininininin29)19)53)300)326)468)752)419)516)578)1)294)207)366)3)304)585)135)358)367)6.76.02.30.70.50.30.20.20.10.70.60.40.30.30.22.30.10.30.10.6(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininininin15)17)44)148)193)292)586)598)968)140)173)240)323)347)483)44)827)288)840)170)15.110.03.51.30.90.60.30.40.22.01.60.80.40.60.46.30.20.30.10.9(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininininin7)10)29)80)112)157)321)271)4)49))129)246)173)233)16)653)306)842)109)36.026.46.73.93.51.30.71.30.96..92.10.91.81.410.90.20.40.21.3(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininininin3)4)15)26)28)76)134)75)117)15)20)47)112)55)72)9)4)263)565)76)43.337.812.34.84.52.01.21.71.27.46.23.01.92.41.915.00.61.70.62.7(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1(1inininininininininininininininininininin2)3)8)21)22)49)84)59)84)13)16)34)53)42)52)7)174)60)1)37)

*Forpeoplefreeofcanceratbeginningofageinterval.

†Allsitesexcludesbasalcellandsquamouscellskincancersandinsitucancersexcepturinarybladder.‡Probabilitiesareforwhites.

probabilityofdevelopingcancerwascalculatedusingNCI’sDevCansoftware(version6.7.1).13Allincidenceanddeathrateswereage-standardizedtothe2000USstandardpopula-tionandexpressedper100,000population,ascalculatedbyNCI’sSEER*Statsoftware(version8.1.5).14Theannualper-centchangeinrateswasquantiﬁedusingNCI’sJoinpointRegressionProgram(version4.1.1).15Wheneverpossible,cancerincidenceratespresentedinthisreportwereadjustedfordelaysinreporting,whichcanoccurbecauseofalagincasecaptureordatacorrections.Thisadjustmentisonlyavailablefordatafromthe13old-estSEERregistriesbecausehistoricpatternsofcaseascer-tainmentarerequiredtoanticipatefuturecorrectionstoregistrydata.Delayadjustmenthasthelargesteffectonthemostrecentyearsofdataforcancersthatarefrequentlydiagnosedinoutpatientsettings(eg,melanoma,leukemia,andprostatecancer)andprovidesamoreaccurateportrayalofthecancerburdeninthemostrecenttimeperiod.16Forexample,leukemiaincidenceratesadjustedforreportingdelaysare13%higherthanunadjustedratesinthemostrecentdatayear.4Delay-adjustedrateswereobtainedfromSEER*Statdatabases.17,186

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ProjectedCancerCasesandDeathsin2015

Themostrecentyearforwhichincidenceandmortalitydataareavailablelags3to4yearsbehindthecurrentyearduetothetimerequiredfordatacollection,compilation,qualitycontrol,anddissemination.Therefore,weprojectthenumbersofnewcancercasesanddeathsintheUnitedStatesinthecurrentyearinordertoprovideanestimateofthecontemporarycancerburden.These4-year-aheadpro-jectionsarenotusefulfortrackingcanceroccurrenceovertimebecausetheyaremodel-basedandbecausethemeth-odologyvariesovertimeaswecontinuallystrivetoachievethemostaccurateestimatesbytakingadvantageofimprovedmodelingtechniques,increasedcancerregistra-tioncoverage,andupdatedcovariates.

A3-stepspatio-temporalmodelwasusedtoestimatethenumberofnewinvasivecancercasesthatwillbediagnosedin2015basedonhigh-qualityincidencedatafrom49states(Minnesotadatawereunavailable)andtheDistrictofColumbiaduring1995through2011.Casecoveragerepre-sentsapproximately%ofthepopulationbecause,inadditiontolackingMinnesota,manystatesdidnotachievehigh-qualitydatastandardseveryyear.Intheﬁrststep,

CACANCERJCLIN2015;00:00–00

completeincidencecountswereestimatedforeachcountyfrom1995through2011usinggeographicvariationsinsociodemographicandlifestylefactors,medicalsettings,andcancerscreeningbehaviorsaspredictorsofincidence.19Thenthesecountswereadjustedtoaccountfordelaysincancerreportingandaggregatedtoobtainnational-andstate-levelestimates.Finally,atemporalprojectionmethod(thevectorautoregressivemodel)wasappliedtothelast15yearsofdatatoestimatecountsfor2015.Thismethodcan-notestimatenumbersofbasalcellorsquamouscellskincancersbecausedataontheoccurrenceofthesecancersarenotrequiredtobereportedtocancerregistries.Forthecompletedetailsofthecaseprojectionmethodology,pleaserefertoZhuetal.20Toestimatethenumberofcasesoffemalebreastcarci-nomainsituandmelanomainsitudiagnosedin2015,weﬁrstestimatedthenumberofcasesoccurringannuallyfrom2002through2011byapplyingage-speciﬁcNAACCRincidencerates(datafrom44stateswithhigh-qualitydataeveryyear)tothecorrespondingUSpopulationestimatesprovidedinSEER*Stat.8,14SEER13-baseddelay-adjustmentratios,accessedfromNCI’sCancerQuerySys-tem,21wereappliedtoinsitubreastcancercountstoaccountfordelaysinreporting.(Delay-adjustmentratiosarenotavailableforinsitumelanoma.)Thenthetotalnumberofcasesin2015wasprojectedbasedontheaverageannualper-centchangeincasecountsfrom2002through2011gener-atedbythejoinpointregressionmodel.15Weestimatedthenumberofcancerdeathsexpectedtooccurin2015intheUnitedStatesoverallandineachstateusingthejoinpointregressionmodelbasedontheactualnumbersofcancerdeathsfrom1997through2011atthestateandnationallevelsasreportedtotheNCHS.Forthecompletedetailsofthismethodology,pleaserefertoChenetal.22FIGURE2.TrendsinCancerIncidenceandDeathRatesby

Sex,UnitedStates,1975to2011.

Ratesareageadjustedtothe2000USstandardpopulation.Incidenceratesareadjustedfordelaysinreporting.

becausepeakyearsvariedacrossstates,withamajorityofstatesreachingpeakratesduring1990to1992.

SelectedFindings

ExpectedNumbersofNewCancerCases

Table1presentstheestimatednumbersofnewcasesofinvasivecancerexpectedintheUnitedStatesin2015bysex.Theoverallestimateof1,658,370newcasesistheequivalentofmorethan4,500newcancerdiagnoseseachday.Inaddition,about60,290casesoffemalebreastcarci-nomainsituand63,440casesofmelanomainsituareexpectedtobediagnosedin2015.TheestimatednumbersofnewcasesbystateforselectedcancersitesareshowninTable2.

Figure1indicatesthemostcommoncancersexpectedtooccurinmenandwomenin2015.Prostate,lungandbronchus,andcolorectalcancerswillaccountforaboutone-halfofallcasesinmen,withprostatecanceraloneaccountingforaboutone-quarterofnewdiagnoses.The3mostcommonlydiagnosedcancersinwomenwillbebreast,lungandbronchus,andcolorectum,accountingforone-halfofallcasesinwomen.Breastcanceraloneisexpectedtoaccountfor29%ofallnewcancersinwomen.

OtherStatistics

Theestimatednumberofcancerdeathsavertedinmenandwomenduetothereductioninoverallcancerdeathrateswascalculatedbyﬁrstestimatingthenumberofcancerdeathsthatwouldhaveoccurredifdeathrateshadremainedattheirpeak.Theexpectednumberofdeathswasestimatedbyapplyingthe5-yearage-speciﬁccancerdeathratesinthepeakyearforage-standardizedcancerdeathrates(1990inmenand1991inwomen)tothecorrespond-ingage-speciﬁcpopulationsinsubsequentyearsthrough2011.Thedifferencebetweenthenumberofexpectedandrecordedcancerdeathsineachagegroupandcalendaryearwasthensummed.Averteddeathsbystatein2011werecalculatedsimilarlyusingstate-andage-speciﬁcaverageannualcruderatesfor5agegroupsduring1990through1992.Anaggregateratewasusedinsteadofasingleyear

ExpectedNumbersofCancerDeaths

Table1alsoshowstheexpectednumbersofdeathsfromcancerin2015.Itisestimatedthatabout5,430Americans

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FIGURE3.TrendsinIncidenceRatesforSelectedCancersbySex,UnitedStates,1975to2011.

Ratesareageadjustedtothe2000USstandardpopulationandadjustedfordelaysinreporting.*Includesintrahepaticbileduct.

willdiefromcancerthisyear,correspondingtoabout1,600deathsperday.Themostcommoncausesofcancerdeatharecancersofthelungandbronchus,prostate,andcolorec-tuminmenandcancersofthelungandbronchus,breast,andcolorectuminwomen.These4cancersaccountforalmostone-halfofallcancerdeaths(Fig.1),withmorethanone-quarter(27%)ofallcancerdeathsduetolungcancer.Table3providestheestimatednumbersofdeathsin2015bystateforselectedcancersites.

78.6(per100,000population)inmalesand125.1infemales,comparedwith1732.8and1188.9,respectively,amongadultsaged50yearsandolder.8Theestimatedprobabilityofdevelopingcancerisbasedontheaverageexperienceofthegeneralpopulationandmayover-orunderestimateindividualriskbecauseofdifferencesinexposure(eg,smokinghistory),medicalhistory,and/orgeneticsusceptibility.

TrendsinCancerIncidence

LifetimeProbabilityofDevelopingCancer

Thelifetimeprobabilityofbeingdiagnosedwithaninva-sivecancerishigherformen(43%)thanforwomen(38%)(Table4).Thereasonsforincreasedsusceptibilityinmenarenotwellunderstood,buttosomeextentlikelyreﬂectdifferencesinenvironmentalexposures,endoge-noushormones,andcomplexinteractionsbetweentheseinﬂuences.Recentstudiessuggestthatheightmayalsobeafactor.23,24Foradultsagedyoungerthan50years,how-ever,cancerriskishigherforwomen(5.4%)thanformen(3.4%)becauseofthehigheroccurrenceofbreast,genital,andthyroidcancersinyoungwomen.Thecurrentcancerincidencerateamongindividualsagedbirthto49yearsis

CA:ACancerJournalforClinicians

Figures2and3illustratelong-termtrendsincancerinci-denceratesforallcancerscombinedandforselectedcancersitesbysex.CancerincidencepatternsintheUnitedStatesreﬂectbehavioraltrendsandimprovementsincancerpre-ventionandcontrol,aswellaschangesinmedicalpractice.Trendsinoverallincidenceareheavilyinﬂuencedbythe4majorcancers(lung,breast,prostate,andcolorectal).Forexample,thesteadyincreaseinincidenceratesinmenfrom1975totheearly1990s(Fig.2)wasdrivenbyasurgeinprostatecancerincidencelargelyduetotheincreaseddetectionofasymptomaticdisease,ﬁrstthroughtheuseoftransurethralprostatectomyandthenthroughwidespreadprostate-speciﬁcantigen(PSA)testing(Fig.3).25,26The

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TABLE5.

TrendsinCancerIncidence(Delay-Adjusted)andDeathRatesforSelectedCancersbySex,UnitedStates,1992to2011

TREND1YEARS

APC

TREND2YEARS

APC

TREND3YEARS

APC

TREND4YEARS

APC

2007-2011AAPC

AllsitesIncidenceOverall1992-1994Male1992-1994Female1992-1998DeathOverall1992-2001Male1992-2001Female1992-1995FemalebreastIncidence1992-1999Death1992-1995ColorectumIncidenceMale1992-1995Female1992-1995DeathMale1992-2002Female1992-2001Liver&intrahepaticbileductIncidenceMale1992-2011Female1992-2011DeathMale1992-2007Female1992-2008Lung&bronchusIncidenceMale1992-2009Female1992-2007DeathMale1992-2005Female1992-1995MelanomaofskinIncidenceMale1992-2011Female1992-1997DeathMale1992-2011Female1992-2011PancreasIncidenceMale1992-2001Female1992-1999DeathMale1992-1996Female1992-1997ProstateIncidence1992-1995Death1992-1994ThyroidIncidenceMale1992-1995Female1992-1999DeathMale1992-2011Female1992-1994

23.1

25.9*0.8*21.0*21.4*20.21.3*21.3*

1994-19991994-20071998-20032001-20112001-20111995-19981999-20041995-1998

0.320.5*20.721.5*21.8*21.2*22.2*23.4*

1999-20112007-20112003-201120.5*21.8*0.020.5*21.8*0.021.5*21.8*21.4*0.321.9*

1998-20012004-20111998-2011

20.40.321.9*

2001-201121.4*

22.6*21.8*22.0*21.7*

1995-19981995-19982002-20052001-2011

1.41.823.9*23.0*

1998-20081998-20082005-2011

22.5*21.9*22.6*

2008-20112008-201124.0*24.2*23.6*23.6*22.6*23.0*

3.6*2.9*2.2*1.3*

2007-20112008-2011

3.3*3.1*

3.6*2.9*3.3*2.6*

21.9*0.021.9*1.4*

2009-20112007-20112005-20111995-2003

24.0*22.2*22.9*0.3*

23.0*22.2*22.9*21.9*

2003-200720.82007-201121.9*

2.3*4.1*0.3*20.5*

1997-20111.5*

2.3*1.5*0.3*20.5*

0.020.121.0*20.4211.2*21.0

2001-20111999-20111996-20111997-20111995-20001994-2004

1.2*1.1*0.3*0.4*2.323.8*

2000-20112004-2011

22.1*23.2*

1.2*1.1*0.3*0.4*22.1*23.2*

23.14.2*1.6*26.0

1995-20111999-20095.3*6.9*

2009-20112.2

5.3*4.5*1.6*0.8*

1994-20110.8*

APCindicatesannualpercentchangebasedonincidence(delay-adjusted)andmortalityratesageadjustedtothe2000USstandardpopulation;AAPC,averageannualpercentchange.

*TheAPCorAAPCissignificantlydifferentfromzero(P<.05).

Note:TrendsanalyzedbytheJoinpointRegressionProgram,version4.1.1,allowingupto3joinpoints.IncidencetrendsbasedonSurveillance,Epidemiology,andEndResults(SEER)13areas.

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TABLE6.Trendsin5-YearRelativeSurvivalRates*(%)byRaceandYearofDiagnosis,UnitedStates,1975to2010

ALLRACES

1975TO1977

1987TO19

2004TO2010

1975TO1977

WHITE1987TO19

2004TO2010

1975TO1977

BLACK1987TO19

2004TO2010

Allsites

Brain&othernervoussystemBreast(female)ColonEsophagus

HodgkinlymphomaKidney&renalpelvisLarynxLeukemia

Liver&intrahepaticbileductLung&bronchusMelanomaoftheskinMyeloma

Non-HodgkinlymphomaOralcavity&pharynxOvaryPancreasProstateRectumStomachTestisThyroid

UrinarybladderUterinecervixUterinecorpus492275515725066343128227533636848158392726987552984609795763513882751384835820959479708268†35†91†65†20†88†74†63†60†18†18†93†47†71†66†45†7†>99†68†29†97†98†79†7083†502276516725067353128224473536948148392737088572885611180576744613882751563838459169480738469†33†92†67†21†88†74†61†17†18†93†47†73†67†44†7†>99†68†28†97†98†80†7185†39256247049583321157‡304832261441673‡§905065604332715277255563531179‡30463434671521988‡9263575762†42†80†56†13†85†72†52†13†15†77†63†45†367†98†63†28†9096††6265†

*SurvivalratesareadjustedfornormallifeexpectancyandarebasedoncasesdiagnosedintheSurveillance,Epidemiology,andEndResults(SEER)9areasfrom1975to1977,1987to19,and2004to2010,allfollowedthrough2011.

†Thedifferenceinratesbetween1975to1977and2004to2010isstatisticallysignificant(P<.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.§Survivalrateisfor1978to1980.

increaseinincidenceinwomenduringthe1980sreﬂectstheincreaseinlungcancerasaresultofthetobaccoepi-demicandtheincreaseinbreastcancerbecauseofchangesinfemalereproductivepatterns,aswellasincreaseddetec-tionofasymptomaticdiseaseduringtherapiduptakeofmammographyscreening.27Table5presentstheannualpercentchangeindelay-adjustedincidenceratesintheSEER13registriesduring1992through2011basedonjoinpointregressionanalysis.Joinpointisatoolusedtodescribeandquantifytrendsbyﬁttingobservedratestolinesconnectedat“joinpoints”wheretrendschangeindirectionormagnitude.7,28Duringthepast5yearsforwhichtherearedata(2007-2011),theoverallincidencerateremainedstableinwomenanddeclinedby1.8%peryearinmen.Thedecreaseinmenisdrivenbytherapiddeclinesincolorectal(3.6%peryear),lung(3.0%peryear),andprostate(2.1%peryear)cancers.Amongwomen,althoughtherecentratesofdeclineforcolorectalandlungcancershavebeensimilartothoseinmen,breastcancerincidenceratesremainedﬂatandthyroidcancerincidenceratesincreaseddramatically,byanaverage

CA:ACancerJournalforClinicians

of4.5%peryearfrom2007to2011.Althoughthyroidcancerincidenceisalsoincreasingrapidlyinmen,the3-foldhigherratesinwomenhavealargerinﬂuenceonoveralltrends.8Thelong-termdeclinesincolorectalcancerincidenceratessincethemid-1980shavebeenattributedtobothchangesinriskfactorsandtheintroductionofcolorectalcancerscreening.29However,therapiddeclinesinrecentyears(4.0%orgreaterperyearfrom2008-2011)likelyreﬂecttheincreaseduptakeofscreening,primarilyintheformofcolonoscopy,whichcanpreventcancerbyallowingfortheremovalofprecancerouslesions.30,31Amongadultsaged50to75years,colonoscopyuseincreasedfrom19.1%in2000to.5%in2013.32Lungcancerincidenceratesbegandeclininginthemid-1980sinmenandinthelate1990sinwomenasaresultofreductionsinsmokingprevalencethatbegandecadesearlier.Contemporarydifferencesinlungcancerincidencepatternsbetweenmenandwomen(Fig.3)reﬂecthistoricaldifferencesintobaccouse.Womentookupsmokinginlargenumbersdecadeslaterthanmen,ﬁrst

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TABLE7.RelativeDeclineinCancerDeathRatesbyStateSincetheEarly1990sandPotentialDeathsAvertedin2011

1990TO1992RATE

2011RATE

RELATIVEDECLINE

2011OBSERVEDCOUNTS*

2011EXPECTEDCOUNTS†

2011AVERTEDDEATHS‡

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelaware

Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada

NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio

OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming220.2219.3197.8221.8202.2187.5206.9240.9269.7208.0214.8172.5187.0222.9221.0198.5197.2236.3240.4230.5237.3225.1220.2197.8224.2217.5203.4192.9226.7224.0229.6182.5215.4213.9199.1224.2209.6209.2223.6222.7219.7195.9220.6211.3157.4218.9222.1205.9226.8208.1193.2187.4176.1148.4191.1151.8143.9157.9179.7180.6160.2171.0138.2157.6174.8185.2172.4169.9200.9193.5181.7165.9166.4177.4160.5196.8179.41.41.2170.3178.0165.6146.6159.6174.8160.5184.4191.2172.2177.3168.3182.2168.61.1162.6125.6175.6170.7166.6199.6174.9156.115%20%25%14%25%23%24%25%33%23%20%20%16%22%16%13%14%15%20%21%30%26%19%19%12%18%19%15%25%21%28%20%26%18%19%18%9%18%21%24%17%14%14%23%20%20%23%19%12%16%19%10,23393510,6906,49756,4487,0516,8371,9051,07041,68115,6022,2782,57324,00613,1806,4815,4409,7339,2333,20110,24912,520,4209,46,27812,4732,0223,4104,6052,74016,7083,32835,46918,2841,32125,1407,9977,80228,52,1709,31,66513,56237,3512,7461,34714,37412,0024,78211,603612,1221,20414,3637,62576,1299,4168,9482,5831,62953,72320,1842,8413,11131,03615,9667,5026,34311,72611,,08714,86517,53125,59711,8497,23315,3112,74,0526,3083,51023,3324,20047,93422,6941,430,8808,8599,66836,3982,88811,6621,93016,019,6963,4691,73519,12515,1945,56913,9501,1921,82693,6731,12819,6812,3652,11167855912,0424,5825635387,0302,7861,0219031,9932,41388,61,6365,1772,3609552,83852521,7037706,62487212,46,4103235,7408621,8667,5037182,1192652,45312,3457233884,7513,1927872,342256

Ratesareper100,000andageadjustedtothe2000USstandardpopulation.*Excludesunknownage.

†Expectedcountswereestimatedbyapplyingage-specificcruderatesfor1990–1992to2011populationestimates.‡Deathsavertedisthedifferencebetweenthenumberofexpectedandobserveddeathsin2011.

initiatedsmokingatolderages,andwereslowertoquit,includingrecentupturnsinsmokingprevalenceinsomebirthcohorts.33,34Thedeclineinprostatecancerincidenceratesthatbeganinthemid-1990slikelyreﬂectsthediminishingproportionofmenreceivinganinitialPSAtest.35VOLUME00_NUMBER00_MONTH2015

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TABLE8.TenLeadingCausesofDeathbyAgeandSex,UnitedStates,2011

ALLAGES

AGES1TO19MALEAllCauses13,202

FEMALEAllCauses7,039

AGES20TO39MALEAllCauses61,744

FEMALEAllCauses28,555

AGES40TO59MALEAllCauses226,700Cancer,172

FEMALEAllCauses143,234Cancer50,445

AGES60TO79MALEAllCauses484,159Cancer158,118

FEMALEAllCauses382,212Cancer129,632

AGES󰀃80

MALEAllCauses455,747Heartdiseases132,1Cancer84,860

FEMALEAllCauses688,747Heartdiseases191,463Cancer,145

MALEAllCauses1,2,9781

Heartdiseases308,398Cancer302,231

FEMALEAllCauses1,260,480Heartdiseases288,179Cancer274,460

AccidentsAccidentsAccidentsAccidents(unintentional(unintentional(unintentional(unintentionalinjuries)injuries)injuries)injuries)4,9162,39422,4598,122Assault(homicide)1,862Intentionalself-harm(suicide)1,633Cancer1,055

Cancer797

Intentionalself-harm(suicide)9,708Assault(homicide)7,051

Cancer4,407

Heartdiseases52,247Heartdiseases21,470Heartdiseases118,232Chroniclowerrespiratorydiseases32,493Cerebro-vasculardisease19,925Diabetesmellitus18,200

Heartdiseases72,365Chroniclowerrespiratorydiseases31,990Cerebro-vasculardisease19,350Diabetesmellitus14,392

Accidents(unintentionalinjuries)79,257Chroniclowerrespiratorydiseases67,521Cerebro-vasculardisease52,335Diabetesmellitus38,324Intentionalself-harm(suicide)31,003Alzheimerdisease25,677

Cerebro-vasculardisease76,597Chroniclowerrespiratorydiseases75,422Alzheimerdisease59,297

Assault(homicide)513Heartdiseases2,446

AccidentsAccidents(unintentional(unintentionalinjuries)injuries)

12,13225,372Intentional

self-harm(suicide)12,287Chronicliverdisease&cirrhosis11,123Diabetesmellitus7,795Cerebro-vasculardisease6,557Chroniclowerrespiratorydiseases5,393HIVdisease3,567

Chroniclowerrespiratorydiseases5,428Chronicliverdisease&cirrhosis5,298Cerebro-vasculardisease4,994Diabetesmellitus4,867

Chroniclowerrespiratorydiseases29,122Cerebro-vasculardisease25,029Alzheimerdisease20,171

Alzheimerdisease51,567

Congenitalanomalies4Heartdiseases5,143

Intentionalself-harm(suicide)2,409Assault(homicide)1,359

Cerebro-vasculardisease51,528Chroniclowerrespiratorydiseases37,5Influenza&pneumonia19,413

Congenitalanomalies594

Intentionalself-harm(suicide)456Heartdiseases283Influenza&pneumonia138

Cancer3,984

Accidents(unintentionalinjuries)47,181Diabetesmellitus35,507

Heartdiseases403Chroniclowerrespiratorydiseases172Influenza&pneumonia158

HIVdisease879

Pregnancy,childbirth&puerperium684Diabetesmellitus593

AccidentsAccidentsInfluenza&(unintentional(unintentionalpneumoniainjuries)injuries)14,114,1388,345Nephritis,nephroticsyndrome&nephrosis8,596Chronicliverdisease&cirrhosis8,2Influenza&pneumonia7,741

Diabetesmellitus842

Nephritis,AccidentsAccidentsnephrotic(unintentional(unintentionalsyndrome&injuries)injuries)nephrosis11,70615,6717,5Alzheimerdisease7,530

Diabetesmellitus11,443

Diabetesmellitus15,616

Influenza&pneumonia28,425

Chroniclowerrespiratorydiseases86Septicemia86

Chronicliverdisease&cirrhosis821Cerebro-vasculardisease634Influenza&pneumonia556

Cerebro-vasculardisease581HIVdisease522

Intentionalself-harm(suicide)3,981Septicemia2,409

Influenza&pneumonia25,401

Nephritis,nephroticsyndrome&nephrosis22,942Septicemia19,2

Cerebro-vasculardisease114Septicemia86

Septicemia6,7

Nephritis,nephroticsyndrome&nephrosis11,184Parkinsondisease8,744

Nephritis,nephroticsyndrome&nephrosis13,284Hypertension&hypertensiverenaldisease*11,615

Nephritis,nephriticsyndrome&nephrosis22,9

Cerebro-vasculardisease84Chronicliverdisease&cirrhosis471

Viralhepatitis3,347Influenza&pneumonia1,947

Septicemia7,001

Influenza&pneumonia6,408

HIVindicateshumanimmunodeficiencyvirus.*Includesprimaryandsecondaryhypertension.

Note:Deathswithineachagegroupdonotsumtoallagescombinedduetotheinclusionofunknownages.InaccordancewiththeNationalCenterforHealthStatistics’cause-of-deathranking,\"Symptoms,signs,andabnormalclinicalorlaboratoryfindings\"andcategoriesthatbeginwith“Other”and“Allother”werenotranked.Source:USFinalMortalityData,2011,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention,2014.

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FIGURE4.GeographicPatternsinCancerDeathRatesin2011(A)andintheRelativeDecline(%)inCancerDeathRates

from1990–1992to2011(B).

Ratesareper100,000andageadjustedtothe2000USstandardpopulation.

RoutinescreeningwiththePSAtestisnolongerrec-ommendedbecauseofgrowingconcernsabouthighratesofoverdiagnosis,estimatedat23%to42%forscreen-detectedcancers.36PSAtestingratesmayhavedeclinedinrecentyearsamongmenagedyoungerthan50years,aswellasinthoseaged75yearsorolder,butremainhighforoldermenwithalimitedlifeexpectancy.37–39VOLUME00_NUMBER00_MONTH2015

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FIGURE5.TrendsinDeathRatesOverallandforSelectedSitesbySex,UnitedStates,1930to2011.

Ratesareageadjustedtothe2000USstandardpopulation.DuetochangesinInternationalClassificationofDiseases(ICD)coding,numeratorinformationhaschangedovertime.Ratesforcancersofthelungandbronchus,colorectum,liver,uterus,andovaryareaffectedbythesechanges.*Mortalityratesforpancreaticandlivercancersareincreasing.†Uterusincludesuterinecervixanduterinecorpus.

Incontrasttothestableordecliningtrendsformostcancers,incidenceratesintheSEER13registriesincreasedfrom2007through2011amongbothmenandwomenforcancersofthesmallintestine,anus,liver,pancreas,softtissue(includingtheheart),andthyroid;melanomaoftheskin;myeloma;andleuke-mia.7,17Inaddition,incidenceratesincreasedinmen

CA:ACancerJournalforClinicians

forbreastcancer,non-Hodgkinlymphoma,andhumanpapillomavirus-positiveoropharyngealcancersandinwomenforesophagealadenocarcinomaanduterinecan-cer.Thelargestannualincreaseswereforcancersofthethyroid(5.3%and4.5%inmenandwomen,respec-tively)andliver(3.6%and2.9%inmenandwomen,respectively)(Table5).

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TABLE9.FiveLeadingTypesofCancerDeathbyAgeandSex,UnitedStates,2011

<20

20TO39

MALE

40TO59

60TO79

󰀃80

ALLAGES

ALLSITES302,231ALLSITES1,094ALLSITES3,984ALLSITES,172ALLSITES158,118ALLSITES84,860

Lung&bronchus

86,738Prostate27,970Colorectum26,804Pancreas18,881Liver*14,626

Brain&ONS

308Leukemia293Bones&joints

107Softtissue(includingheart)

NHL44

Leukemia529Brain&ONS

491Colorectum442NHL278

Softtissue(includingheart)

225

FEMALE

Lung&bronchus

14,347Colorectum5,7Liver*4,7Pancreas3,676Esophagus2,691

Lung&bronchus

51,951Colorectum13,088Prostate11,732Pancreas10,594Liver*7,467

Lung&bronchus

20,216

Prostate14,956Colorectum7,480Urinarybladder

4,785

Pancreas4,510

ALLSITES274,460ALLSITES828ALLSITES4,407

ALLSITES

50,445Breast11,340Lung&bronchus

11,043Colorectum4,209Ovary3,0Pancreas2,578

ALLSITES129,632ALLSITES,145

Lung&bronchus

70,219

Breast40,931Colorectum24,979Pancreas18,463Ovary14,346

Brain&ONS

242Leukemia226

Softtissue(includingheart)

Bones&joints

67Kidney&renalpelvis

Breast1,041Uterinecervix

417Leukemia356Colorectum344Brain&ONS

303

Lung&bronchus

39,287

Breast17,538Colorectum10,084Pancreas9,076Ovary7,192

Lung&bronchus

19,694

Breast11,010Colorectum10,338Pancreas6,747Leukemia4,111

NHLindicatesNon-Hodgkinlymphoma;ONS,othernervoussystem.*Liverincludesintrahepaticbileduct.

Note:Rankingorderexcludescategorytitlesthatbeginwith“Other.”

TrendsinCancerSurvival

Therehavebeennotableimprovementsinsurvivaloverthepast3decadesformostcancertypesinbothblacksandwhites(Table6).The5-yearrelativesurvivalrateforallsitescombinedhasincreased19percentagepointsamongwhitesand23percentagepointsamongblacks.Progresshasbeenmostrapidforhematopoieticandlymphoidmalignanciesduetoimprovementsintreatmentprotocols,includingthediscoveryoftargetedtherapies.Forexample,the5-yearsurvivalforacutelymphocyticleukemiaincreasedfrom41%duringthemid-1970sto70%during2004to2010.TheuseofBCR-ABLtyrosinekinaseinhib-itors(eg,imatinib)doubledsurvivalforpatientswithchronicmyeloidleukemiainlessthan2decades,from31%intheearly1990sto60%in2004through2010.40Incontrasttothesteadyincreaseinsurvivalformostcancers,advanceshavebeenslowforlungandpancreaticcancers,forwhichthe5-yearrelativesurvivaliscurrently18%and7%,respectively.Theselowratesarepartlybecause

morethanone-halfofcasesarediagnosedatadistantstage,forwhich5-yearsurvivalis4%and2%,respectively.Thereispromiseforimprovinglungcancersurvivalratesbecauseofearlierdetectionthroughscreeningwithspiralcomputedtomography,whichhasbeenshowntoreducelungcancerdeathsby16%to20%amongadultswithatleasta30-pack-yearsmokinghistory.41,42However,itisimportanttorealizethatscreening,aswellasotherchangesindetectionprac-tices,introducesleadtimebiasinsurvivalrates,therebyreducingtheirusefulnessinmeasuringprogressagainstcan-cer.43Advancesagainstcancerarebestmeasuredusingage-standardizedmortalityrates.

TrendsinCancerMortality

Theoverallcancerdeathrateroseduringmostofthe20thcentury,peakingin1991.Thisincreasewaslargelydrivenbyrapidincreasesinlungcancerdeathsamongmenasaconse-quenceofthetobaccoepidemic.Overthepast2decades,however,therehasbeenasteadydeclineinthecancerdeath

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TABLE10.IncidenceandDeathRatesbySite,Race,andEthnicity,UnitedStates,2007to2011

NON-HISPANIC

WHITE

NON-HISPANIC

BLACK

ASIAN/PACIFICISLANDER

AMERICANINDIAN/ALASKANATIVE*

HISPANIC

Incidence

AllsitesMaleFemale

Breast(female)ColorectumMaleFemale

Kidney&renalpelvisMaleFemale

Liver&intrahepaticbileductMaleFemale

Lung&bronchusMaleFemaleProstateStomachMaleFemale

Uterinecervix

0.8435.8127.9.237.421.611.38.93.081.359.3133.27.83.57.1

606.2406.3123.061.945.624.112.916.04.695.451.7219.815.48.110.2Mortality

AllsitesMaleFemale

Breast(female)ColorectumMaleFemale

Kidney&renalpelvisMaleFemale

Liver&intrahepaticbileductMaleFemale

Lung&bronchusMaleFemaleProstateStomachMaleFemale

Uterinecervix

214.0151.222.218.713.25.92.67.33.063.942.120.73.81.92.0

275.5173.031.428.418.95.82.712.44.377.537.449..84..2

131.091.511.313.19.53.01.314.56.034.718.410.08.34.81.8

190.0135.215.219.215.69..413.86.050.032.421.27.03.83.4

150.199.914.515..95.12.312.65.530.514.018.57..22.8

322.3283.786.039.930.010.75.021.28.048.028.072.515.38.66.4

432.2368.391.750.941.130.117.818.48.668.552.597.912.06.59.5

420.9330.191.5.931.620.611.619.16.945.026.3120.213.87.910.5

Ratesareper100,000populationandageadjustedtothe2000USstandardpopulation.NonwhiteandnonblackracecategoriesarenotmutuallyexclusiveofHispanicorigin.

*DatabasedonIndianHealthServiceContractHealthServiceDeliveryAreas(CHSDA)counties.IncidenceratesexcludedatafromKansas.

rateasaresultoffewerAmericanssmokingandadvancesincancerprevention,earlydetection,andtreatment.The22%dropincancerdeathratesfrom1991(215.1per100,000population)to2011(168.7per100,000population)trans-latesintotheavoidanceofanestimated1,519,300cancerdeaths(1,071,600inmenand447,700inwomen)thatwouldhaveoccurredifpeakrateshadpersisted.

Althoughcancerdeathrateshavedeclinedineverystate,thereismuchvariationinthemagnitudeofthe

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declines.Table7showstherelativedeclineincancerdeathratesbystatefromtheearly1990sto2011andtheestimatednumberofcancerdeathsavertedin2011asaresult.Thedeclinewascalculatedfromanaverageannualbaselinerateduring1990to1992becausethedeathratedidnotpeakin1991inallstates.Declinesrangedfrom9%inOklahomato33%intheDistrictofColumbia,andweregenerallylargestinnortheast-ernstates.Thedeclinesof25%to30%inMaryland,

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FIGURE6.StageDistributionofSelectedCancersbyRace,UnitedStates,2004to2010.

Stagecategoriesdonotsumto100%becausesufficientinformationisnotavailabletostageallcases.

*Theproportionofcasesofcarcinomainsituoftheurinarybladderis51%inallracescombined,52%inwhites,and39%inblacks.

NewJersey,Massachusetts,NewYork,andDelawareresultedin29,000fewercancerdeaths,collectively,in2011.Almost20,000deathswereavertedinCaliforniabecauseofa25%drop.Ingeneral,Southernstateshadtheslowestdeclinesandthehighestcurrentdeathrates,whereaswesternstateshadthelowestdeathrates(Fig.4).Forexample,2011cancerdeathratesrangedfrom125.6(per100,000population)inUtahto200.9inKentucky.Thelargegeographicvariationincancerdeathratesandtrendsreﬂectsdifferencesinriskfactorpatterns,suchassmokingandobesity,aswellasdis-paritiesinthenationaldistributionofpovertyandaccesstohealthcare,whichhaveincreasedovertime.44,45VOLUME00_NUMBER00_MONTH2015

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FIGURE7.Five-YearRelativeSurvivalRatesforSelectedCancersbyRaceandStageatDiagnosis,UnitedStates,2004to2010.

*Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.†Thesurvivalrateforcarcinomainsituoftheurinarybladderis96%inallracescombined,96%inwhites,and90%inblacks.

Figure5depictstrendsincancerdeathratessince1930amongmenandwomenoverallandforselectedcancersitesbysex.Incontrasttomalecancerdeathrates,whichrosecontinuouslypriorto1990,femalecancerdeathratesfellfromthelate1940stothemid-1970s(Fig.5A).Itisalsointerestingtonotethatpriorto1941,deathrateswere

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higherinwomenthaninmenduetothehighdeathrateforuterinecancer(uterinecorpusanduterinecervixcom-bined),whichwastheleadingcauseofcancerdeathamongwomenintheearly20thcentury.Uterinecancerdeathratesdeclinedbymorethan80%between1930and2011,largelyduetothewidespreaduptakeofscreening

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TABLE11.

AverageAnnualPercentChangeinCancerIncidenceandMortalityRatesFrom2007to2011byRace/Ethnicity,UnitedStates

5-YEARAAPC

INCIDENCE

MALE

FEMALE

MALE

MORTALITY

FEMALE

Non-HispanicwhiteNon-HispanicblackAsian/PacificIslander

AmericanIndian/AlaskaNative†Hispanic22.9*23.0*21.6*24.3*23.2*20.820.4*0.122.320.6*21.6*22.5*21.3*20.521.6*21.3*21.1*20.8*21.6*21.2*

*Averageannualpercentchangeisstatisticallysignificant(P<.05).

†DatabasedonIndianHealthServiceContractHealthServiceDeliveryAreas(CHSDA).IncidenceratesexcludedatafromKansas.

Notes:Trendsanalyzedfrom2002to2011usingtheJoinpointRegressionProgram,version4.1.1,allowingupto2joinpoints.Incidencetrendsbasedon44states,representing92%oftheUSpopulation.

forthepreventionandearlydetectionofcervicalcancer.Asimilarlydramaticdeclineoccurredforstomachcancer,whichaccountedfor30%and20%ofmaleandfemalecancerdeaths,respectively,inthe1930s,butjust2%foreachin2011.AlthoughreasonsforthedeclineintheUnitedStatesandmostotherpartsoftheworldarecom-plexandnotcompletelyunderstood,contributorsarethoughttoincludealowerprevalenceofHelicobacterpyloribecauseofimprovedhygieneandlowersaltintakeandahigherconsumptionoffreshfruitsandvegetablesbecauseofadvancesinfoodpreservationtechniques(eg,refrigeration).46Recentstudiesindicatethatinci-denceratesforcertainsubtypesofstomachcancerareincreasingforsomesubsetsoftheUSpopulation.47,48Duringthemostrecent5yearsforwhichdataareavail-able,theaverageannualdeclineincancerdeathrateswasslightlylargeramongmen(1.8%)thanwomen(1.4%)(Table5).Thesedeclinesaredrivenbycontinueddecreasesindeathratesforthe4majorcancersites(lung,breast,prostate,andcolorectum).Lungcancerdeathratesdeclined36%between1990and2011amongmalesand11%between2002and2011amongfemalesduetoreducedtobaccouseasaresultofincreasedawarenessofthehealthhazardsofsmokingandtheimplementationofcomprehensivetobaccocontrol.7,49Researchersrecentlyestimatedthattobaccocon-troleffortsadoptedinthewakeoftheﬁrstSurgeonGener-al’sreportonsmokingandhealthin19haveresultedin8millionfewerprematuresmoking-relateddeaths,one-thirdofwhichareduetocancer.50,51Deathratesforfemalebreastcanceraredown35%frompeakrates,andthosefrompros-tateandcolorectalcancersareeachdown47%asaresultofimprovementsinearlydetectionandtreatments.7,29,52,53Incontrasttodecliningtrendsforthemajorcancers,joinpointanalysisindicatesthatdeathratesarerisinginbothsexesforcancersoftheoropharynx,anus,liver,pan-creas,andsofttissue(includingtheheart).7Deathratesare

alsoincreasingfortonsilcancerandmelanomainmenandforuterinecancerinwomen.Thyroidcancerdeathratesalsoincreased,butonlyslightly,from0.51(per100,000population)in2007to0.52in2011amongmenandfrom0.48to0.49amongwomen.

RecordedNumberofDeathsin2011

Atotalof2,515,458deathswererecordedintheUnitedStatesin2011,ofwhich576,691(23%)werefromcancer.Overall,canceristhesecondleadingcauseofdeathfollowingheartdisease,whichaccountedfor24%oftotaldeaths.However,cancerisexpectedtoovertakeheartdiseaseastheleadingcauseofdeathwithinthenextseveralyears.In2011,cancerwastheleadingcauseofdeathamongadultsaged40to79yearsandwastheﬁrstorsecondleadingcauseofdeathineveryagegroupamongwomen(Table8).Table9presentsthenumberofdeathsfromallcancerscombinedandfromthe5mostcommonsitesforeach20-yearagegroupbysex.Morecancerdeathsoccurinmenthaninwomenexceptforthoseaged20to39yearsand80yearsorolder.Breastcanceristheleadingcauseofcancerdeathinwomenaged20to59years,butisreplacedbylungcancerinwomenaged60yearsorolder.Amongmen,leukemiaistheleadingcauseofcancerdeathforthoseaged20to39years,whereaslungcancerranksﬁrstamongmenaged40yearsorolder.

CancerOccurrencebyRace/Ethnicity

Cancerincidenceanddeathratesvaryconsiderablybetweenandwithinracialandethnicgroups.Ofthe5broadlydeﬁnedpopulationgroupsinTable10,blackmenhavethehighestoverallcancerincidenceanddeathrates—aboutdoublethoseofAsian/PaciﬁcIslander(API)men,whohavethelowestrates.Cancerincidenceanddeathratesarehigheramong

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TABLE12.IncidenceRatesforSelectedCancersbyState,UnitedStates,2007to2011

ALLCANCERS

BREASTFEMALE

COLORECTUMMALE

FEMALE

LUNG&BRONCHUSMALE

FEMALE

NON-HODGKINLYMPHOMAMALE

FEMALE

PROSTATEMALE

URINARYBLADDERMALE

FEMALE

STATEMALEFEMALE

AlabamaAlaskaArizonaArkansas*†CaliforniaColoradoConnecticutDelaware

Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesota‡MississippiMissouriMontanaNebraskaNevada*§

NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio

OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming

UnitedStates568.8501.4432.8552.7499.2490.7567.45.5579.8514.25.4477.9526.2560.6522.5552.1552.5604.0601.6563.6526.8558.7567.4-593.4519.8519.6513.94.8573.2576.47.8580.6560.9524.8531.6539.1505.2571.5559.04.6501.8562.5504.7492.1528.9508.6534.9555.1532.9488.5535.8396.24.1373.5385.1396.3397.2455.7444.9435.7400.07.8398.1411.2441.3424.38.9424.74.2416..9420.7460.0432.3-402.7423.3425.3421.4394..4450.0362.2451.2417.9411.1421.14.8429.56.9455.8402.9411.7417.9387.1361.1441.4398.1438.8437.2426.8387.1419.1118.4127.3111.6109.8122.4125.3136.6128.0143.4114.6123.8126.0118.8127.4118.5124.8122.5120.7121.3126.4130.3135.6120.7-116.0122.6125.8121.8112.7134.1129.5110.0128.5126.6121.8120.0120.4129.4126.8130.1123.0122.0119.7113.7112.0129.1125.0132.5110.5124.8112.1122.855.650.941.155.247.941.849.449.151.246.650.856.4.957.252.955.852.462.460.848.446.247.8.9-60.353.248.6.950.245.152.3.051.8.457.251.851.4.5.347.148.255.951.749.738.143.345.044.657.7.444.050.038.741.431.438.736.332.837.437.3.735.437.637.434.1.941.142.138.5.043.539.335.937.637.5-44.039.438.2.935.838.039.932.239.835.741.138.939.535.341.138.936.741.438.934.630.436.135.135.2.537.135.537.8100.679.460.7106.758.0.774.386.075.377.491.062.661.284.995.083.078.2122.996.988.172.277.183.6-110.293.068.872.272.278.871.451.275.494.468.9.493.569.183.282.792.570.9101.075.734.277.279.770.1104.773.256.378.6.859.7.760.243.144.058.263.447.256.0.838.447.160.462.9.7.080.757.066.2.963.661.2-56.863.7.750.861.362.855.137.755.656.744.359.961.157.857.663.153.849.161.447.423.3.053.156.168.8.145.6.619.721.318.721.923.022.525.323.421.021.922.121.322.523.923.527.023.624.924.325.321.524.824.6-21.322.123.023.719.725.325.117.926.422.723.222.622.122.525.623.320.122.422.422.124.924.721.325.923.224.720.123.213.714.913.614.815.615.917.416.912.915.114.814.417.016.616.818.716.317.216.617.515.216.417.4-14.615.915.317.815.017.517.913.418.115.618.515.616.215.517.817.613.416.316.115.615.717.214.617.216.817.314.516.1153.7126.0100.9149.6136.4147.6152.4168.1198.2128.3161.0113.9155.0149.4117.4133.3152.6128.8168.9133.9152.1148.9161.5-161.4121.8147.2136.6133.9151.7166.1124.4163.3149.1149.0135.8142.7134.4145.9143.1146.7142.0143.7126.9170.6133.4143.2144.3126.3139.2143.4142.133.437.532.733.733.132.847.143.125.135.034.224.538.739.335.941.138.740.434.348.133.742.841.2-30.734.037.635.036.849.2.725.741.936.937.838.534.037.844.346.431.634.235.328.831.339.533.038.039.140.037.836.77.811.08.47.87.98.412.311.49.18.67.96.19.09.88.88.79.39.88.113.09.211.910.6-7.38.510.18.510.613.511.46.210.69.09.39.48.29.511.114.08.58.88.16.85.611.18.39.410.810.010.69.1

Ratesareper100,000andageadjustedtothe2000USstandardpopulation.

*Thisstate’sdataarenotincludedintheUScombinedratesbecauseitdidnotmeethigh-qualitystandardsforoneormoreyearsduring2007to2011accordingtotheNorthAmericanAssociationofCentralCancerRegistries(NAACCR).†Ratesarebasedonincidencedatafor2007to2009.

‡Thisstate’sregistrydidnotsubmitcancerincidencedatatotheNAACCR.§Ratesarebasedonincidencedatafor2007to2010.

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TABLE13.DeathRatesforSelectedCancersbyState,UnitedStates,2007to2011

ALLSITES

BREASTFEMALE

COLORECTUMMALE

FEMALE

LUNG&BRONCHUSMALE

FEMALE

NON-HODGKINLYMPHOMAMALE

FEMALE

PANCREASMALE

FEMALE

PROSTATEMALE

STATEMALEFEMALE

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelaware

Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada

NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio

OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming

UnitedStates251.6215.4182.6248.7186.8177.7195.7222.8234.8200.3222.9175.8192.2218.9235.8211.1211.3257.5250.7227.7211.8210.8219.4201.12.7225.9192.5204.2206.9211.1203.7183.8196.6227.7200.0232.8238.2206.6222.2217.5236.1201.4251.1205.21.6213.6216.7205.7246.1212.6192.3211.61.3155.0130.0159.8137.3130.5141.3158.9166.8138.8146.3115.6138.6156.4159.0147.1145.0172.2162.2156.5150.2149.2157.1143.0157.0157.8142.2142.5151.7152.1151.0129.8143.4147.2133.1160.4159.7151.41.9147.5150.0143.9158.1139.7109.1153.2149.1149.7167.8148.4143.4147.422.922.720.122.821.519.320.822.929.421.023.115.221.923.423.220.721.422.825.020.023.920.423.520.724.223.820.119.823.521.224.620.822.022.721.124.223.521.123.520.623.521.122.721.320.819.723.521.122.521.021.122.221.519.616.522.917.215.815.319.020.617.619.817.616.020.720.820.019.822.623.319.419.617.719.117.224.620.915.820.421.016.620.218.718.518.820.821.422.118.220.718.119.918.921.719.414.016.818.316.723.717.919.119.114.413.911.715.612.412.011.413.518.812.413.510.712.314.814.214.813.116.115.413.713.212.713.712.116.514.112.715.014.313.314.312.513.312.713.114.614.313.314.613.413.713.615.312.810.314.513.512.615.612.412.813.585.562.847.988.145.2.851.367.357.159.270.146.748.0.277.363.2.394.579.167.658.958.066.551.992.074.252.357.958.059.253.942.252.974.452.772.878.456.463.963.974.960.086.558.626.561.3.755.682.357.848.961.0.745.332.245.331.530.337.245.935.438.138.125.533.941.5.538.138.855.3.144.539.741.243.536.141.345.539.435.5.243.136.527.935.839.931.443.946.241.839.342.639.035.045.734.516.245.439.141.049.838.634.638.58.28.27.38.37.77.47.37.46.57.67.57.47.88.39.18..28.68.69.17.57.78.99.48.08.37.88.36.97.47.56.27.77.56.79.28.88.48.97.77.77.68.97.87.38.38.28.68.48.77.38.15.24.74.85..74.34.84.83.94..34.35.45.15.45.35.25.85.05.34..65.65.24.65.34.55..44.65.04.34.84.84.65.55.65.05.44.24.65.15.14.74..74.75.16.25.45.35.013.313.411.313.311.710.813.812.916.412.012.312.812.113.012.812.312.512.914.312.113.212.713.812.013.812.911.911.312.813.513.611.012.911.812.813.312.312.313.312.313.110.413.111.810.312.912.712.811.913.011.912.59..28.69.59.49.19.910.112.48.99.19.78.810.09.58.99.39.511.49.910.110.410.09.210.09.88.09.69.69.910.18.39.99.48.110.19.29.810.18.710.09.79.68.98.09.79.610.17..88.59.628.222.620.124.321.922.821.523.637.619.526.015.625.823.322.721.720.422.325.122.123.721.421.123.429.620.724.822.622.821.421.223.021.424.622.623.223.123.922.021.326.322.124.020.424.622.423.923.420.724.321.322.3

Ratesareper100,000andageadjustedtothe2000USstandardpopulation.

blackthanwhitemenforeverysiteincludedinTable10withtheexceptionofkidneycancermortality,forwhichratesaresimilar.Thelargestdisparitiesareforstomachandpros-tatecancers,forwhichdeathratesinblackmenareabout2.5timesthoseinwhitemen.Factorsknowntocontributetoracialdisparitiesvarybycancersiteandincludedifferencesinriskfactorprevalenceandaccesstohigh-qualityhealthcare,includingcancerpreventionandearlydetection,timely

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TABLE14.

Trendsin5-YearRelativeSurvivalRates*(%)forChildren(Birthto14Years)byYearofDiagnosis,UnitedStates,1975to2010

1975TO1977

1978TO1980

1981TO1983

1984TO1986

1987TO19

1990TO1992

1993TO1995

1996TO1998

1999TO2003

2004TO2010

Allsites

AcutelymphocyticleukemiaAcutemyeloidleukemiaBones&joints

Brain&othernervoussystemHodgkinlymphomaNeuroblastoma

Non-HodgkinlymphomaSofttissueWilmstumor58571950‡578153436173626628588757537479677127‡57‡578855676987687231‡57‡629052707391727837‡67‡8763716692768342679776778092778441‡74719567817792798749707596668371928190587174957290799283†92†66†79†7498†77†86†81†92†

*Survivalratesareadjustedfornormallifeexpectancyandarebasedonfollow-upofpatientsthrough2011.†Thedifferenceinratesbetween1975to1977and2004to2010isstatisticallysignificant(P<.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.

diagnosis,andoptimaltreatment.,55EvenamongMedicare-insuredpatients,blacksarelesslikelythanwhitestoreceivestandard-cancertherapiesforlung,breast,colo-rectal,andprostatecancers.56Amajorsourceoftheseinequalitiesisthedisproportionatelyhighburdenofpovertyintheblackcommunity.AccordingtotheUSCensusBureau,27%ofblackslivedinpovertyand19%werewithouthealthinsurancein2012,comparedwith10%and11%,respectively,ofnon-Hispanicwhites.57Highermortalityratesamongblackscomparedwithwhitespartlyreﬂectalaterstageofdiseaseatdiagnosis.Thisdisparityisparticularlystrikingforcancersoftheuterinecorpus,oralcavity,femalebreast,andcervix(Fig.6).Moreover,blackpatientshavelowerstage-speciﬁcsurvivalformostcancertypes(Fig.7).Asaresult,althoughblackwomenhavealowerbreastcancerincidenceratethanwhitewomen,theyhaveahigherbreastcancerdeathrate(Table10).Thehigherincidencerateamongwhitewomenisthoughttoreﬂectacombinationoffactorsthataffectbothdiagnosis(moreprevalentmammography)andunderlyingdiseaseoccurrence(suchaslaterageatﬁrstbirthandgreateruseofmenopausalhormonetherapy).58Thehigherriskofdeathfrombreastcanceramongblackwomenisthoughttoreﬂectahigherprevalenceofcomor-bidities,alongertimetofollow-upafteranabnormalmammogram,lessreceiptofhigh-qualitytreatment,andahigherprevalenceofaggressivetumorcharacteristics.59–61However,ananalysisofclinicaltrialdatashowedthatblackwomenwerelesslikelythanwhitewomentosurvivetheirbreastcancerdespiteuniformtreatment,evenaftercontrollingforstageofdisease,tumorcharacteristics,follow-up,andsocioeconomicstatus.62CancerincidenceanddeathratesareloweramongAPIs,AmericanIndians/AlaskaNatives(AI/ANs),andHis-22

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panicsthannon-Hispanicwhitesforallcancersitescom-binedandforthe4mostcommoncancersites.However,cancersassociatedwithinfectiousagents(eg,thoseoftheuterinecervix,stomach,andliver)aregenerallymorecom-moninnonwhitepopulations.Forexample,stomachandlivercancerincidenceanddeathratesaretwiceashighintheAPIpopulationasinwhites,reﬂectingahigherpreva-lenceofchronicinfectionwithHelicobacterpyloriandhepa-titisBvirus,respectively,inimmigrantcountriesoforigin.63KidneycancerincidenceanddeathratesarethehighestamongAI/ANs,whichmaybedueinparttohighratesofobesity,smoking,andhypertensioninthispopula-tion.Regionalvariationintheprevalenceoftheseriskfac-torsmaycontributetostrikinggeographicdifferencesinkidneycancerdeathratesamongAI/ANmen,whicharehighestintheSouthernandNorthernPlainsandlowestintheEastandPaciﬁcCoast.Table11showsthevariationintrendsincancerinci-denceanddeathratesduringthemostrecent5datayearsbyraceandethnicity.Thesetrendsarebasedonincidencedatafrom2002to2011covering92%oftheUSpopula-tion,butarenotadjustedforreportingdelays.Amongmen,themagnitudeofdeclineforincidenceratesislargerthanthatfordeathrates,whiletheoppositeisgenerallytrueforwomen.Signiﬁcantdeclinesinincidenceratesinwomenwereconﬁnedtoblacks(0.4%peryear)andHis-panics(0.6%peryear).Blackmencontinuetohavethelargestdeclineindeathrates(2.5%peryear).

RegionalVariationsinCancerRates

Tables12and13depictcurrentcancerincidenceanddeathratesforselectedcancersbystate.Thelargestgeo-graphicvariationincanceroccurrencebyfarisforlungcancer,reﬂectingthelargehistoricalandcontinuing

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differencesinsmokingprevalenceamongstates.49Forexample,lungcancerincidenceratesinKentucky,whichhashistoricallyhadthehighestsmokingprevalence,are3.5timeshigherthanthoseinUtah,whichhasthelowestsmokingprevalence.Thereisa2-folddifferenceforpros-tatecancerincidencerates,whichrangefrom100.9(per100,000population)inArizonato198.2intheDistrictofColumbia,likelyreﬂectingbothstatedifferencesinPSAtestingprevalenceandpopulationdemographics.26Incontrast,statevariationsforothercancertypesaresmallerinbothabsoluteandrelativeterms.Forexample,breastcancerincidenceratesrangefrom109.8(per100,000pop-ulation)inArkansasto143.4intheDistrictofColumbia,arelativedifferenceofjust23%.Someofthisvariationisattributabletodifferencesinmammographyprevalence.65Statevariationincancerincidenceratesreﬂectsdifferencesintheuseofscreeningtestsanddiagnosticpracticesinadditiontodifferencesintheprevalenceofriskfactors,whilethevariationindeathratesreﬂectsdifferencesincanceroccurrenceandsurvival.

decades.From1970to2011,thedeathrateforchildhoodcancerdecreased67%(from6.3to2.1per100,000popula-tion)andthedeathrateforadolescentsdecreasedby58%(from7.2to3.0).Table14providestrendsinsurvivalratesforthemostcommonchildhoodcancers.The5-yearrela-tivesurvivalrateforallcancersitescombinedimprovedfrom58%forchildrendiagnosedduring1975-1977to83%forthosediagnosedduring2004-2010.Thesubstantialprogressforallofthemajorchildhoodcancersreﬂectsbothimprovementsintreatmentandhighlevelsofparticipationinclinicaltrials.

Limitations

Theprojectednumbersofcancercasesanddeathsin2015shouldbeinterpretedwithcautionbecausetheyaremodel-basedestimatesthatmayvaryconsiderablyfromyeartoyearforreasonsotherthanchangesincanceroccurrence.Forinstance,estimatesareaffectedbychangesinmethod,whichareimplementedregularlyasmodelingtechniquesimproveandsurveillancecoveragebecomesmorecomplete.Inaddition,themodelissometimesoversensitiveorunder-sensitivetoabruptorlargechangesinobserveddata.Therefore,whiletheseestimatesprovideareasonablyaccu-rateportrayalofthecontemporarycancerburden,theyshouldnotbeusedtotrackcanceroccurrenceovertime.Age-standardizedorage-speciﬁccancerdeathratesfromtheNCHSandcancerincidenceratesfromSEER,NPCR,and/orNAACCRarethemostinformativeindicatorsofcancertrends.

Errorsinreportingrace/ethnicityinmedicalrecordsandondeathcertiﬁcatesmayresultinunderestimatesofcancerincidenceandmortalityratesinnonwhiteandnonblackpopulations.ThisisparticularlyrelevantforAI/ANpopu-lations.ItisalsoimportanttonotethatcancerdataintheUnitedStatesareprimarilyreportedforbroadracialandethnicgroupsthatarenothomogenous,maskingimportantdifferencesinthecancerburdenwithinthesegroups.

CancerinChildren

Canceristhesecondmostcommoncauseofdeathamongchildrenaged1to14yearsintheUnitedStates,surpassedonlybyaccidents.In2015,anestimated10,380children(0-14years)willbediagnosedwithcancer(excludingbenign/borderlinebraintumors)and1,250willdiefromthedisease.Benignandborderlinebraintumorsarenotincludedintheestimatednewcasesfor2015becausethecalculationmethodrequireshistoricdataandthesetumorswerenotreportableuntil2004.Leukemia(77%ofwhicharelymphoidleukemias)accountsfor30%ofallchildhoodcancers(includingbenignbraintumors).Cancersofthebrainandothernervoussystemarethesecondmostcom-moncancertype(26%),followedbyneuroblastoma(6%),softtissuesarcomas(6%,one-halfofwhicharerhabdomyo-sarcoma),renal(Wilms)tumors(5%),non-Hodgkinlym-phomas(includingBurkittlymphoma)(5%),andHodgkinlymphomas(3%).8Cancersinadolescents(aged15-19years)differsome-whatfromthoseinchildrenintermsoftypeanddistribu-tion.Forexample,asmallerproportionofthecancersdiagnosedinadolescentsareleukemiasandalargerpro-portionarelymphomas.Cancersofthebrainandothernervoussystemaremostcommon(20%),followedbyleu-kemia(13%),Hodgkinlymphoma(13%),thyroidcarci-noma(10%),andgonadalgermcelltumors(9%).Melanomaaccountsfor5%ofthecancersdiagnosedinthisagegroup.

From2007to2011,theoverallincidencerateforcancerincreasedby0.6%peryearinchildrenandwasstableinadolescents.Incontrast,deathrateshavebeendecliningfor

Conclusions

Cancerdeathrateshavebeencontinuouslydecliningforthepast2decades.Overall,theriskofdyingfromcancerdecreasedby22%between1991and2011.Regionally,pro-gresshasbeenmostrapidforresidentsoftheNortheast,amongwhomdeathrateshavedeclinedby25%to30%,andslowestintheSouth,whereratesdeclinedbyabout15%.Furtherreductionsincancerdeathratescanbeaccel-eratedbyapplyingexistingcancercontrolknowledgeacrossallsegmentsofthepopulation,withanemphasisonthoseinthelowestsocioeconomicbracketandotherdisadvan-tagedpopulations.᭿

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CancerStatistics,2015

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