Volume 68, Issue 1 p. 7-30
Article
Free Access

Cancer statistics, 2018

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: 04 January 2018
Citations: 12,072

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 and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, 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, available through 2015, were collected by the National Center for Health Statistics. In 2018, 1,735,350 new cancer cases and 609,640 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2005-2014) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2006-2015) declined by about 1.5% annually in both men and women. The combined cancer death rate dropped continuously from 1991 to 2015 by a total of 26%, translating to approximately 2,378,600 fewer cancer deaths than would have been expected if death rates had remained at their peak. Of the 10 leading causes of death, only cancer declined from 2014 to 2015. In 2015, the cancer death rate was 14% higher in non-Hispanic blacks (NHBs) than non-Hispanic whites (NHWs) overall (death rate ratio [DRR], 1.14; 95% confidence interval [95% CI], 1.13-1.15), but the racial disparity was much larger for individuals aged <65 years (DRR, 1.31; 95% CI, 1.29-1.32) compared with those aged ≥65 years (DRR, 1.07; 95% CI, 1.06-1.09) and varied substantially by state. For example, the cancer death rate was lower in NHBs than NHWs in Massachusetts for all ages and in New York for individuals aged ≥65 years, whereas for those aged <65 years, it was 3 times higher in NHBs in the District of Columbia (DRR, 2.89; 95% CI, 2.16-3.91) and about 50% higher in Wisconsin (DRR, 1.78; 95% CI, 1.56-2.02), Kansas (DRR, 1.51; 95% CI, 1.25-1.81), Louisiana (DRR, 1.49; 95% CI, 1.38-1.60), Illinois (DRR, 1.48; 95% CI, 1.39-1.57), and California (DRR, 1.45; 95% CI, 1.38-1.54). Larger racial inequalities in young and middle-aged adults probably partly reflect less access to high-quality health care. CA Cancer J Clin 2018;68:7-30. © 2018 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 estimated numbers of new cancer cases and deaths in 2018 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most current population-based data for cancer incidence through 2014 and for mortality through 2015. We also estimate the total number of deaths averted as a result of the continual decline in cancer death rates since the early 1990s and quantify the black-white disparity in cancer mortality by state and age based on the actual number of reported cancer deaths in 2015.

Materials and Methods

Incidence and Mortality Data

Mortality data from 1930 to 2015 were provided by the National Center for Health Statistics (NCHS).1-3 Forty-seven states and the District of Columbia (DC) 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 historic population-based incidence data. Long-term incidence and survival trends (1975-2014) 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 The lifetime probability of developing cancer and contemporary stage distribution and survival statistics 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.6 The probability of developing cancer was calculated using NCI's DevCan software (version 6.7.5).7 Some of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975-2014.8

The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for 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 2018 and cross-sectional incidence rates by state and race/ethnicity.9, 10 Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2010-2014.11, 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, 14 Causes of death were classified according to the International Classification of Diseases.15 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 8.3.4).16 The annual percent change in rates was quantified using NCI's Joinpoint Regression Program (version 4.5.0.1).17

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.18 For example, the leukemia incidence rate for 2014 is 13% higher after adjusting for reporting delays.19

Projected Cancer Cases and Deaths in 2018

The most recent year for which reported 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 2018 to provide an estimate of the contemporary cancer burden.

To calculate the number of invasive cancer cases, a generalized linear mixed model was used to estimate complete counts for each county (or health service area for rare cancers) from 2000 through 2014 using high-quality incidence data from 48 states and DC (approximately 96% population coverage) and geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.20 Data were unavailable for all years for Kansas and Minnesota and for some years for other states. Modeled counts were adjusted for delays in cancer reporting using registry-specific or combined delay ratios and aggregated to obtain national- and state-level counts for each year. Finally, a time series projection method (vector autoregression) was applied to all 15 years of modeled data to estimate counts for 2018. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are generally not reported to cancer registries. For complete details of the case projection methodology, please refer to Zhu et al.21

In situ cases of female breast carcinoma and melanoma of the skin diagnosed in 2018 were estimated by first approximating the number of cases occurring annually from 2005 through 2014 based on age-specific NAACCR incidence rates (data from 46 states and DC with high-quality data every year) and US population estimates provided in SEER*Stat. Counts were then adjusted for delays in reporting using SEER delay factors for invasive breast cancer and melanoma, respectively, because delay factors are not available for in situ cases. Counts were then projected to 2018 based on the average annual percent change during the entire time period as generated by the joinpoint regression model.

The number of cancer deaths expected to occur in 2018 was estimated based on the most recent joinpoint-generated annual percent change in reported cancer deaths from 2001 through 2015 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.22

Other Statistics

The number of cancer deaths averted in men and women due to the reduction in cancer death rates since the early 1990s was estimated by summing the difference between the annual number of recorded cancer 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- and sex-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- and sex-specific populations in subsequent years through 2015. We also calculated the racial disparity in overall cancer mortality by state and age (<65 years and ≥65 years) in 2015 based on death rate ratios (DRRs) comparing non-Hispanic blacks (NHBs) with non-Hispanic whites (NHWs) using SEER*Stat.

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 2018 by sex. The overall estimate of 1,735,350 cases is the equivalent of more than 4,700 new cancer diagnoses each day. In addition, about 63,960 cases of female breast carcinoma in situ and 87,290 cases of melanoma in situ of the skin are expected to be diagnosed in 2018. The estimated numbers of new cases by state for selected cancers are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2018a
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All sites 1,735,350 856,370 878,980 609,640 323,630 286,010
Oral cavity & pharynx 51,540 37,160 14,380 10,030 7,280 2,750
Tongue 17,110 12,490 4,620 2,510 1,750 760
Mouth 13,580 7,980 5,600 2,650 1,770 880
Pharynx 17,590 14,250 3,340 3,230 2,480 750
Other oral cavity 3,260 2,440 820 1,640 1,280 360
Digestive system 319,160 181,960 137,200 160,820 94,230 66,590
Esophagus 17,290 13,480 3,810 15,850 12,850 3,000
Stomach 26,240 16,520 9,720 10,800 6,510 4,290
Small intestine 10,470 5,430 5,040 1,450 810 640
Colonb 97,220 49,690 47,530 50,630 27,390 23,240
Rectum 43,030 25,920 17,110
Anus, anal canal, & anorectum 8,580 2,960 5,620 1,160 480 680
Liver & intrahepatic bile duct 42,220 30,610 11,610 30,200 20,540 9,660
Gallbladder & other biliary 12,190 5,450 6,740 3,790 1,530 2,260
Pancreas 55,440 29,200 26,240 44,330 23,020 21,310
Other digestive organs 6,480 2,700 3,780 2,610 1,100 1,510
Respiratory system 253,290 136,400 116,890 158,770 87,200 71,570
Larynx 13,150 10,490 2,660 3,710 2,970 740
Lung & bronchus 234,030 121,680 112,350 154,050 83,550 70,500
Other respiratory organs 6,110 4,230 1,880 1,010 680 330
Bones & joints 3,450 1,940 1,510 1,590 930 660
Soft tissue (including heart) 13,040 7,370 5,670 5,150 2,770 2,380
Skin (excluding basal & squamous) 99,550 60,350 39,200 13,460 9,070 4,390
Melanoma 91,270 55,150 36,120 9,320 5,990 3,330
Other nonepithelial skin 8,280 5,200 3,080 4,140 3,080 1,060
Breast 268,670 2,550 266,120 41,400 480 40,920
Genital system 286,390 176,320 110,070 62,330 30,210 32,120
Uterine cervix 13,240 13,240 4,170 4,170
Uterine corpus 63,230 63,230 11,350 11,350
Ovary 22,240 22,240 14,070 14,070
Vulva 6,190 6,190 1,200 1,200
Vagina & other genital, female 5,170 5,170 1,330 1,330
Prostate 164,690 164,690 29,430 29,430
Testis 9,310 9,310 400 400
Penis & other genital, male 2,320 2,320 380 380
Urinary system 150,350 107,600 42,750 33,170 23,110 10,060
Urinary bladder 81,190 62,380 18,810 17,240 12,520 4,720
Kidney & renal pelvis 65,340 42,680 22,660 14,970 10,010 4,960
Ureter & other urinary organs 3,820 2,540 1,280 960 580 380
Eye & orbit 3,540 2,130 1,410 350 190 160
Brain & other nervous system 23,880 13,720 10,160 16,830 9,490 7,340
Endocrine system 56,430 14,350 42,080 3,080 1,490 1,590
Thyroid 53,990 13,090 40,900 2,060 960 1,100
Other endocrine 2,440 1,260 1,180 1,020 530 490
Lymphoma 83,180 46,570 36,610 20,960 12,130 8,830
Hodgkin lymphoma 8,500 4,840 3,660 1,050 620 430
Non-Hodgkin lymphoma 74,680 41,730 32,950 19,910 11,510 8,400
Myeloma 30,770 16,400 14,370 12,770 6,830 5,940
Leukemia 60,300 35,030 25,270 24,370 14,270 10,100
Acute lymphocytic leukemia 5,960 3,290 2,670 1,470 830 640
Chronic lymphocytic leukemia 20,940 12,990 7,950 4,510 2,790 1,720
Acute myeloid leukemia 19,520 10,380 9,140 10,670 6,180 4,490
Chronic myeloid leukemia 8,430 4,980 3,450 1,090 620 470
Other leukemiac 5,450 3,390 2,060 6,630 3,850 2,780
Other & unspecified primary sitesc 31,810 16,520 15,290 44,560 23,950 20,610
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder.
  • About 63,960 cases of carcinoma in situ of the female breast and 87,290 cases of melanoma in situ will be newly diagnosed in 2018.
  • 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 a lack of specificity in recording the underlying cause of death on death certificates and/or an undercount in the case estimate.
  • Note: These are model-based estimates that should be interpreted with caution and not compared to those for previous years.
Table 2. Estimated New Cases for Selected Cancers by State, 2018a
STATE ALL CASES FEMALE BREAST UTERINE CERVIX COLON & RECTUM UTERINE CORPUS LEUKEMIA LUNG & BRONCHUS MELANOMA OF SKIN NON-HODGKIN LYMPHOMA PROSTATE URINARY BLADDER
Alabama 27,830 3,760 220 2,230 770 830 4,190 1,380 990 2,460 1,110
Alaska 3,550 510 b 270 120 110 460 130 140 360 160
Arizona 34,740 5,700 270 2,840 1,210 1,150 4,460 1,880 1,480 3,180 1,810
Arkansas 16,130 2,160 150 1,370 480 510 2,720 670 650 1,260 720
California 178,130 29,360 1,540 14,400 6,610 6,220 18,760 9,830 8,190 15,190 7,800
Colorado 25,570 3,630 180 1,850 870 910 2,560 1,640 1,100 3,190 1,180
Connecticut 21,240 3,540 120 1,520 890 760 2,700 970 970 2,220 1,210
Delaware 6,110 780 b 450 210 180 890 380 250 640 290
Dist. of Columbia 3,260 520 b 240 120 70 310 120 120 420 80
Florida 135,170 19,860 1,100 11,670 4,450 4,770 18,710 7,940 5,990 13,630 6,600
Georgia 56,920 7,490 430 4,120 1,600 1,590 7,160 3,040 1,970 5,340 1,960
Hawaii 6,280 1,150 50 650 280 200 830 490 270 510 260
Idaho 8,450 1,070 50 630 290 310 1,060 590 390 900 490
Illinois 66,330 9,960 570 5,340 2,800 2,170 9,220 2,980 2,830 6,300 3,190
Indiana 37,250 5,630 290 3,190 1,400 1,210 5,840 1,900 1,600 3,460 1,740
Iowa 17,630 2,560 110 1,510 710 700 2,480 1,050 810 1,580 880
Kansas 15,400 2,290 110 1,220 530 590 2,050 850 640 1,360 660
Kentucky 25,990 3,720 210 2,370 850 960 5,150 1,440 1,060 2,210 1,200
Louisiana 25,080 3,570 210 2,310 670 740 3,660 1,000 1,040 2,600 1,000
Maine 8,600 1,350 50 660 380 320 1,450 470 400 710 580
Maryland 33,810 5,940 220 2,950 1,270 910 4,270 1,690 1,290 3,470 1,500
Massachusetts 37,130 6,490 210 2,630 1,590 1,150 5,140 2,090 1,650 4,060 2,040
Michigan 56,590 8,730 370 4,510 2,330 1,820 8,780 2,890 2,590 5,400 3,070
Minnesota 31,270 4,500 140 2,270 1,120 1,270 3,980 1,420 1,420 2,920 1,380
Mississippi 18,130 2,240 150 1,550 430 560 2,690 590 560 1,370 620
Missouri 35,520 5,160 250 2,890 1,240 1,240 5,750 1,800 1,480 3,000 1,640
Montana 6,080 1,020 b 520 220 230 830 440 280 810 350
Nebraska 10,320 1,560 70 900 380 410 1,310 540 460 960 490
Nevada 14,060 2,180 130 1,130 410 500 2,090 790 580 1,190 770
New Hampshire 8,080 1,360 b 590 360 280 1,230 460 370 840 520
New Jersey 53,260 8,550 380 4,100 2,180 1,990 5,870 2,830 2,370 5,430 2,590
New Mexico 9,730 1,470 80 800 340 360 1,090 500 410 960 390
New York 110,800 17,890 870 9,080 4,580 4,410 13,190 4,920 4,890 9,880 5,440
North Carolina 55,130 7,760 410 4,440 1,910 2,050 8,490 3,310 2,240 5,580 2,530
North Dakota 4,110 570 b 350 140 150 500 220 170 380 200
Ohio 68,470 10,610 480 5,550 2,740 2,060 10,760 3,400 2,880 5,810 3,350
Oklahoma 19,030 2,870 170 1,670 590 710 3,210 860 860 1,670 890
Oregon 21,520 3,400 140 1,510 890 650 3,140 1,570 1,010 2,040 1,130
Pennsylvania 80,960 12,140 500 6,440 3,320 2,930 10,470 4,320 3,430 7,360 4,240
Rhode Island 5,920 1,010 b 460 260 190 880 280 270 740 360
South Carolina 30,450 4,540 220 2,410 920 960 4,630 1,820 1,150 3,080 1,310
South Dakota 5,100 740 b 440 170 190 650 270 220 510 260
Tennessee 36,760 5,590 310 3,110 1,130 1,370 6,030 1,900 1,540 2,750 1,660
Texas 121,860 18,260 1,360 10,080 4,000 4,580 15,460 4,440 5,460 12,600 4,530
Utah 10,950 1,720 70 780 400 480 900 1,010 520 1,250 440
Vermont 3,840 600 b 270 160 120 560 230 170 390 250
Virginia 42,420 7,510 290 3,380 1,570 1,250 5,860 2,620 1,760 4,200 1,900
Washington 36,170 5,580 240 2,710 1,390 1,330 4,810 2,650 1,770 3,730 1,940
West Virginia 12,110 1,700 90 1,030 450 390 2,060 720 480 820 620
Wisconsin 33,340 5,420 190 2,650 1,410 1,350 4,400 1,740 1,410 3,660 1,710
Wyoming 2,780 450 b 210 100 100 330 200 120 330 160
United States 1,735,350 266,120 13,240 140,250 63,230 60,300 234,030 91,270 74,680 164,690 81,190
  • 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 and not compared to those for previous years. 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 2018. Prostate, lung and bronchus (referred to as lung hereafter), 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 common cancers are breast, lung, and colorectum, which collectively represent one-half of all cases; breast cancer alone accounts for 30% 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, 2018.

Estimates are rounded to the nearest 10 and cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Ranking is based on modeled projections and may differ from the most recent observed data.

The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (39.7%) than for women (37.6%) (Table 3). The 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,23 and has been estimated to account for one-third of the sex disparity.24

Table 3. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2012 to 2014a
BIRTH TO 49 50 TO 59 60 TO 69 ≥70 BIRTH TO DEATH
All sitesb Male 3.4 (1 in 30) 6.1 (1 in 16) 13.4 (1 in 7) 32.2 (1 in 3) 39.7 (1 in 3)
Female 5.5 (1 in 18) 6.1 (1 in 16) 9.9 (1 in 10) 26.0 (1 in 4) 37.6 (1 in 3)
Breast Female 1.9 (1 in 52) 2.3 (1 in 43) 3.4 (1 in 29) 6.8 (1 in 15) 12.4 (1 in 8)
Colorectum Male 0.3 (1 in 287) 0.7 (1 in 145) 1.2 (1 in 85) 3.4 (1 in 29) 4.5 (1 in 22)
Female 0.3 (1 in 306) 0.5 (1 in 194) 0.8 (1 in 122) 3.1 (1 in 32) 4.2 (1 in 24)
Kidney & renal pelvis Male 0.2 (1 in 456) 0.4 (1 in 284) 0.6 (1 in 155) 1.3 (1 in 74) 2.1 (1 in 48)
Female 0.1 (1 in 706) 0.2 (1 in 579) 0.3 (1 in 320) 0.7 (1 in 136) 1.2 (1 in 83)
Leukemia Male 0.2 (1 in 400) 0.2 (1 in 573) 0.4 (1 in 260) 1.4 (1 in 71) 1.8 (1 in 56)
Female 0.2 (1 in 515) 0.1 (1 in 887) 0.2 (1 in 446) 0.9 (1 in 111) 1.3 (1 in 80)
Lung & bronchus Male 0.1 (1 in 682) 0.7 (1 in 154) 1.9 (1 in 54) 6.1 (1 in 16) 6.9 (1 in 15)
Female 0.2 (1 in 635) 0.6 (1 in 178) 1.4 (1 in 70) 4.8 (1 in 21) 5.9 (1 in 17)
Melanoma of the skinc Male 0.5 (1 in 218) 0.5 (1 in 191) 0.9 (1 in 106) 2.6 (1 in 38) 3.6 (1 in 27)
Female 0.7 (1 in 152) 0.4 (1 in 254) 0.5 (1 in 202) 1.1 (1 in 91) 2.4 (1 in 42)
Non-Hodgkin lymphoma Male 0.3 (1 in 382) 0.3 (1 in 349) 0.6 (1 in 174) 1.8 (1 in 54) 2.4 (1 in 42)
Female 0.2 (1 in 545) 0.2 (1 in 480) 0.4 (1 in 248) 1.3 (1 in 74) 1.9 (1 in 54)
Prostate Male 0.2 (1 in 403) 1.7 (1 in 58) 4.8 (1 in 21) 8.2 (1 in 12) 11.6 (1 in 9)
Thyroid Male 0.2 (1 in 517) 0.1 (1 in 791) 0.2 (1 in 606) 0.2 (1 in 425) 0.6 (1 in 160)
Female 0.8 (1 in 124) 0.4 (1 in 271) 0.3 (1 in 289) 0.4 (1 in 256) 1.8 (1 in 56)
Uterine cervix Female 0.3 (1 in 368) 0.1 (1 in 845) 0.1 (1 in 942) 0.2 (1 in 605) 0.6 (1 in 162)
Uterine corpus Female 0.3 (1 in 342) 0.6 (1 in 166) 1.0 (1 in 103) 1.3 (1 in 75) 2.8 (1 in 35)
  • 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.

Expected Numbers of Cancer Deaths

An estimated 609,640 Americans will die from cancer in 2018, corresponding to almost 1,700 deaths per day (Table 1). The most common causes of cancer death are cancers of the lung, prostate, and colorectum in men and the lung, breast, and colorectum in women (Fig. 1). These 4 cancers account for 45% of all cancer deaths, with one-quarter due to lung cancer. Table 4 provides the estimated numbers of cancer deaths in 2018 by state for selected cancers.

Table 4. Estimated Deaths for Selected Cancers by State, 2018a
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 10,720 330 670 950 400 500 3,140 300 240 740 490
Alaska 1,120 b 70 100 b 60 290 b b 80 50
Arizona 12,390 380 850 1,040 540 680 2,850 410 310 970 680
Arkansas 6,910 190 410 600 260 290 2,130 200 150 430 280
California 60,650 1,860 4,500 5,300 2,580 3,900 11,830 2,140 1,570 4,570 3,490
Colorado 8,000 270 580 660 340 410 1,600 250 230 580 510
Connecticut 6,590 200 410 460 290 320 1,570 220 160 520 320
Delaware 2,080 50 140 140 80 110 580 70 50 160 90
Dist. of Columbia 1,030 b 110 90 b 80 200 b b 90 70
Florida 45,030 1,290 2,940 3,640 1,820 2,150 11,760 1,510 970 3,300 2,260
Georgia 17,730 500 1,320 1,580 620 890 4,650 530 420 1,210 870
Hawaii 2,580 50 160 230 90 180 590 100 b 230 120
Idaho 3,020 100 210 240 120 140 680 110 80 240 200
Illinois 24,670 620 1,720 2,080 980 1,100 6,410 790 560 1,680 1,160
Indiana 13,820 350 860 1,110 550 550 3,960 450 290 910 600
Iowa 6,570 190 370 570 250 260 1,740 250 150 460 300
Kansas 5,600 170 350 470 260 240 1,490 180 120 420 260
Kentucky 10,590 260 580 830 380 440 3,530 320 190 660 390
Louisiana 9,370 220 610 830 330 550 2,580 290 170 730 400
Maine 3,360 100 180 230 130 120 970 110 60 230 150
Maryland 10,780 290 810 870 420 580 2,560 340 260 850 530
Massachusetts 12,610 370 750 890 520 650 3,180 380 320 960 600
Michigan 21,380 570 1,400 1,670 840 880 5,860 750 500 1,610 940
Minnesota 10,080 300 630 770 460 410 2,420 380 230 750 520
Mississippi 6,750 220 420 640 230 310 1,930 170 110 490 310
Missouri 13,280 320 850 1,050 520 580 3,950 370 250 920 550
Montana 2,110 70 140 180 80 90 510 70 50 150 130
Nebraska 3,550 110 230 320 150 130 890 130 70 250 190
Nevada 5,330 150 390 520 210 240 1,380 150 120 380 280
New Hampshire 2,810 80 170 190 110 100 760 80 70 210 130
New Jersey 16,040 430 1,250 1,400 650 720 3,670 510 400 1,300 750
New Mexico 3,750 100 260 340 140 240 760 120 110 270 220
New York 35,350 900 2,390 2,970 1,460 1,710 8,490 1,200 910 2,760 1,680
North Carolina 20,380 540 1,370 1,570 760 1,010 5,770 610 430 1,390 940
North Dakota 1,290 b 80 110 60 b 310 50 b 90 70
Ohio 25,740 640 1,700 2,100 1,000 1,040 7,200 860 550 1,860 1,110
Oklahoma 8,470 210 530 750 350 400 2,460 270 190 540 390
Oregon 8,310 260 530 650 310 480 2,000 280 240 620 450
Pennsylvania 28,620 710 1,880 2,380 1,180 1,270 7,280 970 670 2,160 1,300
Rhode Island 2,180 50 130 160 90 120 610 60 50 150 100
South Carolina 10,630 270 710 860 400 470 2,900 300 230 730 520
South Dakota 1,680 60 110 160 80 60 440 50 b 110 80
Tennessee 14,900 350 920 1,220 540 700 4,480 460 310 960 600
Texas 41,030 1,130 2,880 3,740 1,660 2,700 9,310 1,330 920 2,880 1,830
Utah 3,270 130 280 280 170 150 470 130 110 270 220
Vermont 1,450 50 80 110 50 50 390 50 b 110 60
Virginia 15,260 400 1,090 1,210 550 720 3,780 490 370 1,120 700
Washington 13,030 400 860 970 520 710 3,080 450 340 950 690
West Virginia 4,900 110 280 430 200 190 1,470 150 90 300 180
Wisconsin 11,840 360 720 890 520 450 3,000 420 230 890 620
Wyoming 980 b 70 80 60 b 220 b b 70 b
United States 609,640 16,830 40,920 50,630 24,370 30,200 154,050 19,910 14,070 44,330 29,430
  • 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 and not compared to those for previous years. 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 use of cancer screening tests. 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.25

Details are in the caption following the image

Trends in Cancer Incidence (1975 to 2014) and Death Rates (1975 to 2015) 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 2014.specific

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

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 5). This trend reflects large continuing declines for cancers of the lung and colorectum, in addition to a sharp reduction in prostate cancer incidence of about 10% annually from 2010 to 2014. The drop in prostate cancer incidence has been attributed to decreased PSA testing from 2008 to 2013 in the wake of US Preventive Services Task Force recommendations against routine use of the test to screen for prostate cancer (Grade D) in ages 75 and older in 2008 and in all men in 2011 because of growing concerns about overdiagnosis and overtreatment.26, 27 The effect of screening reductions on the incidence of advanced disease is being monitored closely. One analysis of SEER data through 2012 indicated a slight uptick in the diagnosis of distant stage prostate cancer among men aged 50 to 69 years,28 which may reflect the larger downturn in PSA testing among younger men.29, 30 In April 2017, the Task Force issued a draft statement revising its recommendation for men aged 55 to 69 years to informed decision making (Grade C) based on an updated evidence review.31, 32

Table 5. Trends in Delay-Adjusted Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2014
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC 2005-2014 AAPC 2010-2014 AAPC
All sites
Overall 1975-1989 1.2a 1989-1992 2.8 1992-1995 −2.4 1995-1998 1.1 1998-2009 −0.3a 2009-2014 −1.4a −0.9a −1.4a
Male 1975-1989 1.3a 1989-1992 5.2a 1992-1995 −4.8a 1995-2000 0.4 2000-2009 −0.7a 2009-2014 −2.7a −1.8a −2.7a
Female 1975-1979 −0.3 1979-1987 1.6a 1987-1995 0.1 1995-1998 1.5 1998-2003 −0.6 2003-2014 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 2004-2014 0.4a 0.4a 0.4a
Colorectum
Male 1975-1985 1.1a 1985-1991 −1.2a 1991-1995 −3.2a 1995-1998 2.1 1998-2014 −2.9a −2.9a −2.9a
Female 1975-1985 0.3 1985-1995 −1.9a 1995-1998 1.8 1998-2008 −2.0a 2008-2012 −4.1a 2012-2014 0.4 −2.4a −1.9
Liver & intrahepatic bile duct
Male 1975-1984 2.2a 1984-2011 3.9a 2011-2014 0.4 2.7a 1.3
Female 1975-1983 0.6 1983-1996 4.1a 1996-2014 2.8a 2.8a 2.8a
Lung & bronchus
Male 1975-1982 1.5a 1982-1991 −0.5a 1991-2008 −1.7a 2008-2014 −2.9a −2.5a −2.9a
Female 1975-1982 5.6a 1982-1991 3.4a 1991-2006 0.5a 2006-2014 −1.4a −1.2a −1.4a
Melanoma of skin
Male 1975-1986 5.4a 1986-2005 3.1a 2005-2014 1.8a 1.8a 1.8a
Female 1975-1986 4.0a 1986-1993 0.6 1993-1996 5.4 1996-2009 2.3a 2009-2012 −1.3 2012-2014 6.1 1.9 2.3
Pancreas
Male 1975-1995 −0.8a 1995-2014 0.9a 0.9a 0.9a
Female 1975-1984 1.4a 1984-1996 −0.5 1996-2014 1.0a 1.0a 1.0a
Prostate 1975-1988 2.6a 1988-1992 16.5a 1992-1995 −11.6a 1995-2000 2.3 2000-2010 −1.8a 2010-2014 −10.1a −5.6a −10.1a
Thyroid
Male 1975-1980 −4.6 1980-1997 1.8a 1997-2012 5.5a 2012-2014 −1.5 3.9a 2.0
Female 1975-1977 6.6 1977-1980 −5.2 1980-1993 2.3a 1993-1999 4.5a 1999-2009 7.1a 2009-2014 1.3a 3.9a 1.3a
Uterine corpus 1975-1979 −6.0a 1979-1988 −1.7a 1988-1997 0.7a 1997-2006 −0.4a 2006-2009 3.5 2009-2014 0.2 1.2a 0.2
  • AAPC indicates average annual percent change; APC, annual percent change based on delay-adjusted incidence rates age adjusted to the 2000 US standard population.
  • a The APC or AAPC is significantly different from zero (P <.05).
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.5.0.1, allowing up to 5 joinpoints. Trends are based on Surveillance, Epidemiology, and End Results (SEER) 9 areas.

The overall cancer incidence rate in women has remained generally stable over the past few decades because declines in lung and colorectal cancers have been offset by increasing or stable rates for breast, uterine corpus, and thyroid cancers and for melanoma (Table 5). The slight increase in breast cancer incidence from 2005 to 2014 was driven by increases of 0.3% to 0.4% per year among Hispanic and black women and 1.7% per year among Asian/Pacific Islander women; rates among NHWs and American Indians/Alaska Natives remained stable.33

Lung cancer incidence rates continue to decline about twice as fast in men as in women, reflecting historical differences in tobacco uptake and cessation, as well as upturns in female smoking prevalence in some birth cohorts.34, 35 In contrast, colorectal cancer (CRC) incidence patterns are generally similar in men and women (Fig. 3); from 2005 through 2014, incidence rates declined annually by about 2% to 3%, although the trend may have stabilized in women during the most recent data years (Table 5). Reductions in CRC incidence prior to 2000 are attributed equally to changes in risk factors and the use of screening, which allows for the removal of premalignant lesions.36 However, more recent rapid declines are thought to primarily reflect increased uptake of colonoscopy, which now is the predominant screening test.37, 38 Colonoscopy use among US adults aged 50 years and older tripled from 21% in 2000 to 60% in 2015.39 In contrast to the rapid declines in CRC incidence overall, which are driven by trends in older age groups, rates in individuals aged younger than 55 years increased by almost 2% per year from the mid-1990s to 2014.40

Liver cancer incidence continues to increase rapidly in women, but appears to be plateauing in men since 2010 (Table 5). However, trends vary by age; from 2010 to 2014, rates increased annually by 1% to 2% in men and women aged younger than 40 years, decreased or were stable in men and women aged 40 to 59 years, and increased annually by 8% in individuals aged 60 to 69 years and by 3% in those aged 70 years and older.40 There is potential to avert much of the future burden of liver cancer associated with hepatitis C virus (HCV) infection through increased HCV detection coupled with new, well-tolerated antiviral therapies that lower the risk of hepatocellular carcinoma.41, 42 Most HCV-infected individuals are undiagnosed, and 80% are baby boomers (those born between 1945 and 1965), for whom one-time screening has been recommended since 2012.43, 44 Several states have even mandated that health care providers offer HCV testing to appropriate patients.45 However, of the more than 76 million estimated baby boomers in 2015, only 14% reported having received HCV testing.46 Adding to the disease burden is a worrisome 2-fold increase in HCV infections from 2010 to 2014 (following a stable trend) driven by individuals aged 20-39 years as a consequence of the opioid epidemic.

The long-term, rapid rise in melanoma incidence appears to be slowing, particularly among younger age groups; from 2005 to 2014, rates were stable in men and women aged younger than 50 years (except for declines of 0.7% annually in men aged 40-49 years), while increasing more rapidly with advancing age in those aged 50 years and older. Incidence rates for thyroid cancer also may have begun to stabilize in recent years, particularly among whites,8 in the wake of changes in clinical practice guidelines that include more conservative indications for biopsy and the reclassification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features.47-49

Cancer Survival

For all cancers combined, the 5-year relative survival rate is 68% in whites and 61% in blacks.8 Figure 4 shows 5-year relative survival rates by cancer type and race during the most recent time period (2007-2013). For all stages combined, survival is highest for prostate cancer (99%), melanoma of the skin (92%), and female breast cancer (90%) and lowest for cancers of the pancreas (8%), lung (18%), and liver (18%). Survival is lower for black than for white patients for every cancer type shown in Figure 4 except cancers of the kidney and pancreas, with an absolute difference ≥10% for more than one-half of these. The largest differences are for melanoma (26%) and cancers of the uterine corpus (22%) and oral cavity and pharynx (18%), in part reflecting a much later stage at diagnosis in black patients (Fig. 5). Blacks are more likely than whites to be diagnosed with cancer at an advanced stage, but also have lower stage-specific survival for most cancer types. After adjusting for sex, age, and stage at diagnosis, the relative risk of death after a cancer diagnosis is 33% higher in black patients than in white patients.50 The disparity is even more striking for American Indians/Alaska Natives, who are 51% more likely than whites to die from their cancer.

Details are in the caption following the image

Five-Year Relative Survival Rates for Selected Cancers by Race and Stage at Diagnosis, United States, 2007 to 2013.

*The standard error 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 91% in blacks.

Details are in the caption following the image

Stage Distribution for Selected Cancers by Race, United States, 2007 to 2013.

Stage categories do not sum to 100% because some cases are unstaged.

Cancer survival has improved since the mid-1970s for all of the most common cancers except those of the uterine cervix and uterine corpus,50 although increased survival for some cancer types (eg, breast and prostate) is difficult to interpret because of changes in detection practice (eg, lead time bias). Progress has been especially rapid for hematopoietic and lymphoid malignancies due to improvements in treatment protocols, including the discovery of targeted therapies. For example, the 5-year relative survival rate for chronic myeloid leukemia increased from 22% for patients diagnosed in the mid-1970s to 68% for those diagnosed during 2007 through 2013.8 Based on a review of clinical trial data, 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.51 In general, oncology advances have benefitted patients aged 50 to 64 years more than their older counterparts, likely reflecting lower efficacy or use of new therapies in the elderly population.52 Survival gains are also often stage specific; for example, patients with liver cancer diagnosed at a localized stage had among the largest absolute gains in survival over the past 3 decades, largely because of advances in liver transplantation, whereas those diagnosed with distant stage disease had no improvement.50

In contrast to the steady increase in survival observed for most cancer types, advances have been slow for lung and pancreatic cancers, which are typically diagnosed at a distant stage (Fig. 5), for which the 5-year survival rates are 5% and 3%, respectively. There is potential for lung cancer to be diagnosed at an earlier stage among high-risk individuals through the use of screening with low-dose computed tomography (LDCT), 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.53, 54 However, in 2015, only 4% of the 6.8 million eligible Americans reported being screened for lung cancer with LDCT.55

Trends in Cancer Mortality

Mortality trends are the best indicator of progress against cancer because they are less affected by detection practices than incidence and survival.56 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 26% to 158.6 in 2015. This decline, which is larger in men (32% since 1990) than in women (23% since 1991), translates to approximately 2,378,600 fewer cancer deaths (1,639,100 in men and 739,500 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 2015 in Men and From 1992 to 2015 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 primarily 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 39% from 1989 to 2015 for female breast cancer, 52% from 1993 to 2015 for prostate cancer, and 52% from 1970 to 2015 for CRC. Lung cancer death rates declined 45% from 1990 to 2015 among males and 19% from 2002 to 2015 among females due to reduced tobacco use because of increased awareness of the health hazards of smoking and the implementation of comprehensive tobacco control.57 The rapid declines in prostate cancer mortality, attributed to earlier detection due to PSA testing and advances in treatment,58 appear to be plateauing in recent years in men aged younger than 70 years.1 Similarly, CRC death rates increased slightly in individuals aged younger than 55 years since the mid-2000s,59 despite rapid declines in older age groups.

Details are in the caption following the image

Trends in Cancer Death Rates by Sex Overall and for Selected Cancers, United States, 1930 to 2015.

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 the overall declining trends for the 4 major cancers, death rates rose during 2011 through 2015 for liver cancer by 2.7% per year in women and by 1.6% per year in men, as well as for uterine corpus cancer by about 2% per year and for pancreatic cancer in men by 0.3% per year (Table 6). Death rates also increased slightly for cancers of the brain and other nervous system in both sexes and the oral cavity and pharynx in men.1

Table 6. Trends in Death Rates for Selected Cancers by Sex, United States, 1975 to 2015
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC 2006-2015 AAPC 2011-2015 AAPC
All sites
Overall 1975-1984 0.5a 1984-1991 0.3a 1991-1994 −0.5 1994-1998 −1.3a 1998-2001 −0.8a 2001-2015 −1.5a −1.5a −1.5a
Male 1975-1979 1.0a 1979-1990 0.3a 1990-1993 −0.5 1993-2001 −1.5a 2001-2015 −1.8a −1.8a −1.8a
Female 1975-1990 0.6a 1990-1994 −0.2 1994-2002 −0.8a 2002-2015 −1.4a −1.4a −1.4a
Female breast 1975-1990 0.4a 1990-1995 −1.8a 1995-1998 −3.4a 1998-2015 −1.8a −1.8a −1.8a
Colorectum
Male 1975-1979 0.6 1979-1987 −0.6a 1987-2002 −1.9a 2002-2005 −4.1a 2005-2015 −2.5a −2.5a −2.5a
Female 1975-1984 −1.0a 1984-2001 −1.8a 2001-2012 −2.9a 2012-2015 −1.4 −2.4a −1.8a
Liver & intrahepatic bile duct
Male 1975-1985 1.5a 1985-1996 3.8a 1996-1999 0.3 1999-2013 2.7a 2013-2015 0.6 2.2a 1.6a
Female 1975-1978 −1.5 1978-1988 1.4a 1988-1995 3.9a 1995-2000 0.4 2000-2008 1.5a 2008-2015 2.7a 2.4a 2.7a
Lung & bronchus
Male 1975-1978 2.4a 1978-1984 1.2a 1984-1991 0.3a 1991-2005 −1.9a 2005-2012 −3.0a 2012-2015 −4.0a −3.3a −3.8a
Female 1975-1982 6.0a 1982-1990 4.2a 1990-1995 1.7a 1995-2003 0.3a 2003-2009 −1.1a 2009-2015 −2.3a −1.9a −2.3a
Melanoma of skin
Male 1975-1987 2.4a 1987-1997 0.9a 1997-2000 −1.7 2000-2009 0.9a 2009-2013 −0.9 2013-2015 −5.0a −1.3 −3.0a
Female 1975-1989 0.8a 1989-2015 −0.7a −0.7a −0.7a
Pancreas
Male 1975-1986 −0.8a 1986-2000 −0.3a 2000-2015 0.3a 0.3a 0.3a
Female 1975-1984 0.8a 1984-2003 0.1 2003-2006 1.1 2006-2015 −0.0 −0.0 −0.0
Prostate 1975-1987 0.9a 1987-1991 3.0a 1991-1994 −0.5 1994-1998 −4.2a 1998-2013 −3.5a 2013-2015 −0.8 −2.9a −2.2a
Uterine corpus 1975-1989 −1.6a 1989-1997 −0.7a 1997-2008 0.3a 2008-2015 1.9a 1.6a 1.9a
  • AAPC indicates average annual percent change; APC, annual percent change based on mortality rates age adjusted to the 2000 US standard population.
  • a The APC or AAPC is significantly different from zero (P <.05).
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.5.0.1, allowing up to 5 joinpoints.

Recorded Number of Deaths in 2015

A total of 2,712,630 deaths were recorded in the United States in 2015, 22% of which were from cancer (Table 7). Of the 10 leading causes of death, cancer was the only one for which the age-standardized death rate declined from 2014 to 2015 (by 1.7%).60 Cancer is the second leading cause of death after heart disease in both men and women nationally, but is the leading cause of death in many states61 and in Hispanic and Asian Americans.62, 63 Cancer is the first or second leading cause of death for every age group shown in Table 8 among females, whereas accidents, assault, and suicide predominate among males aged younger than 40 years.

Table 7. Ten Leading Causes of Death in the United States, 2014 and 2015
2014 2015 RELATIVE CHANGE IN RATE
RANK NO. PERCENT RATE NO. PERCENT RATE
All Causes 2,626,418 724.4 2,712,630 732.5 1.1%
1 Heart disease 614,348 23% 166.8 633,842 23% 168.3 0.9%
2 Cancer 591,699 23% 161.3 595,930 22% 158.6 −1.7%
3 Chronic lower respiratory diseases 147,101 6% 40.6 155,041 6% 41.8 3.0%
4 Accidents (unintentional injuries) 136,053 5% 40.4 146,571 5% 43.1 6.7%
5 Cerebrovascular disease 133,103 5% 36.5 140,323 5% 37.6 3.0%
6 Alzheimer disease 93,541 4% 25.4 110,561 4% 29.4 15.7%
7 Diabetes mellitus 76,488 3% 21.0 79,535 3% 21.3 1.4%
8 Influenza and pneumonia 55,227 2% 15.1 57,062 2% 15.2 0.7%
9 Nephritis, nephrotic syndrome, & nephrosis 48,146 2% 13.2 49,959 2% 13.4 1.5%
10 Intentional self-harm (suicide) 42,773 2% 12.9 44,193 2% 13.3 3.1%
  • Death counts include unknown age.
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population.
  • Source: National Center for Health Statistics, Centers for Disease Control and Prevention.
Table 8. Ten Leading Causes of Death in the United States by Age and Sex, 2015
ALL AGES AGES 1 TO 19 AGES 20 TO 39 AGES 40 TO 59 AGES 60 TO 79 AGES ≥80
MALE All Causes 1,373,404 FEMALE All Causes 1,339,226 MALE All Causes 12,621 FEMALE All Causes 6,941 MALE All Causes 71,130 FEMALE All Causes 32,112 MALE All Causes 228,199 FEMALE All Causes 147,555 MALE All Causes 556,520 FEMALE All Causes 427,097 MALE All Causes 491,831 FEMALE All Causes 715,031
1 Heart Heart Accidents Accidents Accidents Accidents Heart Cancer Cancer Cancer Heart Heart
diseases diseases (unintentional (unintentional (unintentional (unintentional diseases diseases diseases
injuries) injuries) injuries) injuries)
335,002 298,840 4,442 2,230 27,692 9,877 51,810 48,995 170,331 138,798 141,863 193,226
2 Cancer Cancer Assault Cancer Intentional Cancer Cancer Heart Heart Heart Cancer Cancer
(homicide) self-harm diseases diseases diseases
(suicide)
313,818 282,112 1,797 791 10,862 4,420 51,244 22,614 135,522 79,944 87,155 89,081
3 Accidents Chronic Intentional Intentional Assault Intentional Accidents Accidents Chronic Chronic Chronic Alzheimer
(unintentional lower self-harm self-harm (homicide) self-harm (unintentional (unintentional lower lower lower disease
injuries) respiratory (suicide) (suicide) (suicide) injuries) injuries) respiratory respiratory respiratory
diseases diseases diseases diseases
92,919 82,543 1,792 682 8,217 2,856 27,779 13,311 36,579 35,984 29,807 66,730
4 Chronic Cerebro- Cancer Assault Heart Heart Intentional Chronic Cerebro- Cerebro- Cerebro- Cerebro-
lower vascular (homicide) diseases diseases self-harm lower vascular vascular vascular vascular
respiratory diseases (suicide) respiratory disease disease disease disease
diseases diseases
72,498 82,035 1,011 457 5,250 2,629 12,357 6,063 22,697 20,931 28,190 55,301
5 Cerebro- Alzheimer Congenital Congenital Cancer Assault Chronic liver Chronic liver Diabetes Diabetes Alzheimer Chronic
vascular disease anomalies anomalies (homicide) disease & disease & mellitus mellitus disease lower
diseases cirrhosis cirrhosis respiratory
diseases
58,288 76,871 530 437 4,040 1,428 11,550 5,970 21,478 15,884 26,711 40,096
6 Diabetes Accidents Heart Heart Chronic liver Pregnancy, Diabetes Cerebro- Accidents Accidents Influenza & Influenza &
mellitus (unintentional diseases diseases disease & childbirth mellitus vascular (unintentional (unintentional pneumonia pneumonia
injuries) cirrhosis & puerperium diseases injuries) injuries)
43,123 53,652 385 278 1,172 741 8,451 5,079 18,376 10,020 14,712 20,074
7 Intentional Diabetes Chronic Influenza & Diabetes Chronic liver Cerebro- Diabetes Chronic liver Alzheimer Accidents Accidents
self-harm mellitus lower pneumonia mellitus disease & vascular mellitus disease & disease (unintentional (unintentional
(suicide) respiratory cirrhosis disease cirrhosis injuries) injuries)
diseases
33,994 36,412 167 112 981 700 6,530 5,072 11,258 9,940 13,861 17,674
8 Alzheimer Influenza & Influenza & Chronic HIV Diabetes Chronic Intentional Nephritis, Nephritis, Diabetes Diabetes
disease pneumonia pneumonia lower disease mellitus lower self-harm nephrotic nephrotic mellitus mellitus
respiratory respiratory (suicide) syndrome & syndrome &
diseases diseases nephrosis nephrosis
33,690 30,159 131 109 729 679 5,541 4,447 10,357 8,762 12,164 14,739
9 Influenza & Nephritis, Cerebro- Cerebro- Cerebro- Cerebro- Assault Septicemia Influenza & Septicemia Nephritis, Nephritis,
pneumonia nephrotic vascular vascular vascular vascular (homicide) pneumonia nephrotic nephrotic
syndrome & disease disease disease disease syndrome & syndrome &
nephrosis nephrosis nephrosis
26,903 24,518 103 84 710 601 3,177 2,673 8,999 8,233 11,890 13,476
10 Chronic liver Septicemia Septicemia Septicemia Congenital Septicemia Septicemia Nephritis, Septicemia Influenza & Parkinson Hypertension
disease & anomalies nephrotic pneumonia disease & hypertensive
cirrhosis syndrome & renal diseasea
nephrosis
25,666 21,388 79 78 496 371 2,886 1,946 8,756 7,663 10,764 12,297
  • 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, 2015, National Center for Health Statistics, Centers for Disease Control and Prevention, 2017.

Table 9 presents the number of deaths in 2015 for the 5 leading cancer types by age and sex. Among men, the leading cause of cancer death is brain and other nervous system tumors before age 40 years and lung cancer in those of older ages. Among women, the leading cause of cancer death is brain and other nervous system tumors before age 20 years, breast cancer from ages 20 to 59 years, and lung cancer thereafter. Notably, cervical cancer is the second leading cause of cancer death in women aged 20 to 39 years, underscoring the need for increased screening in young women, as well higher uptake of the human papillomavirus (HPV) vaccination. In 2016, only one-half (49.5%) of females aged 13 to 17 years were up to date with HPV vaccination.64

Table 9. Five Leading Causes of Cancer Death by Age and Sex, United States, 2015
ALL AGES <20 20 TO 39 40 TO 59 60 TO 79 ≥80
MALE
ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES
313,818 1,042 4,040 51,244 170,331 87,155
Lung & bronchus Brain & ONSa Brain & ONSa Lung & bronchus Lung & bronchus Lung & bronchus
83,648 297 546 12,595 51,361 19,459
Prostate Leukemia Leukemia Colorectum Colorectum Prostate
28,848 282 518 5,913 13,728 14,821
Colorectum Bones & joints Colorectum Livera Prostate Colorectum
27,508 118 489 4,306 12,722 7,377
Pancreas Soft tissue Non-Hodgkin Pancreas Pancreas Urinary bladder
(including heart) lymphoma
21,392 84 236 3,817 12,581 5,431
Livera Non-Hodgkin Soft tissue Esophagus Livera Pancreas
lymphoma (including heart)
17,414 42 229 2,586 10,302 4,860
FEMALE
ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES
282,112 813 4,420 48,995 138,798 89,081
Lung & bronchus Brain & ONSa Breast Breast Lung & bronchus Lung & bronchus
70,074 234 1,049 10,736 39,925 19,582
Breast Leukemia Uterine cervix Lung & bronchus Breast Breast
41,524 208 439 10,387 18,762 10,976
Colorectum Bone & joints Colorectum Colorectum Pancreas Colorectum
24,888 79 369 4,399 10,443 9,829
Pancreas Soft tissue Brain & ONSa Ovary Colorectum Pancreas
(including heart)
20,223 74 355 2,749 10,287 7,034
Ovary Non-Hodgkin Leukemia Pancreas Ovary Non-Hodgkin
lymphoma lymphoma
13,920 31 318 2,668 7,375 3,947
  • ONS indicates other nervous system.
  • a Includes intrahepatic bile duct.
  • Note: Ranking order excludes category titles that begin with the word “Other.”

Cancer Disparities by Race/Ethnicity

Cancer occurrence and outcomes vary considerably between racial and ethnic groups, largely because of inequalities in wealth that lead to differences in risk factor exposures and barriers to high-quality cancer prevention, early detection, and treatment.65, 66 Cancer incidence and mortality are generally highest among NHBs and lowest among Asian/Pacific Islanders (Table 10). The overall cancer incidence rate in NHB men is 85% higher than that in Asian/Pacific Islander men and 10% higher than that in NHW men, although rates are higher in NHWs compared with NHBs for men aged younger than 45 years and older than 80 years. Notably, NHB women have 7% lower cancer incidence than NHW women because of lower rates of breast and lung cancer, but 14% higher overall cancer mortality.

Table 10. Incidence and Mortality Rates for Selected Cancers by Race and Ethnicity, United States
ALL RACES COMBINED NON-HISPANIC WHITE NON-HISPANIC BLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKA NATIVEa HISPANIC
Incidence, 2010-2014
All sites
Male 501.9 510.7 560.9 302.8 425.3 386.3
Female 417.9 436.0 407.4 287.6 388.7 329.6
Breast (female) 123.6 128.7 125.5 90.8 100.7 91.9
Colon & rectum
Male 45.9 45.2 56.4 37.0 50.1 41.9
Female 34.8 34.5 41.7 27.0 41.3 29.3
Kidney & renal pelvis
Male 21.8 22.1 24.8 10.9 30.0 20.7
Female 11.3 11.3 12.9 4.9 17.4 12.0
Liver & intrahepatic bile duct
Male 12.1 10.0 17.2 20.0 20.1 19.8
Female 4.2 3.4 5.1 7.6 8.8 7.6
Lung & bronchus
Male 73 75.9 87.9 45.2 71.9 40.6
Female 52.8 57.6 50.1 27.9 55.9 25.2
Prostate 114.9 107.0 186.8 58.4 78.3 97.0
Stomach
Male 9.2 7.9 14.3 14.1 11.6 12.9
Female 4.7 3.5 7.8 8.1 6.5 7.8
Uterine cervix 7.6 7.0 9.5 6.0 9.1 9.7
Mortality, 2011-2015
All sites
Male 196.7 200.7 246.1 120.4 181.4 140.0
Female 139.5 143.7 163.2 87.7 127.6 96.7
Breast (female) 20.9 20.8 29.5 11.3 14.3 14.2
Colon & rectum
Male 17.3 16.9 25.1 12.0 20.2 14.6
Female 12.2 12.1 16.5 8.6 13.6 9.0
Kidney & renal pelvis
Male 5.6 5.8 5.7 2.6 8.4 5.0
Female 2.4 2.5 2.4 1.1 4.1 2.3
Liver & intrahepatic bile duct
Male 9.4 8.2 13.5 14.0 14.8 13.0
Female 3.8 3.4 4.7 6.0 7.0 5.9
Lung & bronchus
Male 53.8 56.3 66.9 31.0 45.0 26.4
Female 35.4 39.0 34.4 17.7 30.6 13.3
Prostate 19.5 18.2 40.8 8.7 19.7 16.1
Stomach
Male 4.3 3.4 8.5 6.8 7.3 6.7
Female 2.3 1.7 4.0 4.2 3.5 4.0
Uterine cervix 2.3 2.1 3.8 1.8 2.6 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 men and women combined, the cancer death rate in 2015 was 14% higher in NHBs than in NHWs (death rate ratio [DRR], 1.14; 95% confidence interval [95% CI], 1.13-1.15), down from a peak of 33% in 1993. However, the racial gap was substantially larger for individuals aged younger than 65 years (DRR, 1.31; 95% CI, 1.29-1.32) than for those aged 65 years or older (DRR, 1.07; 95% CI, 1.06-1.09), probably in part due to universal health care access for seniors through Medicare. Racial inequalities have also been shown to vary substantially across states.33 Among the 40 states (including DC) for which there was a sufficient number (≥50) of cancer deaths in NHBs for stable estimates, the DRR in blacks versus whites ranged from 1.89 (95% CI, 1.62-2.21) in DC to 0.89 (95% CI, 0.81-0.97) in Massachusetts (Table 11). Death rates were not statistically significantly different in 13 states, albeit some of which had few deaths. Importantly, a lack of racial disparity is not always indicative of progress. For example, Kentucky and West Virginia, for which death rates were not statistically different by race, have the highest cancer death rates in NHWs of all states while DC, with the largest disparity, has the lowest rate. Among individuals aged 65 years and older, death rates were lower in NHBs than in NHWs in New York (871.3 per 100,000 population vs 909.6) as well as Massachusetts (754.0 per 100,000 population vs 925.3), and were not statistically significantly different in one-half (19 of 37) of states. Notably, among those aged younger than 65 years, the disparity was ≥45% in DC (DRR, 2.89; 95% CI, 2.16-3.91), Wisconsin (DRR, 1.78; 95% CI, 1.56-2.02), Kansas (DRR, 1.51; 95% CI, 1.25-1.81), Louisiana (DRR, 1.49; 95% CI, 1.38-1.60), Illinois (DRR, 1.48; 95% CI, 1.39-1.57), and California (DRR, 1.45; 95% CI, 1.38-1.54); of these 6 states, all but Kansas also had statistically significantly higher rates in blacks aged 65 years and older.

Table 11. State Variation in the Racial Disparity in Cancer Mortality in the United States, 2015
NHW NHB 2011-2015 %
RATE COUNT RATE COUNT NHB:NHW DRR (95% CI) FOREIGN-BORN NHB*
Total US 163.3 467,198 185.8 68,522 1.14 (1.13–1.15) 9%
Dist. of Columbia 110.9 221 209.4 792 1.89 (1.62–2.21) 6%
Wisconsin 158.8 10,568 206.2 535 1.30 (1.18–1.42) 3%
Illinois 171.1 19,166 214.0 3,845 1.25 (1.21–1.30) 3%
Louisiana 172.8 6,281 215.6 2,922 1.25 (1.19–1.31) 1%
Minnesota 152.8 9,227 186.9 300 1.22 (1.07–1.39) 30%
Nebraska 159.2 3,277 194.6 115 1.22 (1.00–1.48) 12%
Pennsylvania 166.2 25,110 202.0 2,659 1.22 (1.17–1.27) 7%
California 156.9 37,076 188.6 4,448 1.20 (1.16–1.24) 6%
Missouri 173.0 11,438 203.7 1,310 1.18 (1.11–1.25) 3%
South Carolina 162.8 7,258 191.5 2,528 1.18 (1.12–1.23) 1%
Texas 158.6 25,548 184.7 4,826 1.16 (1.13–1.20) 6%
Kansas 165.8 5,050 192.9 286 1.16 (1.02–1.32) 6%
New Jersey 160.0 12,492 184.9 2,116 1.16 (1.10–1.21) 16%
Maryland 154.8 6,982 178.7 3,033 1.15 (1.10–1.21) 11%
Michigan 166.5 17,484 192.0 2,607 1.15 (1.10–1.20) 2%
North Carolina 163.3 14,725 186.9 3,930 1.14 (1.10–1.19) 3%
Colorado 135.7 6,336 154.4 266 1.14 (1.00–1.29) 14%
Tennessee 180.2 12,023 204.8 1,954 1.14 (1.08–1.19) 3%
Alabama 173.3 7,854 196.4 2,387 1.13 (1.08–1.19) 1%
Oregon 163.4 7,486 185.1 110 1.13 (0.92–1.38) 16%
Ohio 175.0 22,246 197.7 2,744 1.13 (1.08–1.18) 4%
Arkansas 185.5 5,735 208.3 853 1.12 (1.04–1.21) 1%
Virginia 162.0 11,377 181.2 2,813 1.12 (1.07–1.17) 6%
Mississippi 184.3 4,407 204.0 2,017 1.11 (1.05–1.17) 0%
Oklahoma 185.3 6,965 202.4 505 1.09 (0.99–1.20) 3%
Georgia 165.1 11,812 179.2 4,614 1.09 (1.05–1.12) 5%
Indiana 178.5 12,237 191.5 997 1.07 (1.00–1.15) 3%
Connecticut 149.5 5,745 158.3 517 1.06 (0.96–1.16) 20%
New York 154.9 25,321 161.2 4,827 1.04 (1.01–1.07) 28%
West Virginia 191.2 4,672 197.0 139 1.03 (0.86–1.23) 3%
Florida 159.1 33,552 163.3 4,596 1.03 (0.99–1.06) 20%
Arizona 145.6 9,482 149.2 339 1.03 (0.91–1.15) 9%
Kentucky 198.3 9,577 200.7 628 1.01 (0.93–1.10) 4%
Delaware 169.7 1,617 169.0 323 1.00 (0.88–1.13) 7%
Nevada 174.3 3,918 173.2 386 0.99 (0.89–1.11) 7%
Washington 162.4 11,205 160.9 340 0.99 (0.88–1.11) 20%
New Mexico 151.4 2,153 139.5 56 0.92 (0.69–1.21) 7%
Massachusetts 154.7 11,168 137.3 561 0.89 (0.81–0.97) 34%
Iowa 166.6 6,327 143.3 84 0.86 (0.67–1.08) 13%
Rhode Island 169.3 2,048 136.0 68 0.80 (0.61–1.03) 29%
  • CI indicates confidence interval; DRR, death rate ratio; NHB, non-Hispanic black; NHW, non-Hispanic white.
  • States with ≥50 cancer deaths among NHB individuals.*Based on data from the 5-year American Community Survey, 2011-2015.
  • Gray shading indicates that the death rate for NHB individuals is statistically significantly higher than that for NHW individuals.
  • No shading indicates that there is no statistical difference between the death rate for NHB and NHW individuals.
  • Blue shading indicates that the death rate for NHB individuals is statistically significantly lower than that for NHW individuals.

Some of the variation in racial disparities by state may reflect the growing number of black immigrants, who are healthier and older than their native-born counterparts, and now account for 9% of the US black population. The number of foreign-born blacks more than doubled over the past 2 decades, from 1.4 million in 1990 to 3.8 million in 2013, and is highly concentrated in the Northeast and the South.67 The proportion of the black population that was foreign born in 2011-2015 was ≥28% in 10 states, including New York (28%) and Massachusetts (34%) (Table 11). Immigrant populations have lower disease rates than those born in the United States, partly because of more favorable characteristics such as lower smoking and obesity prevalence.68-70 One study found that foreign-born blacks in the United States have cancer mortality rates that are about 10% lower than those of native NHWs and 40% lower than those of native blacks.68 Comprehensive health care reform in Massachusetts, which began rolling out in 2006 and has achieved near-universal insurance coverage, has been associated with mortality reductions71 and may have also contributed to the state's success in eliminating racial disparities.

Geographic Variation in Cancer Occurrence

Tables 12 and 13 show cancer incidence and mortality rates for selected cancers by state. State variation in cancer incidence results from differences in medical detection practice and the prevalence of risk factors, such as smoking, obesity, and other health behaviors. For example, the large geographic variation in HPV vaccination coverage, which ranged from 29% in Mississippi and South Carolina to 71% in Rhode Island in 2016,64 may contribute to future differential patterns in HPV-associated cancers.72, 73 Geographic disparities, which have increased over time,74, 75 often reflect the national distribution of poverty. This trend may be exacerbated by widening inequalities in access to health care because of state differences in Medicaid expansion and other initiatives to improve insurance coverage.76, 77

Table 12. Incidence Rates for Selected Cancers by State, United States, 2010 to 2014
LUNG & BRONCHUS NON-HODGKIN LYMPHOMA URINARY BLADDER
ALL CANCERS BREAST COLORECTUM PROSTATE
STATE MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE
Alabama 533.2 394.9 119.6 52.2 36.9 92.5 52.1 19.6 14.0 129.3 34.0 7.6
Alaska 447.7 411.9 125.4 46.6 40.2 67.5 53.3 20.9 13.5 91.4 33.8 9.6
Arizona 413.8 375.0 112.4 39.2 29.8 56.0 45.4 18.4 13.4 80.8 32.2 8.0
Arkansas 528.0 398.1 112.7 50.1 37.1 99.0 60.7 20.4 14.8 120.7 36.0 7.4
California 459.3 388.5 120.7 42.5 32.6 51.0 39.9 22.8 15.3 109.3 31.4 7.4
Colorado 445.4 390.2 123.7 37.9 30.8 48.3 41.6 21.1 14.5 110.9 32.7 8.1
Connecticut 526.7 458.4 139.2 44.4 34.3 69.7 56.8 25.6 17.2 118.8 46.9 12.4
Delaware 570.7 456.4 133.1 43.5 32.9 81.3 62.9 25.4 17.3 141.6 42.2 10.9
Dist. of Columbia 534.4 446.1 143.5 48.7 40.3 67.4 49.5 22.5 13.1 159.7 23.3 9.0
Florida 479.4 396.9 115.5 42.5 32.3 71.4 53.1 21.0 14.5 103.6 33.2 8.2
Georgia 534.1 410.9 123.5 48.9 35.6 84.6 52.2 21.9 14.7 129.3 33.3 7.8
Hawaii 444.1 407.4 136.0 51.3 36.5 56.9 38.1 22.1 14.6 90.1 23.7 5.7
Idaho 477.5 410.5 120.5 39.8 32.5 55.7 46.8 21.9 15.4 119.7 37.9 8.7
Illinois 520.1 437.9 130.0 52.5 38.1 79.2 57.8 23.5 16.3 119.4 37.5 9.4
Indiana 494.3 425.6 120.1 48.8 38.5 88.9 60.8 22.8 16.1 95.7 36.7 9.1
Iowa 529.6 439.5 122.8 51.7 39.8 78.3 53.0 26.9 18.1 112.2 38.4 9.0
Kansasa 521.8 430.0 123.5 47.4 36.1 73.1 52.8 24.0 16.8 124.1 38.8 9.3
Kentucky 590.8 472.7 123.3 59.3 42.4 116.3 79.7 25.2 16.7 113.0 40.2 10.1
Louisiana 576.5 420.8 123.2 56.0 41.4 90.8 54.9 23.9 16.7 144.4 33.5 7.7
Maine 517.6 454.0 125.5 42.7 34.3 83.9 65.3 22.8 18.2 99.8 47.5 12.4
Maryland 502.5 421.0 131.0 42.6 33.3 66.6 52.0 20.7 15.1 131.5 37.0 9.4
Massachusetts 504.1 449.3 136.1 42.9 33.7 70.3 60.5 23.4 16.6 114.2 40.5 11.3
Michigan 516.4 426.3 122.2 44.0 34.0 77.2 58.8 24.4 16.9 126.3 39.1 10.2
Minnesotaa 510.9 434.6 130.2 43.8 34.7 61.8 50.2 27.1 18.1 119.4 38.5 9.6
Mississippi 558.7 407.4 115.5 58.2 41.8 101.4 56.3 20.9 14.3 135.5 30.9 7.4
Missouri 502.0 427.6 125.9 49.7 36.6 89.0 64.3 22.6 15.4 101.0 33.8 8.7
Montana 485.9 424.7 123.1 44.2 34.1 60.9 53.8 22.6 16.3 116.6 36.0 10.1
Nebraska 507.5 416.0 121.8 49.9 38.2 71.8 50.2 24.8 16.9 119.6 37.1 8.2
Nevadaa, b 504.8 403.2 114.3 50.7 36.4 71.9 60.5 20.4 14.9 136.8 39.0 10.8
New Hampshire 527.5 463.1 140.4 40.9 34.2 71.2 63.3 25.3 17.4 123.5 48.1 12.1
New Jersey 543.0 452.9 132.0 47.9 37.8 65.6 52.5 25.5 17.9 139.4 41.5 10.6
New Mexicoa, c 417.1 363.8 112.6 40.2 30.5 49.1 36.3 17.6 13.2 99.4 26.1 6.0
New York 546.4 451.0 129.0 46.9 35.7 69.9 54.2 26.3 17.8 136.8 41.0 10.5
North Carolina 527.9 421.4 129.4 43.7 33.0 88.5 56.1 21.4 14.5 125.0 35.5 8.8
North Dakota 510.4 414.5 121.4 53.8 40.0 70.8 48.9 22.8 18.2 123.2 37.0 8.7
Ohio 504.6 424.4 122.9 47.9 35.8 83.7 59.0 22.9 15.3 111.8 38.6 9.2
Oklahoma 502.0 412.3 117.8 48.6 36.9 86.6 58.7 22.1 15.0 108.3 33.6 7.9
Oregon 467.9 419.2 126.0 40.8 31.2 63.1 53.4 22.4 15.8 101.1 38.0 8.9
Pennsylvania 543.9 461.3 129.8 49.9 37.5 78.3 56.1 26.0 17.9 117.5 43.9 11.1
Rhode Island 518.5 457.9 130.3 41.2 34.7 77.7 63.7 26.5 18.1 108.5 45.1 12.8
South Carolina 521.3 411.9 127.2 44.7 33.8 85.7 53.7 20.0 14.0 121.4 34.7 8.6
South Dakota 498.4 428.1 130.7 51.6 38.8 69.7 50.8 24.6 16.1 116.8 35.1 8.9
Tennessee 529.2 418.7 121.1 46.8 36.4 95.7 61.0 21.5 14.9 119.1 34.5 8.0
Texas 465.1 380.2 111.5 46.3 32.2 68.0 44.7 21.5 15.0 99.4 27.4 6.4
Utah 457.4 373.9 114.7 35.5 27.7 32.7 24.1 23.2 15.1 130.6 29.8 6.0
Vermont 493.3 437.4 130.1 39.3 33.0 71.8 59.7 26.5 17.5 98.4 38.9 10.6
Virginia 460.8 398.7 126.9 41.1 33.1 73.1 50.8 20.9 14.1 107.6 31.1 8.2
Washington 502.1 437.9 134.9 40.9 32.9 65.5 53.7 25.3 16.7 116.3 37.6 9.3
West Virginia 523.7 443.8 114.8 53.1 40.9 98.7 66.2 21.8 16.0 99.6 39.9 10.5
Wisconsin 515.8 437.3 127.9 43.6 33.6 69.5 54.8 25.5 17.3 116.0 39.9 10.0
Wyoming 447.2 382.5 113.5 41.7 30.5 49.4 44.1 19.7 13.3 108.5 36.0 9.3
United States 501.9 417.9 123.6 45.9 34.8 73.0 52.8 22.9 15.8 114.9 35.8 8.8
  • Rates are per 100,000 population 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 consent (Kansas) or because they did not meet high-quality standards for one or more years during 2010 to 2014 according to the North American Association of Central Cancer Registries (NAACCR).
  • b Rates are based on incidence data for 2008 to 2010.
  • c Rates are based on incidence data for 2010 to 2012.
Table 13. Death Rates for Selected Cancers by State, United States, 2011 to 2015
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 231.6 145.7 21.8 20.1 13.4 73.7 38.2 7.3 4.5 13.4 9.8 22.7
Alaska 196.1 146.5 19.7 17.4 13.6 53.1 40.0 7.3 4.1 11.1 10.8 18.5
Arizona 170.6 124.9 19.4 15.2 10.9 41.5 30.1 6.5 4.2 11.5 8.9 17.8
Arkansas 234.2 152.5 21.6 21.2 14.1 78.5 43.7 7.4 4.6 12.6 9.2 20.0
California 173.8 128.2 20.2 15.6 11.4 38.2 27.4 7.0 4.3 11.8 9.1 19.7
Colorado 163.7 122.2 19.0 14.3 10.7 34.0 27.3 6.5 3.8 10.7 8.4 21.4
Connecticut 178.4 130.8 18.3 13.5 10.4 43.9 32.9 7.1 4.2 12.1 9.8 17.9
Delaware 201.6 149.2 21.6 16.1 11.1 59.4 40.9 7.7 4.4 13.8 10.3 18.1
Dist. of Columbia 205.0 159.1 28.9 18.3 14.7 47.2 32.7 6.1 3.2 15.6 11.5 32.3
Florida 185.8 130.4 19.8 15.9 11.1 52.1 34.5 7.0 4.1 12.0 8.9 17.2
Georgia 209.2 138.9 22.1 19.3 12.4 62.2 34.5 7.1 4.2 12.3 9.1 22.5
Hawaii 164.9 114.9 15.9 16.7 10.3 40.0 25.1 6.7 3.8 12.8 9.9 13.7
Idaho 183.5 132.4 20.5 15.7 10.9 41.9 31.3 8.0 5.0 12.9 9.5 23.6
Illinois 205.9 148.4 22.3 18.9 13.1 57.3 38.3 7.7 4.5 12.8 9.6 20.5
Indiana 221.4 152.1 21.4 19.0 13.4 68.4 42.2 8.3 5.1 13.0 9.6 20.4
Iowa 204.1 141.6 19.2 18.2 13.6 58.0 36.0 8.7 5.1 12.7 9.3 19.5
Kansas 198.1 143.1 20.0 17.9 12.6 55.9 38.3 7.4 4.8 12.9 10.2 18.8
Kentucky 245.7 165.9 21.7 20.7 14.1 86.6 53.5 8.7 4.9 13.1 9.7 19.5
Louisiana 233.4 154.5 23.6 21.3 14.6 70.6 40.7 8.7 4.7 15.2 11.3 21.5
Maine 211.8 150.1 18.0 15.4 11.7 63.3 42.4 7.8 5.3 11.9 10.8 19.6
Maryland 193.9 141.0 22.4 17.1 11.9 50.0 35.4 7.1 4.2 13.8 10.0 20.1
Massachusetts 191.3 138.1 18.5 15.1 10.9 49.5 36.9 6.9 4.3 12.7 10.0 18.8
Michigan 205.3 149.5 21.7 17.3 12.3 58.6 40.9 8.7 5.0 13.3 10.3 19.0
Minnesota 184.7 134.3 18.6 14.7 11.3 45.8 33.6 8.4 5.0 12.4 9.0 19.9
Mississippi 249.9 156.0 23.3 23.4 15.5 80.3 40.5 7.3 4.0 15.1 11.2 25.2
Missouri 213.9 152.4 22.2 18.7 12.9 67.3 44.0 7.3 4.4 12.9 9.8 18.0
Montana 181.1 138.3 20.2 16.3 11.1 45.7 37.4 7.0 4.2 10.8 9.5 20.2
Nebraska 194.8 137.1 20.0 18.3 13.6 52.5 34.4 7.4 4.7 12.4 8.8 20.2
Nevada 188.8 143.8 22.2 19.6 13.6 51.2 40.6 6.5 3.8 12.1 8.8 20.5
New Hampshire 196.4 142.1 19.6 13.6 12.5 52.6 40.5 7.0 4.3 13.1 9.2 19.8
New Jersey 186.2 139.0 22.4 17.9 12.4 45.9 32.9 7.3 4.3 13.1 10.2 18.5
New Mexico 173.0 123.6 18.9 16.8 11.5 36.3 26.2 6.1 4.1 10.9 8.4 20.3
New York 183.5 135.9 20.2 16.4 11.8 47.5 32.9 7.2 4.3 12.9 9.9 18.7
North Carolina 210.7 140.4 21.3 17.0 11.7 65.0 37.1 7.3 4.4 12.7 9.4 20.7
North Dakota 186.9 128.7 17.5 17.0 12.0 50.6 31.3 6.7 4.7 12.3 8.7 19.4
Ohio 215.9 153.5 22.9 19.1 13.4 64.6 42.1 8.3 4.9 13.3 10.2 19.5
Oklahoma 225.3 156.5 23.0 20.9 14.1 70.0 44.6 8.2 4.8 12.3 9.7 20.5
Oregon 193.1 143.9 20.2 16.1 12.0 48.3 37.8 7.7 4.7 13.0 9.7 21.1
Pennsylvania 207.1 147.1 21.9 18.4 13.2 57.1 36.5 8.1 4.7 13.7 10.1 19.2
Rhode Island 206.8 140.6 18.5 16.2 11.9 58.8 41.2 6.6 4.5 12.9 9.1 19.2
South Carolina 218.7 143.2 22.3 18.0 12.6 65.0 36.6 7.0 4.3 13.1 9.7 22.5
South Dakota 192.3 136.5 19.9 19.3 13.0 52.8 35.6 7.3 4.0 11.6 9.1 18.7
Tennessee 230.7 152.7 22.0 19.7 13.6 75.1 43.2 8.2 4.8 12.6 9.8 19.9
Texas 190.4 131.2 20.2 17.9 11.6 49.8 30.6 7.1 4.3 11.6 8.9 18.1
Utah 148.8 110.3 20.3 13.0 9.7 23.9 15.9 6.7 4.6 11.2 8.6 20.4
Vermont 197.7 144.7 19.0 15.6 12.4 51.3 39.6 8.5 4.2 12.9 9.8 19.4
Virginia 198.0 139.7 21.8 16.7 11.8 55.4 35.4 7.3 4.4 12.9 9.5 20.2
Washington 187.9 138.3 19.9 14.8 11.0 47.5 35.3 7.9 4.7 12.3 9.5 20.1
West Virginia 233.4 163.2 22.2 21.7 15.6 75.7 45.7 7.8 5.0 12.4 9.1 17.6
Wisconsin 198.3 141.6 20.0 16.1 11.7 51.8 36.4 8.0 4.7 13.3 10.1 21.2
Wyoming 170.7 130.0 18.5 16.9 10.1 39.8 31.8 6.8 4.6 10.3 8.6 16.3
United States 196.7 139.5 20.9 17.3 12.2 53.8 35.4 7.4 4.5 12.6 9.5 19.5
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population.

The largest geographic variation in cancer occurrence by far is for lung cancer, reflecting the large historical and continuing differences in smoking prevalence between states.57 For example, lung cancer incidence rates in Kentucky (116 per 100,000 population in men and 80 per 100,000 population in women), where smoking prevalence continues to be highest, are about 3.5 times higher than those in Utah (33 per 100,000 population in men and 24 per 100,000 population in women), where smoking prevalence is lowest. In 2015, more than one-quarter (26%) of residents in Kentucky and West Virginia were current smokers compared with 9% in Utah.78 Smoking history similarly predicts state disparities in smoking-attributable mortality; the proportion of total cancer deaths caused by smoking in 2014 was 38% in men and 29% in women in Kentucky, compared with 22% and 11%, respectively, in Utah.

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 2018, an estimated 10,590 children (birth to 14 years) will be diagnosed with cancer (excluding benign/borderline malignant brain tumors) and 1,180 will die from the disease. Benign and borderline malignant brain tumors are not included in the 2018 case estimates because the calculation method requires historical data and these tumors were not required to be reported to cancer registries until 2004.

Leukemia accounts for 29% of all childhood cancers (including benign and borderline malignant brain tumors), three-quarters of which are lymphoid. Brain and other nervous system tumors are second most common (26%), of which approximately one-quarter are benign/borderline malignant. The third most common category is lymphomas and reticuloendothelial neoplasms (12%), almost one-half of which are non-Hodgkin lymphoma (including Burkitt lymphoma) and 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%).9

Cancers in adolescents (aged 15 to 19 years) differ somewhat from those in children in terms of type and distribution. For example, brain and other nervous system tumors (21%) (more than one-half [58%] of which are benign/borderline malignant) and lymphoma (20%) are equally common, and there are almost twice as many cases of Hodgkin lymphoma as non-Hodgkin lymphoma. Leukemia is third (13%), followed by germ cell and gonadal tumors (11%) and thyroid carcinoma (11%). Melanoma of the skin accounts for 4% of the cancers diagnosed in adolescents.

Although overall cancer incidence in children and adolescents has been increasing slightly (by 0.6% per year) since 1975, rates appear to have stabilized over the past 5 data years. In contrast, death rates in individuals aged birth to 19 years have declined continuously, from 6.5 (per 100,000 population) in 1970 to 2.3 in 2015, an overall reduction of 65% (67% in children and 61% in adolescents). The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 83% during 2007 through 2013 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 (%) for the Most Common Childhood and Adolescent Cancers, United States, 2007 to 2013
BIRTH TO 14 15 TO 19
All ICCC groups combined 83.0 84.2
Lymphoid leukemia 90.5 74.2
Acute myeloid leukemia 65.1 61.5
Hodgkin lymphoma 97.6 96.1
Non-Hodgkin lymphoma 90.6 87.1
Central nervous system neoplasms 72.5 78.9
Neuroblastoma & other peripheral nervous cell tumors 79.0 62.8a
Retinoblasoma 95.2 b
Renal tumors 91.8 72.7a
Hepatic tumors 79.0 50.9a
Osteosarcoma 69.8 65.5
Ewing tumor & related bone sarcomas 77.7 61.5
Soft tissue and other extraosseous sarcomas 74.6 68.2
Rhabdomyosarcoma 69.8 45.9
Germ cell and gonadal tumors 92.4 92.0
Thyroid carcinoma 99.4 99.5
Malignant melanoma 93.3 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 2014.
  • 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 2007 to 2013.

Limitations

Although the estimated numbers of new cancer cases and deaths expected to occur in 2018 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 models are robust, they can only account for trends through the most recent data year (currently 2014 for incidence and 2015 for mortality) and cannot anticipate abrupt fluctuations for cancers affected by changes in detection practice (eg, PSA testing and 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 American Indian/Alaska Native 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, although Hispanics in the United States have the lowest lung cancer mortality overall (one-half that in NHWs), within this population, rates in Cuban men approach those of NHW men.79 Similarly, lung cancer rates are equivalent in Hawaiian and NHW men, but about 50% lower in Asian/Pacific Islanders overall.63 Thus, the high burden of lung and other cancers among Cuban Americans and Hawaiians is completely concealed by the presentation of aggregated data.

Conclusions

The continuous decline in cancer death rates over 2 decades has resulted in an overall drop of 26%, resulting in approximately 2.4 million fewer cancer deaths during this time period. While the racial gap in cancer mortality continues to narrow, this progress primarily reflects older age groups, masking stark persistent inequalities for young and middle-aged black Americans. High cancer mortality in Kentucky and West Virginia, irrespective of race, highlights the strong influence of socioeconomic and health policy factors on the cancer burden. Nevertheless, the elimination of racial disparities in many states, let alone lower cancer mortality in blacks in Massachusetts and New York, demonstrates the potential for the nation. Advancing the fight against cancer for all citizens requires broader application of existing cancer control knowledge, including smoking cessation and the increased uptake of cancer-preventing cervical and colorectal cancer screening and HPV vaccination, across all segments of the population, with an emphasis on disadvantaged groups.