Volume 67, Issue 1 p. 7-30
Article
Free Access

Cancer statistics, 2017

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

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

Corresponding author: Rebecca L. Siegel, MPH, Surveillance Information Services, 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: 05 January 2017
Citations: 11,412

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 Surveillance, Epidemiology, and End Results Program; the 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 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the “epidemic of diagnosis.” Over the past decade of available data, the overall cancer incidence rate (2004-2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7–30. © 2017 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 2017 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 population-based data. The most current cancer data are available through 2013 for incidence and through 2014 for mortality. We also estimate the total number of deaths averted as a result of the continual decline in cancer death rates since the early 1990s. In addition, we present the actual number of deaths reported in 2014 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 2014 were provided by the National Center for Health Statistics (NCHS).1-3 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.3, 4

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 (CDC'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 (1975-2013) 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.5, 6 The lifetime probability of developing cancer, stage distribution, and survival by stage and for children and adolescents were based on data from all 18 SEER registries (the SEER 9 registries plus Alaska Natives, California, Georgia, Kentucky, Louisiana, and New Jersey), covering 28% of the US population.7 The probability of developing cancer was calculated using NCI's DevCan software (version 6.7.4).8 Some of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975-2013.9

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 2017 and incidence rates by state and race/ethnicity.10, 11 Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2009-2013.12, 13

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).14, 15 Causes of death were classified according to the International Classification of Diseases.16 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 8.3.2).17 The annual percent change in rates was quantified using NCI's Joinpoint Regression Program (version 4.3.1.0).18

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.19 For example, the leukemia incidence rate for 2013 is 14% higher after adjusting for reporting delays.20

Projected Cancer Cases and Deaths in 2017

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 2017 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 95% 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 (or health service area for rare cancers) from 1999 through 2013 using geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence.21 Then these counts were adjusted for delays in cancer reporting using registry-specific or combined NAACCR delay ratios and aggregated to obtain national- and state-level counts for each year. Finally, a temporal projection method (the vector autoregressive model) was applied to all 15 years of data to estimate counts for 2017. 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.22

New cases of female breast carcinoma in situ and melanoma in situ diagnosed in 2017 were estimated by first approximating the number of cases occurring annually from 2004 through 2013 based on age-specific NAACCR incidence rates (data from 46 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 2004 through 2013 generated by the joinpoint regression model was then used to project cases to 2017. The estimates for in situ cases were not adjusted for reporting delays.

The number of cancer deaths expected to occur in 2017 was estimated based on the most recent joinpoint-generated annual percent change in reported numbers of cancer deaths from 2000 through 2014 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.23

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 2014. 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 2017 by sex. The overall estimate of 1,688,780 cases is the equivalent of more than 4,600 new cancer diagnoses each day. In addition, about 63,410 cases of female breast carcinoma in situ and 74,680 cases of melanoma in situ are expected to be diagnosed in 2017. 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, 2017a
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All Sites 1,688,780 836,150 852,630 600,920 318,420 282,500
Oral cavity & pharynx 49,670 35,720 13,950 9,700 7,000 2,700
Tongue 16,400 11,880 4,520 2,400 1,670 730
Mouth 13,210 7,800 5,410 2,580 1,680 900
Pharynx 17,000 13,780 3,220 3,050 2,340 710
Other oral cavity 3,060 2,260 800 1,670 1,310 360
Digestive system 310,440 175,650 134,790 157,700 92,350 65,350
Esophagus 16,940 13,360 3,580 15,690 12,720 2,970
Stomach 28,000 17,750 10,250 10,960 6,720 4,240
Small intestine 10,190 5,380 4,810 1,390 770 620
Colonb 95,520 47,700 47,820 50,260 27,150 23,110
Rectum 39,910 23,720 16,190
Anus, anal canal, & anorectum 8,200 2,950 5,250 1,100 450 650
Liver & intrahepatic bile duct 40,710 29,200 11,510 28,920 19,610 9,310
Gallbladder & other biliary 11,740 5,320 6,420 3,830 1,630 2,200
Pancreas 53,670 27,970 25,700 43,090 22,300 20,790
Other digestive organs 5,560 2,300 3,260 2,460 1,000 1,460
Respiratory system 243,170 133,050 110,120 160,420 88,100 72,320
Larynx 13,360 10,570 2,790 3,660 2,940 720
Lung & bronchus 222,500 116,990 105,510 155,870 84,590 71,280
Other respiratory organs 7,310 5,490 1,820 890 570 320
Bones & joints 3,260 1,820 1,440 1,550 890 660
Soft tissue (including heart) 12,390 6,890 5,500 4,990 2,670 2,320
Skin (excluding basal & squamous) 95,360 57,140 38,220 13,590 9,250 4,340
Melanoma of the skin 87,110 52,170 34,940 9,730 6,380 3,350
Other nonepithelial skin 8,250 4,970 3,280 3,860 2,870 990
Breast 255,180 2,470 252,710 41,070 460 40,610
Genital system 279,800 172,330 107,470 59,100 27,500 31,600
Uterine cervix 12,820 12,820 4,210 4,210
Uterine corpus 61,380 61,380 10,920 10,920
Ovary 22,440 22,440 14,080 14,080
Vulva 6,020 6,020 1,150 1,150
Vagina & other genital, female 4,810 4,810 1,240 1,240
Prostate 161,360 161,360 26,730 26,730
Testis 8,850 8,850 410 410
Penis & other genital, male 2,120 2,120 360 360
Urinary system 146,650 103,480 43,170 32,190 22,260 9,930
Urinary bladder 79,030 60,490 18,540 16,870 12,240 4,630
Kidney & renal pelvis 63,990 40,610 23,380 14,400 9,470 4,930
Ureter & other urinary organs 3,630 2,380 1,250 920 550 370
Eye & orbit 3,130 1,800 1,330 330 180 150
Brain & other nervous system 23,800 13,450 10,350 16,700 9,620 7,080
Endocrine system 59,250 15,610 43,640 3,010 1,440 1,570
Thyroid 56,870 14,400 42,470 2,010 920 1,090
Other endocrine 2,380 1,210 1,170 1,000 520 480
Lymphoma 80,500 44,730 35,770 21,210 12,080 9,130
Hodgkin lymphoma 8,260 4,650 3,610 1,070 630 440
Non-Hodgkin lymphoma 72,240 40,080 32,160 20,140 11,450 8,690
Myeloma 30,280 17,490 12,790 12,590 6,660 5,930
Leukemia 62,130 36,290 25,840 24,500 14,300 10,200
Acute lymphocytic leukemia 5,970 3,350 2,620 1,440 800 640
Chronic lymphocytic leukemia 20,110 12,310 7,800 4,660 2,880 1,780
Acute myeloid leukemia 21,380 11,960 9,420 10,590 6,110 4,480
Chronic myeloid leukemia 8,950 5,230 3,720 1,080 610 470
Other leukemiac 5,720 3,440 2,280 6,730 3,900 2,830
Other & unspecified primary sitesc 33,770 18,230 15,540 42,270 23,660 18,610
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder.
  • About 63,410 cases of carcinoma in situ of the female breast and 74,680 cases of melanoma in situ will be newly diagnosed in 2017.
  • 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, 2017a
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 26,160 3,960 210 2,210 720 770 3,880 1,320 960 2,410 1,090
Alaska 3,600 500 b 280 120 100 450 130 140 320 150
Arizona 35,810 4,870 240 2,630 1,110 1,170 3,940 2,050 1,410 2,990 1,670
Arkansas 16,040 2,100 150 1,390 480 580 2,620 610 660 1,440 710
California 176,140 27,980 1,490 13,890 6,280 6,740 18,270 9,180 7,880 14,520 7,500
Colorado 24,330 3,840 170 1,770 890 960 2,420 1,590 1,090 2,880 1,120
Connecticut 21,900 3,420 120 1,600 890 800 2,540 970 950 2,140 1,220
Delaware 5,660 840 b 440 200 180 850 340 250 590 270
Dist. of Columbia 3,070 520 b 210 110 90 310 120 110 380 90
Florida 124,740 18,170 1,040 9,930 4,230 5,070 19,000 7,610 5,410 12,830 6,430
Georgia 48,850 7,820 410 4,040 1,510 1,550 6,610 2,930 1,890 5,410 1,880
Hawaii 6,540 1,120 50 660 290 210 700 460 260 500 240
Idaho 7,310 1,080 50 610 290 310 980 550 370 870 480
Illinois 64,720 10,210 520 5,580 2,740 2,350 8,600 2,810 2,750 6,410 3,070
Indiana 36,440 5,140 290 3,080 1,370 1,280 5,540 1,730 1,560 3,410 1,710
Iowa 17,230 2,400 100 1,510 700 760 2,410 1,020 800 1,430 870
Kansas 14,400 2,180 110 1,170 540 560 1,880 830 630 1,320 640
Kentucky 26,220 3,590 210 2,250 830 1,050 4,830 1,410 1,070 2,050 1,190
Louisiana 24,220 3,320 230 2,150 630 770 3,510 960 990 2,620 980
Maine 8,750 1,350 b 710 380 310 1,380 450 380 720 570
Maryland 31,820 5,250 220 2,430 1,200 1,000 4,020 1,700 1,260 3,400 1,390
Massachusetts 37,130 5,940 200 2,760 1,600 1,220 4,890 1,890 1,630 3,930 2,050
Michigan 57,600 8,160 370 4,660 2,320 2,010 8,190 2,780 2,480 5,350 3,050
Minnesota 30,000 4,230 140 2,170 1,080 1,290 3,620 1,330 1,370 2,750 1,320
Mississippi 17,290 2,340 140 1,520 410 530 2,570 560 560 1,380 620
Missouri 34,400 4,930 240 2,860 1,250 1,210 5,620 1,690 1,420 2,990 1,610
Montana 6,140 900 b 500 220 260 750 400 280 750 350
Nebraska 9,520 1,450 60 840 380 380 1,220 490 440 840 450
Nevada 13,840 2,010 110 1,160 400 460 1,680 560 560 1,190 700
New Hampshire 8,670 1,260 b 620 350 290 1,150 470 340 770 520
New Jersey 51,680 7,890 360 4,000 2,100 1,990 5,540 2,790 2,380 5,180 2,560
New Mexico 10,040 1,410 80 800 350 370 1,010 490 400 960 390
New York 107,530 16,310 810 8,490 4,420 4,320 12,700 4,900 4,760 10,060 5,410
North Carolina 56,900 8,580 400 4,290 1,810 1,970 7,940 3,060 2,180 5,560 2,500
North Dakota 4,180 550 b 330 140 150 480 210 170 360 200
Ohio 68,180 9,430 460 5,510 2,670 2,270 10,660 3,140 2,860 5,840 3,360
Oklahoma 18,710 2,690 170 1,610 590 760 3,050 790 840 1,700 860
Oregon 21,780 3,450 140 1,620 870 730 2,900 1,580 970 2,060 1,070
Pennsylvania 77,710 11,300 520 6,300 3,270 2,800 9,930 4,140 3,310 7,320 4,190
Rhode Island 5,870 930 b 480 250 190 860 270 260 780 350
South Carolina 28,680 4,250 210 2,270 890 990 4,320 1,740 1,120 3,250 1,260
South Dakota 4,920 690 b 410 180 200 590 240 210 430 240
Tennessee 37,080 5,510 290 3,080 1,090 1,300 5,830 1,840 1,490 2,830 1,620
Texas 116,200 17,060 1,300 9,690 3,890 4,550 14,560 4,240 5,250 12,550 4,270
Utah 10,990 1,460 70 740 400 460 850 950 490 1,240 430
Vermont 4,000 580 b 280 160 110 510 220 170 380 240
Virginia 42,770 7,020 280 3,260 1,490 1,380 5,400 2,500 1,720 3,950 1,870
Washington 35,560 5,950 250 2,720 1,380 1,390 4,390 2,590 1,740 3,580 1,830
West Virginia 11,690 1,520 80 1,050 450 410 1,980 700 480 840 610
Wisconsin 32,990 4,850 180 2,650 1,360 1,460 4,280 1,590 1,380 3,570 1,670
Wyoming 2,780 410 b 220 100 100 320 190 120 320 150
United States 1,688,780 252,710 12,820 135,430 61,380 62,130 222,500 87,110 72,240 161,360 79,030
  • 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 depicts the most common cancers expected to occur in men and women in 2017. Prostate, lung and bronchus, and colorectal cancers account for 42% of all cases in men, with prostate cancer alone accounting for almost 1 in 5 new diagnoses. For women, the 3 most commonly diagnosed cancers are breast, lung and bronchus, and colorectum, which collectively represent one-half of all cases; breast cancer alone is expected to account for 30% of 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, 2017.

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

An estimated 600,920 Americans will die from cancer in 2017, corresponding to about 1,650 deaths per day (Table 1). The most common causes of cancer death are cancers of the lung and bronchus, colorectum, and prostate in men and lung and bronchus, breast, and colorectum in women (Fig. 1). These 4 cancers account for 46% of all cancer deaths, with more than one-quarter (26%) due to lung cancer. Table 3 provides the estimated numbers of cancer deaths in 2017 by state for selected cancer sites.

Table 3. Estimated Deaths for Selected Cancers by State, 2017a
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 10,530 320 650 940 420 470 3,200 320 250 710 450
Alaska 1,070 b 70 100 b 60 280 b b 80 50
Arizona 12,050 380 810 1,020 550 660 2,820 430 310 930 600
Arkansas 6,800 180 420 600 250 280 2,160 210 150 430 260
California 59,400 1,830 4,440 5,240 2,610 3,750 12,000 2,140 1,530 4,510 3,130
Colorado 7,840 270 570 660 340 380 1,640 260 240 580 450
Connecticut 6,610 190 430 450 300 300 1,630 230 170 490 310
Delaware 2,050 50 130 150 70 110 590 70 50 150 90
Dist. of Columbia 1,060 b 100 90 b 90 220 b b 100 70
Florida 43,870 1,250 2,910 3,620 1,800 2,020 11,790 1,510 970 3,170 2,050
Georgia 17,280 490 1,320 1,540 620 850 4,720 510 420 1,160 780
Hawaii 2,520 50 140 240 90 170 590 100 50 220 100
Idaho 2,900 100 190 250 110 120 680 110 70 230 170
Illinois 24,040 610 1,680 2,030 990 1,040 6,470 790 570 1,650 1,040
Indiana 13,590 350 860 1,110 550 520 4,030 450 300 900 550
Iowa 6,460 190 380 570 260 240 1,740 240 150 440 280
Kansas 5,440 170 330 470 260 230 1,500 180 120 400 230
Kentucky 10,400 250 590 830 390 400 3,560 330 200 640 340
Louisiana 9,240 220 620 830 320 520 2,610 300 170 700 370
Maine 3,260 100 170 220 130 120 960 110 60 220 140
Maryland 10,650 280 820 860 410 560 2,630 340 260 840 470
Massachusetts 12,620 350 760 910 540 670 3,270 410 320 950 550
Michigan 21,050 570 1,410 1,680 830 860 5,650 760 500 1,560 830
Minnesota 9,860 280 610 760 480 390 2,450 390 230 710 470
Mississippi 6,560 220 420 650 230 300 1,940 170 110 460 280
Missouri 14,380 330 860 1,070 550 580 4,030 390 250 910 500
Montana 2,030 60 130 170 80 80 510 70 50 140 120
Nebraska 3,520 110 230 330 150 130 900 120 70 250 180
Nevada 5,200 150 380 500 200 230 1,400 160 120 360 270
New Hampshire 2,710 80 170 200 110 90 760 80 60 200 120
New Jersey 15,880 420 1,250 1,420 640 700 3,760 510 410 1,270 700
New Mexico 3,630 90 250 340 150 220 760 110 100 250 200
New York 35,960 910 2,410 2,870 1,460 1,680 8,660 1,210 910 2,750 1,560
North Carolina 20,020 600 1,360 1,530 760 940 5,830 620 440 1,350 840
North Dakota 1,290 b 70 120 60 b 340 b b 90 70
Ohio 25,430 640 1,690 2,130 990 990 7,300 860 570 1,810 1,020
Oklahoma 8,200 200 530 710 340 360 2,450 270 200 520 350
Oregon 8,140 260 520 660 320 440 2,030 290 230 580 410
Pennsylvania 28,510 700 1,900 2,390 1,210 1,220 7,420 1,010 690 2,110 1,200
Rhode Island 2,160 50 120 170 90 110 610 60 50 140 90
South Carolina 10,320 260 700 830 380 440 2,920 300 230 710 460
South Dakota 1,660 60 110 160 90 60 450 50 b 110 70
Tennessee 14,830 380 920 1,220 570 670 4,590 470 310 950 550
Texas 40,260 1,100 2,830 3,700 1,690 2,620 9,540 1,380 920 2,780 1,650
Utah 3,180 130 270 260 170 150 460 120 100 270 210
Vermont 1,400 50 70 100 50 50 400 b b 110 70
Virginia 14,870 390 1,060 1,190 550 670 3,810 490 370 1,080 650
Washington 12,720 410 850 970 520 680 3,100 460 330 920 620
West Virginia 4,780 110 280 430 190 170 1,450 160 90 280 160
Wisconsin 11,710 360 740 880 540 440 3,070 420 220 870 570
Wyoming 960 b 60 80 60 b 220 b b 70 b
United States 600,920 16,700 40,610 50,260 24,500 28,920 155,870 20,140 14,080 43,090 26,730
  • 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.

Trends in Cancer Incidence

Figure 2 illustrates long-term trends in cancer incidence rates for all cancers combined by sex. Cancer incidence patterns reflect trends in behaviors associated with cancer risk and changes in medical practice, such as the introduction of screening. The volatility in incidence for males compared with females reflects rapid changes in prostate cancer incidence, which spiked in the late 1980s and early 1990s (Fig. 3) due to a surge in the detection of asymptomatic disease as a result of widespread prostate-specific antigen (PSA) testing.24 Over the past decade of data, the overall cancer incidence rate in men declined by about 2% per year, with the pace accelerating in more recent years (Table 4). This trend reflects large continuing declines for cancers of the lung and colorectum, in addition to a sharp reduction in prostate cancer incidence of more than 10% annually from 2010 to 2013. This drop is attributed to decreased PSA testing in the wake of US Preventive Services Task Force recommendations against routine use of the test to screen for prostate cancer because of growing concerns about overdiagnosis and overtreatment.25, 26 The effect of reduced screening on the occurrence of advanced disease is being watched closely. Incidence rates for distant stage disease, which accounted for 4% of diagnoses during 2006 to 2012 (Fig. 4), have been stable since the mid-2000s following at least a decade of decline.6

Table 4. Trends in Delay-Adjusted Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2013
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2004-2013 AAPC 2009-2013 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC
All sites
Overall 1975-1989 1.2a 1989-1992 2.8 1992-1995 −2.4 1995-1998 1.0 1998-2009 −0.3a 2009-2013 −1.5a −0.8a −1.5a
Male 1975-1989 1.3a 1989-1992 5.2a 1992-1995 −4.9a 1995-1999 0.6 1999-2009 −0.6a 2009-2013 −2.9a −1.6a −2.9a
Female 1975-1979 −0.3 1979-1987 1.6a 1987-1995 0.1 1995-1998 1.5 1998-2003 −0.6 2003-2013 0.1 0.1 0.1
Female breast 1975-1980 −0.5 1980-1987 4.0a 1987-1994 −0.2 1994-1999 1.8a 1999-2004 −2.3a 2004-2013 0.4a 0.4a 0.4a
Colorectum
Male 1975-1985 1.1a 1985-1991 −1.2a 1991-1995 −3.2a 1995-1998 2.3 1998-2013 −3.0a −3.0a −3.0a
Female 1975-1985 0.3 1985-1995 −1.9a 1995-1998 1.8 1998-2008 −2.0a 2008-2013 −3.8a −3.0a −3.8a
Liver & intrahepatic bile duct
Male 1975-1980 0.7 1980-2013 3.8a 3.8a 3.8a
Female 1975-1983 0.6 1983-1996 4.1a 1996-2013 2.8a 2.8a 2.8a
Lung & bronchus
Male 1975-1982 1.5a 1982-1991 −0.5a 1991-2008 −1.7a 2008-2013 −2.9a −2.4a −2.9a
Female 1975-1982 5.6a 1982-1991 3.4a 1991-2006 0.5a 2006-2013 −1.4a −1.0a −1.4a
Melanoma of skin
Male 1975-1985 5.6a 1985-2005 3.2a 2005-2013 1.7a 1.8a 1.7a
Female 1975-1980 5.5a 1980-2008 2.4a 2008-2013 0.4 1.3a 0.4
Pancreas
Male 1975-1993 −0.8a 1993-2003 0.2 2003-2006 3.0 2006-2013 0.4 0.9 0.4
Female 1975-1984 1.3a 1984-1999 −0.3 1999-2013 1.3a 1.3a 1.3a
Prostate 1975-1988 2.6a 1988-1992 16.5a 1992-1995 −11.5a 1995-2000 2.3 2000-2010 −1.7a 2010-2013 −10.7a −4.8a −8.6a
Thyroid
Male 1975-1980 −4.7 1980-1997 1.9a 1997-2013 5.4a 5.4a 5.4a
Female 1975-1977 6.5 1977-1980 −5.2 1980-1993 2.3a 1993-1999 4.5a 1999-2009 7.1a 2009-2013 1.5 4.6a 1.5
Uterine corpus 1975-1979 −6.0a 1979-1988 −1.7a 1988-1997 0.7a 1997-2006 −0.4a 2006-2009 3.7a 2009-2013 0.0 1.1 0.0
  • 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 4.3.0.0, allowing up to 5 joinpoints. Trends are based on Surveillance, Epidemiology, and End Results (SEER) 9 areas.
Details are in the caption following the image

Trends in Cancer Incidence (1975 to 2013) and Death Rates (1975 to 2014) by Sex, United States.

Rates are age adjusted to the 2000 US standard population. Incidence rates also 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 2013.

Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Includes intrahepatic bile duct.

Details are in the caption following the image

Stage Distribution by Race, United States, 2006 to 2012.

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

The overall incidence rate in women has remained generally stable since 1987 because declines in lung and colorectal cancers are being offset by increasing or stable rates for breast, uterine corpus, and thyroid cancers and for melanoma (Table 4). The slight increase in breast cancer incidence from 2004 to 2013 is driven wholly by nonwhite women; rates increased by about 2% per year among women other than white or black and by 0.5% per year among black women, while remaining stable among white women.6

Lung cancer incidence rates continue to decline about twice as fast in men as in women (Table 4). Sex differences in lung cancer trends reflect historical differences in tobacco use. Women took up smoking in large numbers later and at older ages than men, but were also slower to quit, including recent upturns in smoking prevalence in some birth cohorts.27, 28 In contrast, incidence patterns for colorectal cancer are very similar in men and women, with rates declining by 3% per year from 2004 through 2013 (Table 4). While declines in colorectal cancer incidence rates prior to 2000 are attributed equally to changes in risk factors and the introduction of screening,29 recent rapid declines are thought to primarily reflect the increased uptake of colonoscopy and the removal of precancerous adenomatous polyps.30, 31 Colonoscopy use among adults aged 50 years and older has tripled, from 21% in 2000 to 60% in 2015.32 In contrast to the rapid declines in colorectal cancer incidence among screening aged adults, rates increased by about 2% per year from 1993 to 2013 in individuals aged younger than 50 years.6

Incidence rates continue to increase rapidly for liver cancer, by about 3% per year in women and 4% per year in men, although rates have begun to decline in adults aged younger than 50 years.25 Similarly, the long-term, rapid rise in melanoma incidence appears to be slowing, particularly among younger age groups. Incidence rates for thyroid cancer also appear to have begun stabilizing in recent years after changes in clinical practice guidelines were initiated in 2009, including more conservative indications for biopsy, following increased awareness of the “epidemic in diagnosis.”33 In an effort to further reduce overdiagnosis and overtreatment, an international panel of experts convened by the NCI recently proposed downgrading the terminology for a common subtype of thyroid cancer from encapsulated follicular variant of papillary thyroid carcinoma to noninvasive follicular thyroid neoplasm with papillary-like nuclear features.34 These indolent tumors, which represent approximately 20% of thyroid cancer diagnoses in the United States, have a recurrence rate of <1% at 15 years when removed with limited surgery (ie, thyroid lobectomy).

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 24 percentage points among blacks. Improvements in survival for the most common cancers have been similar by sex, but are much more pronounced among patients aged 50 to 64 years than among those aged older than 65 years,35 likely reflecting lower efficacy or use of new therapies in the elderly population. Progress has been most rapid for hematopoietic and lymphoid malignancies due to improvements in treatment protocols, including the discovery of targeted therapies. For example, comparing patients diagnosed in the mid-1970s with those diagnosed during 2006 to 2012, the 5-year relative survival rate has increased from 41% to 71% for acute lymphocytic leukemia and from 22% to 66% for chronic myeloid leukemia.9 Most patients with chronic myeloid leukemia who are treated with tyrosine kinase inhibitors experience near normal life expectancy, particularly those diagnosed before age 65 years, based on a recent review of clinical trial data.36 Although historical groupings of lymphoid malignancies are still used to track progress, they do not reflect the substantial biologic variation by subtype that is captured by the more contemporary World Health Organization classification system.37

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 (Fig. 5). These low rates are partly because more than one-half of cases are diagnosed at a distant stage (Fig. 4), for which the 5-year survival is 4% and 3%, respectively. There is potential for lung cancer to be diagnosed at an earlier stage through the use of screening with low-dose computed tomography, which has been shown to reduce lung cancer mortality by up to 20% among current and former smokers with a smoking history of 30 or more pack-years.38, 39 However, only 2% to 4% of the 8.7 million Americans eligible for screening reported undergoing a computed tomography scan of the chest to check for lung cancer in 2010.40

Details are in the caption following the image

Five-Year Relative Survival Rates by Stage at Diagnosis and Race, United States, 2006 to 2012.

*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, 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, but has declined by about 1.5% per year since the early 1990s. From its peak of 215.1 (per 100,000 population) in 1991, the cancer death rate dropped 25% to 161.2 in 2014. This decline, which is larger in men (31% since 1990) than in women (21% since 1991), translates into approximately 2,143,200 fewer cancer deaths (1,484,000 in men and 659,200 in women) than what would have occurred if peak rates had persisted (Fig. 6).

Details are in the caption following the image

Total Number Of Cancer Deaths Averted From 1991 to 2014 in Men and From 1992 to 2014 in Women, United States.

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.

The decline in cancer mortality over the past 2 decades is the result of steady reductions in smoking and advances in early detection and treatment, reflected in considerable decreases for the 4 major cancers (lung, breast, prostate, and colorectum) (Fig. 7). Specifically, the death rate dropped 38% from 1989 to 2014 for female breast cancer, 51% from 1993 to 2014 for prostate cancer, and 51% from 1976 to 2014 for colorectal cancer. Lung cancer death rates declined 43% from 1990 to 2014 among males and 17% from 2002 to 2014 among females due to reduced tobacco use because of increased awareness of the health hazards of smoking and the implementation of comprehensive tobacco control.41 Tobacco control efforts adopted in the wake of the first Surgeon General's report on smoking and health in 1964 have resulted in an estimated 8 million fewer premature smoking-related deaths, one-third of which are due to cancer.42, 43 Despite this progress, in much of the Southern United States, 40% of cancer deaths in men in 2014 were caused by smoking.44

Details are in the caption following the image

Trends in Death Rates by Sex Overall and for Select Cancers, United States, 1930 to 2014.

Rates are age adjusted to the 2000 US standard population. Due to improvements in International Classification of Diseases (ICD) coding over time, numerator data for cancers of the lung and bronchus, colon and rectum, liver, and uterus differ from the contemporary time period. For example, rates for lung and bronchus include pleura, trachea, mediastinum, and other respiratory organs.

In contrast to declining trends for the 4 major cancers, death rates rose from 2010 to 2014 by almost 3% per year for liver cancer and by about 2% per year for uterine cancer (Table 5). Pancreatic cancer death rates continued to increase slightly (by 0.3% per year) in men but have leveled off in women.

Table 5. Trends in Death Rates for Selected Cancers by Sex, United States, 1975 to 2014
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2005-2014 AAPC 2010-2014 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC
All sites
Overall 1975-1984 0.5a 1984-1991 0.3a 1991-1994 −0.5 1994-1998 −1.3a 1998-2001 −0.8 2001-2014 −1.5a −1.5a −1.5a
Male 1975-1979 1.0a 1979-1990 0.3a 1990-1993 −0.5 1993-2001 −1.5a 2001-2014 −1.8a −1.8a −1.8a
Female 1975-1990 0.6a 1990-1994 −0.2 1994-2002 −0.8a 2002-2014 −1.4a −1.4a −1.4a
Female breast 1975-1990 0.4a 1990-1995 −1.8a 1995-1998 −3.3a 1998-2014 −1.8a −1.8a −1.8a
Colorectum
Male 1975-1978 0.8 1978-1984 −0.3 1984-1990 −1.3a 1990-2002 −2.0a 2002-2005 −3.9a 2005-2014 −2.5a −2.5a −2.5a
Female 1975-1984 −1.0a 1984-2001 −1.8a 2001-2014 −2.8a −2.8a −2.8a
Liver & intrahepatic bile duct
Male 1975-1985 1.5a 1985-1996 3.8a 1996-1999 0.5 1999-2014 2.6a 2.6a 2.6a
Female 1975-1978 −1.5 1978-1988 1.4a 1988-1995 3.9a 1995-2000 0.4 2000-2008 1.5a 2008-2014 2.8a 2.4a 2.8a
Lung & bronchus
Male 1975-1978 2.4a 1978-1984 1.2a 1984-1991 0.3a 1991-2005 −1.9a 2005-2012 −3.0a 2012-2014 −4.0a −3.2a −3.5a
Female 1975-1982 6.0a 1982-1990 4.2a 1990-1995 1.7a 1995-2003 0.3a 2003-2007 −0.8 2007-2014 −2.0a −1.7a −2.0a
Melanoma of skin
Male 1975-1990 2.2a 1990-2002 0.0 2002-2009 0.9a 2009-2014 −1.3a −0.3 −1.3a
Female 1975-1988 0.8a 1988-2014 −0.6a −0.6a −0.6a
Pancreas
Male 1975-1986 −0.8a 1986-2000 −0.3a 2000-2014 0.3a 0.3a 0.3a
Female 1975-1984 0.8a 1984-2002 0.1 2002-2008 0.6a 2008-2014 −0.2 0.1 −0.2
Prostate 1975-1987 0.9a 1987-1991 3.0a 1991-1994 −0.5 1994-1999 −4.1a 1999-2014 −3.4a −3.4a −3.4a
Uterine corpus 1975-1993 −1.5a 1993-2008 0.2 2008-2014 2.1a 1.4a 2.1a
  • APC indicates annual percent change based 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 4.3.1.0, allowing up to 5 joinpoints.

Recorded Number of Deaths in 2014

A total of 2,626,418 deaths were recorded in the United States in 2014, 23% of which were from cancer (Table 6). Cancer is the second leading cause of death following heart disease. However, it is the leading cause of death in 22 states,45 and in Hispanic and Asian Americans.46, 47 Cancer is also the leading cause of death among women aged 40 to 79 years and among men aged 45 to 79 years when data are analyzed by 5-year age group.1

Table 6. Ten Leading Causes of Death by Age and Sex, United States, 2014
ALL AGES AGES 1 to 19 AGES 20 to 39 AGES 40 to 59 AGES 60 to 79 AGES ≥80
MALE All Causes 1,328,241 FEMALE All Causes 1,298,177 MALE All Causes 12,128 FEMALE All Causes 6,538 MALE All Causes 65,486 FEMALE All Causes 30,221 MALE All Causes 227,562 FEMALE All Causes 147,196 MALE All Causes 534,113 FEMALE All Causes 411,138 MALE All Causes 475,956 FEMALE All Causes 692,702
1 Heart diseases 325,077 Heart diseases 289,271 Accidents (unintentional injuries) 4,409 Accidents (unintentional injuries) 2,023 Accidents (unintentional injuries) 24,467 Accidents (unintentional injuries) 8,850 Cancer 52,478 Cancer 49,683 Cancer 167,075 Cancer 136,649 Heart diseases 137,360 Heart diseases 187,680
2 Cancer 311,296 Cancer 280,403 Intentional self-harm (suicide) 1,681 Cancer 757 Intentional self-harm (suicide) 10,353 Cancer 4,440 Heart diseases 52,140 Heart diseases 22,465 Heart diseases 129,926 Heart diseases 76,242 Cancer 86,662 Cancer 88,842
3 Accidents (unintentional injuries) 85,448 Chronic lower respiratory diseases 77,645 Assault (homicide) 1,563 Intentional self-harm (suicide) 581 Assault (homicide) 7,040 Intentional self-harm (suicide) 2,649 Accidents (unintentional injuries) 26,259 Accidents (unintentional injuries) 12,789 Chronic lower respiratory diseases 34,508 Chronic lower respiratory diseases 33,872 Chronic lower respiratory diseases 28,801 Alzheimer disease 56,533
4 Chronic lower respiratory diseases 69,456 Cerebro- vascular disease 77,632 Cancer 1,028 Assault (homicide) 477 Heart diseases 5,077 Heart diseases 2,459 Intentional self-harm (suicide) 12,196 Chronic lower respiratory diseases 5,960 Cerebro- vascular disease 21,645 Cerebro- vascular disease 19,932 Cerebro- vascular disease 26,324 Cerebro- vascular disease 52,068
5 Cerebro- vascular disease 55,471 Alzheimer disease 65,179 Congenital anomalies 498 Congenital anomalies 428 Cancer 4,020 Assault (homicide) 1,287 Chronic liver disease & cirrhosis 11,443 Chronic liver disease & cirrhosis 5,646 Diabetes mellitus 20,335 Diabetes mellitus 14,965 Alzheimer disease 22,353 Chronic lower respiratory diseases 37,397
6 Diabetes mellitus 41,111 Accidents (unintentional injuries) 50,605 Heart diseases 373 Heart diseases 266 Chronic liver disease & cirrhosis 971 Pregnancy, childbirth & puerperium 748 Diabetes mellitus 8,118 Cerebro- vascular disease 4,959 Accidents (unintentional injuries) 16,588 Accidents (unintentional injuries) 9,714 Influenza & pneumonia 13,482 Influenza & pneumonia 17,954
7 Intentional self-harm (suicide) 33,113 Diabetes mellitus 35,377 Chronic lower respiratory diseases 158 Influenza & pneumonia 126 Diabetes mellitus 970 Chronic liver disease & cirrhosis 628 Cerebro- vascular disease 6,585 Diabetes mellitus 4,947 Chronic liver disease & cirrhosis 10,620 Alzheimer disease 8,462 Accidents (unintentional injuries) 13,047 Accidents (unintentional injuries) 16,726
8 Alzheimer disease 28,362 Influenza & pneumonia 28,641 Influenza & pneumonia 145 Chronic lower respiratory diseases 89 HIV disease 784 Diabetes mellitus 624 Chronic lower respiratory diseases 5,550 Intentional self-harm (suicide) 4,389 Nephritis, nephrotic syndrome & nephrosis 9,698 Nephritis, nephrotic syndrome & nephrosis 8,352 Nephritis, nephrotic syndrome & nephrosis 11,665 Diabetes mellitus 14,817
9 Influenza & pneumonia 26,586 Nephritis, nephrotic syndrome & nephrosis 23,710 Cerebro- vascular disease 96 Cerebro- vascular disease 83 Cerebro- vascular disease 766 Cerebro- vascular disease 548 Influenza & pneumonia 3,236 Septicemia 2,664 Influenza & pneumonia 9,030 Septicemia 7,854 Diabetes mellitus 11,644 Nephritis, nephrotic syndrome & nephrosis 13,234
10 Chronic liver disease & cirrhosis 24,584 Septicemia 20,607 Septicemia 77 Septicemia 78 Influenza & pneumonia 602 Influenza & pneumonia 511 HIV disease 2,943 Influenza & pneumonia 2,592 Septicemia 8,227 Influenza & pneumonia 7,359 Parkinson disease 10,059 Hypertension & hypertensive renal disease* 11,724
  • HIV indicates human immunodeficiency virus.
  • *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, 2014, National Center for Health Statistics, Centers for Disease Control and Prevention, 2016.

Table 7 presents the number of deaths in 2014 for the 5 leading cancer types by age and sex. The leading causes of cancer death are brain cancer, leukemia, and female breast cancer before age 40 years and lung cancer in those aged 40 years or older. In 2013, lung cancer surpassed breast cancer as the leading cause of cancer death among women aged 40 to 59 years. Cervical cancer is the second leading cause of cancer death in women aged 20 to 39 years, underscoring the need to improve screening rates in this age group, as well as increase acceptance of and access to human papillomavirus vaccination. In 2014, only 40% of females aged 13 to 17 years had completed the 3-dose series, up slightly from 37% in 2013.48

Table 7. Five Leading Types of Cancer Death by Age and Sex, United States, 2014
ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥ 80
MALE
ALL SITES 311,296 ALL SITES 1,050 ALL SITES 4,020 ALL SITES 52,478 ALL SITES167,075 ALL SITES 86,662
Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus
84,861 314 529 13,078 51,714 19,821
Prostate Leukemia Leukemia Colorectum Colorectum Prostate
28,344 272 507 5,947 13,317 14,529
Colorectum Bones & joints Colorectum Liver* Prostate Colorectum
27,134 100 446 4,461 12,489 7,422
Pancreas Soft tissue Non-Hodgkin Pancreas Pancreas Urinary bladder
(including heart) lymphoma
20,755 78 246 3,830 11,997 5,269
Liver* Non-Hodgkin Lung & bronchus Esophagus Liver* Pancreas
lymphoma
16,623 46 236 2,581 9,503 4,815
FEMALE
ALL SITES 280,403 ALL SITES 787 ALL SITES 4,440 ALL SITES 49,683 ALL SITES 136,649 ALL SITES 88,842
Lung & bronchus Brain & ONS Breast Lung & bronchus Lung & bronchus Lung & bronchus
70,667 245 1,051 10,812 40,256 19,415
Breast Leukemia Uterine cervix Breast Breast Breast
41,213 184 446 10,708 18,461 10,991
Colorectum Bone & joints Colorectum Colorectum Colorectum Colorectum
24,517 81 376 4,214 10,060 9,864
Pancreas Soft tissue Leukemia Ovary Pancreas Pancreas
(including heart)
19,664 65 363 2,869 10,019 6,914
Ovary Non-Hodgkin Brain & ONS Pancreas Ovary Leukemia
lymphoma
14,195 23 307 2,660 7,419 4,190
  • ONS indicates other nervous system.
  • *Includes intrahepatic bile duct.
  • Note: Ranking order excludes category titles that begin with the word “Other.”

Cancer Disparities by Sex

The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (40.8%) than for women (37.5%) (Table 8). Reasons for the 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,49 and has been estimated to account for one-third of the gender disparity in cancer risk.50

Table 8. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2011 to 2013a
BIRTH TO 49 50 TO 59 60 TO 69 ≥70 BIRTH TO DEATH
All sitesb Male 3.4 (1 in 30) 6.3 (1 in 16) 14.0 (1 in 7) 33.3 (1 in 3) 40.8 (1 in 2)
Female 5.4 (1 in 18) 6.0 (1 in 17) 10.0 (1 in 10) 25.9 (1 in 4) 37.5 (1 in 3)
Breast Female 1.9 (1 in 52) 2.3 (1 in 44) 3.5 (1 in 29) 6.8 (1 in 15) 12.4 (1 in 8)
Colorectum Male 0.3 (1 in 294) 0.7 (1 in 149) 1.2 (1 in 84) 3.5 (1 in 28) 4.6 (1 in 22)
Female 0.3 (1 in 318) 0.5 (1 in 198) 0.8 (1 in 120) 3.2 (1 in 31) 4.2 (1 in 24)
Kidney & renal pelvis Male 0.2 (1 in 457) 0.3 (1 in 289) 0.6 (1 in 157) 1.3 (1 in 75) 2.1 (1 in 48)
Female 0.1 (1 in 729) 0.2 (1 in 582) 0.3 (1 in 315) 0.7 (1 in 135) 1.2 (1 in 83)
Leukemia Male 0.2 (1 in 410) 0.2 (1 in 574) 0.6 (1 in 259) 1.4 (1 in 72) 1.8 (1 in 57)
Female 0.2 (1 in 509) 0.1 (1 in 901) 0.4 (1 in 447) 0.9 (1 in 113) 1.2 (1 in 81)
Lung & bronchus Male 0.2 (1 in 643) 0.7 (1 in 149) 1.9 (1 in 53) 6.2 (1 in 16) 7.0 (1 in 14)
Female 0.2 (1 in 598) 0.6 (1 in 178) 1.5 (1 in 68) 4.8 (1 in 21) 6.0 (1 in 17)
Melanoma of the skinc Male 0.5 (1 in 220) 0.5 (1 in 198) 0.9 (1 in 111) 2.5 (1 in 40) 3.5 (1 in 28)
Female 0.6 (1 in 155) 0.4 (1 in 273) 0.5 (1 in 212) 1.0 (1 in 97) 2.3 (1 in 44)
Non-Hodgkin lymphoma Male 0.3 (1 in 385) 0.3 (1 in 353) 0.4 (1 in 175) 1.8 (1 in 55) 2.4 (1 in 42)
Female 0.2 (1 in 547) 0.2 (1 in 483) 0.2 (1 in 245) 1.3 (1 in 74) 1.9 (1 in 54)
Prostate Male 0.3 (1 in 354) 1.9 (1 in 52) 5.4 (1 in 19) 9.1 (1 in 11) 12.9 (1 in 8)
Thyroid Male 0.2 (1 in 533) 0.1 (1 in 799) 0.2 (1 in 620) 0.2 (1 in 429) 0.6 (1 in 163)
Female 0.8 (1 in 127) 0.4 (1 in 275) 0.3 (1 in 292) 0.4 (1 in 258) 1.8 (1 in 57)
Uterine cervix Female 0.3 (1 in 371) 0.1 (1 in 868) 0.1 (1 in 899) 0.2 (1 in 594) 0.6 (1 in 161)
Uterine corpus Female 0.3 (1 in 352) 0.6 (1 in 169) 1.0 (1 in 105) 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 for non-Hispanic whites only.

Table 9 shows sex differences in cancer-specific incidence and mortality. Overall, incidence rates are about 20% higher in men while mortality rates are about 40% higher. The larger disparity for mortality reflects differences in the composition and distribution of cancers. For example, rates of liver cancer, which is highly fatal, are 3 times higher in men than in women. The largest sex disparities are for cancers of the esophagus, larynx, and bladder, for which incidence and death rates are about 4-fold higher in men. However, incidence rates are higher in women for cancers of the anus, gallbladder, and thyroid. Notably, thyroid cancer incidence rates are 3 times higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population). This pattern is indicative of a preponderance of nonfatal thyroid tumors in women, which is consistent with more prominent and prolonged overdiagnosis in women than in men.51 However, consistency in the gender disparity for thyroid cancer globally and across racial/ethnic groups in the United States suggests a higher underlying disease burden in women,52 despite unknown etiologic mechanisms.53

Table 9. Sex Differences in Cancer Incidence and Mortality Rates, 2009 to 2013
INCIDENCE MORTALITY
RATE RATE RATIO (M/F) (95% CI) RATE RATE RATIO (M/F) (95% CI)
All sites Female 418.5 143.4
Male 512.1 1.2 (1.22-1.23) 204.0 1.4 (1.42-1.43)
Oral cavity and pharynx Female 6.3 1.3
Male 17.2 2.7 (2.69-2.75) 3.8 2.8 (2.77-2.89)
Esophagus Female 1.8 1.5
Male 8.1 4.5 (4.44-4.60) 7.4 4.8 (4.75-4.93)
Stomach Female 4.6 2.4
Male 9.2 2.0 (1.97-2.02) 4.5 1.9 (1.85-1.91)
Colon and rectum Female 35.6 12.7
Male 46.9 1.3 (1.31-1.32) 18.1 1.4 (1.42-1.44)
Colon excluding rectum Female 26.6
Male 32.4 1.2 (1.21-1.22)
Rectum and rectosigmoid junction Female 8.9
Male 14.5 1.6 (1.61-1.64)
Anus, anal canal, and anorectum Female 2.1 0.3
Male 1.5 0.7 (0.68-0.72) 0.2 0.8 (0.77-0.87)
Liver and intrahepatic bile duct Female 4.0 3.6
Male 11.8 2.9 (2.89-2.96) 9.1 2.5 (2.45-2.52)
Gallbladder Female 1.4 0.7
Male 0.8 0.6 (0.59-0.62) 0.5 0.7 (0.62-0.68)
Pancreas Female 10.9 9.5
Male 14.1 1.3 (1.28-1.30) 12.5 1.3 (1.30-1.33)
Larynx Female 1.4 0.4
Male 6.2 4.5 (4.39-4.57) 1.9 4.8 (4.62-4.97)
Lung and bronchus Female 53.5 37.0
Male 75.0 1.4 (1.40-1.41) 57.8 1.6 (1.55-1.57)
Melanoma of the skin Female 16.1 1.7
Male 25.9 1.6 (1.60-1.62) 4.1 2.4 (2.35-2.45)
Urinary bladder Female 8.9 2.2
Male 36.2 4.1 (4.02-4.08) 7.7 3.5 (3.47-3.59)
Kidney and renal pelvis Female 11.3 2.5
Male 21.7 1.9 (1.90-1.93) 5.7 2.3 (2.25-2.32)
Brain and ONS Female 5.6 3.5
Male 7.8 1.4 (1.37-1.40) 5.3 1.5 (1.48-1.52)
Thyroid Female 20.8 0.5
Male 7.0 0.3 (0.34-0.34) 0.5 1.0 (0.99-1.08)
Hodgkin lymphoma Female 2.4 0.3
Male 3.1 1.3 (1.27-1.32) 0.5 1.6 (1.53-1.70)
Non-Hodgkin lymphoma Female 15.9 4.7
Male 23.0 1.4 (1.44-1.46) 7.7 1.7 (1.63-1.67)
Myeloma Female 5.2 2.7
Male 8.0 1.5 (1.51-1.54) 4.2 1.6 (1.54-1.59)
Leukemia Female 10.6 5.2
Male 17.3 1.6 (1.62-1.65) 9.3 1.8 (1.78-1.82)
Acute lymphocytic leukemia Female 1.4 0.4
Male 1.8 1.3 (1.27-1.33) 0.5 1.4 (1.36-1.50)
Chronic lymphocytic leukemia Female 3.1 0.9
Male 6.1 1.9 (1.90-1.95) 2.0 2.2 (2.15-2.27)
Acute myeloid leukemia Female 3.4 2.2
Male 5.0 1.5 (1.44-1.49) 3.7 1.7 (1.65-1.72)
Chronic myeloid leukemia Female 1.4 0.2
Male 2.2 1.6 (1.57-1.65) 0.4 1.7 (1.64-1.83)
  • 95% CI indicates 95% confidence interval; F, female, M, male, ONS, other nervous system.

Melanoma incidence rates are about 60% higher in men than in women, while death rates are more than double. The larger disparity for mortality reflects an earlier stage at diagnosis and better stage-specific survival in women than in men. Sex disparities in melanoma survival, which have also been observed in Europe and Australia,54, 55 partly reflect more unfavorable prognostic indicators (eg, thick tumors, ulceration, and trunk loci) and an older age at diagnosis in men compared with women. However, sex is a predictor of survival independent of clinicopathologic factors for reasons that remain unclear.56 While hormonal influences are thought to play a role, survival is higher and disease progression less likely in women, regardless of menopausal status, even for patients with advanced disease.57 A recent study found a survival advantage for women when melanoma arose de novo (70%–80% of tumors), but no difference in survival for nevi-associated tumors, which are associated with better outcomes.58

Cancer Disparities by Race/Ethnicity and Socioeconomic Status

Cancer incidence and death rates vary considerably between racial and ethnic groups, with rates generally highest among blacks and lowest among Asian/Pacific Islanders (APIs) (Tables 10 and 11). Importantly, there are considerable differences within all of the broadly defined population groups described here, despite scant data. For example, while overall cancer incidence rates are 40% lower for API men than non-Hispanic white men based on aggregated data, rates in Hawaiians and Samoans are similar to those in non-Hispanic whites.47 The same is true for Puerto Ricans within the lower risk Hispanic population.

Table 10. Incidence Rates by Site, Race, and Ethnicity, United States, 2009 to 2013
ALL RACES COMBINED NON-HISPANICWHITE NON-HISPANICBLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKA NATIVEa HISPANIC
All sites
Male 512.1 519.3 577.3 310.2 426.7 398.1
Female 418.5 436.0 408.5 287.1 387.3 329.6
Breast (female) 123.3 128.3 125.1 89.3 98.1 91.7
Colorectum
Male 46.9 46.1 58.3 37.8 51.4 42.8
Female 35.6 35.2 42.7 27.8 41.2 29.8
Kidney & renal pelvis
Male 21.7 21.9 24.4 10.8 29.9 20.7
Female 11.3 11.3 13.0 4.8 17.6 11.9
Liver & intrahepatic bile duct
Male 11.8 9.7 16.9 20.4 18.5 19.4
Female 4.0 3.3 5.0 7.6 8.9 7.5
Lung & bronchus
Male 75.0 77.7 90.8 46.6 71.3 42.2
Female 53.5 58.2 51.0 28.3 56.2 25.6
Prostate 123.2 114.8 198.4 63.5 85.1 104.9
Stomach
Male 9.2 7.8 14.7 14.4 11.2 13.1
Female 4.6 3.5 7.9 8.4 6.5 7.8
Uterine cervix 7.6 7.0 9.8 6.1 9.7 9.9
  • 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 and exclude data from Kansas.
Table 11. Death Rates by Site, Race, and Ethnicity, United States, 2010 to 2014
ALL RACES COMBINED NON-HISPANICWHITE NON-HISPANICBLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKA NATIVEa HISPANIC
All sites
Male 200.4 204.0 253.4 122.7 183.6 142.5
Female 141.5 145.5 165.9 88.8 129.1 97.7
Breast (female) 21.2 21.1 30.0 11.3 14.1 14.4
Colorectum
Male 17.7 17.3 25.9 12.4 19.5 15.0
Female 12.4 12.3 16.9 8.8 14.0 9.2
Kidney & renal pelvis
Male 5.6 5.8 5.7 2.7 8.9 4.9
Female 2.4 2.5 2.5 1.1 4.2 2.3
Liver & intrahepatic bile duct
Male 9.2 8.0 13.3 14.3 14.9 13.1
Female 3.7 3.3 4.6 6.1 6.8 5.8
Lung & bronchus
Male 55.9 58.3 69.8 31.7 46.2 27.3
Female 36.3 39.8 35.5 18.0 30.8 13.4
Prostate 20.0 18.7 42.8 8.8 19.4 16.5
Stomach
Male 4.4 3.4 8.7 7.1 7.5 6.9
Female 2.3 1.7 4.2 4.3 3.8 4.1
Uterine cervix 2.3 2.1 3.9 1.7 2.8 2.6
  • 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.

In 2014, the cancer death rate was 15% higher in blacks than in whites. The racial disparity has been most striking for men, with the excess risk growing from 20% in 1970 to 47% in 1990. However, that gap had narrowed to 21% in 2014, due in part to more rapid declines in smoking-related cancers in blacks driven by sharper reductions in smoking initiation in the 1970s and early 1980s.59, 60 The racial disparity has declined similarly in women, from a peak of 20% in 1998 to 13% in 2014. Other than behavioral differences, racial disparities are caused by unequal access to and use of high-quality health care, including cancer prevention and early detection, timely diagnosis, and optimal treatment.61, 62 Blacks are more likely than whites to be diagnosed with cancer at an advanced stage (Fig. 4), but also have lower stage-specific survival for most cancer types (Fig. 5). Both stage at diagnosis and survival are closely aligned with health insurance coverage,63 which is lower among minorities than non-Hispanic whites. However, this gap is also narrowing rapidly. As a result of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, together referred to as the Affordable Care Act or ACA, 11% of blacks and 7% of non-Hispanic whites were uninsured in 2015, down from 21% and 12%, respectively, in 2010.64, 65 Progress for Hispanics is similar, with the uninsured rate dropping from 31% in 2010 to 16% in 2015. If maintained, these shifts should help to expedite progress in reducing socioeconomic disparities in cancer, as well as other health conditions.

Cancer incidence and death rates among APIs, American Indians/Alaska Natives (AI/ANs), and Hispanics are lower than among non-Hispanic whites for the 4 most common cancers, but higher for cancers associated with infectious agents (eg, those of the stomach and liver). For example, liver cancer incidence rates in these populations are double those in non-Hispanic whites, reflecting a higher prevalence of risk factors such as chronic infection with hepatitis B and/or hepatitis C viruses, obesity, diabetes, and binge drinking.66 AI/ANs have the highest rates of kidney cancer, although there is striking geographic variation, most likely reflecting differences in the prevalence of renal cancer risk factors such as obesity, smoking, and hypertension.67

Regional Variations in Cancer Rates

Tables 12 and 13 depict average annual cancer incidence and death rates for selected cancers by state. State variation in cancer occurrence reflects differences in medical practice and the prevalence of risk factors, such as smoking and obesity. Geographic disparities often reflect the national distribution of poverty and access to health care, which have increased over time and may continue to exacerbate because of differential state expansion of Medicaid facilitated by the ACA.68-70 The largest geographic variation by far is for lung cancer, reflecting the large historical and continuing differences in smoking prevalence among states.41 For example, lung cancer incidence rates in Kentucky (118 per 100,000 population in men and 80 per 100,000 population in women), which has historically had the highest smoking prevalence, are about 3.5 times higher than those in Utah (34 per 100,000 population in men and 24 per 100,000 population in women), which continues to have the lowest smoking prevalence. Smoking history similarly predicts state disparities in smoking-attributable mortality; the proportion of total cancer deaths caused by smoking is 38% in men and 29% in women in Kentucky, compared with 22% and 11%, respectively, in Utah.44 The 2-fold difference for prostate cancer incidence rates, which range from 84 (per 100,000 population) in Arizona to 169 in the District of Columbia, reflect state differences in PSA testing prevalence and racial composition.24 State variations are smaller for cancers without particularly strong risk factors or early detection tests (eg, pancreas).

Table 12. Incidence Rates for Selected Cancers by State, United States, 2009 to 2013
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 548.1 395.6 119.3 52.8 37.3 95.3 53.4 19.8 13.9 139.1 34.0 7.7
Alaska 459.7 411.9 123.5 49.2 40.4 71.6 55.6 21.4 14.3 100.3 34.7 10.8
Arizona 418.1 375.1 111.0 39.6 30.5 58.0 46.4 18.6 13.5 84.1 32.1 8.0
Arkansas 531.2 390.7 111.5 50.1 37.0 99.6 59.4 20.8 14.8 128.4 35.7 7.2
California 473.0 390.9 121.4 43.8 33.7 53.6 41.2 22.8 15.3 118.7 32.0 7.6
Colorado 458.0 393.8 124.8 38.7 31.0 49.8 42.4 21.5 14.9 122.1 32.7 8.3
Connecticut 541.8 459.1 137.8 46.5 35.1 70.9 57.7 25.3 17.7 130.3 47.4 12.5
Delaware 581.7 451.2 130.0 44.3 33.3 83.4 62.3 25.0 17.3 151.1 41.8 11.1
Dist. of Columbia 543.1 444.8 143.0 47.9 41.1 72.0 49.7 22.1 13.9 169.1 24.4 9.3
Florida 490.1 398.5 115.3 43.4 33.1 73.6 54.4 21.3 14.8 111.2 34.1 8.3
Georgia 542.5 409.6 123.4 48.8 36.2 86.7 53.2 21.7 14.6 139.8 33.6 7.7
Hawaii 454.0 408.7 134.4 53.1 36.4 58.0 38.7 21.8 14.9 96.5 23.3 6.1
Idaho 496.0 408.7 119.4 42.2 32.2 56.4 46.9 20.7 16.1 131.8 39.0 8.7
Illinois 531.6 437.6 128.5 53.4 38.9 81.0 58.5 23.5 16.2 128.8 38.2 9.5
Indiana 503.2 425.9 120.0 49.5 39.4 91.1 61.7 23.3 16.4 102.0 36.4 8.9
Iowa 536.5 438.8 122.6 52.2 39.7 80.2 52.7 26.7 18.5 119.2 39.7 8.8
Kansas 529.0 426.8 122.0 48.8 36.0 73.6 53.5 23.6 16.6 133.5 38.8 9.2
Kentucky 593.8 470.2 122.0 59.6 43.7 118.3 80.2 25.4 17.1 118.1 40.0 9.7
Louisiana 585.0 420.0 123.4 57.3 41.8 92.1 55.5 24.0 16.6 154.4 34.2 8.0
Maine 529.7 450.8 124.5 44.8 35.6 86.0 66.1 24.0 17.6 106.5 46.6 12.5
Maryland 506.0 421.0 130.2 42.5 33.8 67.9 52.9 21.2 15.1 135.0 36.0 9.2
Massachusetts 522.5 454.4 136.0 43.8 35.0 72.7 61.9 23.8 16.7 124.9 41.5 11.4
Michigan 530.2 428.3 123.0 45.2 34.9 78.9 59.1 24.5 17.2 137.0 39.5 10.2
Minnesotaa 518.7 431.8 130.1 44.6 35.3 62.9 50.1 27.2 18.5 130.3 38.3 9.5
Mississippi 567.0 405.4 116.1 58.9 42.6 103.1 56.5 20.8 14.4 142.7 30.9 7.3
Missouri 504.9 427.6 124.8 50.5 37.3 90.8 64.7 22.3 15.3 106.3 33.6 8.5
Montana 500.4 425.5 122.7 45.7 34.5 62.6 54.9 23.3 15.8 127.3 37.0 10.5
Nebraska 493.8 414.0 120.7 49.5 38.9 70.4 49.9 24.0 17.8 119.2 34.8 8.4
Nevadaa, b 496.9 397.1 113.9 50.7 35.1 67.9 58.6 20.5 14.2 135.4 38.0 11.1
New Hampshire 544.2 460.9 138.1 41.4 34.7 73.5 64.4 26.2 17.9 133.5 50.1 12.8
New Jersey 555.2 452.9 131.4 49.5 38.8 67.7 53.1 25.4 17.8 148.7 41.6 11.0
New Mexicoa, c 424.2 365.8 112.9 41.1 30.6 49.6 36.8 17.8 13.8 106.1 25.5 6.0
New York 557.3 450.6 128.4 47.9 36.6 72.0 54.7 26.3 18.0 145.2 41.4 10.6
North Carolina 534.8 419.5 128.4 44.8 33.4 90.5 55.9 21.7 15.0 130.2 36.1 8.8
North Dakota 515.5 415.5 124.6 54.5 40.2 69.8 47.5 22.7 18.3 130.9 38.5 8.7
Ohio 513.8 423.8 122.0 48.9 36.2 85.6 59.7 22.9 15.7 119.7 38.8 9.3
Oklahoma 511.4 409.8 117.7 49.9 38.1 87.7 58.5 21.7 14.9 120.6 33.8 8.1
Oregon 478.5 424.0 128.1 42.2 32.5 65.3 54.9 22.5 15.4 110.6 37.5 9.2
Pennsylvania 550.8 460.4 129.0 51.3 38.6 80.0 56.5 26.1 17.8 125.4 44.1 11.0
Rhode Island 528.3 459.2 130.4 42.7 35.3 78.3 64.0 25.0 17.8 117.4 46.3 13.3
South Carolina 530.6 409.6 125.6 45.5 34.4 87.8 54.3 20.4 13.4 129.0 34.2 8.7
South Dakota 487.0 428.6 130.6 50.9 39.8 67.4 50.9 23.6 16.3 119.6 33.8 9.4
Tennessee 540.5 420.6 121.7 47.6 36.6 97.6 61.2 22.0 15.1 126.3 35.1 8.1
Texas 474.1 381.1 112.3 47.0 32.8 70.1 45.5 21.5 15.2 106.4 27.9 6.5
Utah 468.6 369.8 112.7 36.1 28.2 34.4 24.2 23.4 15.1 144.4 30.2 5.8
Vermont 505.6 439.3 128.3 41.2 33.4 74.2 61.2 25.4 18.2 109.8 40.0 9.8
Virginia 473.3 399.3 125.5 42.2 33.5 75.2 52.2 21.1 14.4 116.5 31.7 8.3
Washington 513.3 442.2 135.6 41.7 34.0 67.1 54.7 25.6 17.0 125.7 37.8 9.5
West Virginia 533.4 440.0 114.4 54.3 40.8 101.0 65.9 22.1 16.1 106.6 39.9 10.9
Wisconsin 517.9 433.5 127.2 44.6 34.3 70.3 54.5 25.0 17.3 122.0 40.0 10.0
Wyoming 458.1 380.7 109.6 44.0 31.6 52.6 43.1 18.4 14.4 116.0 36.7 10.5
United States 512.1 418.5 123.3 46.9 35.6 75.0 53.5 23.0 15.9 123.2 36.2 8.9
  • 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 they did not meet high-quality standards for one or more years during 2009 to 2013 according to the North American Association of Central Cancer Registries (NAACCR).
  • b Rates are based on incidence data for 2009 to 2010.
  • c Rates are based on incidence data for 2009 to 2012.
Table 13. Death Rates for Selected Cancers by State, United States, 2010 to 2014
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 235.7 148.2 22.0 20.6 13.3 77.1 39.5 7.5 4.8 13.2 9.7 23.8
Alaska 203.5 146.7 20.4 18.5 13.5 54.7 41.7 7.1 3.7 11.9 9.9 20.5
Arizona 174.2 126.2 19.5 15.6 11.2 42.9 30.4 6.8 4.3 11.5 9.0 18.2
Arkansas 237.0 153.8 22.1 21.8 14.6 81.0 43.9 7.6 5.2 12.7 9.4 20.8
California 176.7 130.4 20.4 15.9 11.5 39.8 28.5 7.1 4.4 11.8 9.2 20.0
Colorado 166.4 125.1 19.2 14.5 11.1 36.4 28.1 6.6 4.0 10.9 8.6 21.7
Connecticut 182.5 133.5 19.1 13.8 10.4 46.3 34.4 7.1 4.3 12.5 9.8 18.6
Delaware 208.3 150.5 21.9 17.1 10.8 62.3 42.6 7.8 4.6 14.1 9.6 19.2
Dist. of Columbia 210.0 160.0 29.3 18.6 15.5 49.6 33.5 6.1 3.3 15.5 12.1 33.6
Florida 189.4 132.7 20.2 16.3 11.3 54.1 35.5 7.2 4.2 12.0 8.9 17.6
Georgia 212.3 140.5 22.5 19.4 12.6 64.1 35.6 7.1 4.1 12.3 9.1 23.4
Hawaii 167.3 114.9 15.0 17.5 10.7 40.8 25.1 6.7 4.0 12.4 9.8 13.7
Idaho 185.4 132.6 20.4 15.9 11.1 43.7 31.4 7.9 5.1 12.8 9.7 23.3
Illinois 208.3 150.3 22.5 19.1 13.2 59.0 39.4 7.8 4.6 12.8 9.8 20.9
Indiana 224.8 153.7 21.8 19.3 13.4 71.2 42.9 8.6 5.1 13.1 9.6 21.0
Iowa 206.5 142.2 19.4 19.2 13.9 59.1 36.0 8.7 5.1 12.7 9.3 19.8
Kansas 200.9 143.0 20.1 18.4 12.6 57.3 38.4 7.7 4.9 13.0 9.9 19.1
Kentucky 249.4 167.1 21.9 20.9 14.2 89.6 54.7 9.0 5.1 13.3 9.6 19.8
Louisiana 237.7 157.1 24.2 21.7 14.9 72.9 41.5 8.6 5.0 15.1 11.3 22.4
Maine 215.7 150.4 18.0 16.5 11.8 64.4 43.3 7.6 5.3 11.8 10.6 19.8
Maryland 198.1 143.3 22.8 17.6 12.1 52.2 36.6 7.1 4.2 13.9 9.9 20.3
Massachusetts 196.6 140.2 18.8 15.9 11.3 51.8 38.0 7.1 4.4 12.6 9.9 19.4
Michigan 209.2 151.6 22.4 17.7 12.7 60.8 41.5 8.8 5.2 13.3 10.1 19.5
Minnesota 188.7 135.8 18.8 15.2 11.5 47.6 33.9 8.6 5.2 12.4 8.8 20.6
Mississippi 252.2 158.5 23.9 23.7 16.1 82.7 41.0 7.2 4.2 14.3 11.0 26.2
Missouri 216.6 154.5 22.5 19.1 13.2 69.3 44.7 7.5 4.7 13.0 9.9 18.2
Montana 182.5 138.2 20.2 16.2 11.1 46.2 37.2 7.5 4.1 10.5 9.0 21.4
Nebraska 197.1 138.3 20.1 18.5 14.2 54.3 34.6 7.2 5.1 12.5 8.9 20.8
Nevada 194.1 145.4 22.7 20.2 13.8 52.8 41.4 6.9 4.0 12.2 9.0 21.1
New Hampshire 197.7 143.4 20.3 14.0 13.3 53.9 40.7 6.8 4.1 12.9 9.5 19.9
New Jersey 191.3 141.6 22.9 18.2 12.8 48.4 33.7 7.3 4.4 13.2 10.2 19.4
New Mexico 176.2 123.8 19.3 17.3 11.3 38.1 26.4 6.0 4.1 10.9 8.1 20.7
New York 187.1 138.0 20.6 16.9 12.1 49.0 33.8 7.3 4.4 13.0 9.9 19.5
North Carolina 215.1 142.1 21.6 17.3 11.6 67.9 37.9 7.4 4.5 12.6 9.2 21.6
North Dakota 189.6 128.0 17.8 17.9 13.1 52.0 31.4 6.9 4.5 12.1 7.9 19.8
Ohio 219.6 155.0 23.1 19.8 13.6 66.5 42.7 8.5 5.1 13.3 10.0 19.9
Oklahoma 227.2 157.4 23.4 20.6 13.8 71.5 44.9 8.3 5.0 12.4 9.9 20.8
Oregon 196.2 145.9 20.8 16.6 12.2 50.5 39.1 8.2 4.9 12.5 9.5 21.2
Pennsylvania 210.5 149.4 22.2 18.9 13.5 59.0 37.1 8.3 4.9 13.6 10.0 19.7
Rhode Island 209.2 143.5 18.8 16.4 12.9 59.1 41.8 6.8 4.7 12.6 9.1 19.8
South Carolina 223.0 145.7 22.7 18.7 12.9 67.0 37.8 7.2 4.4 13.1 9.7 23.4
South Dakota 196.9 138.5 20.2 19.8 12.8 55.5 35.2 7.5 4.3 11.6 9.1 19.5
Tennessee 236.2 153.9 22.1 20.1 14.0 78.4 43.7 8.3 4.8 12.6 10.0 20.7
Texas 195.1 133.2 20.4 18.3 11.9 52.2 31.7 7.4 4.4 11.7 9.0 18.7
Utah 151.0 111.2 20.8 13.0 9.7 24.6 16.2 6.8 4.7 11.4 8.6 22.1
Vermont 202.5 147.0 18.6 15.8 12.7 54.3 41.5 8.0 4.4 12.7 10.0 21.1
Virginia 201.9 141.3 21.9 17.0 12.0 57.4 36.5 7.5 4.4 12.9 9.4 21.0
Washington 191.4 140.1 20.1 15.2 11.2 49.9 36.3 7.9 4.8 12.3 9.8 20.4
West Virginia 236.7 163.3 22.1 22.1 15.0 77.2 47.2 8.1 5.3 12.2 8.7 18.2
Wisconsin 202.0 144.0 20.5 16.4 12.1 53.4 37.5 8.1 4.9 13.2 10.0 21.8
Wyoming 177.9 134.9 18.9 17.1 10.6 41.9 32.5 6.6 4.6 10.8 8.4 18.5
United States 200.4 141.5 21.2 17.7 12.4 55.9 36.3 7.6 4.6 12.6 9.5 20.0
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.

Cancer in Children and Adolescents

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 2017, an estimated 10,270 children (birth to 14 years) will be diagnosed with cancer (excluding benign/borderline malignant brain tumors) and 1,190 will die from the disease. Benign and borderline malignant brain tumors are not included in the 2017 case estimates because the calculation method requires historical data and these tumors were not required to be reported to cancer registries until 2004.

Leukemias (76% of which are lymphoid leukemias) account for 29% of all childhood cancers (including benign and borderline malignant brain tumors). Cancers of the brain and other nervous system are the second most common cancer type (26%). The third most common category is lymphomas and reticuloendothelial neoplasms (11%), almost one-half of which are non-Hodgkin lymphoma (including Burkitt lymphoma) and more than one-quarter of which are Hodgkin lymphoma. Soft tissue sarcomas (almost one-half of which are rhabdomyosarcoma) and neuroblastoma each account for 6% of childhood cancers, followed by renal (Wilms) tumors (5%).10

Cancers in adolescents (aged 15 to 19 years) differ somewhat from those in children in terms of type and distribution. For example, the most common cancer type in adolescents is lymphoma (21%), almost two-thirds of which is Hodgkin lymphoma. Cancers of the brain and other nervous system account for 17% of cases, followed by leukemia (14%), germ cell and gonadal tumors (12%), and thyroid carcinoma (11%). Melanoma accounts for 5% of the cancers diagnosed in this age group.

Although overall cancer incidence in children and adolescents has been increasing slightly (by 0.6% per year) since 1975, rates appear to have stabilized during the most recent data years. In contrast, death rates among those aged birth to 19 years have declined continuously, from 6.5 (per 100,000 population) in 1970 to 2.2 in 2014, an overall reduction of 66% (68% in children and 60% in adolescents). The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 83% during 2006-2012 for children and from 68% to 84% for adolescents. However, survival varies substantially by cancer type and age at diagnosis (Table 14).

Table 14. Five-Year Relative Survival Rate (%) by Age and ICCC Type, Ages Birth to 19 Years, United States, 2006 to 2012
BIRTH TO 14 15 TO 19
All ICCC groups combined 83.0 83.9
Lymphoid leukemia 90.2 74.7
Acute myeloid leukemia 64.2 59.7
Hodgkin lymphoma 97.7 96.4
Non-Hodgkin lymphoma 90.7 86.0
Central nervous system neoplasms 72.6 79.1
Neuroblastoma & other peripheral nervous cell tumors 79.7 74.2a
Retinoblasoma 95.3 b
Renal tumors 90.6 68.1a
Hepatic tumors 77.1 47.4a
Osteosarcoma 69.5 63.4
Ewing tumor & related bone sarcomas 78.7 59.2
Soft tissue and other extraosseous sarcomas 74.0 69.1
Rhabdomyosarcoma 69.6 48.9
Germ cell and gonadal tumors 93.3 91.9
Thyroid carcinoma 99.7 99.7
Malignant melanoma 93.7 94.0
  • ICCC indicates International Classification of Childhood Cancer.
  • Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2013.
  • a The standard error of the survival rate is between 5 and 10 percentage points.
  • b Statistic could not be calculated due to fewer than 25 cases during 2006 to 2012.

Limitations

Although the estimated numbers of new cancer cases and deaths expected to occur in 2017 provide a reasonably accurate portrayal of the contemporary cancer burden, they are model-based, 3-year- or 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 as we take advantage of improvements in modeling techniques and cancer surveillance coverage. Second, although the model is robust, it can only account for trends through the most recent year of data (currently 2013 for incidence and 2014 for mortality) 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 metrics for tracking 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 substantial and important differences in the cancer burden within these subpopulations. For example, among API men, lung cancer incidence rates in Hawaiian men are just as high as those in non-Hispanic white men and 3-fold higher than those in Asian Indian/Pakistani men based on limited data available by population subgroups. Thus, the high burden of lung and other cancers among Hawaiians is completely concealed with the presentation of aggregated API data.

Conclusions

The continuous decline in cancer death rates over 2 decades has resulted in an overall drop of 25%, resulting in 2.1 million fewer cancer deaths during this time period. Moreover, racial disparities in cancer death rates are continuing to decline and the proportion of blacks who are uninsured has halved since 2010, potentially expediting further progress. Despite these successes, death rates are increasing rapidly for cancers of the liver (one of the most fatal cancers) and uterine corpus, both of which are strongly associated with obesity. Advancing the fight against cancer requires continued clinical and basic research to improve detection practices, as well as treatment. In addition, creative new strategies are also needed to increase healthy behaviors nationwide and to more broadly apply existing cancer control knowledge across all segments of the population, with an emphasis on disadvantaged groups.

Author Contributions

Rebecca L. Siegel: Conceptualization, formal analysis, investigation, writing–original draft, writing–review and editing, and visualization. Kimberly D. Miller: Software, formal analysis, investigation, writing–review and editing, and visualization. Ahmedin Jemal: Conceptualization, methodology, writing–review and editing, visualization, and supervision.