Volume 62, Issue 1 p. 10-29
Article
Free Access

Cancer statistics, 2012

Rebecca Siegel MPH

Corresponding Author

Rebecca Siegel MPH

Manager, Surveillance Information, Surveillance Research, American Cancer Society, Atlanta, GA

Surveillance Research, American Cancer Society, 250 Williams St, NW, Atlanta, GA 30303-1002Search for more papers by this author
Deepa Naishadham MA, MS

Deepa Naishadham MA, MS

Epidemiologist, Surveillance Research, American Cancer Society, Atlanta, GA

Search for more papers by this author
Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

Vice President, Surveillance Research, American Cancer Society, Atlanta, GA

Search for more papers by this author
First published: 04 January 2012
Citations: 8,557

DISCLOSURES: The authors report no conflicts of interest.

We thank Carol DeSantis in Surveillance Research at the American Cancer Society for providing analytic assistance.

Abstract

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. A total of 1,638,910 new cancer cases and 577,190 deaths from cancer are projected to occur in the United States in 2012. During the most recent 5 years for which there are data (2004-2008), overall cancer incidence rates declined slightly in men (by 0.6% per year) and were stable in women, while cancer death rates decreased by 1.8% per year in men and by 1.6% per year in women. Over the past 10 years of available data (1999-2008), cancer death rates have declined by more than 1% per year in men and women of every racial/ethnic group with the exception of American Indians/Alaska Natives, among whom rates have remained stable. The most rapid declines in death rates occurred among African American and Hispanic men (2.4% and 2.3% per year, respectively). Death rates continue to decline for all 4 major cancer sites (lung, colorectum, breast, and prostate), with lung cancer accounting for almost 40% of the total decline in men and breast cancer accounting for 34% of the total decline in women. The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 1,024,400 deaths from cancer. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket. CA Cancer J Clin 2012. © 2012 American Cancer Society.

Introduction

Cancer is a major public health problem in the United States and many other parts of the world. One in 4 deaths in the United States is due to cancer. In this article, we provide the expected numbers of new cancer cases and deaths in 2012 nationally and by state, as well as an overview of current cancer statistics using data through 2008, including incidence, mortality, and survival rates and trends. We also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s, and provide the reported number of cancer deaths in 2008 by age for the 5 leading cancer types.

Materials and Methods

Incidence and Mortality Data

Mortality data from 1930 to 2008 in the United States were obtained from the National Center for Health Statistics (NCHS).1, 2 There are several sources for cancer incidence data. The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute reports long-term (beginning in 1973), high-quality, population-based incidence data covering up to 26% of the US population. Cancer incidence rates for long-term trends (1975-2008), 5-year relative survival rates (2001-2007), and estimations of the lifetime probability of developing cancer (2006-2008) were obtained from SEER registries.3-7 The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data for 1995 onward from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention's National Program of Cancer Registries, covering up to 95% of the US population. State-specific incidence rates (2004-2008), incidence rates for trends by race/ethnicity (1999-2008), and incidence data (1995-2008) for projecting new cancer cases were obtained from NAACCR.8, 9 Cancer cases were classified according to the International Classification of Diseases for Oncology.10 All incidence and death rates are age-standardized to the 2000 US standard population and expressed per 100,000 persons.

Cancer incidence rates in this report are delay-adjusted whenever possible in order to account for anticipated future corrections to registry data due to inherent delays and errors in case reporting. Delay-adjusted rates primarily affect the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate) and provide a more accurate portrayal of the cancer burden in the most recent time period.11 Delay-adjusted rates are available for SEER registry data and were obtained from the National Cancer Institute.12

Projected Cancer Cases and Deaths in 2012

The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection, compilation, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in 2012 in order to provide an estimate of the contemporary cancer burden. The methods for projecting both new cases and deaths in 2012 have been modified, so these estimates should not be compared with those from previous years.

We projected the numbers of new malignant cancer cases that will be diagnosed in 2012 using a 2-step process that first estimates complete incidence counts by state during years for which observed data are available, and then projects these counts 4 years ahead for the United States overall and each state individually.13 To obtain estimated counts for each state through 2008, we used a spatiotemporal model based on incidence data from 1995 through 2008 for 47 states and the District of Columbia that met NAACCR's high-quality data standard for incidence, covering about 95% of the US population.14 This method accounts for expected delays in case reporting and considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence. A temporal projection method (the vector autoregressive model) was then applied to the estimated counts to obtain the 2012 projections. For the complete details of this methodology, please refer to Zhu et al.13

To estimate the numbers of new breast carcinoma in situ (female) and melanoma in situ cases in 2012, we first estimated the number of in situ cases occurring annually from 2000 through 2008 in the United States by applying the age-specific incidence rates in the 17 SEER areas to the corresponding US population estimates.3, 15 We then projected the total number of cases in 2012 based on the annual percent change from 2000 through 2008 generated by the joinpoint regression model.16

We estimated the number of cancer deaths expected to occur in 2012 in the United States overall and in each state using the joinpoint regression model based on the actual number of cancer deaths from 1994 through 2008 at the state and national levels as reported to the NCHS.2, 17 For the complete details of this methodology, please refer to Chen et al.17

Other Statistics

The estimated numbers of cancer deaths averted in men and women due to the reduction in overall cancer death rates were calculated by applying the 5-year age-specific cancer death rates in the peak year for age-standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age-specific populations in subsequent years through 2008 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 numbers of expected and observed deaths in each age group and calendar year for men and women separately.

Selected Findings

Expected Numbers of New Cancer Cases

Table 1 presents the estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2012. The overall estimate of more than 1.6 million new cases does not include carcinoma in situ of any site except the urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. About 63,300 cases of breast carcinoma in situ and 55,560 cases of melanoma in situ are expected to be newly diagnosed in 2012. The estimated numbers of new cancer cases by state for selected cancers are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2012*
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All Sites 1,638,910 848,170 790,740 577,190 301,820 275,370
Oral cavity & pharynx 40,250 28,540 11,710 7,850 5,440 2,410
 Tongue 12,770 9,040 3,730 2,050 1,360 690
 Mouth 11,620 7,030 4,590 1,790 1,070 720
 Pharynx 13,510 10,790 2,720 2,330 1,730 600
 Other oral cavity 2,350 1,680 670 1,680 1,280 400
Digestive system 284,680 156,760 127,920 142,510 80,560 61,950
 Esophagus 17,460 13,950 3,510 15,070 12,040 3,030
 Stomach 21,320 13,020 8,300 10,540 6,190 4,350
 Small intestine 8,070 4,380 3,690 1,150 610 540
 Colon 103,170 49,920 53,250 51,690 26,470 25,220
 Rectum 40,290 23,500 16,790
 Anus, anal canal, & anorectum 6,230 2,250 3,980 780 300 480
 Liver & intrahepatic bile duct 28,720 21,370 7,350 20,550 13,980 6,570
 Gallbladder & other biliary 9,810 4,480 5,330 3,200 1,240 1,960
 Pancreas 43,920 22,090 21,830 37,390 18,850 18,540
 Other digestive organs 5,690 1,800 3,890 2,140 880 1,260
Respiratory system 244,180 130,270 113,910 164,770 91,110 73,660
 Larynx 12,360 9,840 2,520 3,650 2,880 770
 Lung & bronchus 226,160 116,470 109,690 160,340 87,750 72,590
 Other respiratory organs 5,660 3,960 1,700 780 480 300
Bones & joints 2,890 1,600 1,290 1,410 790 620
Soft tissue (including heart) 11,280 6,110 5,170 3,900 2,050 1,850
Skin (excluding basal & squamous) 81,240 46,890 34,350 12,190 8,210 3,980
 Melanoma-skin 76,250 44,250 32,000 9,180 6,060 3,120
 Other nonepithelial skin 4,990 2,640 2,350 3,010 2,150 860
Breast 229,060 2,190 226,870 39,920 410 39,510
Genital system 340,650 251,900 88,750 58,360 28,840 29,520
 Uterine cervix 12,170 12,170 4,220 4,220
 Uterine corpus 47,130 47,130 8,010 8,010
 Ovary 22,280 22,280 15,500 15,500
 Vulva 4,490 4,490 950 950
 Vagina & other genital, female 2,680 2,680 840 840
 Prostate 241,740 241,740 28,170 28,170
 Testis 8,590 8,590 360 360
 Penis & other genital, male 1,570 1,570 310 310
Urinary system 141,140 97,610 43,530 29,330 19,670 9,660
 Urinary bladder 73,510 55,600 17,910 14,880 10,510 4,370
 Kidney & renal pelvis 64,770 40,250 24,520 13,570 8,650 4,920
 Ureter & other urinary organs 2,860 1,760 1,100 880 510 370
Eye & orbit 2,610 1,310 1,300 270 120 150
Brain & other nervous system 22,910 12,630 10,280 13,700 7,720 5,980
Endocrine system 58,980 14,600 44,380 2,700 1,240 1,460
 Thyroid 56,460 13,250 43,210 1,780 780 1,000
 Other endocrine 2,520 1,350 1,170 920 460 460
Lymphoma 79,190 43,120 36,070 20,130 10,990 9,140
 Hodgkin lymphoma 9,060 4,960 4,100 1,190 670 520
 Non-Hodgkin lymphoma 70,130 38,160 31,970 18,940 10,320 8,620
Myeloma 21,700 12,190 9,510 10,710 6,020 4,690
Leukemia 47,150 26,830 20,320 23,540 13,500 10,040
 Acute lymphocytic leukemia 6,050 3,450 2,600 1,440 820 620
 Chronic lymphocytic leukemia 16,060 9,490 6,570 4,580 2,730 1,850
 Acute myeloid leukemia 13,780 7,350 6,430 10,200 5,790 4,410
 Chronic myeloid leukemia 5,430 3,210 2,220 610 370 240
 Other leukemia 5,830 3,330 2,500 6,710 3,790 2,920
Other & unspecified primary sites 31,000 15,620 15,380 45,900 25,150 20,750
  • * Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 63,300 carcinoma in situ of the female breast and 55,560 melanoma in situ will be newly diagnosed in 2012.
  • 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.
Table 2. Incidence Rates for All Cancers Combined, 2004 to 2008, and Estimated New Cases* for Selected Cancers by State, United States, 2012
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 469.2 26,440 3,450 220 2,540 590 630 4,440 1,090 1,000 3,860 1,050
Alaska 481.0 3,640 470 290 100 120 490 70 160 490 160
Arizona 398.3 31,990 4,470 250 2,700 820 960 3,970 1,650 1,390 4,390 1,520
Arkansas 458.4 16,120 2,150 130 1,590 370 460 2,760 570 680 2,400 690
California 444.0 165,810 25,040 1,450 14,370 4,960 5,070 18,060 9,250 7,460 23,410 6,880
Colorado 436.9 22,820 3,420 140 1,750 600 730 2,400 1,470 1,000 3,830 1,070
Connecticut 510.7 21,530 3,140 110 1,730 680 550 2,720 1,290 890 3,340 1,170
Delaware 519.0 5,340 740 410 170 140 800 280 220 850 230
Dist. of Columbia 471.7 2,980 460 260 80 70 370 80 100 540 90
Florida 459.0 117,580 15,540 910 10,200 2,910 3,310 17,860 5,450 4,970 17,160 5,460
Georgia 466.9 48,130 6,970 410 4,090 1,170 1,230 6,570 2,150 1,840 7,900 1,680
Hawaii 438.9 6,610 1,120 50 680 220 180 860 280 230 740 220
Idaho 463.0 7,720 1,000 50 640 210 230 920 400 320 1,320 380
Illinois 490.4 65,750 9,090 510 6,030 1,900 1,980 9,190 2,460 2,870 8,950 3,030
Indiana 468.1 35,060 4,490 250 3,200 1,070 1,020 5,460 1,450 1,500 4,320 1,690
Iowa 484.6 17,010 2,350 90 1,680 540 560 2,330 850 800 2,640 850
Kansas 468.4 14,090 1,990 90 1,330 420 440 1,910 610 630 1,890 630
Kentucky 519.2 25,160 3,160 180 2,280 630 670 4,430 1,370 1,070 3,200 1,080
Louisiana 496.7 23,480 3,320 200 2,350 520 660 3,660 810 930 4,040 930
Maine 528.4 8,990 1,170 50 750 300 240 1,340 480 390 1,320 520
Maryland § 31,000 4,700 210 2,420 920 780 4,250 1,420 1,280 5,190 1,200
Massachusetts 509.9 38,470 5,480 190 2,990 1,250 930 4,920 2,190 1,590 6,180 2,000
Michigan 494.2 57,790 7,710 350 5,080 1,770 1,700 8,210 2,700 2,550 9,450 2,830
Minnesota 484.7 28,060 4,110 150 2,370 910 900 3,750 1,130 1,290 4,520 1,320
Mississippi 481.2 15,190 1,990 140 1,580 330 360 2,550 510 540 2,330 550
Missouri 471.2 33,440 4,440 230 3,250 1,060 1,010 5,370 1,280 1,460 4,110 1,510
Montana 458.3 5,550 740 470 150 170 700 320 250 1,000 270
Nebraska 480.4 9,030 1,270 60 910 280 300 1,230 380 440 1,240 430
Nevada 464.2 13,780 1,770 120 1,260 330 390 1,930 510 530 1,850 610
New Hampshire 505.3 8,350 1,160 680 280 240 1,130 470 350 1,260 460
New Jersey 509.7 50,650 6,970 390 4,630 1,670 1,460 5,990 2,340 2,160 7,550 2,480
New Mexico 412.0 9,640 1,310 70 840 260 310 1,090 560 420 1,430 380
New York 494.8 109,440 14,730 850 9,390 3,730 2,970 13,620 4,700 4,680 17,090 5,460
North Carolina 479.7 51,860 7,090 390 4,140 1,390 1,410 7,950 2,360 2,050 8,010 2,100
North Dakota 477.4 3,510 490 350 110 120 460 130 160 530 170
Ohio 472.4 66,560 8,990 400 6,020 2,110 1,810 10,270 3,030 2,920 8,560 3,160
Oklahoma 483.9 19,210 2,630 170 1,780 470 600 3,370 750 850 2,560 820
Oregon 473.3 21,370 3,200 130 1,670 620 610 2,920 1,290 950 3,460 1,020
Pennsylvania 503.9 78,340 10,290 460 7,330 2,570 2,340 10,890 3,470 3,510 11,890 4,150
Rhode Island 517.9 6,310 870 540 200 170 860 290 240 810 330
South Carolina 468.7 26,570 3,570 220 2,350 670 700 4,270 1,150 1,040 4,140 1,060
South Dakota 441.5 4,430 600 420 140 130 620 170 200 700 220
Tennessee 466.8 35,610 4,680 270 3,240 850 920 6,140 1,640 1,440 4,900 1,490
Texas 446.9 110,470 15,050 1,080 9,700 2,600 3,530 14,810 4,020 4,750 15,730 3,940
Utah 402.5 10,620 1,480 70 780 290 370 880 780 480 1,850 420
Vermont 494.2 4,060 560 330 130 110 550 220 160 580 210
Virginia 456.4 41,380 6,190 290 3,250 1,220 1,020 5,550 2,150 1,700 6,860 1,620
Washington 484.0 35,790 5,240 220 2,770 1,080 1,050 4,700 2,140 1,600 5,060 1,670
West Virginia 498.4 11,610 1,430 80 1,080 330 330 2,070 520 490 1,540 510
Wisconsin 482.4 31,920 4,270 190 2,730 1,040 1,110 4,220 1,370 1,460 4,310 1,600
Wyoming 447.5 2,650 360 240 70 80 330 150 110 480 130
United States 472.6 1,638,910 226,870 12,170 143,460 47,130 47,150 226,160 76,250 70,130 241,740 73,510
  • * Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • Estimate is fewer than 50 cases.
  • § Rate is not available.
  • Note: These model-based estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusion of states with fewer than 50 cases.

Figure 1 indicates the most common cancers expected to occur in men and women in 2012. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about half of all newly diagnosed cancers; prostate cancer alone will account for 29% (241,740) of incident cases. The 3 most commonly diagnosed types of cancer among women in 2012 will be breast, lung and bronchus, and colorectum, accounting for about half of the estimated cancer cases in women. Breast cancer alone is expected to account for 29% (226,870) of all new cancer cases among women.

Details are in the caption following the image

Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2012.

*Estimates are rounded to the nearest 10 and exclude basal and squamous cell skin cancers and in situ carcinoma except urinary bladder.

Expected Numbers of Cancer Deaths

Table 1 also shows the expected numbers of deaths from cancer projected for 2012. It is estimated that 577,190 Americans will die from cancer this year, corresponding to more than 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colorectum in men and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common causes of cancer death. These 4 cancers account for almost half of the total cancer deaths among men and women (Fig. 1). In 2012, lung cancer is expected to account for 26% of all female cancer deaths and 29% of all male cancer deaths. Table 3 provides the estimated numbers of cancer deaths in 2012 by state for selected cancers.

Table 3. Death Rates for All Cancers Combined, 2004 to 2008, and Estimated Deaths* for Selected Cancers by State, United States, 2012
STATE DEATH RATE ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER & INTRAHEPATIC BILE DUCT LUNG & BRONCHUS NON-HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE
Alabama 199.9 10,290 230 710 980 390 320 3,240 320 300 600 560
Alaska 181.2 930 70 80 260 60
Arizona 156.2 11,090 300 780 1,010 460 440 2,850 400 330 720 570
Arkansas 201.7 6,570 150 420 610 260 180 2,160 170 150 370 290
California 165.1 56,620 1,540 4,110 5,140 2,430 2,880 12,830 2,000 1,680 3,860 3,110
Colorado 156.1 7,190 230 510 680 300 270 1,690 250 250 490 380
Connecticut 176.9 6,940 160 480 560 270 230 1,780 230 210 510 380
Delaware 196.6 1,930 50 120 170 70 70 580 60 50 120 90
Dist. of Columbia 198.3 1,010 80 100 250 80 60
Florida 172.5 42,170 850 2,600 3,660 1,760 1,460 12,200 1,400 1,040 2,670 2,160
Georgia 183.1 15,790 350 1,140 1,470 600 480 4,650 470 450 970 860
Hawaii 149.2 2,380 140 240 80 120 580 80 60 200 100
Idaho 167.8 2,640 90 170 220 130 80 660 100 70 190 160
Illinois 189.3 23,970 500 1,650 2,300 990 730 6,590 760 620 1,580 1,140
Indiana 197.2 13,240 320 850 1,160 560 350 4,140 450 340 790 560
Iowa 180.5 6,410 180 400 590 290 180 1,790 230 190 390 330
Kansas 180.7 5,400 150 370 510 250 160 1,580 200 140 340 230
Kentucky 213.6 9,890 190 570 890 350 250 3,530 310 220 530 360
Louisiana 208.4 9,150 210 660 900 330 380 2,730 270 220 570 390
Maine 196.0 3,230 80 180 260 120 90 970 110 70 200 130
Maryland 186.8 10,440 230 810 940 420 350 2,850 320 280 720 510
Massachusetts 183.0 12,930 300 800 1,060 500 480 3,570 420 370 910 600
Michigan 189.3 20,430 530 1,350 1,730 890 660 5,910 720 550 1,370 840
Minnesota 171.5 9,490 240 600 800 440 320 2,500 330 260 600 480
Mississippi 206.8 6,330 140 440 640 240 220 1,960 170 140 370 310
Missouri 194.5 12,710 300 900 1,120 550 390 3,970 390 280 800 580
Montana 175.7 2,010 60 110 170 90 50 580 70 60 130 110
Nebraska 175.4 3,450 100 210 360 150 80 900 130 90 210 190
Nevada 186.1 4,590 140 350 510 170 210 1,490 140 120 340 260
New Hampshire 184.2 2,700 70 180 220 100 80 750 80 60 200 120
New Jersey 182.6 16,650 340 1,340 1,600 650 540 4,200 550 490 1,130 720
New Mexico 160.8 3,530 90 240 350 140 170 780 110 100 240 200
New York 169.6 34,140 740 2,420 3,090 1,430 1,350 8,880 1,080 1,010 2,420 1,610
North Carolina 189.6 18,440 390 1,290 1,530 690 580 5,600 560 460 1,130 1,020
North Dakota 173.0 1,300 90 130 60 320 50 90 70
Ohio 197.2 25,030 570 1,750 2,250 970 720 7,350 800 600 1,710 1,210
Oklahoma 195.9 7,800 200 500 720 310 240 2,440 260 180 420 430
Oregon 183.0 7,790 220 510 670 310 270 2,120 280 240 520 410
Pennsylvania 190.2 28,790 570 1,950 2,460 1,190 880 7,750 1,030 810 1,940 1,330
Rhode Island 184.9 2,190 50 130 170 100 80 620 70 60 130 90
South Carolina 191.1 9,670 220 660 830 350 300 2,970 280 220 570 440
South Dakota 172.4 1,630 110 160 70 450 60 50 100 80
Tennessee 202.8 13,880 340 890 1,230 510 410 4,570 430 330 790 580
Texas 174.7 36,820 900 2,650 3,400 1,490 1,830 9,780 1,180 930 2,240 1,630
Utah 131.8 2,780 110 250 240 160 90 460 110 90 210 270
Vermont 178.4 1,300 80 110 50 370 90 60
Virginia 185.6 14,610 320 1,110 1,290 570 440 4,150 450 420 990 660
Washington 178.6 12,170 400 800 990 510 500 3,270 390 390 810 670
West Virginia 207.8 4,600 100 280 440 160 110 1,460 160 120 220 160
Wisconsin 181.5 11,240 300 690 920 510 350 3,000 400 320 760 570
Wyoming 171.0 940 60 90 250 70
United States 181.3 577,190 13,700 39,510 51,690 23,540 20,550 160,340 18,940 15,500 37,390 28,170
  • * Rounded to the nearest 10.
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • Estimate is fewer than 50 deaths.
  • Note: State estimates may not add to US total due to rounding and the exclusion of states with fewer than 50 deaths.

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (45%) than for women (38%) (Table 4). However, because of the earlier median age at diagnosis for breast cancer compared with other major cancers, women have a slightly higher probability of developing cancer before age 60 years. These estimates are based on the average experience of the general population and may over- or underestimate individual risk because of differences in exposure (eg, smoking history) and/or genetic susceptibility.

Table 4. Probability (%) of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2006 to 2008*
BIRTH TO 39 40 TO 59 60 TO 69 70 AND OLDER BIRTH TO DEATH
All sites Male 1.45 (1 in 69) 8.68 (1 in 12) 16.00 (1 in 6) 38.27 (1 in 3) 44.85 (1 in 2)
Female 2.15 (1 in 46) 9.10 (1 in 11) 10.34 (1 in 10) 26.68 (1 in 4) 38.08 (1 in 3)
Urinary bladder Male 0.02 (1 in 5,035) 0.38 (1 in 266) 0.92 (1 in 109) 3.71 (1 in 27) 3.84 (1 in 26)
Female 0.01 (1 in 12,682) 0.12 (1 in 851) 0.25 (1 in 400) 0.98 (1 in 102) 1.15 (1 in 87)
Breast Female 0.49 (1 in 203) 3.76 (1 in 27) 3.53 (1 in 28) 6.58 (1 in 15) 12.29 (1 in 8)
Colorectum Male 0.08 (1 in 1,236) 0.92 (1 in 109) 1.44 (1 in 70) 4.32 (1 in 23) 5.27 (1 in 19)
Female 0.08 (1 in 1,258) 0.73 (1 in 137) 1.01 (1 in 99) 3.95 (1 in 25) 4.91 (1 in 20)
Leukemia Male 0.16 (1 in 614) 0.22 (1 in 445) 0.34 (1 in 291) 1.24 (1 in 81) 1.57 (1 in 64)
Female 0.14 (1 in 737) 0.15 (1 in 665) 0.21 (1 in 482) 0.81 (1 in 123) 1.14 (1 in 88)
Lung & bronchus Male 0.03 (1 in 3,631) 0.91 (1 in 109) 2.26 (1 in 44) 6.69 (1 in 15) 7.66 (1 in 13)
Female 0.03 (1 in 3,285) 0.76 (1 in 132) 1.72 (1 in 58) 4.91 (1 in 20) 6.33 (1 in 16)
Melanoma of the skin§ Male 0.15 (1 in 677) 0.63 (1 in 158) 0.75 (1 in 133) 1.94 (1 in 52) 2.80 (1 in 36)
Female 0.27 (1 in 377) 0.56 (1 in 180) 0.39 (1 in 256) 0.82 (1 in 123) 1.83 (1 in 55)
Non-Hodgkin lymphoma Male 0.13 (1 in 775) 0.45 (1 in 223) 0.60 (1 in 167) 1.77 (1 in 57) 2.34 (1 in 43)
Female 0.09 (1 in 1,152) 0.32 (1 in 313) 0.44 (1 in 228) 1.41 (1 in 71) 1.94 (1 in 51)
Prostate Male 0.01 (1 in 8,499) 2.63 (1 in 38) 6.84 (1 in 15) 12.54 (1 in 8) 16.48 (1 in 6)
Uterine cervix Female 0.15 (1 in 650) 0.27 (1 in 373) 0.13 (1 in 771) 0.18 (1 in 549) 0.68 (1 in 147)
Uterine corpus Female 0.07 (1 in 1,373) 0.77 (1 in 130) 0.87 (1 in 114) 1.24 (1 in 81) 2.61 (1 in 38)
  • * For people free of cancer at beginning of age interval.
  • All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder.
  • Includes invasive and in situ cancer cases.
  • § Statistics for whites only.

Trends in Cancer Incidence

Figures 2-5 depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancers by sex. Table 5 shows incidence (delay-adjusted) and mortality trends for all cancers combined and for the 4 most common cancer sites based on joinpoint regression analysis. Joinpoint is a tool used to describe and quantify trends by fitting observed rates to lines connected at “joinpoints” where trends change in direction or magnitude.16, 18 According to data from the SEER 13 cancer registries, incidence rates in the most recent 5 years (2004-2008) decreased in males by 0.6% per year and were stable in females (Table 5). Incidence rates decreased for all 4 major cancer sites except the female breast, for which rates remained relatively stable from 2005 to 2008 after decreasing by 2% per year from 1999 to 2005. Lung cancer incidence rates in women began declining in the late 1990s, more than a decade after the decline began in men.6 Differences in lung cancer incidence patterns between men and women (Fig. 3) reflect historical differences in tobacco use; cigarette smoking prevalence peaked about 20 years later in women than in men.19 Recent rapid declines in colorectal cancer incidence rates have largely been attributed to increases in screening that can detect and remove precancerous polyps.20-22 Although joinpoint trend analysis shows that the incidence rate for prostate cancer declined steadily by 1.9% per year from 2000 to 2008, it is important to realize that annual rates fluctuate widely from year to year (Fig. 3), likely reflecting variation in the prevalence of prostate-specific antigen testing for the detection of prostate cancer. For example, in the SEER 13 areas, the delay-adjusted prostate cancer incidence rate increased from 152.8 (per 100,000) in 2005 to 162.8 in 2006, then dropped from 165.9 in 2007 to 151.8 in 2008.12

Table 5. Trends in Cancer Incidence (Delay-Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1992 to 2008
TREND 1 TREND 2 TREND 3 TREND 4 2004-2008 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC
All cancers
Incidence
  Male and female 1992-1994 −3.2* 1994-1999 0.4 1999-2005 −0.8* 2005-2008 0.1 −0.1
  Male 1992-1994 −5.6* 1994-2008 −0.6* −0.6*
  Female 1992-1998 0.8* 1998-2006 −0.5* 2006-2008 1.1 0.3
Death
  Male and female 1992-2001 −1.0* 2001-2008 −1.6* −1.6*
  Male 1992-2001 −1.4* 2001-2008 −1.8* −1.8*
  Female 1992-2002 −0.7* 2002-2008 −1.6* −1.6*
Lung & bronchus
Incidence
  Male 1992-2008 −1.9* −1.9*
  Female 1992-1997 0.7 1997-2008 −0.3* −0.3*
Death
  Male 1992-2005 −1.9* 2005-2008 −2.8* −2.6*
  Female 1992-2002 0.6* 2002-2008 −0.9* −0.9*
Colorectum
Incidence
  Male 1992-1995 −2.6* 1995-1998 1.5 1998-2008 −2.6* −2.6*
  Female 1992-1995 −1.8* 1995-1998 1.9 1998-2008 −2.0* −2.0*
Death
  Male 1992-2002 −2.0* 2002-2005 −4.0* 2005-2008 −2.3* −2.7*
  Female 1992-2001 −1.7* 2001-2005 −3.6* 2005-2008 −2.1* −2.5*
Female breast
Incidence 1992-1999 1.3* 1999-2005 −2.0* 2005-2008 1.1 0.3
Death 1992-1995 −1.2* 1995-1998 −3.6* 1998-2003 −1.7* 2003-2008 −2.3* −2.3*
Prostate
Incidence 1992-1995 −11.1* 1995-2000 2.0 2000-2008 −1.9* −1.9*
Death 1992-1994 −1.3 1994-2008 −3.7* −3.7*
  • APC indicates annual percent change based on incidence (delay-adjusted) and mortality rates age adjusted to the 2000 US standard population; AAPC, average annual percent change.
  • * The APC or AAPC is significantly different from 0 (P < .05).
  • Note: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 3 joinpoints. Incidence trends based on Surveillance, Epidemiology, and End Results (SEER) 13 areas.
Details are in the caption following the image

Trends in Cancer Incidence and Mortality Rates by Sex, United States, 1975 to 2008.

Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting.

Details are in the caption following the image

Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2008.

Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting.

*Liver includes intrahepatic bile duct.

Details are in the caption following the image

Trends in Death Rates Among Males for Selected Cancers, United States, 1930 to 2008.

Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (ICD) coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colorectum, and liver are affected by these changes.

Details are in the caption following the image

Trends in Death Rates Among Females for Selected Cancers, United States, 1930 to 2008.

Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (ICD) coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colorectum are affected by these changes.

*Uterus includes uterine cervix and uterine corpus.

Trends in Cancer Mortality

Based on the most recent 5 years of mortality data (2004-2008), the overall cancer death rate decreased by 1.8% per year in males and by 1.6% per year in females. These declines have been consistent since 2001/2002 and are larger in magnitude than those occurring in the previous decade (Table 5). Death rates peaked in men in 1990 (279.8 per 100,000) and in women in 1991 (175.3 per 100,000). Between 1990/1991 and 2008, cancer death rates decreased 22.9% in men and 15.3% in women. Death rates continue to decrease for the 4 major cancer sites: lung and bronchus, colorectum, breast, and prostate (Figs. 4 and 5). Among men, reductions in death rates for lung, prostate, and colorectal cancers account for 78% of the total decrease in the cancer death rate, with lung cancer alone accounting for almost 40% of the decrease. Among women, reductions in death rates for breast and colorectal cancers account for 56% of the total decrease, with breast cancer accounting for 34% of the decrease in women. The decrease in lung cancer death rates among men since 1990 is due to the reduction in tobacco use over the past 50 years,23 while the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment.20, 24, 25

Figure 6 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. About 1,024,400 cancer deaths (732,900 in men and 291,500 in women) were averted from 1991/1992 through 2008 as a result of 18 years of consistent declines in cancer death rates.

Details are in the caption following the image

Total Number of Cancer Deaths Averted From 1991 to 2008 in Men and From 1992 to 2008 in Women.

The blue line represents the actual number of cancer deaths recorded in each year, and the red line represents the expected number of cancer deaths if cancer mortality rates had remained at their peak (1990 in men and 1991 in women).

Recorded Number of Deaths From Cancer in 2008

A total of 565,469 cancer deaths were recorded in the United States in 2008, the most recent year for which actual data are available. Cancer is the second leading cause of death following heart disease, accounting for 23% of all deaths. From 2007 to 2008, the age-standardized cancer death rate decreased 1.5%, from 178.4 (per 100,000) to 175.8.

Table 6 presents the numbers of deaths from all cancers combined and from the 5 most common cancer types for each 20-year age group. Leukemia is the most common cause of cancer death among males aged younger than 40 years, while lung cancer ranks first among those aged 40 years and older. Among females, leukemia is the leading cause of cancer death among children and adolescents (those aged younger than 20 years), breast cancer ranks first among women ages 20 to 59 years, and lung cancer causes the most cancer deaths in those aged 60 years and older.

Table 6. Reported Deaths for the 5 Leading Cancers by Age and Sex, United States, 2008
ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥80
MALE
ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES
295,259 1,130 4,169 54,458 153,631 81,865
Lung & bronchus Leukemia Leukemia Lung & bronchus Lung & bronchus Lung & bronchus
88,541 316 616 15,212 52,755 20,288
Prostate Brain & ONS Brain & ONS Colorectum Colorectum Prostate
28,472 290 499 5,516 13,381 15,214
Colorectum Bones & joints Colorectum Liver & bile duct Prostate Colorectum
26,935 99 433 4,244 11,957 7,593
Pancreas Soft tissue Non-Hodgkin lymphoma Pancreas Pancreas Urinary bladder
17,515 87 317 3,709 9,578 4,338
Leukemia Other endocrine system Lung & bronchus Esophagus Esophagus Pancreas
12,711 79 272 2,586 6,140 4,131
FEMALE
ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES
270,210 909 4,530 49,828 127,190 87,750
Lung & bronchus Leukemia Breast Breast Lung & bronchus Lung & bronchus
70,051 282 1,064 11,492 39,770 19,063
Breast Brain & ONS Uterine cervix Lung & bronchus Breast Colorectum
40,589 243 411 10,980 17,051 11,167
Colorectum Bones & joints Colorectum Colorectum Colorectum Breast
25,924 83 383 4,077 10,291 10,981
Pancreas Other endocrine system Leukemia Ovary Pancreas Pancreas
17,721 78 362 3,125 8,545 6,648
Ovary Soft tissue Brain & ONS Pancreas Ovary Non-Hodgkin lymphoma
14,362 73 305 2,437 7,117 4,109
  • ONS indicates 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.

Regional Variations in Cancer Rates

Tables 7 and 8 depict cancer incidence and death rates for selected cancers by state. Lung cancer shows the largest geographic variation in cancer occurrence by far, reflecting the large historical and continuing differences in smoking prevalence among states.23 For example, lung cancer incidence rates in Kentucky, which has highest smoking prevalence, are almost 4-fold higher than those in Utah, which has the lowest smoking prevalence. In contrast, state variations for other cancer sites are smaller in both absolute and proportionate terms. For example, the breast cancer incidence rate in Connecticut, which has the highest rate (136.2 per 100,000), is only 28% higher than that in Arizona, which has the lowest rate (106.7 per 100,000). For cancers that can be detected by screening or other testing practices, such as those of the prostate, female breast, and colorectum, state variation in incidence rates reflects differences in the use of screening tests or detection practices in addition to differences in disease occurrence.

Table 7. Incidence Rates for Selected Cancers by State, United States, 2004 to 2008
ALL CANCERS BREAST COLORECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PROSTATE URINARY BLADDER
STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE
Alabama* 579.9 391.1 117.2 61.3 42.0 106.8 54.1 19.8 13.8 160.8 32.8 7.6
Alaska 531.4 441.0 130.4 55.1 45.5 85.3 64.8 22.3 18.2 141.5 39.4 8.6
Arizona 447.5 360.6 106.7 43.4 32.5 63.9 48.2 18.0 13.3 122.9 32.5 8.6
Arkansas 556.4 385.6 109.0 56.2 41.4 109.2 61.0 21.7 15.4 156.4 32.8 8.4
California 512.8 396.9 122.4 51.2 38.6 63.3 45.7 22.8 15.6 146.5 34.3 8.1
Colorado 498.2 393.5 122.3 48.4 37.0 57.6 45.0 22.0 15.8 156.3 32.1 8.3
Connecticut 590.0 458.5 136.2 57.4 42.9 80.2 60.0 26.3 17.9 162.1 47.6 12.3
Delaware 614.3 446.9 126.6 59.6 42.6 94.4 69.5 24.3 17.0 181.7 44.4 11.9
Dist. of Columbia 573.2 398.3 126.7 54.1 43.7 80.3 45.3 22.7 12.8 187.9 24.4 7.7
Florida 531.2 402.6 113.6 51.9 39.3 85.1 59.0 21.7 15.3 137.3 35.9 9.1
Georgia 571.9 395.7 119.2 55.7 40.0 97.3 54.5 21.7 14.5 167.4 33.1 8.0
Hawaii 503.7 393.3 122.4 59.7 39.8 70.5 40.7 20.3 12.4 132.1 26.2 6.4
Idaho 532.0 408.7 116.5 46.5 37.8 66.8 49.0 22.5 17.1 162.5 36.6 9.2
Illinois 577.0 433.8 123.9 63.9 46.5 89.9 59.8 24.2 16.3 157.7 40.1 10.2
Indiana 544.0 418.6 115.1 59.5 44.2 99.8 63.6 23.0 17.0 132.7 36.7 9.2
Iowa 563.7 431.4 122.5 61.3 47.1 88.0 55.3 26.4 18.4 141.7 42.1 8.9
Kansas 556.4 420.6 124.4 57.9 41.7 85.0 53.6 23.9 17.6 158.1 37.0 9.3
Kentucky 612.1 456.4 120.5 66.7 47.4 130.1 79.5 24.7 17.3 139.8 40.1 10.1
Louisiana* 618.1 409.9 118.2 66.0 44.7 105.8 58.6 24.0 17.1 172.0 35.0 8.4
Maine 612.7 468.1 128.9 58.3 46.0 97.2 66.6 26.0 18.6 163.3 48.2 13.5
Maryland 533.1 411.6 123.4 52.4 39.3 80.0 57.4 20.5 14.2 157.0 33.0 9.7
Massachusetts 588.6 459.2 133.4 56.8 42.0 82.4 64.1 24.6 16.6 160.8 45.6 12.7
Michigan 582.8 432.7 120.3 54.6 41.6 89.1 61.8 25.1 18.3 169.4 41.7 10.7
Minnesota 573.1 421.1 126.4 53.7 41.1 67.6 49.6 26.9 18.1 184.2 40.7 9.7
Mississippi* 608.1 392.1 112.8 64.7 45.7 117.2 56.0 21.6 14.2 174.1 31.3 7.3
Missouri 547.1 418.8 120.6 59.7 43.1 101.3 63.8 22.1 16.0 131.8 35.8 8.4
Montana 518.7 410.9 120.0 51.2 39.3 72.8 58.2 22.2 15.5 160.7 36.3 9.7
Nebraska 559.7 425.4 125.0 65.2 46.9 82.3 52.0 24.4 17.5 157.2 37.2 9.1
Nevada 507.6 404.1 111.7 51.2 41.1 79.0 66.8 20.4 15.7 135.5 37.6 10.6
New Hampshire 576.3 455.7 132.2 54.3 41.4 82.2 62.2 23.1 17.3 154.8 46.0 13.2
New Jersey 595.1 453.8 129.7 60.6 44.4 76.7 56.7 25.6 17.7 171.0 46.7 12.2
New Mexico 467.4 369.5 110.5 46.2 35.5 54.5 39.4 18.5 14.4 137.6 25.9 7.0
New York 580.9 438.4 124.3 56.7 43.0 77.3 54.8 25.5 17.5 166.9 42.5 11.0
North Carolina 576.6 412.5 123.3 55.8 39.9 101.6 57.8 22.7 15.6 158.8 37.1 9.1
North Dakota 559.3 417.1 124.2 66.4 44.5 72.5 46.2 23.1 17.4 169.5 40.8 9.9
Ohio 551.1 421.2 119.8 58.5 43.6 94.9 60.0 23.2 16.2 146.0 39.0 9.6
Oklahoma 566.3 428.0 125.6 56.8 42.7 103.2 65.6 23.0 17.7 151.8 35.8 8.7
Oregon 531.6 431.5 130.3 50.0 38.7 76.0 59.8 24.2 16.3 149.2 38.7 10.0
Pennsylvania 586.6 449.4 124.8 61.4 46.0 88.4 57.6 24.9 17.6 155.8 45.1 11.0
Rhode Island 603.1 464.5 132.5 59.0 44.8 90.8 63.2 24.4 17.5 155.1 53.1 13.4
South Carolina 569.1 396.9 119.9 55.6 41.0 97.9 53.4 20.5 14.1 165.5 30.9 7.8
South Dakota 515.1 386.8 117.4 55.8 40.9 76.3 46.6 20.3 16.7 158.5 34.0 7.9
Tennessee 558.0 404.6 117.2 57.4 42.2 108.7 60.7 22.1 16.1 142.2 34.4 8.3
Texas* 529.9 388.5 113.7 54.4 37.8 82.3 49.9 22.3 15.8 143.3 29.4 7.0
Utah 476.2 344.7 109.5 42.2 31.2 34.1 22.3 23.4 16.0 173.7 28.7 5.8
Vermont 552.6 453.2 130.1 46.7 41.5 81.9 62.1 23.7 17.4 152.1 43.8 13.1
Virginia 542.1 396.9 124.2 52.3 39.5 88.0 54.3 21.2 14.2 159.4 34.0 8.4
Washington 552.5 434.8 129.8 49.5 37.4 73.4 58.3 26.5 17.7 157.9 39.7 9.5
West Virginia 581.9 441.2 112.6 64.7 47.4 115.0 73.2 23.9 17.3 140.4 40.0 11.1
Wisconsin 555.8 430.9 123.4 53.2 41.0 78.1 54.3 28.3 20.1 150.9 38.7 10.0
Wyoming 517.6 391.2 114.6 51.2 39.6 59.5 48.1 22.4 14.8 166.2 41.4 10.1
United States 553.0 416.5 121.2 55.7 41.4 84.4 55.7 23.4 16.3 152.9 37.6 9.4
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • * Due to the effect of large migrations of populations on this state as a result of Hurricane Katrina in September 2005, statistics exclude cases diagnosed from July through December in 2005.
  • This state is not included in the overall US rates because its registry did not achieve high-quality data standards for one or more years during 2004 to 2008 according to the North American Association of Central Cancer Registries (NAACCR) data quality indicators.
Table 8. Death Rates for Selected Cancers by State, United States, 2004 to 2008
ALL CANCERS BREAST COLON & RECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PANCREAS PROSTATE
STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE
Alabama 262.0 158.7 24.5 23.6 15.2 90.3 41.0 8.5 5.5 12.9 9.4 29.9
Alaska 212.4 157.2 21.7 21.5 13.5 62.3 46.3 7.7 5.1 11.9 10.4 22.5
Arizona 186.7 132.4 21.0 17.5 11.9 52.1 33.9 7.7 4.9 11.4 7.8 20.6
Arkansas 254.9 164.1 24.0 23.2 15.6 93.2 47.4 8.6 5.2 12.7 9.5 26.2
California 197.4 143.4 22.5 18.4 13.3 50.3 33.9 8.2 5.1 11.8 9.3 23.6
Colorado 187.3 135.7 20.5 18.3 13.3 46.1 32.3 8.2 4.7 11.2 8.8 24.3
Connecticut 216.4 152.5 23.2 18.1 13.8 58.5 39.1 8.2 5.4 14.4 10.1 25.7
Delaware 238.5 167.5 24.3 20.8 15.0 73.7 50.3 9.0 5.1 12.1 9.8 26.7
Dist. of Columbia 260.4 161.1 27.6 23.0 18.1 68.6 35.1 8.8 3.2 16.1 10.1 41.7
Florida 209.4 143.9 21.9 18.7 13.3 65.1 40.1 8.0 5.0 11.9 8.6 20.3
Georgia 237.1 149.5 23.2 20.7 14.3 78.9 38.9 8.0 4.8 12.8 8.8 28.6
Hawaii 186.2 120.7 17.8 18.8 10.7 51.8 27.4 7.2 4.4 12.9 9.4 16.8
Idaho 197.9 145.7 21.2 15.9 13.8 52.0 34.9 8.2 5.8 11.6 10.2 27.3
Illinois 233.3 162.0 24.7 23.2 16.2 69.9 42.0 9.1 5.6 13.2 10.1 26.1
Indiana 247.3 164.8 24.0 23.1 15.6 82.8 47.2 9.9 5.8 12.9 9.5 25.2
Iowa 224.7 151.7 22.1 21.3 15.5 70.0 39.3 9.2 5.6 12.1 8.8 25.1
Kansas 224.7 151.3 23.1 21.8 14.5 71.8 40.9 9.7 5.5 12.7 9.4 22.2
Kentucky 271.2 175.1 23.5 24.4 17.0 103.0 56.1 9.3 6.0 12.3 9.3 25.6
Louisiana 268.1 168.6 26.8 25.8 16.3 87.8 45.0 9.3 5.5 14.0 10.9 28.6
Maine 243.4 164.7 21.5 20.9 15.4 75.6 47.3 9.3 6.0 12.7 10.0 25.0
Maryland 229.7 159.7 25.6 22.6 15.0 67.4 42.2 8.1 5.0 12.8 10.5 27.5
Massachusetts 227.3 156.0 22.3 20.1 14.4 64.0 42.7 8.7 5.4 13.2 10.3 24.1
Michigan 231.1 162.1 24.4 20.6 15.1 71.5 43.9 9.2 6.2 13.6 9.9 23.6
Minnesota 208.8 147.6 21.6 18.2 13.0 57.0 37.3 9.5 5.4 11.8 9.3 25.1
Mississippi 276.1 161.4 25.5 25.2 16.6 98.9 43.3 8.5 4.6 13.6 9.6 31.7
Missouri 242.0 162.7 25.4 22.1 15.0 83.1 46.4 8.5 5.5 12.9 9.5 23.1
Montana 208.1 153.0 20.7 17.5 13.9 59.5 42.4 8.5 5.6 12.3 9.3 28.0
Nebraska 217.1 147.2 22.0 22.9 15.6 64.1 35.9 9.0 5.9 12.2 8.7 24.9
Nevada 214.7 163.0 23.5 21.3 16.4 62.7 50.0 6.8 4.9 12.1 10.0 24.5
New Hampshire 223.4 159.1 22.8 20.5 13.9 63.4 43.7 8.3 5.1 12.8 11.0 25.1
New Jersey 218.5 160.6 26.5 22.6 16.0 59.7 39.1 8.5 5.7 13.3 9.9 23.4
New Mexico 193.0 136.8 21.5 19.6 13.4 45.5 29.5 6.6 4.8 11.5 9.3 24.6
New York 204.6 148.0 23.1 20.2 14.5 56.6 36.4 8.0 5.1 12.6 9.8 23.0
North Carolina 241.4 155.5 24.4 20.4 14.2 81.1 41.9 8.0 5.3 12.5 9.7 27.0
North Dakota 212.8 146.0 22.3 22.2 14.3 59.3 35.4 8.0 5.1 12.4 9.5 25.9
Ohio 246.5 165.5 25.9 23.3 16.0 78.5 45.0 9.5 5.6 13.1 9.7 26.3
Oklahoma 245.4 161.5 24.1 23.3 14.9 84.0 46.8 9.2 5.7 11.8 8.7 23.9
Oregon 217.7 158.7 22.5 19.0 14.1 62.9 44.3 9.1 5.9 12.3 10.3 26.0
Pennsylvania 235.6 161.1 24.8 22.7 15.8 69.9 40.3 9.4 5.9 13.5 9.8 24.5
Rhode Island 234.4 155.0 22.2 20.6 13.5 69.0 43.4 9.1 4.8 12.3 8.7 23.8
South Carolina 245.7 153.9 24.3 20.9 14.6 81.7 39.9 7.8 5.1 12.6 9.5 28.5
South Dakota 214.2 142.7 21.8 20.5 14.3 65.4 36.3 8.7 5.3 11.2 9.2 24.4
Tennessee 261.1 164.0 24.5 22.7 15.6 93.9 47.2 9.3 5.5 12.8 9.4 26.3
Texas 217.8 145.1 22.6 20.7 13.4 65.7 36.9 8.2 5.2 11.8 8.6 22.6
Utah 158.3 112.4 22.1 14.6 10.2 29.5 16.9 7.8 5.0 9.7 7.9 25.6
Vermont 214.2 155.5 21.7 20.2 15.0 62.5 43.2 7.7 5.1 11.5 9.6 24.3
Virginia 232.7 155.5 25.1 21.0 14.4 73.0 41.3 8.3 5.1 13.1 9.9 26.3
Washington 211.9 155.7 22.4 18.2 13.1 59.7 43.2 8.9 5.7 12.1 9.8 25.2
West Virginia 257.1 174.0 23.9 24.4 16.9 89.1 50.8 9.6 6.5 11.7 7.6 21.6
Wisconsin 222.8 154.3 22.1 19.4 13.6 61.4 39.2 9.5 5.9 12.8 9.7 26.7
Wyoming 199.4 150.7 22.1 19.9 14.6 52.5 38.2 8.1 6.3 12.4 10.4 22.7
United States 223.0 153.2 23.5 20.7 14.5 67.4 40.1 8.6 5.4 12.5 9.4 24.4
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.

Cancer Occurrence by Race/Ethnicity

Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 9). For all cancer sites combined, African American men have a 15% higher incidence rate and a 33% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 16% higher death rate than white women. For the specific cancer sites listed in Table 9, incidence and death rates are consistently higher in African Americans than in whites except for cancers of the breast (incidence) and lung (incidence and mortality) among women, and kidney (mortality) among both men and women. Factors known to contribute to racial disparities in mortality vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer), access to high-quality screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment for many cancers.26 The higher breast cancer incidence rate noted among white women is thought to reflect a combination of factors that affect both diagnosis (more prevalent mammography use in white women) and underlying disease occurrence (increased prevalence of risk factors in white women, such as later age at first birth and greater use of menopausal hormone therapy).27

Table 9. Incidence and Death Rates by Site, Race, and Ethnicity, United States, 2004 to 2008
WHITE AFRICAN AMERICAN ASIAN AMERICAN OR PACIFIC ISLANDER AMERICAN INDIAN OR ALASKA NATIVE* HISPANIC/LATINO
Incidence
All sites
 Male 545.0 626.2 332.4 427.8 423.4
 Female 420.8 394.2 284.0 362.1 333.5
Breast (female) 122.3 116.1 84.9 89.2 92.3
Colorectum
 Male 54.6 66.9 42.4 51.5 48.6
 Female 40.3 49.7 32.7 41.5 34.2
Kidney & renal pelvis
 Male 20.8 22.6 9.9 27.4 19.4
 Female 10.9 11.7 4.9 16.8 11.2
Liver & bile duct
 Male 8.6 14.1 21.7 15.8 17.0
 Female 2.9 4.0 8.2 7.6 6.4
Lung & bronchus
 Male 83.7 102.7 49.8 71.0 46.8
 Female 57.2 51.4 28.1 51.7 27.0
Prostate 142.8 230.8 79.7 101.2 126.7
Stomach
 Male 8.5 16.4 16.8 13.9 13.8
 Female 4.0 8.2 9.4 6.8 8.4
Uterine cervix 7.7 10.6 7.4 9.8 12.2
Mortality
All sites
 Male 222.0 295.3 134.7 190.0 149.1
 Female 152.8 177.7 94.1 138.4 101.5
Breast (female) 22.8 32.0 12.2 17.2 15.1
Colorectum
 Male 20.1 30.5 13.3 19.8 15.5
 Female 14.0 20.4 9.9 14.0 10.3
Kidney & renal pelvis
 Male 6.0 6.0 2.6 8.9 5.2
 Female 2.7 2.6 1.2 4.1 2.3
Liver & bile duct
 Male 7.2 11.5 14.7 11.9 11.6
 Female 3.0 3.9 6.3 6.7 5.2
Lung & bronchus
 Male 66.9 85.4 36.7 50.5 31.9
 Female 41.2 38.8 18.5 33.9 14.3
Prostate 22.4 54.9 10.5 20.7 18.5
Stomach
 Male 4.5 10.7 9.2 8.5 7.7
 Female 2.3 5.0 5.4 3.9 4.5
Uterine cervix 2.2 4.3 2.1 3.4 3.1
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population. Race and ethnicity categories are not mutually exclusive of Hispanic origin.
  • * Data based on Indian Health Service Contract Health Service Delivery Areas.
  • Mortality rates exclude deaths from the District of Columbia and North Dakota due to unreliable Hispanic origin data for 1 or more years.

Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the 4 most common cancer sites. However, incidence and death rates for cancers related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites. Stomach and liver cancer incidence and death rates are twice as high in Asian Americans/Pacific Islanders as in whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses in this population.28 Kidney cancer incidence and death rates are the highest among American Indians/Alaska Natives; the higher prevalence of obesity and smoking in this population may contribute to this disparity.29

Cancer incidence rates can only be adjusted for delayed reporting in whites and African Americans because the long-term incidence data required for delay adjustment are not available for other racial and ethnic groups. During the past 10 years of data (1999-2008), while incidence rates (unadjusted for delayed reporting) declined by 1% or more per year among men of all racial/ethnic groups, among women only slight declines (0.4% per year) occurred in whites and Hispanics (Table 10). In contrast, cancer death rates declined by 1% or more per year among men and women of all races/ethnicities except American Indians/Alaska Natives, among whom rates remained stable. Notably, the largest declines in death rates occurred among men of African American (2.4% per year) and Hispanic (2.3% per year) heritage.

Table 10. Ten-Year Trends in Cancer Incidence and Mortality Rates by Race/Ethnicity, United States, 1999 to 2008
1999-2008 AAPC
INCIDENCE MORTALITY
MALE FEMALE MALE FEMALE
All races/ethnicities −1.0* −0.4* −1.8* −1.3*
White −1.0* −0.4* −1.7* −1.3*
African American −1.3* −0.1 −2.4* −1.5*
Asian American/Pacific Islander −1.5* 0.1 −1.6* −1.1*
American Indian/Alaska Native −1.1* −0.3 −0.4 −0.4
Hispanic −1.5* −0.4* −2.3* −1.4*
  • AAPC indicates average annual percent change.
  • * AAPC is statistically significant (P < .05).
  • Data based on Indian Health Service Contract Health Service Delivery Areas.
  • Excludes deaths from the District of Columbia, Minnesota, New Hampshire, and North Dakota due to unreliable Hispanic origin data for some years.
  • Notes: Trends analyzed by the Joinpoint Regression Program, version 3.5.0, allowing up to 2 joinpoints. Incidence trends based on the North American Association of Central Cancer Registries (NAACCR) data. Race and ethnicity categories are not mutually exclusive of Hispanic origin.

Cancer Survival

Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5-year relative survival is lower in African Americans than in whites for every stage of diagnosis for nearly every type of cancer (Fig. 7). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. As shown in Figure 8, African Americans are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated. The extent to which factors other than stage at diagnosis contribute to the overall survival differential is unclear.30 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.31

Details are in the caption following the image

Five-Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2001 to 2007.

*The standard error of the survival rate is between 5 and 10 percentage points.

†The survival rate for carcinoma in situ of the urinary bladder is 97% for All Races and Whites and 92% for African Americans.

Details are in the caption following the image

Stage Distribution of Selected Cancers by Race, United States, 2001 to 2007.

*The proportions of carcinoma in situ of the urinary bladder are 51%, 51%, and 38% in All Races, Whites, and African Americans, respectively. Stage categories do not sum to 100% because sufficient information is not available to assign a stage to all cancer cases.

There have been notable improvements since 1975 in the relative 5-year survival rates for most cancers for both whites and African Americans (Table 11). Increases in survival rates over time reflect a combination of earlier diagnosis and improvements in treatment. Cancers of the lung and pancreas have shown little improvement in survival over the past 30 years.

Table 11. Trends in 5-Year Relative Survival Rates* (%) by Race and Year of Diagnosis, United States, 1975 to 2007
ALL RACES WHITE AFRICAN AMERICAN
1975 TO 1977 1987 TO 1989 2001 TO 2007 1975 TO 1977 1987 TO 1989 2001 TO 2007 1975 TO 1977 1987 TO 1989 2001 TO 2007
All cancers combined 49 56 67 50 57 69 39 43 59
Brain & other nervous system 22 29 35 22 28 34 25 31 40
Breast (female) 75 84 90 76 85 91 62 71 77
Colon 51 60 65 51 61 67 45 53 55
Esophagus 5 10 19 6 11 20 3 7 13
Hodgkin lymphoma 72 79 86 72 80 88 70 72 81
Kidney & renal pelvis 50 57 71 50 57 71 49 55 68
Larynx 66 66 63 67 67 65 59 56 52
Leukemia 34 43 57 35 44 57 33 36 50
Liver & bile duct 3 5 15 3 6 15 2 3 10
Lung & bronchus 12 13 16 12 13 17 11 11 13
Melanoma of the skin 82 88 93 82 88 93 58 79 73
Myeloma 25 28 41 25 27 42 30 30 41
Non-Hodgkin lymphoma 47 51 70 47 52 71 48 46 62
Oral cavity 53 54 63 54 56 65 36 34 45
Ovary 36 38 44 35 38 43 42 34 36
Pancreas 2 4 6 3 3 6 2 6 4
Prostate 68 83 100 69 85 100 61 72 98
Rectum 48 58 68 48 59 69 45 52 61
Stomach 15 20 27 14 19 26 16 19 27
Testis 83 95 96 83 95 97 73§ 88 86
Thyroid 92 95 97 92 94 98 90 92 95
Urinary bladder 73 79 80 74 80 81 50 63 64
Uterine cervix 69 70 69 70 73 70 65 57 61
Uterine corpus 87 83 83 88 84 85 60 57 61
  • * Survival rates are adjusted for normal life expectancy and are based on cases diagnosed in the Surveillance, Epidemiology, and End Results (SEER) 9 areas from 1975 to 1977, 1987 to 1989, and 2001 to 2007 and followed through 2008.
  • The difference in rates between 1975 to 1977 and 2001 to 2007 is statistically significant (P < .05).
  • The standard error of the survival rate is between 5 and 10 percentage points.
  • § Survival rate is for 1978 to 1980.

Relative survival rates cannot be calculated for some minority populations because accurate life expectancies are not available. However, based on cause-specific survival rates of cancer patients diagnosed from 2001 to 2007 in SEER areas of the United States, all minority male populations have a greater probability of dying from cancer within 5 years of diagnosis than whites.6 Among women, African Americans have the lowest 5-year cancer-specific survival, followed by American Indians/Alaska Natives, Hispanics, whites, and Asian Americans/Pacific Islanders.6 For all 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely than non-Hispanic whites to be diagnosed at a distant stage of disease.32

Cancer in Children

Cancer is the second most common cause of death among children ages 1 to 14 years in the United States, surpassed only by accidents; 1,284 children died from cancer in 2008. Leukemia accounts for one-third of all cancers diagnosed in children (ages 0 to 14 years), 78% of which are acute lymphocytic leukemias.6 Cancers of the brain and other nervous system are the second most common cancer type (27%), followed by soft tissue sarcomas (7%, half of which are rhabdomyosarcoma), neuroblastoma (7%), renal (Wilms) tumors (5%), and Hodgkin and non-Hodgkin lymphomas (4% each).6 From 2004 to 2008, the overall incidence rate for cancer in children aged 14 years and younger increased slightly by 0.5% per year, a trend that has been consistent since 1975. The death rate for childhood cancer has decreased by more than half over the past 3 decades, from 4.9 (per 100,000) in 1975 to 2.2 in 2008.2 Table 12 provides trends in survival rates for the most common childhood cancers. The 5-year relative survival rate for all cancers combined improved from 58% for children diagnosed between 1975 and 1977 to 83% for those diagnosed between 2001 and 2007.6 The substantial progress for all of the major childhood cancers reflects both improvements in treatment and high levels of participation in clinical trials.

Table 12. Trends in 5-Year Relative Survival Rates* (%) for Children Under Age 15 Years, United States, 1975 to 2007
YEAR OF DIAGNOSIS
1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 2000 2001 TO 2007
All cancers combined 58 63 67 68 72 76 77 79 83
Acute lymphocytic leukemia 58 66 71 73 78 83 84 87 91
Acute myeloid leukemia 19 26 27 31 37 42 42 52 64
Bone & joint 50 48 57 57 67 67 74 68 79
Brain & other nervous system 57 58 56 62 64 65 71 74 75
Hodgkin lymphoma 81 87 88 91 87 97 95 96 96
Neuroblastoma 53 57 55 53 63 76 67 68 73
Non-Hodgkin lymphoma 43 53 67 70 71 77 81 86 86
Soft tissue 61 75 69 73 66 80 77 74 82
Wilms tumor 73 79 87 91 92 92 92 93 90
  • * Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2008.
  • The difference in rates between 1975 to 1977 and 2001 to 2007 is statistically significant (P < .05).
  • The standard error of the survival rate is between 5 and 10 percentage points.

Limitations

The projected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are model-based and may vary considerably from year to year for reasons other than changes in cancer occurrence. For instance, estimates are invariably affected by changes in method, which occur regularly as modeling techniques improve over time and cancer registration becomes more complete. Indeed, new methods were used for projecting both incident cases and deaths in 2012. In addition, not all changes in cancer trends can be captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. The data sources used for tracking cancer trends are age-standardized or age-specific cancer death rates from the NCHS and cancer incidence rates from SEER or NPCR. Nevertheless, the American Cancer Society projections of the numbers of new cancer cases and deaths provide a reasonably accurate estimate of the current cancer burden in the United States.

Errors in reporting race/ethnicity in medical records and on death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and non-African American populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic minority groups that are not homogenous, and thus important differences in the cancer burden within racial/ethnic subgroups are often masked.