Volume 69, Issue 1 p. 7-34
Article
Free Access

Cancer statistics, 2019

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

Scientific Director, Surveillance Research, American Cancer Society, Atlanta, GA

Corresponding author

Rebecca L. Siegel, MPH, Surveillance Research, American Cancer Society, 250 Williams St, NW, Atlanta, GA 30303-1002

[email protected]

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Kimberly D. Miller MPH

Kimberly D. Miller MPH

Senior Associate Scientist, Surveillance Research, American Cancer Society, Atlanta, GA

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Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

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

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First published: 08 January 2019
Citations: 14,326

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 2015, 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 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

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 2019 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 2015 and for mortality through 2016. We also estimate the total number of deaths averted because of the continuous decline in cancer death rates since the early 1990s and analyze cancer mortality rates by county-level poverty.

Materials and Methods

Incidence and Mortality Data

Mortality data from 1930 to 2016 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, and Texas, Alaska, and Hawaii began reporting in 1933, 1959, and 1960, respectively. The methods for abstraction and age adjustment of historic mortality data are described elsewhere.3, 4 Five-year mortality rates (2011-2015) for Puerto Rico were previously published in volume 3 of the North American Association of Central Cancer Registries’ (NAACCR’s) Cancer in North America: 2011-2015.5

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 (1975–2015) incidence and survival trends 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.6, 7 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.8 The probability of developing cancer was calculated using NCI’s DevCan software (version 6.7.6).9 Some of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975-2015.10

The 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 for the most recent years and were the source for the projected new cancer cases in 2019 and cross-sectional incidence rates by state and race/ethnicity.11, 12 Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2011-2015.13, 14

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).15, 16 Causes of death were classified according to the International Classification of Diseases.17 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 8.3.5).18 The annual percent change in rates was quantified using NCI’s Joinpoint Regression Program (version 4.6.0).19

Whenever possible, cancer incidence rates 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 data years for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate cancer) and provides the most accurate portrayal of cancer occurrence in the most recent time period.20 For example, the leukemia incidence rate for 2015 in the 9 oldest SEER registries was 12% higher after adjusting for reporting delays (15.2 vs 13.6 per 100,000 population).10

Projected Cancer Cases and Deaths in 2019

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 2019 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 2001 through 2015 using delay-adjusted, high-quality incidence data from 48 states and the District of Columbia (96% population coverage) and geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.21 (Data were unavailable for all years for Kansas and Minnesota, as well as for a few sporadic years for a handful of states.) Modeled counts were aggregated to the national and state level for each year, and a time series projection method (vector autoregression) was applied to all 15 years to estimate cases for 2019. Basal cell and squamous cell skin cancers cannot be estimated because incidence data are not collected by most cancer registries. For complete details of the case projection methodology, please refer to Zhu et al.22

New cases of in situ female breast carcinoma and melanoma of the skin diagnosed in 2019 were estimated by first approximating the number of cases occurring annually from 2006 through 2015 based on age-specific NAACCR incidence rates (data from 46 states with high-quality data for all 10 years) and US Census Bureau population estimates obtained via SEER*Stat. Counts were then adjusted for delays in reporting using SEER delay factors for invasive disease (delay factors are unavailable for in situ cases) and projected to 2019 based on the average annual percent change generated by the joinpoint regression model.

The number of cancer deaths expected to occur in 2019 was estimated based on the most recent joinpoint-generated annual percent change in reported cancer deaths from 2002 through 2016 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 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 2016.

Temporal trends in socioeconomic disparities in cancer mortality were examined using county-level poverty as a proxy for socioeconomic status. Cancer death rates by county-level poverty quintile were calculated using linked attributes from the US Census Bureau American Community Survey 2012–2016 available through SEER*Stat. The total resident population in each quintile was 73,559,180 persons (1.81%-10.84% poverty); 62,695,449 persons (10.85%-14.10% poverty); 74,157,401 persons (14.11%-17.16% poverty); 76,945,467 persons (17.17%-21.17% poverty); and 35,770,016 persons (21.18%-53.95% poverty), respectively. County-level poverty in the United States has shifted slightly from the South to the West since 1970, although the highest concentration remains in the South.24

Selected Findings

Expected Numbers of New Cancer Cases

Table 1 presents the estimated numbers of new cases of invasive cancer in the United States in 2019 by sex and cancer type. In total, there will be approximately 1,762,450 cancer cases diagnosed, which is the equivalent of more than 4,800 new cases each day. In addition, there will be approximately 62,930 new cases of female breast carcinoma in situ and 95,830 new cases of melanoma in situ of the skin. The estimated numbers of new cases by state are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2019*
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All sites 1,762,450 870,970 891,480 606,880 321,670 285,210
Oral cavity & pharynx 53,000 38,140 14,860 10,860 7,970 2,890
Tongue 17,060 12,550 4,510 3,020 2,220 800
Mouth 14,310 8,430 5,880 2,740 1,800 940
Pharynx 17,870 14,450 3,420 3,450 2,660 790
Other oral cavity 3,760 2,710 1,050 1,650 1,290 360
Digestive system 328,030 186,080 141,950 165,460 97,110 68,350
Esophagus 17,650 13,750 3,900 16,080 13,020 3,060
Stomach 27,510 17,230 10,280 11,140 6,800 4,340
Small intestine 10,590 5,610 4,980 1,590 890 700
Colon 101,420 51,690 49,730 51,020 27,640 23,380
Rectum 44,180 26,810 17,370
Anus, anal canal, & anorectum 8,300 2,770 5,530 1,280 520 760
Liver & intrahepatic bile duct 42,030 29,480 12,550 31,780 21,600 10,180
Gallbladder & other biliary 12,360 5,810 6,550 3,960 1,610 2,350
Pancreas 56,770 29,940 26,830 45,750 23,800 21,950
Other digestive organs 7,220 2,990 4,230 2,860 1,230 1,630
Respiratory system 246,440 130,370 116,070 147,510 80,380 67,130
Larynx 12,410 9,860 2,550 3,760 3,010 750
Lung & bronchus 228,150 116,440 111,710 142,670 76,650 66,020
Other respiratory organs 5,880 4,070 1,810 1,080 720 360
Bones & joints 3,500 2,030 1,470 1,660 960 700
Soft tissue (including heart) 12,750 7,240 5,510 5,270 2,840 2,430
Skin (excluding basal & squamous) 104,350 62,320 42,030 11,650 8,030 3,620
Melanoma of the skin 96,480 57,220 39,260 7,230 4,740 2,490
Other nonepithelial skin 7,870 5,100 2,770 4,420 3,290 1,130
Breast 271,270 2,670 268,600 42,260 500 41,760
Genital system 295,290 186,290 109,000 65,540 32,440 33,100
Uterine cervix 13,170 13,170 4,250 4,250
Uterine corpus 61,880 61,880 12,160 12,160
Ovary 22,530 22,530 13,980 13,980
Vulva 6,070 6,070 1,280 1,280
Vagina & other genital, female 5,350 5,350 1,430 1,430
Prostate 174,650 174,650 31,620 31,620
Testis 9,560 9,560 410 410
Penis & other genital, male 2,080 2,080 410 410
Urinary system 158,220 108,450 49,770 33,420 23,290 10,130
Urinary bladder 80,470 61,700 18,770 17,670 12,870 4,800
Kidney & renal pelvis 73,820 44,120 29,700 14,770 9,820 4,950
Ureter & other urinary organs 3,930 2,630 1,300 980 600 380
Eye & orbit 3,360 1,860 1,500 370 200 170
Brain & other nervous system 23,820 13,410 10,410 17,760 9,910 7,850
Endocrine system 54,740 15,650 39,090 3,210 1,560 1,650
Thyroid 52,070 14,260 37,810 2,170 1,020 1,150
Other endocrine 2,670 1,390 1,280 1,040 540 500
Lymphoma 82,310 45,660 36,650 20,970 12,100 8,870
Hodgkin lymphoma 8,110 4,570 3,540 1,000 590 410
Non-Hodgkin lymphoma 74,200 41,090 33,110 19,970 11,510 8,460
Myeloma 32,110 18,130 13,980 12,960 6,990 5,970
Leukemia 61,780 35,920 25,860 22,840 13,150 9,690
Acute lymphocytic leukemia 5,930 3,280 2,650 1,500 850 650
Chronic lymphocytic leukemia 20,720 12,880 7,840 3,930 2,220 1,710
Acute myeloid leukemia 21,450 11,650 9,800 10,920 6,290 4,630
Chronic myeloid leukemia 8,990 5,250 3,740 1,140 660 480
Other leukemia 4,690 2,860 1,830 5,350 3,130 2,220
Other & unspecified primary sites 31,480 16,750 14,730 45,140 24,240 20,900
  • * Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Approximately 62,930 cases of carcinoma in situ of the female breast and 95,830 cases of melanoma in situ will be newly diagnosed in 2019.
  • Deaths for colon and rectal cancers are combined because a large number of deaths from rectal cancer are misclassified as colon.
  • 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 with those for previous years.
Table 2. Estimated New Cases for Selected Cancers by State, 2019*
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 28,950 4,240 240 2,330 760 840 4,150 1,420 990 4,060 1,100
Alaska 3,090 470 290 110 90 400 120 130 460 150
Arizona 37,490 5,630 250 2,840 1,200 1,110 4,290 2,340 1,420 2,800 1,780
Arkansas 16,580 2,210 140 1,440 510 560 2,690 760 640 2,680 740
California 186,920 27,700 1,590 15,360 6,230 6,030 18,990 10,710 8,230 24,550 7,780
Colorado 26,800 4,180 170 1,940 830 810 2,690 1,830 1,130 2,270 1,210
Connecticut 21,950 3,490 120 1,560 720 670 2,580 930 950 1,980 1,160
Delaware 5,870 930 440 220 210 840 400 240 700 300
Dist. of Columbia 3,190 510 260 120 80 340 80 120 300 80
Florida 131,470 19,130 1,040 11,310 4,520 4,980 18,560 8,360 5,420 11,860 6,450
Georgia 50,450 8,000 440 4,450 1,640 1,800 7,070 3,050 2,030 5,400 2,040
Hawaii 7,120 1,280 50 620 310 200 860 490 280 680 280
Idaho 8,390 1,340 50 630 310 340 1,030 670 380 1,370 460
Illinois 68,560 11,560 510 6,030 2,700 2,380 9,130 3,750 2,890 6,990 3,240
Indiana 35,280 5,820 270 3,360 1,330 1,230 5,500 2,120 1,550 2,530 1,710
Iowa 17,810 2,730 100 1,540 660 730 2,410 1,070 830 1,720 890
Kansas 15,340 2,420 110 1,290 520 590 2,000 870 650 2,070 640
Kentucky 26,400 3,670 200 2,320 890 940 4,960 1,310 1,050 2,190 1,130
Louisiana 26,800 3,770 230 2,340 700 830 3,810 1,020 1,060 3,380 1,050
Maine 8,920 1,390 50 670 320 310 1,400 510 400 660 560
Maryland 33,140 5,290 230 2,620 1,280 960 4,040 1,750 1,280 3,810 1,390
Massachusetts 40,020 6,610 210 2,840 1,380 1,140 5,150 1,640 1,720 2,710 2,130
Michigan 58,360 9,310 360 5,040 2,200 1,930 8,070 3,300 2,530 4,580 2,930
Minnesota 30,560 4,740 140 2,300 1,080 1,360 3,600 1,640 1,360 1,970 1,400
Mississippi 17,050 2,370 150 1,680 450 520 2,520 650 570 1,930 630
Missouri 35,480 5,350 260 3,110 1,180 1,240 5,490 1,800 1,430 3,290 1,570
Montana 5,920 890 470 220 240 820 390 260 600 340
Nebraska 9,780 1,580 70 900 360 420 1,290 580 460 750 470
Nevada 14,810 2,190 140 1,340 420 530 1,880 850 600 1,180 770
New Hampshire 8,610 1,330 590 300 260 1,140 450 370 1,030 500
New Jersey 53,400 8,340 410 4,250 2,130 2,070 6,070 2,850 2,330 5,710 2,580
New Mexico 9,460 1,440 80 830 370 360 1,070 630 400 520 410
New York 111,870 17,490 880 9,150 4,500 4,540 13,380 5,150 5,030 9,700 5,410
North Carolina 58,690 8,870 410 4,310 1,960 1,960 8,010 3,550 2,220 7,490 2,490
North Dakota 3,940 590 350 130 170 430 230 180 360 190
Ohio 67,150 10,240 430 6,200 2,600 2,100 9,680 3,750 2,850 5,340 3,210
Oklahoma 20,540 2,980 170 1,840 630 780 3,220 860 850 1,800 910
Oregon 23,320 3,390 150 1,620 810 670 2,900 1,780 1,010 1,950 1,140
Pennsylvania 79,890 12,070 540 6,520 3,280 3,040 10,380 4,340 3,430 7,470 4,230
Rhode Island 6,540 1,010 470 210 190 940 310 270 550 360
South Carolina 29,830 4,470 210 2,370 930 1,040 4,360 1,810 1,100 3,130 1,270
South Dakota 4,770 750 430 160 200 580 250 210 400 240
Tennessee 37,350 5,580 310 3,290 1,210 1,280 6,210 2,070 1,550 3,160 1,670
Texas 124,890 18,750 1,290 10,950 4,090 4,820 14,750 4,270 5,430 10,660 4,470
Utah 11,620 1,660 70 770 420 480 780 1,160 550 1,080 450
Vermont 3,920 620 280 130 130 510 250 170 210 230
Virginia 45,440 7,120 310 3,540 1,650 1,400 5,950 2,810 1,760 5,440 2,010
Washington 39,160 5,840 230 2,800 1,400 1,370 4,770 2,790 1,800 2,470 1,910
West Virginia 12,440 1,540 80 980 450 410 2,010 650 470 1,010 630
Wisconsin 34,220 5,270 190 2,450 1,290 1,320 4,150 1,940 1,480 5,260 1,710
Wyoming 2,930 440 250 100 110 310 210 130 430 150
United States 1,762,450 268,600 13,170 145,600 61,880 61,780 228,150 96,480 74,200 174,650 80,470
  • * Rounded to the nearest 10; excludes basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimates for Puerto Rico are not available.
  • Estimate is fewer than 50 cases.
  • Note: These are model-based estimates that should be interpreted with caution and not compared with 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 be diagnosed in men and women in 2019. Prostate, lung and bronchus (referred to as lung hereafter), and colorectal cancers (CRCs) account for 42% of all cases in men, with prostate cancer alone accounting for nearly 1 in 5 new diagnoses. For women, the 3 most common cancers are breast, lung, and colorectum, which collectively represent one-half of all new diagnoses; breast cancer alone accounts 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, 2019. Estimates are rounded to the nearest 10 and 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 (39.3%) than for women (37.7%) (Table 3). The reasons for the excess risk in men are not fully understood, but partly reflect differences in environmental exposures, endogenous hormones, and probably complex interactions between these influences. Recent research suggests that sex differences in immune function and response may also play a role.25 Adult height, which is determined by genetics and childhood nutrition, is positively associated with cancer incidence and mortality in both men and women,26 and has been estimated to account for one-third of the sex disparity.27

Table 3. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2013 to 2015*
BIRTH TO 49 50 TO 59 60 TO 69 ≥70 BIRTH TO DEATH
All sites Male 3.4 (1 in 30) 6.1 (1 in 16) 13.2 (1 in 8) 31.9 (1 in 3) 39.3 (1 in 3)
Female 5.6 (1 in 18) 6.2 (1 in 16) 10.0 (1 in 10) 26.0 (1 in 4) 37.7 (1 in 3)
Breast Female 2.0 (1 in 51) 2.3 (1 in 43) 3.5 (1 in 29) 6.7 (1 in 15) 12.4 (1 in 8)
Colorectum Male 0.4 (1 in 272) 0.7 (1 in 143) 1.2 (1 in 87) 3.3 (1 in 30) 4.4 (1 in 23)
Female 0.3 (1 in 292) 0.5 (1 in 190) 0.8 (1 in 123) 3.0 (1 in 33) 4.1 (1 in 25)
Kidney & renal pelvis Male 0.2 (1 in 440) 0.4 (1 in 280) 0.6 (1 in 155) 1.3 (1 in 73) 2.1 (1 in 47)
Female 0.2 (1 in 665) 0.2 (1 in 575) 0.3 (1 in 319) 0.7 (1 in 135) 1.2 (1 in 82)
Leukemia Male 0.3 (1 in 396) 0.2 (1 in 570) 0.4 (1 in 259) 1.4 (1 in 72) 1.8 (1 in 56)
Female 0.2 (1 in 508) 0.1 (1 in 876) 0.2 (1 in 434) 0.9 (1 in 112) 1.3 (1 in 80)
Lung & bronchus Male 0.1 (1 in 719) 0.6 (1 in 158) 1.8 (1 in 56) 6.0 (1 in 16) 6.7 (1 in 15)
Female 0.1 (1 in 673) 0.6 (1 in 178) 1.4 (1 in 72) 4.7 (1 in 21) 5.9 (1 in 17)
Melanoma of the skin Male 0.5 (1 in 215) 0.5 (1 in 186) 1.0 (1 in 104) 2.7 (1 in 37) 3.7 (1 in 27)
Female 0.7 (1 in 150) 0.4 (1 in 238) 0.5 (1 in 191) 1.1 (1 in 87) 2.5 (1 in 40)
Non-Hodgkin lymphoma Male 0.3 (1 in 382) 0.3 (1 in 350) 0.6 (1 in 176) 1.8 (1 in 54) 2.4 (1 in 42)
Female 0.2 (1 in 548) 0.2 (1 in 484) 0.4 (1 in 247) 1.4 (1 in 74) 1.9 (1 in 54)
Prostate Male 0.2 (1 in 437) 1.7 (1 in 59) 4.6 (1 in 22) 7.9 (1 in 13) 11.2 (1 in 9)
Thyroid Male 0.2 (1 in 513) 0.1 (1 in 764) 0.2 (1 in 584) 0.2 (1 in 417) 0.6 (1 in 156)
Female 0.8 (1 in 122) 0.4 (1 in 268) 0.3 (1 in 286) 0.4 (1 in 262) 1.8 (1 in 55)
Uterine cervix Female 0.3 (1 in 366) 0.1 (1 in 835) 0.1 (1 in 938) 0.2 (1 in 628) 0.6 (1 in 162)
Uterine corpus Female 0.3 (1 in 333) 0.6 (1 in 164) 1.0 (1 in 102) 1.3 (1 in 75) 2.9 (1 in 35)
  • * For people without a history of cancer at beginning of age interval.
  • All sites excludes basal cell and squamous cell skin cancers and in situ cancers except urinary bladder.
  • Probabilities for non-Hispanic whites only.

Expected Number of Cancer Deaths

An estimated 606,880 Americans will die from cancer in 2019, corresponding to almost 1,700 deaths per day (Table 1). The greatest number of deaths are from cancers of the lung, prostate, and colorectum in men and the lung, breast, and colorectum in women (Fig. 1). One-quarter of all cancer deaths are due to lung cancer. Table 4 provides the estimated numbers of cancer deaths in 2019 by state.

Table 4. Estimated Deaths for Selected Cancers by State, 2019*
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 10,630 350 690 930 380 540 2,760 290 240 770 510
Alaska 1,120 70 110 60 260 90 50
Arizona 12,470 400 890 1,050 510 710 2,630 410 320 1,040 900
Arkansas 6,800 190 410 600 240 310 1,960 200 140 440 280
California 60,590 1,970 4,560 5,290 2,400 4,070 10,970 2,110 1,580 4,720 4,470
Colorado 8,120 290 610 660 330 430 1,500 250 220 600 540
Connecticut 6,470 210 430 470 270 320 1,440 230 160 520 320
Delaware 2,140 60 150 150 80 110 540 80 50 180 90
Dist. of Columbia 1,020 100 100 90 180 90 70
Florida 45,000 1,240 3,000 3,700 1,740 2,300 10,880 1,500 980 3,490 2,290
Georgia 17,880 530 1,350 1,630 590 940 4,340 530 410 1,260 920
Hawaii 2,560 50 160 230 80 190 550 90 230 120
Idaho 3,040 110 220 250 110 160 620 120 90 240 200
Illinois 24,410 670 1,720 2,070 900 1,150 5,940 770 560 1,740 1,480
Indiana 13,690 360 870 1,110 510 580 3,690 460 290 950 610
Iowa 6,480 200 380 560 240 270 1,600 240 150 480 310
Kansas 5,550 170 350 470 240 260 1,370 190 110 420 270
Kentucky 10,580 290 610 820 370 460 3,290 320 190 670 400
Louisiana 9,260 230 620 830 320 580 2,390 290 160 740 410
Maine 3,310 100 180 230 110 120 890 110 60 230 170
Maryland 10,780 300 830 880 390 600 2,380 340 260 870 550
Massachusetts 12,420 400 750 870 480 690 2,920 380 310 990 620
Michigan 21,150 600 1,410 1,650 770 920 5,410 740 490 1,650 980
Minnesota 10,020 320 640 790 420 440 2,260 380 220 780 530
Mississippi 6,720 190 440 650 210 340 1,810 170 110 500 320
Missouri 13,080 340 860 1,050 480 580 3,650 370 250 920 560
Montana 2,100 70 140 180 80 100 480 70 50 160 140
Nebraska 3,520 120 230 310 150 130 840 120 70 270 180
Nevada 5,390 200 400 540 200 250 1,280 160 150 380 290
New Hampshire 2,820 90 180 200 100 120 730 110 60 200 130
New Jersey 15,860 470 1,250 1,410 590 750 3,390 570 380 1,290 780
New Mexico 3,720 100 270 340 130 250 700 120 120 270 210
New York 35,010 940 2,460 2,890 1,370 1,740 7,790 1,210 890 2,830 1,730
North Carolina 20,410 550 1,390 1,580 720 1,110 5,370 610 420 1,450 960
North Dakota 1,280 80 120 50 300 50 90 70
Ohio 25,440 680 1,710 2,110 920 1,100 6,690 860 560 1,880 1,130
Oklahoma 8,420 220 540 760 340 420 2,270 270 180 560 410
Oregon 8,270 250 560 650 300 500 1,820 280 230 650 470
Pennsylvania 28,170 770 1,900 2,380 1,080 1,320 6,730 960 660 2,220 1,320
Rhode Island 2,140 60 130 160 80 120 560 70 170 100
South Carolina 10,720 300 740 870 380 530 2,710 320 220 790 540
South Dakota 1,680 60 110 170 70 70 410 60 130 90
Tennessee 14,840 360 950 1,220 520 730 4,190 470 310 980 620
Texas 41,300 1,300 2,980 3,850 1,580 2,810 8,640 1,350 920 3,030 1,900
Utah 3,310 140 280 280 160 170 440 130 110 280 230
Vermont 1,440 50 80 110 50 50 370 50 110 70
Virginia 15,200 440 1,120 1,340 520 770 3,590 490 360 1,140 730
Washington 13,010 430 890 1,000 480 730 2,830 450 340 970 710
West Virginia 4,820 120 290 440 190 190 1,360 150 90 300 190
Wisconsin 11,730 380 740 900 490 480 2,770 400 260 930 620
Wyoming 980 70 80 50 60 200 70 50
United States 606,880 17,760 41,760 51,020 22,840 31,780 142,670 19,970 13,980 45,750 31,620
  • * Rounded to the nearest 10. Estimates for Puerto Rico are not available.
  • Estimate is fewer than 50 deaths.
  • Note: These are model-based estimates that should be interpreted with caution and not compared with 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 reflects rapid changes in prostate cancer incidence rates, 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 among previously unscreened men.28

Details are in the caption following the image
Trends in Cancer Incidence (1975 to 2015) and Mortality Rates (1975 to 2016) 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 2015. 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 approximately 2% per year (Table 5). This trend reflects accelerated declines during the past 5 data years (2011-2015) of approximately 3% per year for cancers of the lung and colorectum, and 7% per year for prostate cancer. The sharp 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 the routine use of the test to screen for prostate cancer (Grade D) in men aged 75 years and older in 2008 and in all men in 2011 because of growing concerns about overdiagnosis and overtreatment.29, 30 Although PSA testing prevalence stabilized from 2013 to 2015,31 the effect of the reduction in screening on the occurrence of advanced disease is being watched closely. Based on analysis of cancer registry data covering 89% of the US population, Negoita et al recently reported that the overall decline in prostate cancer incidence masks an increase in distant stage diagnoses since around 2010 across age and race, although improved staging may have contributed to this trend.32 The Task Force has revised their recommendation for men aged 55 to 69 years to informed decision making (Grade C) based on an updated evidence review, noting that “screening offers a small potential benefit” of reduced prostate cancer mortality “in some men.”33-35

Table 5. Trends in Delay-Adjusted Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2015
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2006-2015 2011-2015
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC
All sites
Overall 1975-1989 1.2* 1989-1992 2.8 1992-1995 −2.4 1995-1998 1.1 1998-2009 −0.3* 2009-2015 −1.2* −0.9* −1.2*
Male 1975-1989 1.3* 1989-1992 5.2* 1992-1995 −4.9* 1995-1999 0.6 1999-2008 −0.6* 2008-2015 −2.3* −1.9* −2.3*
Female 1975-1979 −0.3 1979-1987 1.6* 1987-1995 0.1 1995-1998 1.5 1998-2003 −0.6 2003-2015 0.1 0.1 0.1
Female breast 1975-1980 −0.5 1980-1987 4.0* 1987-1994 −0.2 1994-1999 1.8* 1999-2004 −2.3* 2004-2015 0.4* 0.4* 0.4*
Colorectum
Male 1975-1985 1.1* 1985-1991 −1.2* 1991-1995 −3.2* 1995-1998 2.1 1998-2015 −2.9* −2.9* −2.9*
Female 1975-1985 0.3 1985-1995 −1.9* 1995-1998 1.8 1998-2008 −2.0* 2008-2011 −4.6* 2011-2015 −0.9 −2.4* −0.9
Liver & intrahepatic bile duct
Male 1975-1984 2.2* 1984-2011 3.9* 2011-2015 1.0 2.6* 1.0
Female 1975-1983 0.4 1983-1998 4.4* 1998-2001 −0.4 2001-2015 3.4* 3.4* 3.4*
Lung & bronchus
Male 1975-1982 1.5* 1982-1991 −0.5* 1991-2008 −1.7* 2008-2015 −2.9* −2.6* −2.9*
Female 1975-1982 5.6* 1982-1991 3.4* 1991-2006 0.5* 2006-2015 −1.5* −1.5* −1.5*
Melanoma of skin
Male 1975-1986 5.4* 1986-2005 3.1* 2005-2015 1.8* 1.8* 1.8*
Female 1975-1980 5.5* 1980-2009 2.4* 2009-2012 −1.3 2012-2015 5.4* 2.1 3.7*
Pancreas
Male 1975-1981 −1.8* 1981-1985 1.2 1985-1990 −2.2* 1990-2003 0.2 2003-2006 3.1 2006-2015 0.3 0.3 0.3
Female 1975-1984 1.4* 1984-1996 −0.5 1996-2015 1.0* 1.0* 1.0*
Prostate 1975-1988 2.6* 1988-1992 16.5* 1992-1995 −11.5* 1995-2000 2.2 2000-2009 −1.6* 2009-2015 −7.4* −5.5* −7.4*
Thyroid
Male 1975-1980 −4.6 1980-1997 1.8* 1997-2012 5.5* 2012-2015 −1.1 3.2* 0.5
Female 1975-1977 6.5 1977-1980 −5.2 1980-1993 2.3* 1993-1999 4.4* 1999-2009 7.1* 2009-2015 1.2* 3.1* 1.2*
Uterine corpus 1975-1979 −6.0* 1979-1988 −1.7* 1988-1997 0.7* 1997-2006 −0.4* 2006-2009 3.5* 2009-2015 0.3 1.3* 0.3
  • AAPC indicates average annual percent change; APC, annual percent change based on delay-adjusted incidence rates age adjusted to the 2000 US standard population.
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.6, allowing up to 5 joinpoints. Trends are based on Surveillance, Epidemiology, and End Results (SEER) 9 areas.
  • * The APC or AAPC is significantly different from zero (P < .05).

The overall cancer incidence rate in women has remained generally stable over the past few decades. Declines have continued for lung cancer, but tapered in recent years for CRC, whereas rates for other common cancers are increasing or stable (Table 5). Breast cancer incidence rates increased from 2006 to 2015 by approximately 0.3% to 0.4% per year among non-Hispanic white (NHW) and Hispanic women, by 0.7% to 0.8% per year among black (non-Hispanic) and American Indian/Alaska Native women, and by 1.8% per year among Asian/Pacific Islander women.36 This trend may in part be a consequence of the obesity epidemic, as well as declining parity.37, 38

Lung cancer incidence continues to decline 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.39, 40 However, smoking patterns do not appear to explain the higher lung cancer incidence rates recently reported in young women compared with men born around the 1960s.41 In contrast, CRC incidence patterns are generally similar in men and women (Fig. 3), although in the past 5 data years rates have continued to decline by approximately 3% per year in men, but appear to have stabilized in women (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.42 However, more recent rapid declines are thought to primarily reflect the increased uptake of colonoscopy, which now is the predominant screening test.43, 44 Colonoscopy use among US adults aged 50 years and older tripled from 21% in 2000 to 60% in 2015.45 The rapid declines in overall CRC incidence rates mask an increase in adults aged younger than 55 years of almost 2% per year since the mid-1990s.7

Incidence rates continue to increase for melanoma and cancers of the liver, thyroid, uterine corpus, and pancreas. Liver cancer incidence is rising faster than that for any other cancer in both men and women.38 Notably, however, the majority (71%) of cases in the United States are potentially preventable because most risk factors are modifiable (eg, obesity, excess alcohol consumption, cigarette smoking, and hepatitis B and C viruses).46 Approximately 24% of cases are caused by chronic hepatitis C virus (HCV) infection, which confers the largest relative risk and is also the most common chronic blood-borne infection in the United States.47 Although there is exciting potential to avert much of the future burden of HCV-associated disease because of new, well-tolerated, antiviral therapies that achieve cure rates of greater than 90%,48 most infected individuals are undiagnosed. One-time screening has been recommended for baby boomers (those born between 1945 and 1965), who account for three-fourths of affected individuals,49, 50 since 2012 and is now even mandated in several states.51 However, only 14% of the more than 76 million boomers reported having received HCV testing in 2015.52 Compounding the challenge is a 3-fold spike in acute HCV infections reported to the CDC from 2010 through 2016, after a decade of stable/declining rates, that is attributed to the opioid epidemic.53, 54 Fewer than 10% of new infections are reported and the CDC estimates the actual number of acute infections in 2016 to be 41,200 (95% confidence interval, 32,600-140,600), approximately 75% to 85% of which will progress to chronic infection.

Cancer Survival

The 5-year relative survival rate for all cancers combined diagnosed during 2008 through 2014 was 67% in whites and 62% in blacks.10 Figure 4 shows 5-year relative survival rates by cancer type, stage at diagnosis, and race. For all stages combined, survival is highest for prostate cancer (98%), melanoma of the skin (92%), and female breast cancer (90%) and lowest for cancers of the pancreas (9%), liver (18%), esophagus (19%), and lung (19%). Black patients have lower survival rates than whites for every cancer type shown in Figure 4 except for cancers of the kidney and pancreas, with the absolute difference being 10% or higher for most. The largest disparities are for melanoma (26%) and cancers of the uterine corpus (21%) and oral cavity and pharynx (18%), in part reflecting a much later stage at diagnosis in black patients (Fig. 5). However, blacks 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.55 The disparity is even larger 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, 2008 to 2014. *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 95% in all races, 95% in whites, and 91% in blacks.
Details are in the caption following the image
Stage Distribution for Selected Cancers by Race, United States, 2008 to 2014. Stage categories do not sum to 100% because sufficient information was not available to stage all cases.

Cancer survival has improved since the mid-1970s for all of the most common cancers except those of the uterine cervix and uterine corpus,55 although for some cancer types (eg, breast and prostate) this partly reflects lead time bias because of changes in detection practice. 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 69% for those diagnosed during 2008 through 2014,10 and most patients treated with tyrosine kinase inhibitors experience nearly normal life expectancy.56

In contrast to the steady increase in survival for most cancer types, advances have been slow for lung and pancreatic cancers, partly because greater than one-half of cases are diagnosed at a distant stage (Fig. 5). There is a potential for earlier lung cancer diagnosis through screening with low-dose computed tomography, which has demonstrated a 20% reduction in lung cancer mortality in current/former smokers with a history of 30 or more pack-years.57 However, the translation of this benefit from clinical trial participants to the general population remains challenging. In 2015, only 4% of the 6.8 million eligible Americans reported being screened for lung cancer with low-dose computed tomography.58 Another study found that more individuals who did not meet guideline-recommended criteria for lung cancer screening had received a recent test than those who did meet criteria.59 Broad implementation of guideline-recommended lung cancer screening will require new systems to facilitate unique aspects of the process, such as identifying eligible patients and acquainting physicians with information that should be delivered during the shared decision-making conversation, which is recommended by the American Cancer Society and US Preventive Services Task Force and required by the Centers for Medicare and Medicaid Services. A recent small study suggests stark failure in the practice of shared decision making by primary care and pulmonary physicians.60

Trends in Cancer Mortality

Mortality rates are a better indicator of progress against cancer than incidence or survival rates because they are less affected by biases resulting from changes in detection practices.61 The 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. However, since its peak of 215.1 deaths (per 100,000 population) in 1991, the cancer death rate has dropped steadily by approximately 1.5% per year, resulting in an overall decline of 27% as of 2016 (156.0 per 100,000 population). This translates to an estimated 2,629,200 fewer cancer deaths (1,804,000 in men and 825,200 in women) than what would have occurred if mortality rates had remained at their peak (Fig. 6). The number of averted deaths is larger for men than for women because the total decline in cancer mortality has been steeper for men (34% vs 24%).

Details are in the caption following the image
Total Number of Cancer Deaths Averted From 1991 to 2016 in Men and From 1992 to 2016 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, which are reflected in the rapid declines for the 4 major cancers (lung, breast, prostate, and colorectum) (Fig. 7). Specifically, the death rate for lung cancer dropped by 48% from 1990 to 2016 among males and by 23% from 2002 to 2016 among females, whereas the death rate for breast cancer dropped by 40% from 1989 to 2016, that for prostate cancer dropped by 51% from 1993 to 2016, and that for CRC dropped by 53% from 1970 to 2016. During the most recent data years, declines in mortality from lung cancer have accelerated whereas those for CRC have slowed (Table 6). Prostate cancer mortality stabilized during 2013 through 2016 after 2 decades of steep (4% per year) reductions that are attributed to an earlier stage at diagnosis due to PSA testing and advances in treatments.62, 63 The leveling of rates is temporally associated with both declines in PSA testing and an uptick in distant stage disease diagnoses.32 Death rates rose from 2012 through 2016 for cancers of the liver, pancreas, and uterine corpus (Table 6), as well as for cancers of the brain and other nervous system, soft tissue (including heart), and sites within the oral cavity and pharynx associated with the human papillomavirus (HPV).1

Details are in the caption following the image
Trends in Cancer Mortality Rates by Sex Overall and for Selected Cancers, United States, 1930 to 2016. 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.
Table 6. Trends in Mortality Rates for Selected Cancers by Sex, United States, 1975 to 2016
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 2007-2016 2012-2016
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC AAPC AAPC
All sites
Overall 1975-1984 0.5a 1984-1991 0.3a 1991-1994 −0.5 1994-1998 −1.3a 1998-2001 −0.8a 2001-2016 −1.5a −1.5a −1.5a
Male 1975-1979 1.0a 1979-1990 0.3a 1990-1993 −0.5 1993-2001 −1.5a 2001-2016 −1.8a −1.8a −1.8a
Female 1975-1990 0.6a 1990-1994 −0.2 1994-2002 −0.8a 2002-2016 −1.4a −1.4a −1.4a
Female breast 1975-1990 0.4a 1990-1995 −1.7a 1995-1998 −3.4a 1998-2016 −1.8a −1.8a −1.8a
Colorectum
Male 1975-1979 0.6 1979-1987 −0.0a 1987-2002 −1.9a 2002-2005 −4.2a 2005-2016 −2.4* −2.4a −2.4a
Female 1975-1984 −1.0a 1984-2001 −1.8a 2001-2012 −2.9a 2012-2016 −1.5a −2.3a −1.5a
Liver & intrahepatic bile duct
Male 1975-1985 1.5a 1985-1996 3.8a 1996-1999 0.3 1999-2013 2.7a 2013-2016 0.7 2.0a 1.2a
Female 1975-1978 −1.5 1978-1988 1.4a 1988-1995 3.9a 1995-2000 0.4 2000-2008 1.6a 2008-2016 2.6a 2.5a 2.6a
Lung & bronchus
Male 1975-1978 2.4a 1978-1984 1.2a 1984-1991 0.3a 1991-2005 −1.9a 2005-2012 −2.9a 2012-2016 −4.3a −3.5a −4.3a
Female 1975-1983 5.9a 1983-1992 3.8a 1992-2002 0.5a 2002-2007 −0.7a 2007-2014 −2.0a 2014-2016 −4.2a −2.5a −3.1a
Melanoma of skin
Male 1975-1989 2.3a 1989-2013 0.3a 2013-2016 −6.9a −2.2a −5.2a
Female 1975-1988 0.8a 1988-2014 −0.6a 2014-2016 −9.3a −2.6a −5.0a
Pancreas
Male 1975-1986 −0.8a 1986-2000 −0.3a 2000-2016 0.3a 0.3a 0.3a
Female 1975-1984 0.8a 1984-2003 0.1 2003-2006 1.0 2006-2016 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 2013-2016 −0.0 −2.3a −0.9
Uterine corpus 1975-1993 −1.5a 1993-2008 0.1 2008-2016 2.1a 1.9a 2.1a
  • AAPC indicates average annual percent change; APC, annual percent change based on mortality rates age adjusted to the 2000 US standard population.
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.6, allowing up to 5 joinpoints.
  • a The APC or AAPC is significantly different from zero (P <.05).

Recorded Number of Deaths in 2016

A total of 2,744,248 deaths were recorded in the United States in 2016, 22% of which were from cancer (Table 7). 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 states,64 in Hispanic and Asian Americans,65, 66 and in people younger than 80 years. However, those 80 years and older are nearly 2 times more likely to die from heart disease than from cancer. Among females, cancer is the first or second leading cause of death for every age group shown in Table 8, whereas among males, accidents, assault, and suicide predominate before age 40 years.

Table 7. Ten Leading Causes of Death in the United States, 2015 and 2016
2015 2016 RELATIVE CHANGE IN RATE
NO. PERCENT RATE NO. PERCENT RATE
RANK (2016) All causes 2,712,630 733.0 2,744,248 729.1 −0.5%
1 Heart disease 633,842 23% 168.3 635,260 23% 165.5 −1.7%
2 Cancer 595,930 22% 158.7 598,038 22% 156.0 −1.7%
3 Accidents (unintentional injuries) 146,571 5% 43.1 161,374 6% 47.3 9.7%
4 Chronic lower respiratory diseases 155,041 6% 41.8 154,596 6% 40.8 −2.4%
5 Cerebrovascular disease 140,323 5% 37.6 142,142 5% 37.4 −0.5%
6 Alzheimer disease 110,561 4% 29.4 116,103 4% 30.3 3.1%
7 Diabetes mellitus 79,535 3% 21.3 80,058 3% 21.0 −1.4%
8 Influenza and pneumonia 57,062 2% 15.2 51,537 2% 13.6 −10.5%
9 Nephritis, nephrotic syndrome, & nephrosis 49,959 2% 13.4 50,046 2% 13.2 −1.5%
10 Intentional self-harm (suicide) 44,193 2% 13.3 44,965 2% 13.4 0.8%
  • Death counts include unknown age.
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population. Rank is based on number of deaths.
  • 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, 2016
ALL AGES AGES 1 TO 19 AGES 20 TO 39 AGES 40 TO 59 AGES 60 TO 79 AGES ≥80
MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes All Causes
1,400,232 1,344,016 13,110 7,250 79,366 35,290 230,142 148,035 573,327 437,947 491,323 705,160
1 Heart disease Heart disease Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Heart disease Cancer Cancer Cancer Heart disease Heart disease
339,265 295,995 4,674 2,373 33,073 11,808 52,128 48,075 172,243 140,971 141,049 188,116
2 Cancer Cancer Assault (homicide) Cancer Intentional self-harm (suicide) Cancer Cancer Heart disease Heart disease Heart disease Cancer Cancer
314,571 283,467 1,886 789 11,593 4,653 49,227 22,669 140,213 82,175 87,954 88,944
3 Accidents (unintentional injuries) Cerebro-vascular disease Intentional self-harm (suicide) Intentional self-harm (suicide) Assault (homicide) Intentional self-harm (suicide) Accidents (unintentional injuries) Accidents (unintentional injuries) Chronic lower respiratory diseases Chronic lower respiratory diseases Chronic lower respiratory diseases Alzheimer disease
103,864 82,787 1,873 687 9,042 2,976 31,493 14,091 37,398 36,278 29,525 69,826
4 Chronic lower respiratory diseases Chronic lower respiratory diseases Cancer Assault (homicide) Heart disease Heart disease Intentional self-harm (suicide) Chronic lower respiratory diseases Cerebro-vascular disease Cerebro-vascular disease Cerebro-vascular disease Cerebro-vascular disease
73,045 81,551 1,064 555 5,362 2,621 12,002 6,166 23,494 21,359 28,254 55,642
5 Cerebro-vascular disease Alzheimer disease Congenital anomalies Congenital anomalies Cancer Assault (homicide) Chronic liver disease & cirrhosis Chronic liver disease & cirrhosis Diabetes mellitus Diabetes mellitus Alzheimer disease Chronic lower respiratory diseases
59,355 80,731 519 460 4,044 1,610 11,157 5,823 22,078 15,952 27,841 38,684
6 Diabetes mellitus Accidents (unintentional injuries) Heart disease Heart disease Chronic liver disease & cirrhosis Pregnancy, childbirth & puerperium Diabetes mellitus Cerebro-vascular disease Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries)
43,763 57,510 341 258 1,255 864 8,545 5,075 19,864 10,771 14,032 17,948
7 Alzheimer disease Diabetes mellitus Chronic lower respiratory diseases Influenza & pneumonia Diabetes mellitus Chronic liver disease & cirrhosis Cerebro-vascular disease Diabetes mellitus Chronic liver disease & cirrhosis Alzheimer disease Influenza & pneumonia Influenza & pneumonia
35,372 36,295 169 111 1,029 818 6,621 5,039 11,656 10,667 12,434 16,333
8 Intentional self-harm (suicide) Influenza & pneumonia Influenza & pneumonia Chronic lower respiratory diseases Cerebro-vascular disease Diabetes mellitus Chronic lower respiratory diseases Intentional self-harm (suicide) Nephritis, nephrotic syndrome & nephrosis Nephritis, nephrotic syndrome & nephrosis Diabetes mellitus Diabetes mellitus
34,727 26,526 133 105 784 722 5,517 4,243 10,604 9,076 12,062 14,541
9 Chronic liver disease & cirrhosis Nephritis, nephrotic syndrome & nephrosis Cerebro-vascular disease Septicemia HIV disease Cerebro-vascular disease Assault (homicide) Septicemia Influenza & pneumonia Septicemia Nephritis, nephrotic syndrome & nephrosis Nephritis, nephrotic syndrome & nephrosis
25,818 24,647 120 87 727 576 3,373 2,586 9,197 8,294 11,596 13,191
10 Nephritis, nephrotic syndrome & nephrosis Septicemia Septicemia Cerebro-vascular disease Influenza & pneumonia Influenza & pneumonia Septicemia Influenza & pneumonia Septicemia Influenza & pneumonia Parkinson disease Hypertension & hypertensive renal diseasea
25,399 20,935 96 85 519 422 3,012 2,140 8,875 7,460 11,342 12,241
  • HIV indicates human immunodeficiency virus.
  • 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, 2016, National Center for Health Statistics, Centers for Disease Control and Prevention, 2018.
  • a Includes primary and secondary hypertension.

Table 9 presents the number of deaths in 2016 for the 5 leading cancer types by age and sex. Brain and other nervous system tumors are the leading cause of cancer death among men aged younger than 40 years and women aged younger than 20 years, whereas breast cancer leads among women aged 20 to 59 years. Lung cancer leads in cancer deaths among men aged 40 years and older and women aged 60 years and older, causing more deaths in 2016 than breast cancer, prostate cancer, CRC, and leukemia combined. There were approximately 20% more lung cancer deaths in men (80,775) than in women (68,095) in 2016, but this pattern is projected to reverse by 2045 if current smoking trends continue.67 Cervical cancer continues to be the second leading cause of cancer death in women aged 20 to 39 years, causing 9 deaths per week in this age group. This finding underscores the need for increased HPV vaccination uptake in adolescents and guideline-adherent screening in young women. Notably, the percentage of women aged 22 to 30 years who had never been screened for cervical cancer increased between 2000 and 2010.68 In addition, an estimated 14 million screening-aged women (ages 21-65 years) had not been tested in the past 3 years in 2015.69

Table 9. Five Leading Causes of Cancer Death by Age and Sex, United States, 2016
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
314,571 1,100 4,044 49,227 172,243 87,954
Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus
80,775 314 538 11,588 49,877 19,095
Prostate Leukemia Leukemia Colorectum Colorectum Prostate
30,370 280 526 5,888 14,010 15,535
Colorectum Bones & joints Colorectum Liver* Prostate Colorectum
27,642 120 487 4,001 13,447 7,250
Pancreas Soft tissue (including heart) Non-Hodgkin lymphoma Pancreas Pancreas Urinary bladder
21,899 87 237 3,747 12,926 5,621
Liver* Non-Hodgkin lymphoma Soft tissue (including heart) Brain & ONS Liver* Pancreas
17,843 42 232 2,562 10,961 5,099
FEMALE
ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES ALL SITES
283,467 820 4,653 48,075 140,971 88,944
Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus
68,095 238 1,158 10,405 39,029 19,199
Breast Leukemia Uterine cervix Lung & bronchus Breast Breast
41,488 219 469 9,676 18,922 11,002
Colorectum Bone & joints Colorectum Colorectum Pancreas Colorectum
24,644 80 417 4,328 10,971 9,637
Pancreas Soft tissue (including heart) Brain & ONS Ovary Colorectum Pancreas
20,858 80 371 2,777 10,259 7,074
Ovary Liver* Leukemia Pancreas Ovary Leukemia
14,223 28 342 2,725 7,669 4,135
  • ONS indicates other nervous system.
  • Note: Ranking order excludes category titles that begin with the word “Other.”
  • * Includes intrahepatic bile duct.

Cancer Disparities by Socioeconomic Status

Lower socioeconomic status (SES), whether measured at the individual or area level, is associated with numerous health disadvantages and higher mortality across race and ethnicity.70-72 A recent study estimated that approximately one-third (34%) of cancer deaths in Americans aged 25 to 74 years could be averted with the elimination of socioeconomic disparities.72 Notably, socioeconomic deprivation was associated with lower cancer mortality prior to the mid-1980s because of the later development of effective treatment and the historically elevated risk of lung and colorectal cancers among individuals with high SES.73, 74

County-level SES indicators only indirectly reflect individual SES, but are valuable because the county is the smallest geographic unit for which policy is legislated. In addition, county-level indicators potentially capture some of the complex environmental influences on health. Figure 8 depicts the distribution of county-level poverty by quintile across the United States during 2012-2016, when the overall cancer death rate was approximately 20% higher among residents of the poorest compared with the most affluent counties. Socioeconomic inequalities in cancer mortality widened over the past 3 decades overall, but there is substantial variation by cancer type. Consistent with socioeconomic inequalities for cancer incidence,75 the largest gaps are for the most preventable cancers. For example, cervical cancer mortality among women in poor counties is twice that of women in affluent counties, and lung and liver cancer mortality among men is >40% higher (Table 10). The most striking socioeconomic shift occurred for CRC mortality; rates in men in the poorest counties were approximately 20% lower than those in affluent counties in the early 1970s, but are now 35% higher (Fig. 9). This reversal reflects changes in dietary and smoking patterns that influence CRC risk,73 as well as the slower dissemination of screening and treatment advances among disadvantaged populations.76 A similar crossover occurred earlier for male lung cancer mortality because historically, men of higher SES were much more likely to smoke.73

Details are in the caption following the image
County-Level Poverty (in Percentage) in the United States, 2012 to 2016.
Table 10. Change in Cancer Mortality Rates by County-Level Poverty, 1970 to 1974 Versus 2012 to 2016
1970 TO 1974 2012 TO 2016
RATE RATIO (95% CI) RATE RATIO (95% CI)
POOR AFFLUENT POOR VS AFFLUENT POOR AFFLUENT POOR VS AFFLUENT
All cancers
Both sexes 199.7 198.8 1.00 (1.00-1.01) 176.7 149.7 1.18 (1.18-1.19)
Male 259.0 250.4 1.03 (1.03-1.04) 217.5 177.3 1.23 (1.22-1.23)
Female 157.5 164.4 0.96 (0.95-0.97) 147.6 130.2 1.13 (1.13-1.14)
Brain & ONS
Both sexes 3.7 4.1 0.90 (0.86-0.93) 4.0 4.6 0.89 (0.86-0.91)
Male 4.6 4.9 0.93 (0.88-0.97) 4.9 5.6 0.87 (0.84-0.91)
Female 3.0 3.4 0.87 (0.82-0.92) 3.4 3.7 0.91 (0.87-0.95)
Breast (female)
All races 29.0 34.0 0.85 (0.84-0.87) 22.5 19.5 1.16 (1.14-1.17)
White 28.8 34.4 0.84 (0.82-0.85) 20.9 19.7 1.06 (1.04-1.09)
Black 30.1 30.8 0.97 (0.90-1.05) 28.8 25.7 1.12 (1.08-1.16)
Colorectum
Both sexes 25.5 30.9 0.83 (0.81-0.84) 16.5 12.7 1.30 (1.28-1.32)
Male 28.6 35.6 0.81 (0.79-0.82) 20.2 14.9 1.35 (1.33-1.38)
Female 23.3 27.8 0.84 (0.82-0.86) 13.6 10.9 1.25 (1.23-1.28)
Esophagus
Both sexes 3.9 3.3 1.19 (1.14-1.24) 4.0 3.9 1.02 (0.99-1.04)
Male 6.7 5.5 1.20 (1.14-1.26) 7.1 6.9 1.03 (1.00-1.06)
Female 1.8 1.6 1.15 (1.06-1.25) 1.5 1.5 0.99 (0.93-1.05)
Leukemia
Both sexes 8.1 8.3 0.97 (0.94-1.00) 6.4 6.4 1.00 (0.97-1.02)
Male 10.5 11.1 0.94 (0.91-0.98) 8.6 8.7 0.99 (0.97-1.02)
Female 6.3 6.4 0.99 (0.95-1.04) 4.8 4.8 1.00 (0.97-1.04)
Liver & intrahepatic bile duct
Both sexes 3.5 2.8 1.27 (1.21-1.33) 7.7 5.6 1.37 (1.35-1.40)
Male 4.8 3.8 1.29 (1.21-1.37) 11.5 8.2 1.41 (1.37-1.44)
Female 2.5 2.0 1.22 (1.13-1.31) 4.5 3.5 1.31 (1.27-1.36)
Lung & bronchus
Both sexes 41.2 37.3 1.11 (1.09-1.12) 47.7 37.2 1.28 (1.27-1.29)
Male 76.3 66.8 1.14 (1.13-1.16) 63.0 44.2 1.42 (1.41-1.44)
Female 14.2 14.7 0.96 (0.94-0.99) 36.1 32.0 1.13 (1.12-1.14)
Myeloma
Both sexes 2.8 2.8 1.00 (0.96-1.05) 3.7 3.1 1.17 (1.14-1.21)
Male 3.4 3.4 1.00 (0.93-1.07) 4.6 4.0 1.14 (1.09-1.19)
Female 2.3 2.3 1.01 (0.94-1.08) 3.0 2.5 1.22 (1.17-1.28)
Non-Hodgkin lymphoma
Both sexes 4.9 6.0 0.83 (0.80-0.85) 5.6 5.5 1.02 (1.00-1.05)
Male 6.2 7.3 0.85 (0.81-0.89) 7.2 7.1 1.02 (0.98-1.05)
Female 4.0 5.0 0.80 (0.76-0.84) 4.4 4.2 1.03 (0.99-1.06)
Ovary
All races 9.0 10.6 0.84 (0.81-0.87) 7.0 7.0 1.00 (0.97-1.03)
White 9.3 10.8 0.86 (0.83-0.90) 7.3 7.3 1.00 (0.97-1.04)
Black 7.6 8.5 0.89 (0.77-1.04) 6.4 6.1 1.05 (0.97-1.14)
Pancreas
Both sexes 10.8 10.5 1.03 (1.01-1.06) 11.4 10.8 1.06 (1.04-1.07)
Male 14.3 13.3 1.07 (1.04-1.11) 13.0 12.5 1.04 (1.02-1.07)
Female 8.3 8.4 0.98 (0.95-1.02) 10.1 9.4 1.07 (1.05-1.10)
Prostate
All races 32.6 30.2 1.08 (1.05-1.11) 22.5 17.9 1.26 (1.23-1.28)
White 28.1 29.9 0.94 (0.91-0.97) 18.2 17.7 1.03 (1.00-1.05)
Black 51.4 52.8 0.97 (0.90-1.06) 42.9 33.7 1.27 (1.21-1.34)
Urinary bladder
Both sexes 5.2 5.9 0.87 (0.84-0.91) 4.2 4.3 0.96 (0.94-0.99)
Male 8.5 10.4 0.82 (0.78-0.86) 7.2 7.6 0.95 (0.92-0.98)
Female 2.9 3.0 0.97 (0.91-1.04) 2.2 2.1 1.03 (0.98-1.08)
Uterine corpus
All races 5.9 5.5 1.08 (1.04-1.13) 5.3 4.6 1.15 (1.11-1.19)
White 5.2 5.4 0.96 (0.92-1.01) 4.3 4.5 0.96 (0.92-1.00)
Black 9.0 8.6 1.04 (0.90-1.22) 8.9 8.2 1.08 (1.01-1.16)
Uterine cervix
All races 8.9 5.1 1.73 (1.66-1.80) 3.2 1.6 2.00 (1.90-2.10)
White 6.7 4.9 1.36 (1.30-1.43) 2.9 1.6 1.86 (1.75-1.98)
Black 16.9 12.4 1.37 (1.22-1.54) 4.3 2.4 1.76 (1.57-1.99)
  • 95% CI indicates 95% confidence interval; ONS, other nervous system.
  • "Poor" and "affluent" refer to extreme county-level poverty categories: 21.18% to 53.95% and 1.81% to 10.84%, respectively.
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population. Rate ratio is the unrounded rate in poor counties divided by the corresponding unrounded rate in affluent counties.
Details are in the caption following the image
Cancer Mortality Rates by County-Level Poverty, United States, 1970 to 2016. Rates are per 100,000 population and are age adjusted to the 2000 US standard population. County-level poverty was derived from the 2012 to 2016 American Community Survey. “Poor” and “affluent” refer to extreme county-level poverty categories: 21.18% to 53.95% and 1.81% to 10.84%, respectively.

In contemporary times, the prevalence of behaviors that increase cancer incidence and mortality are vastly higher among residents of the poorest counties, including double the prevalence of smoking and obesity compared to residents of the wealthiest counties.70 Poverty is also associated with lower cancer screening prevalence,77 later stage diagnosis,78 and a lower likelihood of optimal treatment. Although lack of health care capacity in economically challenged areas likely contributes to these disparities, some states are home to both the poorest and most affluent counties, suggesting an opportunity for improvement in the distribution of services. Increasing access to care weakens the link between SES and health.79 Numerous states have reduced inequalities through various strategies that removed barriers to prevention, early detection, and treatment.80-82

Socioeconomic inequalities in cancer mortality are small or absent for malignancies that are less amenable to prevention or treatment. For example, mortality for leukemia and non-Hodgkin lymphoma was equivalent across poverty levels, despite a higher incidence in more affluent counties,75 likely reflecting survival disparities.83-85 Inferior survival among those with low SES is predominantly driven by a later stage of disease at diagnosis and less aggressive treatment.86 Disparities are also minimal or nonexistent for pancreatic and ovarian cancers, for which early detection is lacking and even optimal treatment has a nominal influence on survival. The inequality for prostate cancer mortality was largely confined to black men, even after accounting for Hispanic ethnicity among whites (data not shown). This finding is consistent with previous studies showing a stronger association between SES and prostate cancer mortality among blacks.87, 88 The slight excess mortality for brain/other nervous system tumors and urinary bladder cancer in affluent counties is in agreement with incidence studies and may partly reflect detection bias.75, 89

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,90, 91 as discussed in the previous section. Cancer incidence and mortality are generally highest among non-Hispanic blacks (NHBs) and lowest among Asian/Pacific Islanders (Table 11). The overall cancer incidence rate in NHB men during 2011 through 2015 was 84% higher than that in Asian/Pacific Islander men and 9% higher than that in NHW men. Notably, NHB women had 7% lower cancer incidence than NHW women (because of lower rates of breast and lung cancer), but 13% higher cancer mortality. In men and women combined, the black-white disparity in overall cancer mortality has declined from a peak of 33% in 1993 (279.0 vs 210.5 per 100,000 population) to 14% in 2016 (183.6 vs 160.7 per 100,000 population). This progress is largely due to the steep drop in smoking prevalence unique among black teens from the late 1970s through the early 1990s.92

Table 11. Incidence and Mortality Rates for Selected Cancers by Race and Ethnicity, United States, 2011 to 2016
ALL RACES COMBINED NON-HISPANIC WHITE NON-HISPANIC BLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ ALASKA NATIVE * HISPANIC
Incidence, 2011-2015
All sites 449.8 465.3 463.9 291.7 398.5 346.6
Male 494.8 505.5 549.1 298.9 418.4 377.6
Female 419.3 438.4 407.0 290.3 386.9 329.9
Breast (female) 124.7 130.1 126.5 92.9 100.9 93.0
Colon & rectum 39.3 39.0 46.6 30.7 44.4 34.4
Male 45.2 44.6 55.2 36.1 49.8 41.7
Female 34.3 34.2 40.7 26.4 40.1 28.8
Kidney & renal pelvis 16.4 16.6 18.4 7.8 23.2 16.2
Male 22.2 22.5 25.4 11.1 29.9 21.1
Female 11.4 11.4 13.1 5.1 17.4 12.2
Liver & intrahepatic bile duct 8.1 6.7 10.7 13.0 14.8 13.3
Male 12.5 10.3 17.6 19.9 20.9 19.7
Female 4.3 3.6 5.2 7.4 9.5 7.8
Lung & bronchus 60.5 64.7 63.8 34.9 61.5 30.7
Male 71.3 74.3 85.4 44.5 69.3 39.2
Female 52.3 57.4 49.2 27.8 55.7 24.6
Prostate 109.2 101.7 179.2 56.0 73.1 91.6
Stomach 6.6 5.4 10.3 10.5 8.4 9.7
Male 9.1 7.8 14.1 13.7 11.2 12.5
Female 4.6 3.5 7.7 8.0 6.1 7.7
Uterine cervix 7.6 7.1 9.2 6.0 9.2 9.6
Mortality, 2012-2016
All sites 161.0 165.4 190.6 100.4 148.8 113.6
Male 193.1 197.3 239.8 119.1 178.8 138.2
Female 137.7 141.8 160.4 87.0 126.8 96.4
Breast (female) 20.6 20.6 28.9 11.3 14.5 14.3
Colon & rectum 14.2 14.0 19.4 9.9 15.9 11.2
Male 16.9 16.6 24.5 11.7 19.5 14.4
Female 11.9 11.9 16.0 8.4 13.1 8.8
Kidney & renal pelvis 3.8 3.9 3.7 1.8 5.8 3.5
Male 5.5 5.7 5.6 2.7 8.2 5.0
Female 2.3 2.4 2.3 1.1 3.8 2.3
Liver & intrahepatic bile duct 6.5 5.7 8.6 9.4 10.8 9.3
Male 9.6 8.3 13.6 13.9 14.6 13.3
Female 3.9 3.4 4.8 5.8 7.5 6.0
Lung & bronchus 41.9 45.0 45.6 22.8 35.4 18.3
Male 51.6 54.1 63.9 30.3 42.7 25.3
Female 34.4 37.9 33.3 17.4 29.9 13.1
Prostate 19.2 18.1 39.8 8.6 19.1 15.9
Stomach 3.1 2.4 5.7 5.3 5.2 5.1
Male 4.2 3.3 8.4 6.8 7.0 6.5
Female 2.3 1.7 3.9 4.2 3.7 4.0
Uterine cervix 2.3 2.1 3.6 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.
  • * Data based on Indian Health Service Contract Health Service Delivery Areas (CHSDA) counties.

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 practices and the prevalence of risk factors, such as smoking, obesity, and other health behaviors. For example, up-to-date HPV vaccination coverage among adolescent (ages 13-17 years) boys and girls ranged widely in 2017, from just 29% in Mississippi to 78% in Rhode Island and the District of Columbia.93 This variation may contribute to future differential patterns in HPV-associated cancers across states.94, 95 Geographic health disparities, which have increased over time,96, 97 often reflect the national distribution of poverty.98 This trend may be exacerbated by widening inequalities in access to health care because of state/territory differences in Medicaid expansion and other initiatives to improve insurance coverage.99, 100

Table 12. Incidence Rates for Selected Cancers by State, United States, 2011 to 2015
STATE ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PROSTATE URINARY BLADDER
MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE MALE FEMALE
Alabama 518.5 392.8 120.9 51.5 37.1 89.0 51.6 19.7 13.6 123.4 33.4 7.5
Alaska 420.2 401.2 124.1 45.7 38.6 65.3 50.1 20.9 13.5 79.6 34.6 9.7
Arizona 403.6 368.6 112.9 38.6 29.1 54.7 45.0 18.3 13.3 78.6 32.3 7.9
Arkansas 520.6 401.2 114.7 50.8 37.5 98.7 61.6 20.9 14.6 115.9 34.6 7.4
California 438.2 382.2 121.6 41.5 31.8 49.2 39.0 22.6 15.2 101.2 30.5 7.2
Colorado 424.4 380.7 123.5 37.8 30.3 46.9 40.7 20.9 14.2 101.0 32.1 7.9
Connecticut 507.6 448.5 140.2 42.9 33.4 67.9 56.2 26.1 17.3 112.8 46.6 12.0
Delaware 552.2 451.8 133.8 42.7 32.8 82.7 62.8 24.8 17.5 136.1 43.2 10.4
Dist. of Columbia* 527.8 444.3 144.6 50.1 38.7 65.4 49.5 22.6 12.9 154.1 23.2 8.5
Florida 462.2 389.9 116.0 42.3 32.1 69.3 51.9 20.9 14.5 97.4 32.9 8.1
Georgia 519.5 409.8 125.2 49.3 35.9 82.9 51.7 22.3 14.7 123.3 32.7 7.7
Hawaii 429.2 399.5 136.1 49.8 35.7 56.8 37.6 21.3 14.0 86.9 23.6 5.7
Idaho 463.0 408.6 122.2 39.6 33.2 56.2 46.5 22.4 15.7 112.2 36.4 8.9
Illinois 508.1 435.7 131.7 51.6 37.6 77.8 57.5 23.6 16.3 114.9 37.5 9.6
Indiana 485.4 423.1 121.7 48.3 38.3 88.1 61.4 22.6 16.0 92.7 37.6 9.2
Iowa 513.0 433.3 123.4 51.2 39.3 77.1 53.4 26.5 17.8 108.0 38.3 8.7
Kansas*
Kentucky 570.2 468.8 125.0 58.0 42.4 112.8 79.0 24.5 16.5 108.8 39.5 10.2
Louisiana 557.2 415.6 124.1 54.9 40.0 87.6 54.4 23.9 16.6 137.4 32.9 7.6
Maine 496.6 448.4 125.7 41.5 33.9 82.5 64.8 23.2 17.7 93.6 47.1 11.9
Maryland 488.4 418.6 131.7 42.0 33.2 65.2 51.8 20.4 14.7 125.7 37.5 9.3
Massachusetts 485.3 445.1 137.6 41.9 33.1 69.3 60.2 23.4 16.3 106.4 40.4 11.2
Michigan 492.8 419.7 123.4 42.8 33.5 75.2 58.5 24.1 16.6 117.6 38.6 10.0
Minnesota* 507.5 438.7 131.5 43.0 34.1 61.6 50.5 26.9 17.9 113.8 37.9 9.5
Mississippi 543.4 401.6 116.0 57.5 41.1 99.8 56.3 20.3 14.3 130.6 30.8 7.0
Missouri 489.7 424.0 128.2 48.8 35.9 87.9 63.9 22.7 15.3 98.0 33.9 8.4
Montana 467.4 415.3 123.2 43.8 33.0 58.6 53.7 21.8 16.4 111.1 35.8 10.2
Nebraska 493.3 415.4 124.1 49.5 37.4 70.6 50.1 24.7 16.8 114.3 36.4 8.7
Nevada* 412.2 377.7 109.4 42.5 32.7 59.0 53.8 17.2 12.6 91.7 32.7 9.2
New Hampshire 511.4 459.2 143.9 42.5 33.9 70.6 62.9 24.8 17.5 116.1 47.0 12.2
New Jersey 525.2 447.6 133.4 47.9 37.0 64.3 52.6 26.0 18.2 134.7 41.7 10.5
New Mexico* 394.1 364.3 112.4 38.2 28.9 46.1 35.6 17.2 13.6 82.4 25.8 6.3
New York 528.1 445.5 131.3 46.0 35.0 69.1 54.1 26.5 17.8 131.7 41.1 10.6
North Carolina 514.6 418.4 131.0 43.3 32.9 86.3 56.5 21.3 14.3 120.9 35.0 8.8
North Dakota 492.8 412.6 123.7 53.0 38.9 68.4 50.7 21.7 17.0 121.0 36.3 8.1
Ohio 497.9 429.5 126.2 48.3 36.4 82.7 59.4 23.1 15.6 108.0 38.7 9.3
Oklahoma 489.8 409.8 118.4 48.1 36.9 85.7 58.7 22.0 15.1 101.1 33.8 7.8
Oregon 453.8 412.4 124.9 39.8 30.4 61.3 52.4 21.8 15.6 95.4 37.1 8.9
Pennsylvania 524.3 455.2 131.0 49.5 37.0 76.5 56.3 25.9 17.9 111.1 43.2 10.9
Rhode Island 505.5 458.1 135.3 40.4 32.5 78.2 64.2 27.0 18.3 104.1 45.6 12.7
South Carolina 512.3 407.5 128.3 44.6 33.7 84.4 53.5 20.2 13.9 119.4 34.6 8.5
South Dakota 484.6 422.2 134.3 48.9 36.8 67.4 51.7 23.6 15.4 114.6 35.3 9.1
Tennessee 514.8 415.2 122.2 46.3 35.6 94.3 61.7 21.6 14.5 114.4 34.2 8.1
Texas 445.9 370.5 111.7 45.7 31.8 65.5 43.5 21.3 14.6 95.4 26.9 6.2
Utah 439.1 371.4 115.1 34.2 27.6 32.4 23.7 22.6 14.9 121.0 29.6 6.1
Vermont 472.4 434.8 130.4 38.7 33.5 69.9 58.3 26.2 18.4 92.0 37.7 10.7
Virginia 444.4 395.6 127.9 40.3 32.3 69.8 50.6 20.4 14.2 102.8 31.1 8.1
Washington 476.5 425.7 135.3 40.0 32.0 62.8 52.1 24.9 16.3 106.8 37.2 9.1
West Virginia 511.0 442.5 116.3 53.2 41.6 98.4 66.2 22.0 15.9 94.7 39.4 10.6
Wisconsin 497.0 430.7 129.7 42.6 33.1 68.0 54.1 25.5 17.2 111.6 39.7 9.9
Wyoming 428.1 375.1 112.6 39.2 27.9 46.6 43.3 19.8 13.9 103.0 36.8 9.7
Puerto Rico 404.9 319.3 93.2 52.5 35.1 24.7 12.3 17.0 12.8 146.6 16.9 4.7
United States 494.8 419.3 124.7 45.2 34.3 71.3 52.3 22.8 15.6 109.2 35.5 8.8
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population.
  • — Data unavailable.
  • * Data for these states are not included in the US combined rates because either the registry did not consent or high-quality incidence data were not available for all years during 2011 through 2015 according to the North American Association of Central Cancer Registries (NAACCR).
  • Rates are based on cases diagnosed during 2011 through 2014.
  • Data for Puerto Rico are not included in the US combined rates for comparability to previously published US rates.
Table 13. Mortality Rates for Selected Cancers by State, United States, 2012 to 2016
STATE ALL SITES BREAST COLORECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PANCREAS PROSTATE
MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE
Alabama 226.0 144.9 21.8 19.8 13.0 70.7 37.7 6.9 4.4 13.4 9.9 21.7
Alaska 189.5 145.9 19.6 17.2 14.1 50.7 37.9 6.4 4.1 11.2 11.1 18.3
Arizona 167.8 122.8 19.3 15.1 10.6 39.7 29.2 6.3 4.0 11.8 8.8 17.7
Arkansas 229.4 151.5 21.6 20.5 13.7 75.5 43.0 7.2 4.3 12.4 9.6 19.3
California 171.0 126.5 19.8 15.1 11.1 36.4 26.4 6.8 4.2 11.8 9.1 19.7
Colorado 162.6 120.8 19.0 14.0 10.5 32.4 26.7 6.4 3.7 10.8 8.2 21.4
Connecticut 175.3 128.4 18.1 13.5 10.0 42.0 32.0 7.1 4.1 12.1 9.7 17.7
Delaware 202.1 145.9 21.4 16.6 10.7 57.1 39.8 8.3 4.7 14.2 9.7 17.5
Dist. of Columbia 200.2 155.6 28.3 18.4 13.5 44.3 30.7 6.3 3.3 15.8 11.8 31.0
Florida 182.0 128.5 19.4 15.7 11.0 49.7 33.2 6.8 4.1 12.2 8.9 16.7
Georgia 206.6 137.0 21.9 19.1 12.1 59.8 33.3 7.0 4.1 12.7 9.1 22.2
Hawaii 162.3 113.0 16.2 15.7 10.6 39.6 23.9 6.3 3.5 12.4 9.9 13.9
Idaho 180.1 132.7 20.4 15.4 10.9 40.1 30.1 7.7 5.1 12.9 9.5 23.2
Illinois 203.0 146.7 21.9 18.7 12.8 55.2 37.6 7.4 4.4 13.0 9.6 20.4
Indiana 217.8 150.2 21.1 18.2 13.1 66.7 41.6 8.4 4.9 13.4 9.7 20.0
Iowa 200.9 139.7 19.1 17.4 13.1 55.7 35.9 8.4 4.8 12.9 9.5 19.6
Kansas 194.4 141.7 20.3 17.5 12.4 53.3 37.3 7.1 4.9 12.8 10.2 18.4
Kentucky 243.7 165.0 21.6 20.2 13.9 84.5 52.2 8.8 4.6 12.8 10.0 19.9
Louisiana 227.6 151.2 23.2 21.0 14.2 67.6 39.3 8.2 4.5 15.1 11.2 21.1
Maine 207.8 148.7 18.4 15.0 11.7 61.6 41.8 7.5 5.0 11.8 10.7 20.1
Maryland 190.7 140.0 22.2 16.9 11.9 48.6 34.3 6.8 4.1 13.6 10.0 20.2
Massachusetts 187.2 135.4 18.0 14.4 10.9 47.6 35.7 6.6 4.2 12.8 9.9 18.7
Michigan 202.4 147.8 21.3 16.8 12.1 56.6 39.8 8.4 4.9 13.5 10.6 19.0
Minnesota 181.2 132.8 18.1 14.4 11.2 44.0 33.3 7.9 4.7 12.5 9.2 19.5
Mississippi 245.5 155.8 23.4 23.1 15.3 78.3 39.9 7.1 4.0 15.6 11.2 24.7
Missouri 210.8 150.2 21.7 18.2 12.7 65.1 43.2 7.0 4.2 12.8 9.7 17.8
Montana 176.5 135.4 20.0 16.2 11.1 41.5 36.1 7.0 4.3 10.9 9.3 21.0
Nebraska 190.1 136.9 20.3 17.6 13.1 50.4 34.3 7.4 4.3 12.8 9.3 18.9
Nevada 184.3 142.9 21.9 19.4 14.0 47.6 39.6 6.5 3.8 11.4 9.0 20.2
New Hampshire 192.0 141.1 19.5 13.9 11.9 50.3 39.9 7.1 4.5 12.3 9.0 19.3
New Jersey 181.4 136.9 21.8 17.5 12.2 43.6 32.0 7.3 4.2 12.6 10.1 18.2
New Mexico 170.4 122.6 18.8 16.5 10.9 35.1 25.7 5.8 4.0 10.9 8.5 19.8
New York 180.5 133.8 19.9 15.9 11.5 45.6 31.7 7.1 4.2 12.9 9.9 18.3
North Carolina 206.0 138.9 20.9 16.7 11.5 62.4 36.5 7.1 4.2 12.9 9.5 20.3
North Dakota 178.8 128.0 17.5 16.2 11.9 47.3 31.2 6.8 4.7 11.3 8.4 17.8
Ohio 212.9 151.9 22.5 18.9 13.2 62.7 41.1 8.0 4.8 13.2 10.4 19.0
Oklahoma 221.5 154.6 22.6 20.9 14.2 67.0 43.3 8.0 4.9 12.5 9.7 20.4
Oregon 189.4 140.9 20.4 15.6 11.4 46.1 35.9 7.9 4.6 13.2 9.7 20.8
Pennsylvania 203.6 145.0 21.6 18.2 13.0 55.2 35.6 7.8 4.7 13.8 10.1 18.9
Rhode Island 201.0 140.4 18.2 15.9 11.3 56.4 40.4 6.5 4.5 13.3 9.8 17.6
South Carolina 213.9 141.3 21.8 17.7 12.2 61.9 35.5 6.8 4.3 13.1 9.8 22.2
South Dakota 192.8 132.7 19.2 19.9 13.2 51.7 33.5 6.9 4.0 12.3 9.4 19.3
Tennessee 227.7 151.5 22.1 19.1 13.2 73.1 42.6 8.2 4.8 12.7 9.7 19.8
Texas 187.0 129.1 20.0 17.8 11.4 47.5 29.4 7.0 4.3 11.7 9.0 17.9
Utah 148.5 109.5 20.1 13.1 9.6 23.4 15.6 6.7 4.3 10.9 8.7 20.5
Vermont 194.0 141.6 18.1 16.2 12.6 49.8 38.1 7.9 4.6 12.5 9.9 19.2
Virginia 194.0 137.4 21.4 16.8 11.5 53.0 34.0 6.9 4.3 12.8 9.5 19.9
Washington 183.6 135.9 19.6 14.5 10.6 44.9 34.1 7.9 4.5 12.2 9.3 20.0
West Virginia 227.1 161.7 21.9 20.9 16.0 72.6 45.1 7.8 4.9 12.0 9.4 17.4
Wisconsin 193.9 139.1 19.5 15.5 11.5 49.6 34.8 7.8 4.4 13.3 10.2 20.6
Wyoming 166.2 128.2 18.1 15.5 10.3 37.3 31.1 7.0 4.4 10.5 9.2 16.5
Puerto Ricoa 152.7 94.6 17.9 19.7 12.2 19.8 8.9 4.7 2.6 7.9 5.8 26.7
United States 193.1 137.7 20.6 16.9 11.9 51.6 34.4 7.3 4.4 12.6 9.6 19.2
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population.
  • a Rates for Puerto Rico are for 2011 through 2015 and are not included in the overall US combined rates.

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.101 For example, lung cancer incidence rates during 2011 through 2015 in Kentucky (113 per 100,000 population in men and 79 per 100,000 population in women), where smoking prevalence continues to be highest, were approximately 3.5 times higher than those in Utah (32 per 100,000 population in men and 24 per 100,000 population in women), where smoking prevalence is lowest. In 2016, 1 in 4 residents of Kentucky and West Virginia were current smokers compared with 1 in 10 in Utah, Puerto Rico, and California.102

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 2019, an estimated 11,060 children (birth to 14 years) will be diagnosed with cancer and 1,190 will die from the disease. Benign and borderline malignant brain tumors are not included in the 2019 case estimates because the calculation method requires historical data and these tumors were not required to be reported to cancer registries until 2004.

Leukemia is the most common childhood cancer, accounting for 28% of cases (including benign and borderline malignant brain tumors). Brain and other nervous system tumors, approximately one-quarter of which are benign/borderline malignant, are second most common (26%) (Table 14). The distribution of cancers that occur in adolescents (aged 15 to 19 years) differs somewhat from that in children. For example, brain and other nervous system tumors (21%), greater than one-half of which (58%) are benign/borderline malignant, and lymphoma (20%) are the most common cancers, whereas leukemia accounts for just 13% of cases. Thyroid carcinoma and melanoma of the skin account for 11% and 4%, respectively, of cancers in adolescents, but only 2% and 1%, respectively, in children.

Table 14. Case Distribution (2011 Through 2015) and 5-Year Relative Survival (2008 Through 2014)* by Age and ICCC Type, Ages Birth to 19 Years, United States
BIRTH TO 14 15 TO 19
PERCENTAGE OF CASES 5-YEAR SURVIVAL, % PERCENTAGE OF CASES 5-YEAR SURVIVAL, %
All ICCC groups combined 83.4 84.6
Lymphoid leukemia 22% 90.8 7% 73.8
Acute myeloid leukemia 4% 66.4 4% 64.2
Hodgkin lymphoma 3% 97.8 12% 96.1
Non-Hodgkin lymphoma (including Burkitt lymphoma) 5% 90.2 7% 89.1
Central nervous system neoplasms 26% 72.9 21% 77.9
Neuroblastoma & other peripheral nervous cell tumors 6% 80.2 <1% 54.1
Retinoblasoma 2% 95.2 <1%
Nephroblastoma & other nonepithelial renal tumors 5% 92.7 <1%
Hepatic tumors 2% 80.4 <1% 52.4
Hepatoblastoma 1% 84.6 <1%
Osteosarcoma 2% 69.6 3% 65.7
Ewing tumor & related bone sarcomas 1% 77.7 2% 64.3
Rhabdomyosarcoma 3% 70.3 1% 46.2
Germ cell & gonadal tumors 3% 91.6 11% 92.6
Thyroid carcinoma 2% 99.7 11% 99.2
Malignant melanoma 1% 94.9 4% 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 2015.
  • — Statistic could not be calculated due to fewer than 25 cases diagnosed during 2008 to 2014.
  • * Benign and borderline brain tumors were excluded from survival calculations, but were included in the denominator for case distribution.
  • The standard error of the survival rate is between 5 and 10 percentage points.

The overall cancer incidence rate in children and adolescents has been increasing slightly (by 0.7% per year) since 1975. In contrast, death rates have declined continuously for many decades, from 6.5 per 100,000 population in 1970 to 2.3 per 100,000 population in 2016, an overall reduction of 65% (65% in children and 61% in adolescents). Much of this progress reflects the dramatic 78% decline in leukemia mortality, from 2.7 per 100,000 children and adolescents in 1970 to 0.6 in 2016. Improved remission rates of 90% to 100% for childhood acute lymphocytic leukemia over the past 4 decades have been achieved primarily through the optimization of established chemotherapeutic agents as opposed to the development of new therapies.103 The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 83% during 2008 through 2014 for children and from 68% to 85% for adolescents.10 However, survival varies substantially by cancer type and age at diagnosis (Table 14).

Limitations

Although the estimated numbers of new cancer cases and deaths expected to occur in 2019 provide a reasonably accurate portrayal of the contemporary cancer burden, they are model-based, 3-year- and 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 2015 for incidence and 2016 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 in nonwhite and nonblack populations, particularly 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 important differences in the cancer burden within these populations. For example, lung cancer incidence is equivalent in Native Hawaiian and NHW men, but approximately 50% lower in Asians/Pacific Islanders overall.66

Conclusions

The continuous decline in cancer death rates since 1991 has resulted in an overall drop of 27%, translating to approximately 2.6 million fewer cancer deaths. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with residents of the poorest counties experiencing an increasingly disproportionate burden of the most preventable cancers. These counties are low-hanging fruit for locally focused cancer control efforts, including increased access to basic health care and interventions for smoking cessation, healthy living, and cancer screening programs. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

Disclosures

All authors are employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research outside of the submitted work. The authors are not funded by or key personnel for any of these grants and their salary is solely funded through American Cancer Society funds.