Volume 66, Issue 1 p. 7-30
Article
Free Access

Cancer statistics, 2016

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA

Corresponding author: Rebecca L. Siegel, MPH, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, 250 Williams St, NW, Atlanta, GA 30303-1002; [email protected]Search for more papers by this author
Kimberly D. Miller MPH

Kimberly D. Miller MPH

Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA

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Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA

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First published: 07 January 2016
Citations: 12,476

DISCLOSURES: The authors report no conflicts of interest.

Abstract

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Overall cancer incidence trends (13 oldest SEER registries) are stable in women, but declining by 3.1% per year in men (from 2009-2012), much of which is because of recent rapid declines in prostate cancer diagnoses. The cancer death rate has dropped by 23% since 1991, translating to more than 1.7 million deaths averted through 2012. Despite this progress, death rates are increasing for cancers of the liver, pancreas, and uterine corpus, and cancer is now the leading cause of death in 21 states, primarily due to exceptionally large reductions in death from heart disease. Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death because of the dramatic therapeutic advances against leukemia. Accelerating progress against cancer requires both increased national investment in cancer research and the application of existing cancer control knowledge across all segments of the population. CA Cancer J Clin 2016;7–30. © 2015 American Cancer Society.

Introduction

Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. In this article, we provide the expected numbers of new cancer cases and deaths in 2016 in the United States nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using the most current population-based data. In addition, we estimate the total number of deaths averted during the past 2 decades as a result of the continual decline in cancer death rates. We also present the actual number of deaths reported in 2012 by age for the 10 leading causes of death and for the 5 leading causes of cancer death.

Materials and Methods

Incidence and Mortality Data

Mortality data from 1930 to 2012 were provided by the National Center for Health Statistics (NCHS).1, 2 Forty-seven states and the District of Columbia met data quality requirements for reporting to the national vital statistics system in 1930. Texas, Alaska, and Hawaii began reporting mortality data in 1933, 1959, and 1960, respectively. The methods for abstraction and age adjustment of mortality data are described elsewhere.2, 3

Population-based cancer incidence data in the United States have been collected by the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program since 1973 and by the Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR) since 1995. The SEER program is the only source for long-term population-based incidence data. Long-term incidence and survival trends (1975-2012) were based on data from the 9 oldest SEER areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound), representing approximately 9% of the US population.4 As of 1992, SEER data have been available for 4 additional SEER registries (Alaska Natives, Los Angeles county, San Jose-Monterey, and rural Georgia) that increase coverage of minority groups, allowing for stratification by race and ethnicity. Delay-adjusted data from these (SEER 13) registries, which represent 14% of the US population, were the source for the annual percent change in incidence from 1992 to 2012.5 The SEER program added 5 additional catchment areas beginning with cases diagnosed in 2000 (greater California, greater Georgia, Kentucky, Louisiana, and New Jersey), achieving 28% population coverage. Data from all 18 SEER areas were the source for cancer stage distribution, stage-specific survival, and the lifetime probability of developing cancer.6 The probability of developing cancer was calculated using NCI's DevCan software (version 6.7.3).7 Much of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975-2012.8

The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for cancer registries that participate in the SEER program and/or the NPCR. These data approach 100% coverage of the US population in the most recent time period and were the source for the projected new cancer cases in 2016 and incidence rates by state and race/ethnicity.9, 10 Some of the data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2008-2012.11, 12

All cancer cases were classified according to the International Classification of Diseases for Oncology except childhood and adolescent cancers, which were classified according to the International Classification of Childhood Cancer (ICCC).13 Causes of death were classified according to the International Classification of Diseases.14 All incidence and death rates were age-standardized to the 2000 US standard population and expressed per 100,000 population, as calculated by NCI's SEER*Stat software (version 8.2.1).15 The annual percent change in rates was quantified using NCI's Joinpoint Regression Program (version 4.2.0.2).16

Whenever possible, cancer incidence rates presented in this report were adjusted for delays in reporting, which occur because of a lag in case capture or data corrections. Delay adjustment has the largest effect on the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate cancer) and provides a more accurate portrayal of the cancer burden in the most recent time period.17 For example, the leukemia incidence rate for 2012 is 16% higher after adjusting for reporting delays.6, 18

Projected Cancer Cases and Deaths in 2016

The most recent year for which incidence and mortality data are available lags 2 to 4 years behind the current year due to the time required for data collection, compilation, quality control, and dissemination. Therefore, we projected the numbers of new cancer cases and deaths in the United States in 2016 to provide an estimate of the contemporary cancer burden. The number of invasive cancer cases was estimated using a 3-step spatio-temporal model based on high-quality incidence data from 49 states and the District of Columbia representing approximately 94% population coverage (data were lacking for all years for Minnesota and for some years for other states). First, complete incidence counts were estimated for each county from 1998 through 2012 using geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence.19 Then these counts were adjusted for delays in cancer reporting and aggregated to obtain national- and state-level estimates. Finally, a temporal projection method (the vector autoregressive model) was applied to the last 15 years of data to estimate counts for 2016. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are not required to be reported to cancer registries. For complete details of the case projection methodology, please refer to Zhu et al.20

New cases of female breast carcinoma in situ and melanoma in situ diagnosed in 2016 were calculated by first approximating the number of cases occurring annually from 2003 through 2012 based on age-specific NAACCR incidence rates (data from 44 states and the District of Columbia with high-quality data every year) and US population estimates provided in SEER*Stat. The average annual percent change in case counts from 2003 through 2012 generated by the joinpoint regression model was then used to project cases to 2016. In contrast to previous years, the estimate for breast carcinoma in situ was not adjusted for reporting delays because delay-adjustment factors were not available.

The number of cancer deaths expected to occur in 2016 was estimated based on the annual percent change in reported numbers of cancer deaths from 1998 through 2012 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.21

Other Statistics

The number of cancer deaths averted in men and women due to the reduction in overall cancer death rates was estimated by subtracting the number of recorded deaths from the number that would have been expected if cancer death rates had remained at their peak. The expected number of deaths was estimated 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 2012. The difference between the number of expected and recorded cancer deaths in each age group and calendar year was then summed.

Selected Findings

Expected Numbers of New Cancer Cases

Table 1 presents the estimated numbers of new cases of invasive cancer expected in the United States in 2016 by sex. The overall estimate of 1,685,210 cases is the equivalent of more than 4,600 new cancer diagnoses each day. In addition, about 61,000 cases of female breast carcinoma in situ and 68,480 cases of melanoma in situ are expected to be diagnosed in 2016. The estimated numbers of new cases by state for selected cancer sites are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2016a
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All sites 1,685,210 841,390 843,820 595,690 314,290 281,400
Oral cavity & pharynx 48,330 34,780 13,550 9,570 6,910 2,660
Tongue 16,100 11,700 4,400 2,290 1,570 720
Mouth 12,910 7,600 5,310 2,520 1,630 890
Pharynx 16,420 13,350 3,070 3,080 2,400 680
Other oral cavity 2,900 2,130 770 1,680 1,310 370
Digestive system 304,930 172,530 132,400 153,030 88,700 64,330
Esophagus 16,910 13,460 3,450 15,690 12,720 2,970
Stomach 26,370 16,480 9,890 10,730 6,540 4,190
Small intestine 10,090 5,390 4,700 1,330 710 620
Colonb 95,270 47,710 47,560 49,190 26,020 23,170
Rectum 39,220 23,110 16,110
Anus, anal canal, & anorectum 8,080 2,920 5,160 1,080 440 640
Liver & intrahepatic bile duct 39,230 28,410 10,820 27,170 18,280 8,890
Gallbladder & other biliary 11,420 5,270 6,150 3,710 1,630 2,080
Pancreas 53,070 27,670 25,400 41,780 21,450 20,330
Other digestive organs 5,270 2,110 3,160 2,350 910 1,440
Respiratory system 243,820 132,620 111,200 162,510 89,320 73,190
Larynx 13,430 10,550 2,880 3,620 2,890 730
Lung & bronchus 224,390 117,920 106,470 158,080 85,920 72,160
Other respiratory organs 6,000 4,150 1,850 810 510 300
Bones & joints 3,300 1,850 1,450 1,490 860 630
Soft tissue (including heart) 12,310 6,980 5,330 4,990 2,680 2,310
Skin (excluding basal & squamous) 83,510 51,650 31,860 13,650 9,330 4,320
Melanoma of the skin 76,380 46,870 29,510 10,130 6,750 3,380
Other nonepithelial skin 7,130 4,780 2,350 3,520 2,580 940
Breast 249,260 2,600 246,660 40,890 440 40,450
Genital system 297,530 191,640 105,890 57,730 26,840 30,890
Uterine cervix 12,990 12,990 4,120 4,120
Uterine corpus 60,050 60,050 10,470 10,470
Ovary 22,280 22,280 14,240 14,240
Vulva 5,950 5,950 1,110 1,110
Vagina & other genital, female 4,620 4,620 950 950
Prostate 180,890 180,890 26,120 26,120
Testis 8,720 8,720 380 380
Penis & other genital, male 2,030 2,030 340 340
Urinary system 143,190 100,920 42,270 31,540 21,600 9,940
Urinary bladder 76,960 58,950 18,010 16,390 11,820 4,570
Kidney & renal pelvis 62,700 39,650 23,050 14,240 9,240 5,000
Ureter & other urinary organs 3,530 2,320 1,210 910 540 370
Eye & orbit 2,810 1,510 1,300 280 150 130
Brain & other nervous system 23,770 13,350 10,420 16,050 9,440 6,610
Endocrine system 66,730 16,200 50,530 2,940 1,400 1,540
Thyroid 64,300 14,950 49,350 1,980 910 1,070
Other endocrine 2,430 1,250 1,180 960 490 470
Lymphoma 81,080 44,960 36,120 21,270 12,160 9,110
Hodgkin lymphoma 8,500 4,790 3,710 1,120 640 480
Non-Hodgkin lymphoma 72,580 40,170 32,410 20,150 11,520 8,630
Myeloma 30,330 17,900 12,430 12,650 6,430 6,220
Leukemia 60,140 34,090 26,050 24,400 14,130 10,270
Acute lymphocytic leukemia 6,590 3,590 3,000 1,430 800 630
Chronic lymphocytic leukemia 18,960 10,830 8,130 4,660 2,880 1,780
Acute myeloid leukemia 19,950 11,130 8,820 10,430 5,950 4,480
Chronic myeloid leukemia 8,220 4,610 3,610 1,070 570 500
Other leukemiac 6,420 3,930 2,490 6,810 3,930 2,880
Other & unspecified primary sitesc 34,170 17,810 16,360 42,700 23,900 18,800
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder.
  • About 61,000 cases of carcinoma in situ of the female breast and 68,480 cases of melanoma in situ will be diagnosed in 2016.
  • b Deaths for colon and rectum cancers are combined because a large number of deaths from rectal cancer are misclassified as colon.
  • c More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates and/or an undercount in the case estimate.
Table 2. Estimated New Cases for Selected Cancers by State, 2016a
STATE ALL CASES FEMALE BREAST UTERINE CERVIX COLON & RECTUM UTERINE CORPUS LEUKEMIA LUNG & BRONCHUS MELANOMA OF THE SKIN NON-HODGKIN LYMPHOMA PROSTATE URINARY BLADDER
Alabama 27,020 3,960 220 2,190 710 900 4,220 1,390 1,030 2,950 1,110
Alaska 3,330 500 b 270 110 120 440 100 140 330 150
Arizona 32,510 4,900 230 2,550 1,060 1,160 3,980 1,510 1,300 3,150 1,630
Arkansas 16,460 2,090 150 1,410 470 510 2,610 340 670 1,670 700
California 173,200 26,730 1,460 13,770 6,120 6,370 18,140 8,560 7,760 17,240 7,580
Colorado 24,730 4,110 180 1,790 860 1,020 2,520 1,460 1,110 3,060 1,080
Connecticut 21,700 3,290 120 1,610 880 790 2,770 680 920 2,460 1,130
Delaware 5,630 800 b 430 190 180 850 320 220 690 260
Dist. of Columbia 2,910 470 b 200 100 80 300 110 110 460 90
Florida 121,240 16,770 1,050 9,710 3,940 3,930 17,360 6,200 5,370 13,310 5,940
Georgia 48,670 7,160 430 3,980 1,450 1,490 6,670 2,540 1,830 5,570 1,830
Hawaii 6,850 1,130 60 650 280 220 740 410 300 610 250
Idaho 8,120 1,110 50 610 280 360 990 490 370 1,010 430
Illinois 65,090 10,160 550 5,580 2,690 2,370 8,820 2,500 2,860 7,250 3,040
Indiana 35,180 4,980 290 2,980 1,310 1,190 5,520 1,460 1,500 3,510 1,620
Iowa 17,100 2,310 110 1,500 700 730 2,420 1,000 790 1,670 840
Kansas 14,530 2,210 110 1,150 560 540 1,970 820 640 1,510 650
Kentucky 25,720 3,470 200 2,200 810 980 4,960 1,450 1,080 2,460 1,120
Louisiana 25,070 3,400 220 2,170 620 710 3,730 620 1,090 2,950 940
Maine 9,270 1,310 50 720 380 380 1,410 340 400 960 570
Maryland 30,990 4,880 230 2,390 1,170 1,000 4,100 1,590 1,230 3,840 1,330
Massachusetts 37,620 6,010 210 2,750 1,560 1,340 4,910 1,380 1,720 4,350 2,030
Michigan 56,530 8,150 380 4,570 2,290 1,890 8,440 2,560 2,520 6,000 3,000
Minnesota 29,130 4,300 140 2,180 1,070 1,280 3,660 1,220 1,370 2,930 1,300
Mississippi 16,680 2,330 150 1,530 430 520 2,550 490 570 1,770 600
Missouri 34,270 5,030 250 2,850 1,250 1,220 5,450 1,610 1,440 3,260 1,550
Montana 6,070 890 b 460 210 270 750 350 270 770 330
Nebraska 9,740 1,480 60 850 380 390 1,220 470 440 960 460
Nevada 14,390 2,010 110 1,140 390 520 1,700 440 550 1,320 670
New Hampshire 8,680 1,280 b 620 350 290 1,140 290 350 910 490
New Jersey 49,750 7,420 370 4,020 2,050 1,870 5,580 2,470 2,430 5,970 2,460
New Mexico 9,750 1,480 80 760 330 380 1,020 450 410 1,020 390
New York 110,280 16,360 790 8,730 4,360 4,490 13,200 4,250 4,860 12,010 5,220
North Carolina 54,450 7,830 400 4,280 1,780 1,870 7,870 2,850 2,210 5,990 2,280
North Dakota 3,930 530 b 310 130 150 480 190 160 400 180
Ohio 66,020 9,390 470 5,340 2,640 2,140 10,550 2,880 2,820 6,760 3,180
Oklahoma 19,650 2,760 180 1,630 590 720 3,150 570 860 2,080 840
Oregon 22,510 3,430 150 1,610 850 750 2,970 1,530 980 2,490 1,130
Pennsylvania 83,560 11,310 540 6,390 3,290 3,020 10,500 3,750 3,540 8,350 4,260
Rhode Island 6,190 940 b 490 250 210 890 210 260 640 350
South Carolina 27,980 4,010 210 2,220 860 920 4,280 1,540 1,080 3,190 1,210
South Dakota 4,690 680 b 390 170 180 590 210 210 470 230
Tennessee 37,650 5,420 300 3,130 1,100 1,350 6,010 1,850 1,510 3,370 1,590
Texas 116,690 16,800 1,330 9,680 3,700 4,210 14,620 2,920 5,120 13,210 4,150
Utah 11,030 1,420 70 720 400 470 890 840 510 1,310 430
Vermont 4,050 580 b 280 160 140 510 180 170 450 220
Virginia 43,190 6,620 300 3,240 1,490 1,310 5,690 2,340 1,660 4,820 1,910
Washington 37,770 5,820 230 2,700 1,390 1,490 4,670 2,440 1,750 4,430 1,830
West Virginia 11,770 1,490 90 1,010 450 410 2,020 640 490 1,030 600
Wisconsin 32,970 4,730 200 2,520 1,310 1,260 4,230 1,350 1,490 3,570 1,630
Wyoming 2,920 420 b 220 100 110 310 180 120 380 160
United States 1,685,210 246,660 12,990 134,490 60,050 60,140 224,390 76,380 72,580 180,890 76,960
  • a Rounded to the nearest 10; excludes basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder.
  • b Estimate is fewer than 50 cases.
  • Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the exclusion of states with fewer than 50 cases.

Figure 1 indicates the most common cancers expected to occur in men and women in 2016. Prostate, lung and bronchus, and colorectal cancers account for 44% of all cases in men, with prostate cancer alone accounting for 1 in 5 new diagnoses. For women, the 3 most commonly diagnosed cancers are breast, lung and bronchus, and colorectum, representing one-half of all cases; breast cancer alone is expected to account for 29% all new cancer diagnoses in 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, 2016.

Estimates are rounded to the nearest 10 and cases exclude basal cell 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 cancer deaths in 2016. It is estimated that 595,690 Americans will die from cancer this year, corresponding to about 1,600 deaths per day. The most common causes of cancer death are cancers of the lung and bronchus, prostate, and colorectum in men and lung and bronchus, breast, and colorectum in women. These 4 cancers account for 46% of all cancer deaths (Fig. 1), with more than one-quarter (27%) due to lung cancer. Table 3 provides the estimated numbers of cancer deaths in 2016 by state for selected cancer sites.

Table 3. Estimated Deaths for Selected Cancers by State, 2016a
STATE ALL SITES BRAIN & OTHER NERVOUS SYSTEM FEMALE BREAST COLON & RECTUM LEUKEMIA LIVER & INTRAHEPATIC BILE DUCT LUNG & BRONCHUS NON-HODGKIN LYMPHOMA OVARY PANCREAS PROSTATE
Alabama 10,650 300 670 920 430 420 3,260 340 260 690 470
Alaska 1,070 b 70 90 b 50 290 b b 70 b
Arizona 11,800 360 780 980 510 590 2,830 410 310 900 590
Arkansas 6,830 170 430 600 260 260 2,190 210 150 420 270
California 59,060 1,760 4,400 5,180 2,560 3,600 12,230 2,140 1,530 4,390 3,050
Colorado 7,760 270 560 650 330 370 1,690 260 240 560 430
Connecticut 6,780 190 450 450 310 300 1,690 220 170 540 320
Delaware 2,050 50 130 150 80 100 600 60 50 140 90
Dist. of Columbia 980 b 90 90 b 80 210 b b 90 70
Florida 43,600 1,080 2,880 3,500 1,770 1,870 11,960 1,480 940 3,080 1,970
Georgia 16,840 460 1,260 1,500 620 730 4,700 490 420 1,090 730
Hawaii 2,480 b 130 230 90 150 570 100 50 230 100
Idaho 2,810 90 180 220 120 110 670 100 70 210 160
Illinois 24,080 600 1,660 2,030 1,010 930 6,540 800 570 1,640 1,020
Indiana 13,510 350 860 1,070 570 460 4,020 440 300 860 520
Iowa 6,470 190 380 570 260 230 1,770 250 160 430 280
Kansas 5,540 180 360 460 260 210 1,540 200 130 390 220
Kentucky 10,350 250 600 830 390 360 3,570 330 200 610 340
Louisiana 9,110 220 630 790 330 470 2,620 280 180 650 360
Maine 3,320 90 170 230 140 120 970 120 60 230 130
Maryland 10,560 270 820 850 390 510 2,670 310 260 800 480
Massachusetts 12,630 330 770 890 520 630 3,380 390 330 930 530
Michigan 21,100 610 1,410 1,640 850 800 6,030 780 480 1,520 790
Minnesota 9,850 280 610 750 480 410 2,430 500 240 660 470
Mississippi 6,480 150 420 630 240 280 1,930 170 110 440 280
Missouri 12,970 320 880 1,050 520 550 3,950 370 250 860 470
Montana 2,020 60 130 170 80 70 520 70 60 130 120
Nebraska 3,500 110 210 330 150 130 890 130 70 240 180
Nevada 4,970 150 380 480 180 210 1,390 160 110 360 240
New Hampshire 2,770 80 170 190 110 90 770 80 60 210 130
New Jersey 16,150 400 1,280 1,450 640 670 3,830 510 440 1,260 680
New Mexico 3,690 100 260 350 150 210 790 130 110 240 200
New York 34,910 880 2,410 2,830 1,460 1,650 8,770 1,200 920 2,660 1,550
North Carolina 19,620 600 1,360 1,480 750 830 5,820 610 450 1,240 820
North Dakota 1,270 b 80 120 50 b 330 b b 90 60
Ohio 25,510 630 1,700 2,060 1,000 1,020 7,420 850 570 1,800 1,060
Oklahoma 8,260 220 530 690 340 330 2,470 280 190 500 340
Oregon 8,150 240 500 660 340 430 2,100 280 220 570 410
Pennsylvania 28,700 680 1,940 2,340 1,240 1,140 7,530 1,030 700 2,090 1,190
Rhode Island 2,090 50 120 160 90 100 580 60 b 120 90
South Carolina 10,330 250 690 830 360 420 3,010 310 240 730 450
South Dakota 1,640 50 110 130 70 60 460 50 b 110 80
Tennessee 14,560 360 900 1,230 550 630 4,610 450 300 870 540
Texas 39,450 1,050 2,780 3,520 1,660 2,470 9,620 1,320 950 2,650 1,520
Utah 2,970 120 270 240 140 130 460 120 90 250 200
Vermont 1,390 50 70 100 50 60 390 b b 100 70
Virginia 14,910 390 1,080 1,160 580 640 4,080 490 390 1,050 630
Washington 12,770 410 820 970 510 660 3,170 440 350 920 630
West Virginia 4,750 120 270 400 180 140 1,460 170 90 270 160
Wisconsin 11,630 350 710 840 540 420 3,060 460 300 840 550
Wyoming 1,000 b 70 90 50 b 230 b b 70 b
United States 595,690 16,050 40,450 49,190 24,400 27,170 158,080 20,150 14,240 41,780 26,120
  • a Rounded to the nearest 10.
  • b Estimate is fewer than 50 deaths.
  • Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US total due to rounding and the 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 (42%) than for women (38%) (Table 4). Reasons for increased susceptibility in men are not well understood, but to some extent reflect differences in environmental exposures, endogenous hormones, and probably complex interactions between these influences. Adult height, which is determined by genetics and childhood nutrition, is positively associated with cancer incidence and death in both men and women,22 and has been estimated to account for one-third of the sex differences in cancer risk.23 For adults aged younger than 50 years, however, cancer risk is higher for women (5.4%) than for men (3.4%) because of the relatively high burden of breast, genital, and thyroid cancers in young women. The estimated probability of developing cancer is based on the average experience of the general population and may over- or underestimate individual risk because of differences in exposure (eg, smoking history), medical history, and/or genetic susceptibility.

Table 4. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2010 to 2012a
BIRTH TO 49 50 TO 59 60 TO 69 ≥70 BIRTH TO DEATH
All sitesb Male 3.4 (1 in 29) 6.5 (1 in 15) 14.5 (1 in 7) 34.6 (1 in 3) 42.1 (1 in 2)
Female 5.4 (1 in 19) 6.0 (1 in 17) 10.0 (1 in 10) 26.1 (1 in 4) 37.6 (1 in 3)
Breast Female 1.9 (1 in 53) 2.3 (1 in 44) 3.5 (1 in 29) 6.7 (1 in 15) 12.3 (1 in 8)
Colorectum Male 0.3 (1 in 300) 0.7 (1 in 149) 1.2 (1 in 82) 3.7 (1 in 27) 4.7 (1 in 21)
Female 0.3 (1 in 318) 0.5 (1 in 195) 0.9 (1 in 117) 3.4 (1 in 30) 4.4 (1 in 23)
Kidney & renal pelvis Male 0.2 (1 in 467) 0.3 (1 in 295) 0.6 (1 in 158) 1.3 (1 in 76) 2.0 (1 in 49)
Female 0.1 (1 in 748) 0.2 (1 in 576) 0.3 (1 in 317) 0.7 (1 in 136) 1.2 (1 in 83)
Leukemia Male 0.2 (1 in 415) 0.2 (1 in 591) 0.4 (1 in 261) 1.4 (1 in 72) 1.8 (1 in 57)
Female 0.2 (1 in 508) 0.1 (1 in 939) 0.2 (1 in 458) 0.9 (1 in 115) 1.2 (1 in 82)
Lung & bronchus Male 0.2 (1 in 608) 0.7 (1 in 145) 2.0 (1 in 51) 6.4 (1 in 16) 7.2 (1 in 14)
Female 0.2 (1 in 572) 0.6 (1 in 177) 1.5 (1 in 67) 4.8 (1 in 21) 6.0 (1 in 17)
Melanoma of the skinc Male 0.3 (1 in 297) 0.4 (1 in 238) 0.8 (1 in 127) 2.2 (1 in 45) 3.0 (1 in 33)
Female 0.5 (1 in 206) 0.3 (1 in 321) 0.4 (1 in 242) 0.9 (1 in 107) 1.9 (1 in 52)
Non-Hodgkin lymphoma Male 0.3 (1 in 376) 0.3 (1 in 347) 0.6 (1 in 174) 1.8 (1 in 55) 2.4 (1 in 42)
Female 0.2 (1 in 546) 0.2 (1 in 477) 0.4 (1 in 237) 1.4 (1 in 73) 1.9 (1 in 53)
Prostate Male 0.3 (1 in 325) 2.1 (1 in 48) 5.8 (1 in 17) 10.0 (1 in 10) 14.0 (1 in 7)
Thyroid Male 0.2 (1 in 560) 0.1 (1 in 821) 0.2 (1 in 635) 0.2 (1 in 451) 0.6 (1 in 169)
Female 0.8 (1 in 131) 0.4 (1 in 281) 0.3 (1 in 306) 0.4 (1 in 258) 1.7 (1 in 58)
Uterine cervix Female 0.3 (1 in 364) 0.1 (1 in 850) 0.1 (1 in 871) 0.2 (1 in 576) 0.6 (1 in 157)
Uterine corpus Female 0.3 (1 in 355) 0.6 (1 in 170) 0.9 (1 in 107) 1.3 (1 in 76) 2.8 (1 in 36)
  • a For people free of cancer at beginning of age interval.
  • b All sites excludes basal cell and squamous cell skin cancers and in situ cancers except urinary bladder.
  • c Probabilities are for whites.

Trends in Cancer Incidence

Figures 2 and 3 illustrate long-term trends in cancer incidence rates for all cancers combined and for selected cancer sites by sex. Cancer incidence patterns in the United States reflect trends in behaviors associated with cancer risk, improvements in cancer prevention and control, and changes in medical practice. Trends in overall incidence are driven by the 4 major cancers (lung, breast, prostate, and colorectal). For example, the spike in incidence rates in men in the late 1980s and early 1990s (Fig. 2) is due to the surge in detection of asymptomatic prostate cancer (Fig. 3) as a result of widespread prostate-specific antigen (PSA) testing.24 The increase in incidence in women during the 1980s reflects increases in both lung cancer, as a result of the tobacco epidemic, and breast cancer, because of changes in female reproductive patterns and the increased detection of asymptomatic disease during the rapid uptake of mammography screening.25

Details are in the caption following the image

Trends in Cancer Incidence and Death Rates by Sex, United States, 1975 to 2012.

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 2012.

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

*Includes intrahepatic bile duct.

Table 5 presents the annual percent change in delay-adjusted incidence rates in the SEER 13 registries from 1992 through 2012 along with the average annual percent change over the past 5 and 10 years of data 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.8, 26 The overall incidence rate in women has remained stable since 1998, but has declined in men by 3.1% per year since 2009. The recent rapid decline in prostate cancer diagnoses accounts for about one-half of the total decline in men. Routine screening with the PSA test is no longer recommended because of growing concerns about high rates of overdiagnosis, estimated at 23% to 42% for screen-detected cancers.27, 28 Despite declines in the prevalence of PSA screening from 2010 to 2013, one-third of men aged 65 years and older with limited life expectancy were screened in 2013.29

Table 5. Trends in Cancer Incidence (Delay-Adjusted) and Death Rates for Selected Cancers by Sex, United States, 1992 to 2012
TREND 1 TREND 2 TREND 3 TREND 4 2003-2012 AAPC 2008-2012 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC
All sites
Incidence
Overall 1992-1994 −3.1a 1994-1998 0.4 1998-2009 −0.3a 2009-2012 −1.5a −0.7a −1.2a
Male 1992-1994 −5.8a 1994-2009 −0.5a 2009-2012 −3.1a −1.4a −2.5a
Female 1992-1998 0.8a 1998-2003 −0.6 2003-2012 0.0 0.0 0.0
Death
Overall 1992-2001 −1.0a 2001-2012 −1.5a −1.5a −1.5a
Male 1992-2001 −1.4a 2001-2012 −1.8a −1.8a −1.8a
Female 1992-1995 −0.2 1995-1998 −1.2a 1998-2001 −0.4 2001-2012 −1.4a −1.4a −1.4a
Female breast
Incidence 1992-1999 1.3a 1999-2004 −2.2a 2004-2012 0.3 0.0 0.3
Death 1992-1995 −1.3a 1995-1998 −3.5a 1998-2012 −1.9a −1.9a −1.9a
Colorectum
Incidence
Male 1992-1995 −2.6a 1995-1998 1.4 1998-2008 −2.5a 2008-2012 −3.6a −3.0a −3.6a
Female 1992-1995 −1.8a 1995-1998 1.8 1998-2008 −2.0a 2008-2012 −3.8a −2.8a −3.8a
Death
Male 1992-2002 −2.0a 2002-2005 −3.9a 2005-2012 −2.6a −2.9a −2.6a
Female 1992-2001 −1.7a 2001-2012 −2.9a −2.9a −2.9a
Liver & intrahepatic bile duct
Incidence
Male 1992-2012 3.7a 3.7a 3.7a
Female 1992-2012 3.0a 3.0a 3.0a
Death
Male 1992-2007 2.2a 2007-2012 3.3a 2.8a 3.3a
Female 1992-2008 1.3a 2008-2012 3.2a 2.1a 3.2a
Lung & bronchus
Incidence
Male 1992-2009 −1.9a 2009-2012 −3.3a −2.4a −3.0a
Female 1992-2007 0.0 2007-2012 −1.9a −1.1a −1.9a
Death
Male 1992-2005 −1.9a 2005-2012 −3.0a −2.7a −3.0a
Female 1992-1995 1.4a 1995-2003 0.3a 2003-2007 −0.8 2007-2012 −1.9a −1.4a −1.9a
Melanoma of skin
Incidence
Male 1992-1996 5.0a 1996-2012 2.0a 2.0a 2.0a
Female 1992-2005 2.4a 2005-2012 0.5 0.9a 0.5
Death
Male 1992-2012 0.3a 0.3a 0.3a
Female 1992-2012 −0.5a −0.5a −0.5a
Pancreas
Incidence
Male 1992-2001 0.0 2001-2012 1.2a 1.2a 1.2a
Female 1992-1999 −0.1 1999-2012 1.1a 1.1a 1.1a
Death
Male 1992-1996 −1.0a 1996-2012 0.3a 0.3a 0.3a
Female 1992-1997 −0.4 1997-2012 0.4a 0.4a 0.4a
Prostate
Incidence 1992-1995 −11.1a 1995-2000 2.1 2000-2010 −1.8a 2010-2012 −11.2a −4.0a −6.6a
Death 1992-1994 −1.5 1994-2012 −3.6a −3.6a −3.6a
Thyroid
Incidence
Male 1992-1995 −3.2 1995-2012 5.3a 5.3a 5.3a
Female 1992-1999 4.1a 1999-2009 6.9a 2009-2012 1.8 5.2a 3.0a
Death
Male 1992-2012 1.5a 1.5a 1.5a
Female 1992-1994 −6.4 1994-2010 0.9a 2010-2012 −5.1 −0.5 −2.2
Uterine corpus
Incidence 1992-2006 −0.1 2006-2012 2.3a 1.5a 2.3a
Death 1992-1997 −0.7a 1997-2009 0.3a 2009-2012 2.5a 1.1a 2.0a
  • 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.
  • a The APC or AAPC is significantly different from zero (P < .05).
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.2.0, allowing up to 3 joinpoints. Incidence trends based on Surveillance, Epidemiology, and End Results (SEER) 13 areas.

Lung cancer incidence rates began declining in the mid-1980s in men and in the mid-2000s in women (Fig. 3) as a result of reductions in smoking prevalence that began decades earlier.30 Contemporary differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use. Women took up smoking in large numbers later than men, first initiated smoking at older ages, and were slower to quit, including recent upturns in smoking prevalence in some birth cohorts.31, 32 Declines in lung cancer incidence and death rates continue to be larger in men than in women (Table 5).

The long-term declines in colorectal cancer incidence rates since the mid-1980s have been attributed to both changes in risk factors and the introduction of screening.33 However, the recent rapid declines are likely driven by the increased uptake of screening with colonoscopy, which can prevent cancer by allowing for the removal of precancerous lesions.34, 35 Among adults aged 50 to 75 years, colonoscopy use increased from 19% in 2000 to 55% in 2013.36 Colorectal cancer incidence and death rates declined by about 3% per year in both men and women from 2003 through 2012, with momentum gaining in the most recent years (Table 5). However, rates increased by 1.8% per year from 1992 through 2012 in men and women aged younger than 50 years, among whom screening is not recommended for those at average risk.5

In contrast to stable or declining trends for most cancers, incidence rates increased from 2003 to 2012 (SEER registries combined) among both men and women for some leukemia subtypes and for cancers of the tongue, tonsil, small intestine, liver, pancreas, kidney, renal pelvis, and thyroid.8 In addition, incidence rates increased in men for melanoma; myeloma; and cancers of the breast, testis, and oropharynx. Recent declines in incidence for melanoma and liver cancer among young adults may portend a reduction in the burden of these cancers in future generations (Fig. 4). Among women, incidence rates increased for cancers of the anus, vulva, and uterine corpus. Uterine corpus cancer incidence rates have been increasing since the early 1990s in black women, but only since the mid-2000s in white women, perhaps due to steeper temporal increases in obesity among black women.37 Excess weight increases endometrial cancer risk by 50% for every 5 body mass index (BMI) units; although the highest risk occurs among the most obese women, some elevation in risk is apparent even within the normal BMI range.38 It is important to note that rates of uterine corpus cancer typically do not account for hysterectomy prevalence, thus substantially underestimating true disease risk. A recent study found that incidence rates corrected for hysterectomy prevalence were 73% higher among white women and 90% higher among black women compared with uncorrected rates.39

Details are in the caption following the image

Incidence Trends for Melanoma and Liver Cancer by Age, United States, 1992 to 2012.

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

Thyroid cancer continues to be the most rapidly increasing cancer (>5% per year in both men and women), partially due to overdiagnosis because of increased use of advanced imaging techniques. A recent study estimated that over the past 2 decades, about one-half of all papillary thyroid cancers diagnosed in women, and 40% of those in men aged ≥50 years, were clinically irrelevant.40 However, increases across tumor size and stage, as well as for follicular carcinoma (a more aggressive subtype), suggest that some of the rise may be due to changes in environmental risk factors, such as obesity.41-43

Trends in Cancer Survival

Over the past 3 decades, the 5-year relative survival rate for all cancers combined has increased 20 percentage points among whites and 23 percentage points among blacks (Table 6). Progress has been most rapid for hematopoietic and lymphoid malignancies due to improvements in treatment protocols, including the discovery of targeted therapies. For example, the 5-year survival for acute lymphocytic leukemia increased from 41% during the mid-1970s to 70% during 2005 to 2011. The use of BCR-ABL tyrosine kinase inhibitors (eg, imatinib) doubled survival for patients with chronic myeloid leukemia in less than 2 decades,44 from 31% in the early 1990s to 63% during 2005 to 2011. A recent study found that improvements in survival since 1990 for the most common cancers have been much more pronounced among patients aged 50 to 64 years than among those aged older than 65 years.45 This disparity may reflect differential care and/or lower efficacy or use of new therapies in the elderly population.

Table 6. Trends in 5-Year Relative Survival Ratesa (%) by Race and Year of Diagnosis, United States, 1975 to 2011
ALL RACES WHITE BLACK
1975 TO 1977 1987 TO 1989 2005 TO 2011 1975 TO 1977 1987 TO 1989 2005 TO 2011 1975 TO 1977 1987 TO 1989 2005 TO 2011
All sites 49 55 69b 50 57 70b 39 43 62b
Brain & other nervous system 22 29 35b 22 28 33b 25 32 40b
Breast (female) 75 84 91b 76 85 92b 62 71 81b
Colorectum 50 60 66b 50 60 67b 45 52 59b
Esophagus 5 10 20b 6 11 21b 4 7 14b
Hodgkin lymphoma 72 79 88b 72 80 89b 70 72 86b
Kidney & renal pelvis 50 57 74b 50 57 74b 49 55 74b
Larynx 66 66 63b 67 67 65 58 56 51
Leukemia 34 43 62b 35 44 63b 33 35 55b
Liver & intrahepatic bile duct 3 5 18b 3 6 18b 2 3 13b
Lung & bronchus 12 13 18b 12 13 19b 11 11 16b
Melanoma of the skin 82 88 93b 82 88 93b 57c 79c 70
Myeloma 25 27 49b 24 27 48b 30 30 50b
Non-Hodgkin lymphoma 47 51 72b 47 51 73b 49 46 64b
Oral cavity & pharynx 53 54 66b 54 56 68b 36 34 45b
Ovary 36 38 46b 35 38 46b 42 34 38
Pancreas 3 4 8b 3 3 8b 2 6 7b
Prostate 68 83 99b 69 84 >99b 61 71 98b
Stomach 15 20 30b 14 18 29b 16 19 28b
Testis 83 95 97b 83 95 97b 73cd 88c 91
Thyroid 92 94 98b 92 94 99b 90 92 97b
Urinary bladder 72 79 79b 73 80 79b 50 63 67b
Uterine cervix 69 70 69 70 73 71 65 57 60b
Uterine corpus 87 82 83b 88 84 85b 60 57 66b
  • a 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 2005 to 2011, all followed through 2012.
  • b The difference in rates between 1975 to 1977 and 2005 to 2011 is statistically significant (P < .05).
  • c The standard error of the survival rate is between 5 and 10 percentage points.
  • d Survival rate is for 1978 to 1980.

In contrast to the steady increase in survival for most cancers, advances have been slow for lung and pancreatic cancers, for which the 5-year relative survival is currently 18% and 8%, respectively (Table 6). These low rates are partly because more than one-half of cases are diagnosed at a distant stage (Fig. 5), for which 5-year survival is 4% and 2%, respectively (Fig. 6). There is promise for improving lung cancer survival rates because of earlier detection through screening with spiral computed tomography.46 However, it is important to realize that screening, as well as other changes in detection practices, introduces lead time bias in survival rates, thereby reducing their usefulness in measuring progress against cancer.47 For example, the jump in 5-year relative survival rates for prostate cancer from 83% in the late 1980s to 93% in the early 1990s to 99% since 2000 predominantly reflects lead time and overdetection. Thus, advances against cancer are best measured using age-standardized death rates.48

Details are in the caption following the image

Stage Distribution of Selected Cancers by Race, United States, 2005 to 2011.

Stage categories do not sum to 100% because sufficient information is not available to stage all cases.

*The proportion of cases of carcinoma in situ of the urinary bladder is 51% in all races combined, 52% in whites, and 40% in blacks.

Details are in the caption following the image

Five-Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2005 to 2011.

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

The survival rate for carcinoma in situ of the urinary bladder is 96% in all races combined, 96% in whites, and 90% in blacks.

Trends in Cancer Mortality

The overall cancer death rate rose during most of the 20th century, largely driven by rapid increases in lung cancer deaths among men as a consequence of the tobacco epidemic. Steady reductions in smoking, as well as advances in cancer prevention, early detection, and treatment, have resulted in a 23% drop in the cancer death rate, from a peak of 215.1 (per 100,000 population) in 1991 to 166.4 in 2012. The decline, which is larger in men (28% since 1990) than in women (19% since 1991), translates into the avoidance of approximately 1,711,300 cancer deaths (1,199,200 in men and 512,100 in women) that would have occurred if peak rates had persisted (Fig. 7).

Details are in the caption following the image

Total Number of Cancer Deaths Averted From 1991 to 2012 in Men and From 1992 to 2012 in Women.

The blue line represents the actual number of cancer deaths recorded in each year, and the red line represents the number of cancer deaths that would have been expected if cancer death rates had remained at their peak.

Figure 8 depicts trends in cancer death rates since 1930 among men and women overall and for selected cancer sites by sex. In contrast to male cancer death rates, which rose continuously prior to 1990, female cancer death rates fell from the late 1940s to the mid-1970s (Fig. 8A). It is interesting to note that prior to 1941, death rates were higher in women than in men due to the high death rate for uterine cancer (uterine corpus and uterine cervix combined), which was the leading cause of cancer death among women in the early 20th century. Uterine cancer death rates declined by more than 80% between 1930 and 2012 (Fig. 8C), largely due to the widespread uptake of the Papanicolaou test for the prevention and early detection of cervical cancer. However, in contrast to continuing declines for cancers of the uterine cervix, death rates for uterine corpus cancer began to increase around 2000 in the wake of rising incidence rates (Fig. 8C, inset) (Table 5).8

Details are in the caption following the image

Trends in Death Rates Overall and for Selected Sites by Sex, United States, 1930 to 2012.

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, liver, and uterus are affected by these changes.

*Mortality rates for liver, pancreatic, and uterine corpus cancers are increasing.

A similarly dramatic decline occurred for stomach cancer, which accounted for 30% and 20% of male and female cancer deaths, respectively, in the 1930s, but only about 2% for each in 2012. Although reasons for the decrease in stomach cancer occurrence in the United States and most other parts of the world are complex and not completely understood, contributors are thought to include a lower prevalence of Helicobacter pylori infection because of improved hygiene and lower salt intake and a higher consumption of fresh fruits and vegetables because of advances in food preservation techniques (eg, refrigeration).49 However, studies indicate that incidence rates for certain subtypes of stomach cancer are increasing for some subsets of the US population for reasons that remain unknown.50, 51

The decline in cancer death rates over the past 2 decades is driven by continued decreases in death rates for the 4 major cancer sites (lung, breast, prostate, and colorectum). Death rates for female breast cancer are down 36% from peak rates, and those for prostate and colorectal cancers are each down about 50% as a result of improvements in early detection and treatment.8, 33, 52, 53 Lung cancer death rates declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females8 due to reduced tobacco use as a result of increased awareness of the health hazards of smoking and the implementation of comprehensive tobacco control.54 Researchers recently estimated that tobacco control efforts adopted in the wake of the first Surgeon General's report on smoking and health in 1964 have resulted in 8 million fewer premature smoking-related deaths, one-third of which are due to cancer.55, 56 Despite this progress, 80% of deaths from lung cancer and one-half of all deaths from cancers of the oral cavity, esophagus, and urinary bladder are caused by smoking.57

In contrast to declining trends for the major cancers, joinpoint analysis indicates that from 2003 to 2012, death rates rose in both sexes for cancers of the anus, liver, and pancreas.8 Death rates also increased in men for melanoma (slightly) and for cancers of the tonsil, oropharynx, and soft tissue (including the heart) and in women for uterine and vulvar cancers. Thyroid cancer death rates also increased slightly in men, from 0.43 (per 100,000 population) in 2003 to 0.51 in 2012.

Recorded Number of Deaths in 2012

A total of 2,543,279 deaths were recorded in the United States in 2012, of which 582,623 (23%) were from cancer. Overall, cancer is the second leading cause of death following heart disease, which accounted for 24% of total deaths. However, cancer is the leading cause of death among adults aged 40 to 79 years (Table 7). It is also the leading cause of death in 21 states (Alaska, Arizona, Colorado, Delaware, Florida, Georgia, Idaho, Kansas, Maine, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, Oregon, South Carolina, Vermont, Virginia, and Washington), primarily due to exceptional gains made in the progress against heart disease. In Minnesota, for example, the death rate for heart disease is 30% below the national average (118 vs 170 per 100,000 population) compared with a 6% lower death rate for cancer. In addition, cancer is the leading cause of death among both Hispanics and Asian/Pacific Islanders (APIs), who combined comprise one-quarter of the US population.58

Table 7. Ten Leading Causes of Death by Age and Sex, United States, 2012
ALL AGES AGES 1 TO 19 AGES 20 TO 39 AGES 40 TO 59 AGES 60 TO 79 AGES ≥80
MALEAll Causes 1,273,722 FEMALE All Causes 1,269,557 MALE All Causes 12,655 FEMALE All Causes 6,837 MALE All Causes 62,383 FEMALE All Causes 28,688 MALE All Causes 226,518 FEMALE All Causes 143,713 MALE All Causes 496,567 FEMALE All Causes 388,343 MALE All Causes 462,360 FEMALE All Causes 691,439
1 Heart diseases 312,491 Heart diseases 287,220 Accidents (unintentional injuries) 4,602 Accidents (unintentional injuries) 2,296 Accidents (unintentional injuries) 22,740 Accidents (unintentional injuries) 8,105 Cancer 54,140 Cancer 50,462 Cancer 161,254 Cancer 132,104 Heart diseases 133,654 Heart diseases 189,726
2 Cancer 305,670 Cancer 276,953 Assault (homicide) 1,781 Cancer 822 Intentional self-harm (suicide) 9,935 Cancer 4,407 Heart diseases 51,906 Heart diseases 21,666 Heart diseases 121,201 Heart diseases 73,030 Cancer 85,193 Cancer 89,122
3 Accidents (unintentional injuries) 80,010 Cerebro- vascular diseases 75,908 Intentional self-harm (suicide) 1,598 Intentional self-harm (suicide) 495 Assault (homicide) 7,408 Intentional self-harm (suicide) 2,481 Accidents (unintentional injuries) 25,157 Accidents (unintentional injuries) 12,226 Chronic lower respiratory diseases 32,909 Chronic lower respiratory diseases 32,460 Chronic lower respiratory diseases 28,926 Cerebro- vascular disease 51,133
4 Chronic lower respiratory diseases 67,673 Chronic lower respiratory diseases 75,816 Cancer 1,110 Assault (homicide) 483 Heart diseases 5,127 Heart diseases 2,397 Intentional self-harm (suicide) 12,475 Chronic lower respiratory diseases 5,591 Cerebro- vascular disease 19,987 Cerebro- vascular disease 19,040 Cerebro- vascular disease 25,241 Alzheimer disease 50,416
5 Cerebro- vascular diseases 52,638 Alzheimer disease 57,984 Congenital anomalies 562 Congenital anomalies 467 Cancer 3,930 Assault (homicide) 1,376 Chronic liver disease & cirrhosis 11,390 Chronic liver disease & cirrhosis 5,240 Diabetes mellitus 18,530 Diabetes mellitus 14,433 Alzheimer disease 20,408 Chronic lower respiratory diseases 37,399
6 Diabetes mellitus 38,584 Accidents (unintentional injuries) 47,782 Heart diseases 380 Heart diseases 251 Chronic liver disease & cirrhosis 890 Pregnancy, childbirth & puerperium 692 Diabetes mellitus 7,673 Cerebro-vascular diseases 5,056 Accidents (unintentional injuries) 14,689 Accidents (unintentional injuries) 8,611 Influenza & pneumonia 13,682 Influenza & pneumonia 18,360
7 Intentional self-harm (suicide) 31,780 Diabetes mellitus 35,348 Chronic lower respiratory diseases 132 Influenza & pneumonia 104 Diabetes mellitus 843 Diabetes mellitus 616 Cerebro- vascular disease 6,539 Diabetes mellitus 4,657 Chronic liver disease & cirrhosis 8,964 Nephritis, nephrotic syndrome & nephrosis 7,591 Accidents (unintentional injuries) 12,136 Accidents (unintentional injuries) 16,048
8 Alzheimer disease 25,653 Influenza & pneumonia 26,623 Influenza & pneumonia 121 Cerebro- vascular disease 92 HIV disease 833 Cerebro- vascular disease 536 Chronic lower respiratory diseases 5,357 Intentional self-harm (suicide) 4,120 Nephritis, nephrotic syndrome & nephrosis 8,803 Alzheimer disease 7,375 Diabetes mellitus 11,495 Diabetes mellitus 15,599
9 Influenza & pneumonia 24,013 Nephritis, nephrotic syndrome & nephrosis 22,891 Cerebro- vascular disease 112 Chronic lower respiratory diseases 92 Cerebro- vascular disease 704 Chronic liver disease & cirrhosis 491 HIV disease 3,283 Septicemia 2,300 Influenza & pneumonia 7,459 Septicemia 7,070 Nephritis, nephrotic syndrome & nephrosis 10,992 Nephritis, nephrotic syndrome & nephrosis 13,140
10 Nephritis, nephrotic syndrome & nephrosis 22,731 Septicemia 19,053 In situ, benign, and unknown neoplasms 84 In situ, benign, and unknown neoplasms 88 Congenital anomalies 477 HIV disease 444 Viral hepatitis 3,181 Nephritis, nephrotic syndrome & nephrosis 1,860 Septicemia 7,262 Influenza & pneumonia 6,042 Parkinson disease 9,242 Hypertension & hypertensive renal diseasea 12,121
  • HIV indicates human immunodeficiency virus.
  • a Includes primary and secondary hypertension.
  • Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages. In accordance with the National Center for Health Statistics' cause-of-death ranking, “Symptoms, signs, and abnormal clinical or laboratory findings” and categories that begin with “Other” and “All other” were not ranked.
  • Source: US Final Mortality Data, 2012, National Center for Health Statistics, Centers for Disease Control and Prevention, 2015.

Table 8 presents the number of deaths from all cancers combined and from the 5 most common sites for each 20-year age group by sex. More cancer deaths occur in men than in women except for those aged 20 to 39 years and 80 years or older. Breast cancer is the leading cause of cancer death in women aged 20 to 59 years, but is replaced by lung cancer in women aged 60 years or older. Among men, lung cancer is the leading cause of cancer death for those aged 40 years or older.

Table 8. Five Leading Types of Cancer Death by Age and Sex, United States, 2012
ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥80
MALE
ALL SITES 305,670 ALL SITES 1,144 ALL SITES 3,930 ALL SITES 54,140 ALL SITES161,254 ALL SITES 85,193
Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus
86,690 323 543 14,087 51,816 20,526
Prostate Leukemia Leukemia Colorectum Colorectum Prostate
27,245 310 504 5,714 13,344 14,216
Colorectum Bones & joints Colorectum Liver* Prostate Colorectum
26,870 105 458 4,755 11,666 7,340
Pancreas Soft tissue (including heart) Lung & bronchus Pancreas Pancreas Urinary bladder
19,718 103 254 3,825 11,125 4,955
Liver* NHL NHL Esophagus Liver* Pancreas
15,563 33 253 2,809 8,254 4,679
FEMALE
ALL SITES 276,953 ALL SITES 851 ALL SITES 4,407 ALL SITES 50,462 ALL SITES 132,104 ALL SITES 89,122
Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus
70,736 252 984 11,356 39,918 19,481
Breast Leukemia Uterine cervix Lung & bronchus Breast Breast
41,152 224 446 11,134 17,760 11,050
Colorectum Soft tissue (including heart) Colorectum Colorectum Colorectum Colorectum
24,651 74 367 4,206 9,905 10,170
Pancreas Bones & joints Leukemia Ovary Pancreas Pancreas
19,079 73 345 3,018 9,407 7,031
Ovary NHL Brain & ONS Pancreas Ovary NHL
14,404 27 336 2,571 7,384 4,170
  • NHL indicates non-Hodgkin lymphoma; ONS, other nervous system.
  • a Liver includes intrahepatic bile duct.
  • Note: Ranking order excludes category titles that begin with the word “Other.”

Among children and adolescents (aged birth to 19 years), brain cancer has surpassed leukemia as the leading cause of cancer death (Table 8). Although treatment options have improved for both cancers based on collaborative efforts and outcomes from randomized clinical trials,59 therapeutic advances for leukemia have been particularly dramatic. From 1970 to 2012, the death rate in this age group declined by 76% for leukemia compared with 31% for tumors of the brain and other nervous system (Fig. 9A). This progress has occurred despite a slow increase in the incidence of both cancer types over this time period (in the 9 oldest SEER areas) (Fig. 9C). Since the mid-1970s, the 5-year relative survival rate has increased from 50% to 87% for leukemia and from 57% to 74% for brain and other nervous system tumors.8

Details are in the caption following the image

Trends in Leukemia and Brain Tumor Occurrence Among Children and Adolescents (Aged Birth to 19 Years), 1970 to 2012.

Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. Underlying mortality data provided by the National Center for Health Statistics (cdc.gov/nchs).

Cancer Occurrence by Race/Ethnicity

Cancer incidence and death rates vary considerably between and within racial and ethnic groups. For example, among men in the 5 broadly defined population groups in Table 9, black men have the highest overall cancer incidence and death rates-about double those of API men, who have the lowest rates. Rates are higher among black than non-Hispanic white men for every site included in Table 9 with the exception of kidney cancer mortality, for which rates are similar. The largest disparities are for stomach and prostate cancers, for which death rates in black men are about 2.5 times those in white men.

Table 9. Incidence and Death Rates by Site, Race, and Ethnicity, United States, 2008 to 2012
NON-HISPANIC WHITE NON-HISPANIC BLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ ALASKA NATIVEa HISPANIC
Incidence
All sites
Male 528.9 592.3 316.8 423.3 408.5
Female 436.2 408.1 287.5 372.9 330.4
Breast (female) 128.1 124.3 88.3 91.9 91.9
Colorectum
Male 47.4 60.3 39.0 50.4 44.6
Female 36.2 44.1 29.2 40.1 30.6
Kidney & renal pelvis
Male 21.8 24.2 10.8 29.7 20.6
Female 11.3 13.0 4.9 18.3 11.8
Liver & intrahepatic bile duct
Male 9.3 16.5 20.6 18.7 19.3
Female 3.2 4.8 7.9 8.9 7.2
Lung & bronchus
Male 79.3 93.4 47.4 66.2 43.3
Female 58.7 51.4 28.3 52.7 26.0
Prostate 123.0 208.7 67.8 90.5 112.1
Stomach
Male 7.8 15.1 14.5 12.0 13.5
Female 3.5 8.0 8.5 6.6 7.8
Uterine cervix 7.1 10.0 6.3 9.4 10.2
Mortality
All sites
Male 210.6 267.7 128.4 186.7 148.0
Female 149.2 170.4 91.2 133.9 99.4
Breast (female) 21.9 31.0 11.4 15.0 14.5
Colorectum
Male 18.2 27.6 13.0 18.8 15.6
Female 12.9 18.2 9.4 15.6 9.6
Kidney & renal pelvis
Male 5.9 5.7 2.9 8.7 5.0
Female 2.6 2.6 1.2 4.7 2.4
Liver & intrahepatic bile duct
Male 7.6 12.8 14.5 13.9 12.9
Female 3.1 4.4 6.1 6.3 5.6
Lung & bronchus
Male 62.2 74.9 34.0 49.1 29.5
Female 41.4 36.7 18.2 32.1 13.7
Prostate 19.9 47.2 9.4 20.2 17.8
Stomach
Male 3.6 9.4 7.9 7.4 7.2
Female 1.8 4.5 4.7 3.6 4.2
Uterine cervix 2.0 4.1 1.8 3.5 2.7
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population. Nonwhite and nonblack race categories are not mutually exclusive of Hispanic origin.
  • a Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties. Incidence rates exclude data from Kansas.

Factors known to contribute to racial disparities vary by cancer site and include differences in risk factor prevalence and access to high-quality health care, including cancer prevention and early detection, timely diagnosis, and optimal treatment.60, 61 Even among Medicare-insured patients, blacks are less likely than whites to receive standard-cancer therapies for lung, breast, colorectal, and prostate cancers.62 A major source of these inequalities is the disproportionately high burden of poverty in the black community. According to the US Census Bureau, 26% of blacks lived in poverty and 12% were without health insurance in 2014, compared with 10% and 8%, respectively, of non-Hispanic whites.

Higher mortality rates among blacks compared with whites partly reflect a later stage of disease at diagnosis. This disparity is particularly striking for cancers of the uterine corpus, oral cavity, female breast, and cervix (Fig. 5). Moreover, black patients have lower stage-specific survival for most cancer types (Fig. 6). As a result, although black women have a lower breast cancer incidence rate than white women, they have a higher breast cancer death rate (Table 9). The historically higher incidence rate among white women is thought to reflect a combination of factors that affect both diagnosis (more prevalent mammography) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy).63 However, a recent study reported that breast cancer incidence rates in white and black women are converging because of a stable trend in whites but an increasing trend in blacks.64 The higher risk of death from breast cancer among black women is thought to reflect a higher prevalence of comorbidities, a longer time to follow-up after an abnormal mammogram, less receipt of high-quality treatment, higher body mass index, and a higher prevalence of aggressive tumor characteristics.65-68 However, an analysis of clinical trial data showed that black women were less likely than white women to survive their breast cancer despite uniform treatment, even after controlling for stage of disease, tumor characteristics, follow-up, and socioeconomic status.69

Cancer incidence and death rates are lower among APIs, American Indians/Alaska Natives (AI/ANs), and Hispanics than non-Hispanic whites for all cancer sites combined and for the 4 most common cancer sites. However, cancers associated with infectious agents (eg, those of the uterine cervix, stomach, and liver) are generally more common in nonwhite populations. For example, stomach and liver cancer incidence and death rates are twice as high in the API population as in whites, reflecting a higher prevalence of chronic infection with Helicobacter pylori and hepatitis B virus, respectively, in immigrant countries of origin.70 Kidney cancer incidence and death rates are highest among AI/ANs, which may be due in part to high rates of obesity, smoking, and hypertension in this population. Regional variation in the prevalence of these risk factors likely contributes to the striking geographic differences in kidney cancer death rates among AI/AN men, which are highest in the Southern and Northern Plains and lowest in the East and Pacific Coast.71

Regional Variations in Cancer Rates

Tables 10 and 11 depict current cancer incidence and death rates for selected cancers by state. Geographic patterns in cancer occurrence reflect differences in risk factors, such as smoking and obesity, as well as disparities in the national distribution of poverty and access to health care, which have increased over time.72, 73 The largest geographic variation in cancer occurrence by far is for lung cancer, reflecting the large historical and continuing differences in smoking prevalence among states.54 For example, lung cancer incidence rates in Kentucky, which has historically had the highest smoking prevalence, are 3.5 times higher than those in Utah, which has the lowest smoking prevalence. There is a 2-fold difference for prostate cancer incidence rates, which range from 89.8 (per 100,000 population) in Arizona to 184.1 in the District of Columbia, likely reflecting both state differences in PSA testing prevalence and population demographics.24 In contrast, state variations for other cancer types are smaller in both absolute and relative terms. For example, breast cancer incidence rates range from 107.7 (per 100,000 population) in Arkansas to 141.7 in the District of Columbia, a relative difference of just 24%. Some of this variation is attributable to differences in mammography prevalence.74

Table 10. Incidence Rates for Selected Cancers by State, United States, 2008 to 2012
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 560.8 398.0 119.5 54.2 38.2 99.2 54.2 19.6 13.7 146.1 33.6 7.5
Alaska 479.3 419.2 125.5 50.5 40.6 74.4 59.9 20.5 14.7 111.8 36.5 10.8
Arizona 420.4 373.9 111.0 40.5 30.9 59.2 47.0 18.3 13.3 89.8 31.9 8.3
Arkansasab 550.2 383.7 107.7 54.3 39.4 103.6 59.9 21.5 15.5 148.1 32.9 7.7
California 485.6 394.8 122.1 46.0 35.1 55.8 42.1 22.8 15.5 126.9 32.6 7.8
Colorado 473.7 396.5 125.2 40.0 31.6 52.8 43.3 22.1 15.5 133.2 32.5 8.3
Connecticut 554.4 456.9 137.1 48.2 36.5 72.6 57.6 25.4 17.7 139.9 47.3 12.6
Delaware 578.7 446.3 126.5 45.6 34.9 83.7 63.3 23.4 17.0 156.3 42.3 11.2
Dist. of Columbia 564.1 436.0 141.7 48.6 40.9 74.5 48.7 21.5 12.8 184.1 25.6 8.9
Florida 502.1 400.2 115.2 45.0 34.2 75.8 55.5 21.7 14.9 118.9 34.9 8.4
Georgia 554.5 409.0 123.5 49.6 36.7 89.0 54.1 22.3 14.6 150.1 34.0 8.0
Hawaii 466.5 403.9 130.2 55.1 37.2 59.5 38.4 21.8 14.7 105.0 24.1 6.1
Idaho 510.4 410.9 118.9 42.8 33.8 59.1 47.4 22.1 16.7 142.7 39.2 8.9
Illinois 546.2 439.8 127.7 55.2 40.3 82.8 59.9 23.5 16.5 138.9 38.6 9.7
Indiana 513.0 425.1 119.0 51.0 40.2 93.2 61.9 23.5 16.5 108.9 36.4 8.9
Iowa 545.6 439.4 123.0 54.2 41.1 81.7 53.6 27.4 18.6 126.2 40.4 8.8
Kansas 541.9 427.3 123.2 50.5 37.8 75.5 53.4 23.4 16.7 143.1 39.1 9.1
Kentucky 598.2 466.6 121.3 60.5 44.1 120.4 80.7 25.4 17.3 122.6 40.8 9.8
Louisiana 595.5 417.9 121.9 59.6 42.7 95.2 56.0 24.6 16.7 161.1 33.7 8.1
Maine 546.3 452.8 124.4 46.5 36.7 85.8 66.9 24.6 17.7 120.2 47.8 12.5
Maryland 512.0 419.5 129.9 44.3 34.6 70.0 53.9 21.0 14.9 141.1 34.5 9.1
Massachusetts 539.2 458.6 136.5 45.7 36.0 75.4 62.9 24.0 16.4 135.6 42.2 11.8
Michigan 544.8 428.6 121.4 46.8 35.9 81.4 59.9 24.5 17.1 147.3 40.3 10.4
Minnesotac - - - - - - - - - - - -
Mississippi 577.5 406.0 116.8 59.4 43.4 106.4 56.9 21.4 14.6 149.7 30.9 7.5
Missouri 511.4 427.0 124.7 51.7 38.7 92.1 64.4 22.2 15.6 113.6 33.5 8.6
Montana 508.4 424.5 124.2 46.6 36.3 66.0 52.8 22.3 15.9 133.5 37.8 10.4
Nebraska 501.8 417.2 122.7 52.0 41.1 70.7 50.0 23.4 17.7 125.7 34.8 8.2
Nevadaad 502.2 401.8 114.0 50.5 36.3 71.4 60.3 20.3 14.8 136.0 38.8 10.7
New Hampshire 558.1 458.4 135.1 43.1 36.3 75.7 63.8 25.8 17.8 140.7 50.2 12.9
New Jersey 564.7 450.5 130.2 51.0 39.4 69.3 53.7 25.4 17.9 157.3 42.1 11.3
New Mexico 431.2 367.2 112.1 41.2 31.3 49.7 37.4 18.0 13.8 110.4 26.1 6.0
New York 568.6 451.2 128.6 49.6 38.1 73.9 55.3 26.4 18.1 153.7 41.8 10.6
North Carolina 546.6 417.9 127.1 46.3 34.3 92.3 56.1 22.2 15.2 138.7 36.7 8.9
North Dakota 517.1 411.5 122.2 54.7 40.5 68.3 45.4 22.8 18.5 141.4 37.3 8.5
Ohio 522.1 421.7 120.5 50.3 37.3 87.5 59.8 22.8 15.6 127.1 38.5 9.4
Oklahoma 520.1 411.8 119.2 50.3 38.8 90.1 60.2 21.9 15.4 128.8 33.6 8.1
Oregon 489.5 427.9 128.4 43.3 34.0 66.9 56.6 22.5 15.6 122.8 37.4 9.5
Pennsylvania 559.2 458.3 128.1 52.6 39.7 81.3 56.8 26.1 17.9 133.6 44.2 10.9
Rhode Island 544.3 456.4 129.9 44.8 36.2 79.9 64.0 24.1 17.7 130.6 46.8 13.7
South Carolina 538.7 408.6 125.3 46.8 35.9 90.6 54.0 20.0 13.5 138.1 33.1 8.6
South Dakota 495.0 416.7 125.9 53.2 40.0 68.6 49.2 23.7 16.7 129.3 34.4 9.3
Tennessee 552.7 420.1 120.6 50.3 37.7 98.9 61.7 22.2 15.8 135.5 35.5 8.1
Texas 488.5 384.4 113.1 48.4 33.5 73.0 46.7 21.8 15.4 115.7 28.2 6.6
Utah 480.6 368.0 113.8 36.7 29.4 34.7 23.7 23.9 15.4 156.8 30.7 5.8
Vermont 514.7 439.8 128.0 43.4 34.7 75.4 62.5 24.7 17.2 121.6 39.9 11.0
Virginia 485.4 397.6 124.6 43.0 34.3 77.9 53.0 20.9 14.3 126.3 32.0 8.3
Washington 524.1 444.3 135.0 43.0 35.0 69.2 55.9 25.6 17.3 133.9 37.9 9.5
West Virginia 541.2 436.7 111.2 55.3 41.3 102.8 67.4 22.3 16.2 114.1 39.5 10.9
Wisconsin 524.4 430.7 125.6 46.1 35.7 71.8 54.4 24.9 17.5 129.6 40.1 9.8
Wyoming 472.4 387.6 111.2 44.8 33.3 55.7 45.8 18.8 13.8 127.1 37.1 11.8
United States 522.6 419.0 123.1 48.3 36.6 76.7 54.1 23.1 16.0 131.5 36.4 9.0
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • a This state's data are not included in the US combined rates because it did not meet high-quality standards for one or more years during 2008 to 2012 according to the North American Association of Central Cancer Registries (NAACCR).
  • b Rates are based on incidence data for 2008 to 2009.
  • c This state's registry did not submit cancer incidence data to the NAACCR.
  • d Rates are based on incidence data for 2008 to 2010.
Table 11. Death Rates for Selected Cancers by State, United States, 2008 to 2012
ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PANCREAS PROSTATE
STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE
Alabama 246.8 152.4 22.6 21.2 14.1 82.6 40.1 7.9 5.1 13.3 9.9 26.4
Alaska 211.4 151.5 21.0 18.0 13.7 61.2 44.8 7.8 5.0 13.7 9.2 21.9
Arizona 180.0 128.1 19.7 15.9 11.3 46.6 31.9 7.2 4.6 11.5 8.9 19.4
Arkansas 246.5 156.6 22.3 22.7 15.3 88.0 44.2 8.2 5.5 13.2 9.4 22.7
California 183.4 135.3 21.2 16.8 12.2 43.7 30.5 7.4 4.6 11.8 9.3 21.1
Colorado 173.8 129.4 19.7 15.3 11.8 40.8 29.7 7.0 4.3 10.8 9.0 22.6
Connecticut 192.2 138.4 20.3 14.8 11.0 49.7 35.8 7.1 4.5 13.2 10.2 20.2
Delaware 218.1 156.3 22.1 17.5 12.2 66.4 45.2 6.9 4.8 13.6 9.5 22.6
Dist. of Columbia 227.1 161.6 29.0 18.7 16.6 54.6 33.9 7.1 3.7 15.7 12.2 34.9
Florida 197.1 136.9 21.0 17.2 12.1 58.1 37.3 7.5 4.5 12.1 9.0 18.7
Georgia 218.2 143.5 22.9 19.5 13.1 68.0 37.2 7.3 4.2 12.2 9.0 24.6
Hawaii 171.7 114.8 15.1 16.8 10.7 44.4 25.0 7.4 4.5 12.9 10.2 14.8
Idaho 189.3 134.9 20.7 16.0 11.8 45.9 33.6 8.0 4.9 12.3 8.9 24.7
Illinois 215.9 154.4 23.0 20.3 14.0 62.4 40.7 8.2 5.0 13.0 10.0 22.4
Indiana 232.4 157.8 22.7 20.3 14.0 75.3 44.7 8.6 5.3 12.8 9.5 22.0
Iowa 209.1 145.3 20.7 19.8 14.3 61.4 37.5 8.8 5.2 12.4 9.2 20.7
Kansas 206.1 144.7 21.3 18.7 12.8 61.7 39.1 8.7 4.8 12.7 9.7 19.2
Kentucky 253.6 170.0 22.6 21.8 15.2 92.2 55.2 8.8 5.7 12.8 9.4 21.5
Louisiana 247.4 161.0 25.0 22.7 15.1 77.4 42.8 8.6 5.0 14.9 11.4 24.2
Maine 223.8 154.6 19.4 18.4 12.8 66.5 44.1 8.8 5.3 12.0 10.6 21.1
Maryland 207.4 148.0 23.7 18.9 12.8 57.1 38.6 7.3 4.3 13.4 10.2 22.5
Massachusetts 205.5 147.1 20.3 17.1 12.2 56.2 40.3 7.4 4.5 12.6 10.2 20.5
Michigan 215.9 155.0 23.1 18.6 13.2 64.7 42.8 9.2 5.4 13.4 10.1 20.3
Minnesota 197.0 141.1 20.0 16.5 11.8 49.7 35.6 9.4 5.4 12.0 9.0 22.5
Mississippi 260.4 158.5 24.5 23.9 16.5 88.5 41.4 7.8 4.4 14.4 10.6 28.4
Missouri 222.7 156.8 23.4 20.5 13.9 72.8 45.2 7.8 5.0 12.7 9.8 19.9
Montana 188.5 138.6 20.3 16.1 12.5 49.7 37.2 8.0 4.3 11.2 8.2 23.4
Nebraska 200.9 140.8 19.8 19.8 14.6 55.5 35.5 7.9 5.0 12.0 9.4 22.0
Nevada 201.9 149.0 23.3 21.0 13.8 55.9 44.1 6.8 4.3 12.5 9.2 21.5
New Hampshire 208.3 147.6 20.4 16.2 13.0 57.7 42.1 7.2 4.3 13.6 9.4 20.8
New Jersey 199.0 147.4 23.9 19.6 13.8 52.0 35.3 7.4 4.7 13.3 10.3 20.3
New Mexico 181.0 128.1 20.4 18.0 12.2 40.9 27.2 6.0 4.3 11.1 8.0 21.9
New York 193.8 141.7 21.5 17.9 13.0 51.9 35.1 7.6 4.7 13.0 10.0 20.6
North Carolina 222.2 145.0 22.2 18.0 12.3 72.0 39.1 7.5 4.7 11.9 9.2 23.5
North Dakota 198.1 130.2 19.8 19.6 13.1 53.3 31.8 6.3 4.6 13.3 7.8 22.6
Ohio 228.2 158.5 23.8 20.9 14.1 70.9 43.8 9.0 5.3 13.4 10.1 22.0
Oklahoma 233.6 159.6 23.2 21.7 14.4 75.7 45.3 8.9 5.3 12.4 9.6 22.4
Oregon 203.6 149.8 20.9 17.3 12.8 55.2 41.2 8.3 5.0 12.3 9.7 23.2
Pennsylvania 218.5 153.3 23.2 20.2 14.1 62.4 38.7 8.7 5.2 13.3 10.1 21.1
Rhode Island 216.1 143.3 19.8 17.6 13.1 62.5 41.6 7.7 4.2 12.7 8.4 20.8
South Carolina 232.7 148.8 23.2 19.6 13.4 72.7 38.9 7.6 4.5 13.0 10.1 25.5
South Dakota 196.9 142.8 20.7 18.5 13.2 58.2 35.0 7.5 5.0 10.8 9.6 20.8
Tennessee 245.9 156.7 22.6 21.3 14.8 83.6 45.1 8.7 5.0 12.9 9.6 22.6
Texas 201.8 137.7 21.0 18.9 12.5 56.4 33.7 7.7 4.6 11.8 8.9 19.6
Utah 153.0 108.6 20.8 13.2 10.2 26.4 15.6 7.2 4.6 10.9 8.1 23.3
Vermont 206.2 149.9 18.7 16.2 13.3 57.2 43.8 8.2 4.6 13.4 10.2 22.4
Virginia 211.5 145.8 22.8 17.9 12.9 62.5 38.2 7.9 4.6 12.5 9.5 22.7
Washington 201.8 146.4 20.3 16.4 12.2 53.9 39.7 8.3 5.1 12.7 10.2 22.2
West Virginia 242.5 165.2 22.5 22.9 15.0 80.5 49.3 8.4 5.8 12.0 8.6 20.1
Wisconsin 208.9 146.8 21.0 17.4 12.3 56.3 38.1 8.6 5.2 13.1 10.1 23.1
Wyoming 187.0 140.3 19.5 18.3 12.2 46.5 33.7 6.3 4.8 10.9 8.3 20.3
United States 207.9 145.4 21.9 18.6 13.1 59.8 37.8 7.9 4.8 12.6 9.6 21.4
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.

Cancer in Children

Cancer is the second most common cause of death among children aged 1 to 14 years in the United States, surpassed only by accidents. In 2016, an estimated 10,380 children (birth to 14 years) will be diagnosed with cancer (excluding benign/borderline brain tumors) and 1,250 will die from the disease. Benign and borderline brain tumors are not included in the 2016 case estimates because the calculation method requires historical data and these tumors were not required to be reported until 2004.

Leukemia (76% of which are lymphoid leukemias) accounts for 30% of all childhood cancers (including benign brain tumors). Cancers of the brain and other nervous system are the second most common cancer type (26%), followed by soft tissue sarcomas (7%, almost one-half of which are rhabdomyosarcoma), neuroblastoma (6%), non-Hodgkin lymphomas, including Burkitt lymphoma (6%), renal (Wilms) tumors (5%), and Hodgkin lymphomas (3%).8

Cancers in adolescents (aged 15 to 19 years) differ somewhat from those in children in terms of type and distribution. For example, a smaller proportion of the cancers diagnosed in adolescents are leukemias and a larger proportion are lymphomas. Cancers of the brain and other nervous system are most common (20%), followed by leukemia (14%), Hodgkin lymphoma (13%), gonadal germ cell tumors (12%), and thyroid carcinoma (11%). Melanoma accounts for 4% of the cancers diagnosed in this age group.

Cancer incidence rates increased in children and adolescents by 0.6% per year from 1975 through 2012. In contrast, death rates have declined continuously, from 6.5 (per 100,000 population) in 1970 to 2.4 in 2012, an overall reduction of 63% (65% in children and 60% in adolescents). Table 12 provides trends in survival rates for the most common childhood cancers. The 5-year relative survival rate for all cancer sites combined improved from 58% for children diagnosed during 1975 to 1977 to 83% for those diagnosed during 2005 to 2011. The substantial progress for all of the major childhood cancers reflects both improvements in treatment and high levels of participation in clinical trials.59

Table 12. Trends in 5-Year Relative Survival Ratesa (%) for Children (Birth to 14 Years) by Year of Diagnosis, United States, 1975 to 2011
1975 TO 1977 1978 TO 1980 1981 TO 1983 1984 TO 1986 1987 TO 1989 1990 TO 1992 1993 TO 1995 1996 TO 1998 1999 TO 2001 2002 TO 2004 2005 TO 2011
All sites 58 62 67 68 72 76 77 79 81 83 83b
Acute lymphocytic leukemia 57 66 71 72 78 83 84 87 89 92 91b
Acute myeloid leukemia 19 26 27c 31c 37c 42 41c 49 58 61 67b
Bones & joints 50c 48 57c 57c 67c 67 74 70 70 78 77b
Brain & other nervous system 57 58 57 62 64 64 71 75 74 75 74b
Hodgkin lymphoma 81 87 88 90 87 97 95 96 94 98 98b
Neuroblastoma 53 57 55 52 63 76 67 66 72 73 74b
Non-Hodgkin lymphoma 43 53 67 70 71 77 81 83 90 85 88b
Soft tissue 61 74 69 73 66 80 77 71 77 85 79b
Wilms tumor 73 79 87 91 92 92 92 92 94 89 94b
  • a Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2012.
  • b The difference in rates between 1975 to 1977 and 2005 to 2011 is statistically significant (P < .05).
  • c The standard error of the survival rate is between 5 and 10 percentage points.

Limitations

Although the numbers of cancer cases and deaths expected in 2016 provide a reasonably accurate portrayal of the contemporary cancer burden, they are model-based, 4-year-ahead projections that should be interpreted with caution and not be used to track trends over time. First, the estimates may be affected by changes in methodology, which are implemented regularly as modeling techniques improve and surveillance coverage becomes more complete. Second, although the model is robust, it can only account for trends through the most recent year of data (currently 2012) and cannot anticipate abrupt fluctuations for cancers affected by changes in detection practice, such as prostate cancer. Third, the model can be oversensitive to sudden or large changes in observed data. The most informative indicators of cancer trends are age-standardized or age-specific cancer death rates from the NCHS and cancer incidence rates from SEER, NPCR, and/or NAACCR.

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 nonblack populations. This is particularly relevant for AI/AN populations. It is also important to note that cancer data in the United States are primarily reported for broad, heterogeneous racial and ethnic groups, masking important differences in the cancer burden within these subpopulations.

Conclusions

The continuous decline in cancer death rates over 2 decades has resulted in an overall drop of 23%, resulting in more than 1.7 million cancer deaths averted. Despite this progress, cancer is now the leading cause of death for much of the US population. Moreover, incidence and death rates are increasing for several cancer types, including liver and pancreas—2 of the most fatal cancers. Advancing the fight against cancer will require continued clinical and basic research, which is dependent on funding, as well as the application of existing cancer control knowledge across all segments of the population, with an emphasis on disadvantaged groups.