Volume 71, Issue 1 p. 7-33
Article
Free Access

Cancer Statistics, 2021

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia

Corresponding Author: Rebecca Siegel, MPH, Surveillance Research, American Cancer Society, 250 Williams Street, NW, Atlanta, GA 30303-1002 ([email protected]).

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Kimberly D. Miller MPH

Kimberly D. Miller MPH

Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia

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Hannah E. Fuchs BS

Hannah E. Fuchs BS

Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia

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Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia

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First published: 12 January 2021
Citations: 10,696
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.
We gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done.

Abstract

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) 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 (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.

Introduction

Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. In 2020, the diagnosis and treatment of cancer was hampered by the coronavirus disease 2019 (COVID-19) pandemic. For example, reduced access to care because of health care setting closures resulted in delays in diagnosis and treatment that may lead to a short-term drop in cancer incidence followed by an uptick in advanced stage disease and ultimately increased mortality. However, this secondary consequence of the pandemic will take several years to quantify because of the lag in dissemination of population-based surveillance data.

In this article, we provide the estimated numbers of new cancer cases and deaths in 2021 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 2017 and for mortality through 2018. We also estimate the total number of cancer deaths averted due to the decline in cancer mortality since the early 1990s.

Materials and Methods

Incidence, Survival, and Mortality Data

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 (1975-2017) 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.1, 2 Contemporary stage distribution and survival statistics were based on data from the 18 SEER registries (SEER 9 plus the Alaska Native Tumor Registry, California, Georgia, Kentucky, Louisiana, and New Jersey).3 Contemporary incidence trends were based on all 21 SEER registries (SEER 18 plus Idaho, Massachusetts, and New York)4 unless otherwise specified, as was the probability of developing cancer, which was calculated using the NCI's DevCan software, version 6.7.8.5 Some of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975-2017.6

The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 forward 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 2021 and cross-sectional incidence rates by state and race/ethnicity.7, 8 Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2013-2017.9, 10

Mortality data from 1930 to 2018 were provided by the National Center for Health Statistics (NCHS).11, 12 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.12, 13 Mortality rates (2013-2017) for Puerto Rico were previously published in volume 3 of the NAACCR's Cancer in North America: 2013-2017.14

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.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 persons, as calculated using the NCI's SEER*Stat software, version 8.3.7.18 The annual percent change in rates was quantified using the NCI's Joinpoint Regression Program (version 4.8.0.1).19 All tests of statistical significance were 2-sided, and a P value <.05 was considered statistically significant.

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 2017 in the 9 oldest SEER registries was 10% higher after adjusting for reporting delays (15.3 vs 13.9 per 100,000).6

Projected Cancer Cases and Deaths in 2021

The most recent year for which incidence and mortality data are available lags 2 to 4 years behind the current year because of the time required for data collection, compilation, quality control, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in 2021 to provide an estimate of the contemporary cancer burden. The methodology for calculating contemporary cases and deaths was revised for 2021 to take advantage of advances in statistical modeling and improved cancer registration coverage. Basal cell and squamous cell skin cancers cannot be estimated because incidence data are not collected by most cancer registries. The 2021 projections are based on currently available incidence and mortality data and thus do not reflect the impact of COVID-19 on cancer cases and deaths.

The first step in calculating the number of invasive cancer cases expected in 2021 was to estimate complete counts in every state from 2003 through 2017 using delay-adjusted, high-quality NAACCR incidence data from 50 states and the District of Columbia (98% population coverage; data were unavailable for a few sporadic years for a limited number of states). A generalized linear mixed model (Liu et al., unpublished data) was used that accounted for geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.21 Modeled state- and national-level counts were projected forward using a novel, data-driven joinpoint algorithm to estimate cases for 2021 (Miller et al., unpublished data).

New cases of ductal carcinoma in situ (DCIS) of the female breast and in situ melanoma of the skin diagnosed in 2021 were estimated by first approximating the number of cases occurring annually from 2008 through 2017 based on age-specific NAACCR incidence rates (data from 49 states with high-quality data available for all 10 years) and US Census Bureau population estimates obtained using SEER*Stat.7, 22 Counts were then adjusted for delays in reporting using SEER 21 delay factors for invasive disease (delay factors are unavailable for in situ cases) and projected to 2021 based on the average annual percent change generated by the joinpoint regression model.4

The number of cancer deaths expected to occur in 2021 was estimated by applying the data-driven joinpoint algorithm described for the invasive cases methodology to reported cancer deaths from 2004 through 2018 at the state and national levels as reported to the NCHS (Miller et al., unpublished data).

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-specific and sex-specific cancer death rates in the peak year for age-standardized cancer death rates (1990 in men, 1991 in women) to the corresponding age-specific and sex-specific populations in subsequent years through 2018.

Selected Findings

Expected Numbers of New Cancer Cases and the Probability of Cancer

Table 1 presents the estimated numbers of new invasive cancer cases in the United States in 2021 by sex and cancer type. In total, there will be approximately 1,898,160 cancer cases diagnosed, the equivalent of 5200 new cases each day. In addition, there will be about 49,290 new cases of DCIS diagnosed in women and 101,280 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, 2021a
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All Sites 1,898,160 970,250 927,910 608,570 319,420 289,150
Oral cavity & pharynx 54,010 38,800 15,210 10,850 7,620 3,230
Tongue 17,960 13,040 4,920 2,870 1,930 940
Mouth 14,290 8,400 5,890 2,650 1,520 1,130
Pharynx 18,470 14,990 3,480 3,870 3,060 810
Other oral cavity 3,290 2,370 920 1,460 1,110 350
Digestive system 338,090 191,090 147,000 169,280 98,140 71,140
Esophagus 19,260 15,310 3,950 15,530 12,410 3,120
Stomach 26,560 16,160 10,400 11,180 6,740 4,440
Small intestine 11,390 6,130 5,260 2,100 1,110 990
Colonb 104,270 52,590 51,680 52,980 28,520 24,460
Rectum 45,230 26,930 18,300
Anus, anal canal, & anorectum 9,090 3,020 6,070 1,430 560 870
Liver & intrahepatic bile duct 42,230 29,890 12,340 30,230 20,300 9,930
Gallbladder & other biliary 11,980 5,730 6,250 4,310 1,770 2,540
Pancreas 60,430 31,950 28,480 48,220 25,270 22,950
Other digestive organs 7,650 3,380 4,270 3,300 1,460 1,840
Respiratory system 254,170 132,910 121,260 137,040 73,340 63,700
Larynx 12,620 9,940 2,680 3,770 3,020 750
Lung & bronchus 235,760 119,100 116,660 131,880 69,410 62,470
Other respiratory organs 5,790 3,870 1,920 1,390 910 480
Bones & joints 3,610 2,100 1,510 2,060 1,190 870
Soft tissue (including heart) 13,460 7,720 5,740 5,350 2,840 2,510
Skin (excluding basal & squamous) 115,320 68,120 47,200 11,540 7,660 3,880
Melanoma of the skin 106,110 62,260 43,850 7,180 4,600 2,580
Other nonepithelial skin 9,210 5,860 3,350 4,360 3,060 1,300
Breast 284,200 2,650 281,550 44,130 530 43,600
Genital system 376,970 260,210 116,760 69,110 35,030 34,080
Uterine cervix 14,480 14,480 4,290 4,290
Uterine corpus 66,570 66,570 12,940 12,940
Ovary 21,410 21,410 13,770 13,770
Vulva 6,120 6,120 1,550 1,550
Vagina & other genital, female 8,180 8,180 1,530 1,530
Prostate 248,530 248,530 34,130 34,130
Testis 9,470 9,470 440 440
Penis & other genital, male 2,210 2,210 460 460
Urinary system 164,000 115,750 48,250 31,940 21,640 10,300
Urinary bladder 83,730 64,280 19,450 17,200 12,260 4,940
Kidney & renal pelvis 76,080 48,780 27,300 13,780 8,790 4,990
Ureter & other urinary organs 4,190 2,690 1,500 960 590 370
Eye & orbit 3,320 1,750 1,570 400 220 180
Brain & other nervous system 24,530 13,840 10,690 18,600 10,500 8,100
Endocrine system 47,200 13,730 33,470 3,290 1,620 1,670
Thyroid 44,280 12,150 32,130 2,200 1,050 1,150
Other endocrine 2,920 1,580 1,340 1,090 570 520
Lymphoma 90,390 50,460 39,930 21,680 12,740 8,940
Hodgkin lymphoma 8,830 4,830 4,000 960 570 390
Non-Hodgkin lymphoma 81,560 45,630 35,930 20,720 12,170 8,550
Myeloma 34,920 19,320 15,600 12,410 6,840 5,570
Leukemia 61,090 35,530 25,560 23,660 13,900 9,760
Acute lymphocytic leukemia 5,690 3,000 2,690 1,580 900 680
Chronic lymphocytic leukemia 21,250 13,040 8,210 4,320 2,620 1,700
Acute myeloid leukemia 20,240 11,230 9,010 11,400 6,620 4,780
Chronic myeloid leukemia 9,110 5,150 3,960 1,220 680 540
Other leukemiac 4,800 3,110 1,690 5,140 3,080 2,060
Other & unspecified primary sites c 32,880 16,270 16,610 47,230 25,610 21,620

NOTE:

  • These are model-based estimates that should be interpreted with caution and not compared with those for previous years.
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancer and in situ carcinoma except urinary bladder. Approximately 49,290 cases of female breast ductal carcinoma in situ and 101,280 cases of melanoma in situ will be diagnosed in 2021.
  • b Deaths for colon and rectal 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 underlying cause of death on death certificates and/or an undercount in the case estimate.
TABLE 2. Estimated New Cases for Selected Cancers by State, 2021a
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 30,830 4,460 250 2,470 820 870 4,520 1,590 1,080 4,020 1,300
Alaska 3,190 520 b 330 100 100 370 110 110 440 160
Arizona 39,640 5,850 300 3,060 1,290 1,110 4,550 2,900 1,690 4,680 1,910
Arkansas 17,980 2,370 160 1,500 540 520 2,970 930 680 2,470 780
California 187,140 30,730 1,720 15,880 7,470 5,830 17,760 11,450 8,510 25,880 7,730
Colorado 28,630 4,580 200 2,140 930 870 2,570 2,240 1,090 3,920 1,230
Connecticut 22,910 3,540 120 1,560 860 650 2,750 1,300 1,010 3,160 1,180
Delaware 7,090 990 b 490 250 200 910 430 290 900 320
Dist. of Columbia 3,450 630 b 270 140 80 360 120 110 550 110
Florida 148,010 20,160 1,260 11,220 4,870 6,660 18,470 9,680 8,440 19,950 6,870
Georgia 58,060 8,770 490 4,840 1,820 1,840 7,250 3,800 2,100 8,550 2,150
Hawaii 7,570 1,390 60 710 360 200 930 460 330 880 300
Idaho 10,240 1,410 70 740 330 350 1,060 860 450 1,260 500
Illinois 74,980 11,190 560 6,200 2,710 2,120 9,600 4,030 3,010 10,250 3,320
Indiana 39,010 5,460 290 3,310 1,300 1,150 5,960 2,310 1,570 4,260 1,830
Iowa 20,000 2,710 120 1,570 700 740 2,610 1,290 890 2,530 880
Kansas 16,980 2,380 100 1,440 530 570 2,160 940 690 2,420 710
Kentucky 30,270 3,820 200 2,540 910 870 4,970 1,740 1,130 3,710 1,270
Louisiana 27,880 4,020 240 2,440 720 850 3,910 1,130 1,110 3,990 1,120
Maine 10,090 1,430 50 700 380 330 1,530 650 430 1,110 600
Maryland 34,590 5,470 220 2,550 1,260 980 4,230 1,870 1,360 5,020 1,320
Massachusetts 42,750 6,650 210 2,940 1,500 1,000 5,550 2,530 1,730 5,290 2,080
Michigan 62,150 8,700 380 4,690 2,240 1,800 8,590 3,440 2,620 8,940 3,010
Minnesota 33,260 4,850 160 2,490 1,210 1,380 3,970 1,850 1,520 4,020 1,520
Mississippi 18,750 2,550 160 1,670 500 510 2,870 750 630 2,380 700
Missouri 37,390 5,490 250 2,930 1,280 1,180 5,570 1,840 1,500 4,280 1,640
Montana 6,930 950 500 210 240 810 510 310 750 340
Nebraska 11,180 1,560 80 950 360 390 1,350 670 460 1,420 510
Nevada 16,970 2,490 160 1,400 480 530 2,080 1,000 740 2,090 790
New Hampshire 9,560 1,340 50 670 380 270 1,240 770 410 1,180 560
New Jersey 56,360 8,330 420 4,250 2,260 1,840 5,900 2,570 2,460 8,120 2,620
New Mexico 10,970 1,640 90 860 410 350 960 680 460 1,350 430
New York 120,200 17,540 920 8,920 4,810 4,110 13,950 4,290 5,480 15,840 5,610
North Carolina 63,930 9,850 430 4,650 2,110 2,050 8,830 4,250 2,480 8,970 2,650
North Dakota 4,200 570 350 140 170 490 250 190 560 200
Ohio 73,320 10,450 500 5,860 2,750 1,930 10,350 4,610 2,890 9,010 3,330
Oklahoma 22,820 3,230 200 1,900 660 760 3,300 1,110 900 2,710 920
Oregon 24,790 3,870 160 1,810 930 720 2,990 1,710 1,070 3,130 1,270
Pennsylvania 85,440 12,140 560 6,670 3,290 2,690 11,170 3,690 3,840 11,160 4,260
Rhode Island 6,910 1,000 50 490 250 210 950 410 310 920 370
South Carolina 33,030 4,990 240 2,570 1,060 1,010 4,510 1,970 1,260 4,860 1,340
South Dakota 5,330 740 b 450 170 190 650 310 230 750 240
Tennessee 41,980 5,850 350 3,370 1,250 1,180 6,410 1,830 1,560 5,430 1,720
Texas 133,730 20,900 1,470 11,280 4,590 4,820 15,010 4,600 5,780 14,200 4,780
Utah 12,750 1,850 80 900 480 400 770 1,610 510 1,980 480
Vermont 4,310 610 b 310 170 110 570 380 190 430 230
Virginia 46,340 7,450 310 3,600 1,500 1,310 5,820 2,530 1,840 6,540 1,940
Washington 42,170 6,810 310 3,140 1,320 1,290 4,780 2,730 1,870 5,370 2,000
West Virginia 12,500 1,610 80 1,090 440 410 2,020 720 530 1,430 660
Wisconsin 36,520 5,210 210 2,620 1,390 1,240 4,540 2,410 1,560 4,930 1,810
Wyoming 3,050 440 b 230 100 90 320 250 130 490 150
United States 1,898,160 281,550 14,480 149,500 66,570 61,090 235,760 106,110 81,560 248,530 83,730

Note:

  • These are model-based estimates that should be interpreted with caution. State estimates may not sum to US total due to rounding and the exclusion of states with fewer than 50 cases.
  • a 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.
  • b Estimate is fewer than 50 cases.

Figure 1 depicts the most common cancers diagnosed in men and women in 2021. Prostate, lung and bronchus (lung hereafter), and colorectal cancers (CRCs) account for 46% of all incident cases in men, with prostate cancer alone accounting for 26% of diagnoses. For women, breast cancer, lung, and CRCs account for 50% of all new diagnoses, with breast cancer alone accounting for 30% of female cancers.

Details are in the caption following the image
Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2021. 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 probability of being diagnosed with invasive cancer is slightly higher for men (40.5%) than for women (38.9%) (Table 3), reflecting differences in life expectancy as well as cancer risk.23 The sex disparity in overall cancer incidence has narrowed over time, with the male-to-female incidence rate ratio (IRR) dropping from 1.39 (95% CI, 1.38-1.40) in 1995 to 1.14 (95% CI, 1.13-1.14) in 2017 This is because incidence rates declined during this time period by 2% overall among women versus 20% among men, largely driven by differences in lung cancer trends. (See section on incidence trends for more information.)

TABLE 3. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2015 to 2017a
BIRTH TO 49 50 TO 59 60 TO 69 70 AND OLDER BIRTH TO DEATH
All sites b
Male 3.5 (1 in 29) 6.2 (1 in 16) 13.6 (1 in 7) 33.2 (1 in 3) 40.5 (1 in 2)
Female 5.8 (1 in 17) 6.4 (1 in 16) 10.3 (1 in 10) 26.8 (1 in 4) 38.9 (1 in 3)
Breast
Female 2.1 (1 in 49) 2.4 (1 in 42) 3.5 (1 in 28) 7.0 (1 in 14) 12.9 (1 in 8)
Colorectum
Male 0.4 (1 in 254) 0.7 (1 in 143) 1.1 (1 in 92) 3.2 (1 in 32) 4.3 (1 in 23)
Female 0.4 (1 in 266) 0.5 (1 in 191) 0.8 (1 in 128) 2.9 (1 in 34) 4.0 (1 in 25)
Kidney & renal pelvis
Male 0.2 (1 in 410) 0.4 (1 in 263) 0.7 (1 in 151) 1.4 (1 in 73) 2.2 (1 in 46)
Female 0.2 (1 in 647) 0.2 (1 in 541) 0.3 (1 in 310) 0.8 (1 in 133) 1.3 (1 in 80)
Leukemia
Male 0.3 (1 in 391) 0.2 (1 in 549) 0.4 (1 in 255) 1.4 (1 in 69) 1.8 (1 in 55)
Female 0.2 (1 in 500) 0.1 (1 in 834) 0.2 (1 in 427) 0.9 (1 in 110) 1.3 (1 in 78)
Lung & bronchus
Male 0.1 (1 in 776) 0.6 (1 in 163) 1.7 (1 in 58) 5.9 (1 in 17) 6.6 (1 in 15)
Female 0.1 (1 in 679) 0.6 (1 in 172) 1.4 (1 in 70) 4.9 (1 in 21) 6.0 (1 in 17)
Melanoma of the skin c
Male 0.4 (1 in 230) 0.5 (1 in 198) 0.9 (1 in 109) 2.7 (1 in 37) 3.7 (1 in 27)
Female 0.6 (1 in 156) 0.4 (1 in 241) 0.5 (1 in 187) 1.2 (1 in 86) 2.5 (1 in 40)
Non-Hodgkin lymphoma
Male 0.3 (1 in 375) 0.3 (1 in 345) 0.6 (1 in 177) 1.9 (1 in 54) 2.4 (1 in 42)
Female 0.2 (1 in 523) 0.2 (1 in 463) 0.4 (1 in 242) 1.4 (1 in 73) 1.9 (1 in 52)
Prostate
Male 0.2 (1 in 451) 1.8 (1 in 55) 5.0 (1 in 20) 8.7 (1 in 12) 12.1 (1 in 8)
Thyroid
Male 0.2 (1 in 447) 0.1 (1 in 703) 0.2 (1 in 571) 0.2 (1 in 412) 0.7 (1 in 146)
Female 0.9 (1 in 114) 0.4 (1 in 258) 0.4 (1 in 283) 0.4 (1 in 263) 1.9 (1 in 53)
Uterine cervix
Female 0.3 (1 in 362) 0.1 (1 in 837) 0.1 (1 in 916) 0.2 (1 in 590) 0.6 (1 in 158)
Uterine corpus
Female 0.3 (1 in 322) 0.6 (1 in 157) 1.1 (1 in 94) 1.5 (1 in 67) 3.1 (1 in 32)
  • 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.

However, these overall sex differences mask variation in risk in both direction and size among younger age groups. For example, during childhood (ages 0-14 years), incidence is about 10% higher in boys than in girls (IRR, 1.11; 95% CI, 1.09-1.13),24 whereas, during early adulthood (ages 20-49 years), it is 44% lower in men (IRR, 0.56; 95% CI, 0.558-0.563), largely because of breast cancer occurrence in young women.25 Reasons for sex differences are not fully understood but probably largely reflect differences in exposure to environmental risk factors and endogenous hormones, as well as complex interactions between these influences. Sex differences in immune function and response may also play a role.26

Expected Number of Cancer Deaths

An estimated 608,570 Americans will die from cancer in 2021, corresponding to more than 1600 deaths per day (Table 1). The greatest number of deaths are from cancers of the lung, prostate, and colorectum in men and cancers of the lung, breast, and colorectum in women (Fig. 1). Table 4 provides estimated number of deaths for these and other common cancers by state.

Almost one-quarter of all cancer deaths are due to lung cancer, 82% of which is directly caused by cigarette smoking.27 This translates to approximately 107,870 smoking-attributable lung cancer deaths in 2021, with an additional 3590 due to second-hand smoke exposure, leaving a residual 20,420 lung cancer deaths. Thus nonsmoking-related lung cancer accounts for a substantial burden, ranking among the top 10 causes of cancer death among sexes combined.

Women have a larger fraction of nonsmoking-related lung cancer than men,27 despite an equivalent relative risk associated with smoking,28 because they have not smoked to the same extent as men. Similarly, the proportion of nonsmoking-related lung cancer is slowly increasing in both sexes because of continuous declines in smoking prevalence.29 (Temporal trends in the incidence of nonsmoking-related lung cancer are unknown because data on smoking status have only recently begun to be collected by cancer registries.) Nevertheless, even among recently diagnosed lung cancer patients (2011-2016), 84% of women and 90% of men had ever smoked, including 72% and 81%, respectively, of those aged 20 to 49 years.30 Smoking continues to be the leading preventable cause of death in the United States, costing more than $300 billion annually. As a result, CDC has redoubled efforts to increase cessation, including publication of a new Surgeon General's report this year.31, 32 Smokers who quit by age 40 years reduce their risk of death from smoking-related disease by about 90% compared with continued smoking.33

TABLE 4. Estimated Deaths for Selected Cancers by State, 2021a
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 10,590 310 720 920 350 470 2,860 270 220 820 480
Alaska 940 b 60 110 b b 180 b b 60 50
Arizona 12,510 410 900 1,240 490 590 2,580 420 310 1,060 780
Arkansas 6,250 140 400 500 210 280 1,810 200 130 450 270
California 61,860 1,990 4,730 5,390 2,300 3,780 9,900 2,190 1,640 4,940 4,140
Colorado 8,420 300 690 700 300 420 1,290 270 180 660 560
Connecticut 6,400 210 420 440 250 320 1,350 230 160 550 390
Delaware 2,170 60 160 160 90 120 540 80 50 190 90
Dist. of Columbia 1,020 70 100 90 b 50 140 b b 100 70
Florida 47,170 1,370 3,120 4,360 1,930 2,080 10,940 1,590 1,020 3,700 2,850
Georgia 17,760 570 1,410 1,700 640 890 4,200 550 410 1,380 1,030
Hawaii 2,430 60 170 230 90 180 540 90 b 230 180
Idaho 3,230 110 250 330 140 140 620 120 80 250 200
Illinois 23,070 680 1,750 2,100 890 1,090 4,990 770 550 2,110 1,210
Indiana 13,460 380 910 1,160 510 610 3,520 450 290 1,030 760
Iowa 6,510 190 390 550 260 240 1,460 240 140 450 440
Kansas 5,620 180 370 500 250 270 1,360 190 140 420 270
Kentucky 10,090 300 630 930 390 400 2,660 330 180 730 440
Louisiana 9,380 240 670 860 330 610 2,360 290 240 660 490
Maine 3,390 110 190 230 120 130 840 120 70 250 160
Maryland 11,010 310 860 1,050 430 540 2,440 350 250 840 640
Massachusetts 12,540 430 780 1,000 500 640 2,770 490 310 1,070 690
Michigan 21,260 600 1,420 1,640 800 940 5,040 750 380 1,750 980
Minnesota 10,220 350 640 850 470 480 1,950 400 210 820 560
Mississippi 6,580 190 450 650 270 370 1,740 170 120 530 340
Missouri 12,960 340 850 1,070 510 680 3,250 410 250 960 630
Montana 2,150 70 140 180 80 110 480 70 50 160 170
Nebraska 3,560 120 240 320 160 100 680 120 80 290 270
Nevada 5,410 170 400 560 210 270 1,080 180 130 420 300
New Hampshire 2,840 90 170 290 80 120 730 90 100 200 150
New Jersey 15,870 520 1,250 1,410 640 760 3,050 570 360 1,360 760
New Mexico 3,820 110 290 350 130 280 560 130 110 280 220
New York 33,920 990 2,510 2,820 1,410 1,330 6,860 1,220 870 2,920 1,880
North Carolina 20,150 590 1,470 1,590 760 950 4,790 630 410 1,560 970
North Dakota 1,310 b 80 110 60 60 300 50 b 100 70
Ohio 25,140 720 1,720 2,110 960 1,130 6,180 870 390 2,000 1,450
Oklahoma 8,610 240 600 770 310 440 2,030 270 190 590 400
Oregon 8,430 270 570 650 320 460 1,690 310 240 690 520
Pennsylvania 27,960 830 1,970 2,340 1,100 1,140 6,140 980 620 2,300 1,510
Rhode Island 2,140 70 120 160 120 120 430 70 b 180 100
South Carolina 10,940 360 780 880 410 580 2,550 320 180 860 620
South Dakota 1,710 60 110 170 60 70 410 60 80 130 80
Tennessee 14,050 390 1,070 1,220 540 690 3,390 480 340 1,040 710
Texas 42,840 1,330 3,420 4,030 1,710 2,800 8,300 1,420 940 3,220 2,180
Utah 3,470 150 300 290 170 160 460 150 100 280 240
Vermont 1,470 60 80 130 50 50 340 50 b 110 70
Virginia 15,550 480 1,240 1,400 580 710 3,520 580 360 1,220 940
Washington 13,130 470 940 1,020 510 780 2,690 470 330 1,030 850
West Virginia 4,580 120 290 430 190 210 1,190 160 90 310 180
Wisconsin 11,700 360 750 900 490 490 2,490 400 260 870 730
Wyoming 990 50 70 80 b 60 210 b b 80 50
United States 608,570 18,600 43,600 52,980 23,660 30,230 131,880 20,720 13,770 48,220 34,130

Note:

  • These are model-based estimates that should be interpreted with caution. State estimates may not sum to US total due to rounding and exclusion of states with fewer than 50 deaths.
  • a Rounded to the nearest 10. Estimates for Puerto Rico are not available.
  • b Estimate is fewer than 50 deaths.

Trends in Cancer Incidence

Figure 2 illustrates long-term trends in overall cancer incidence rates, which reflect both patterns in behaviors associated with cancer risk and changes in medical practice, such as the use of cancer screening tests. For example, the spike in incidence for males during the early 1990s reflects rapid changes in prostate cancer incidence rates due to a surge in detection of asymptomatic disease as a result of widespread prostate-specific antigen (PSA) testing among previously unscreened men.34

Details are in the caption following the image
Trends in Cancer Incidence (1975-2017) and Mortality (1975-2018) Rates by Sex, United States. Rates are age adjusted to the 2000 US standard population. Incidence rates are also adjusted for delays in reporting.

The overall cancer incidence rate in men generally decreased from the early 1990s until around 2013 but has since remained stable (through 2017), reflecting slowing declines for CRC and a halt in the decline for prostate cancer (Fig. 3). The sharp drop in prostate cancer incidence rates from 2007 to 2014 is attributed to decreased PSA testing in the wake of US Preventive Services Task Force recommendations against routine use of the test to screen for prostate cancer (grade D) because of growing concerns about overdiagnosis and overtreatment.35, 36 However, this decision was largely based on clinical trial data that have been criticized for widespread screening among control subjects and insufficient follow-up time.37 Since around 2010, there has been an increase in distant-stage prostate cancer diagnoses across age and race,38-40 and, in 2017 the US Preventive Services Task Force upgraded their recommendation for men aged 55 to 69 years to informed decision making (grade C).41-43 There is some evidence that the long-term benefit of screening is underappreciated, particularly given recent advances in mitigating over detection through more stringent diagnostic criteria and reducing overtreatment via active surveillance for low-risk disease.37, 44, 45

Details are in the caption following the image
Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2017. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Liver includes the intrahepatic bile duct.

Overall cancer incidence in women has ticked up slightly in recent years after stable rates over the past couple of decades.46 This partly reflects a slowing decline for CRC coupled with increasing rates for breast and uterine corpus cancers (Fig. 3). Breast cancer incidence rates continue to increase by about 0.5% per year, which is attributed at least in part to continued declines in the fertility rate and increased body weight.47 These factors may also contribute to the continued increase in uterine corpus cancer incidence of about 1% per year,48 although a recent study indicated that this trend is driven by nonendometrioid subtypes, which are not as strongly associated with obesity as endometrioid carcinoma.49 Thyroid cancer incidence has begun to decline in women (although not yet in men) after the implementation of more conservative diagnostic practices in response to the sharp uptick in largely indolent tumors in recent decades.50, 51

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.52, 53 However, smoking patterns do not appear to fully explain higher lung cancer incidence in women than in men among individuals born since circa 1960.54 In contrast, CRC incidence patterns are generally similar in men and women, with both experiencing rapid declines during the 2000s in the wake of widespread colonoscopy uptake that have slowed in recent years (Fig. 3). Importantly, declines in overall CRC incidence mask increasing rates among adults aged <65 years.55

Incidence continues to increase in both men and women for cancers of the kidney, pancreas, and oral cavity and pharynx (non-Hispanic Whites [NHWs]) and melanoma of the skin, although melanoma has begun to decline in recent birth cohorts.25, 56 Liver cancer incidence has stabilized in men after decades of steep increase but continues to rise in women by >2% annually. The majority (71%) of these cases are potentially preventable because most liver cancer risk factors are modifiable (eg, obesity, excess alcohol consumption, cigarette smoking, and hepatitis B virus and hepatitis C virus [HCV]).27 Chronic HCV infection, the most common chronic blood-borne infection in the United States, confers the largest relative risk and accounts for 1 in 4 liver cancer cases.57 Although well tolerated antiviral therapies achieve >90% cure rates and could potentially avert much of the future burden of HCV-associated disease,58 most infected individuals are undiagnosed and thus untreated. Compounding the challenge is a greater than 3-fold spike in acute HCV infections reported to the CDC between 2010 and 2017 as a consequence of the opioid epidemic, 75% to 85% of which will progress to chronic infection.59 In a renewed attempt to mitigate the rising HCV-associated disease burden, the CDC and the US Preventive Services Task Force issued new recommendations in 2020 for one-time HCV testing of all adults aged ≥18 years.60-62

Cancer Survival

The 5-year relative survival rate for all cancers combined diagnosed during 2010 through 2016 was 67% overall, 68% in White individuals, and 63% in Black individuals.6 Figure 4 shows 5-year relative survival rates for selected cancer types by stage at diagnosis and race. For all stages combined, survival is highest for prostate cancer (98%), melanoma of the skin (93%), and female breast cancer (90%) and lowest for cancers of the pancreas (10%), liver (20%), esophagus (20%), and lung (21%). Survival rates are lower for Black patients than for Whites for every cancer type illustrated in Figure 4 except pancreas and kidney, for which they are the same. For kidney cancer, however, these overall statistics are misleading because they reflect the higher proportion in Black patients of papillary and chromophobe renal cell carcinomas (RCCs), which have a better prognosis than clear cell RCC, which is more common among Whites; indeed, Black patients have lower survival for every RCC subtype.63 The largest Black-White survival differences in absolute terms are for melanoma (25%) and cancers of the uterine corpus (21%), oral cavity and pharynx (18%), and urinary bladder (13%). Although these disparities partly reflect later stage diagnosis in patients who are Black (Fig. 5), Black individuals also have lower stage-specific survival for most cancer types (Fig. 4). After adjusting for sex, age, and stage at diagnosis, the relative risk of death is 33% higher in Black than in White patients with cancer.64 The disparity is even larger for American Indian/Alaska Native patients, among whom the risk of cancer death is 51% higher than in White patients.

Details are in the caption following the image
Five-Year Relative Survival for Selected Cancers by Race and Stage at Diagnosis, United States, 2010 to 2016. *The standard error of the survival rate is between 5 and 10 percentage points. †The survival rate for carcinoma in situ of the urinary bladder is 96% in all races, 96% in Whites, and 93% in Blacks.
Details are in the caption following the image
Stage Distribution for Selected Cancers by Race, United States, 2010 to 2016. Stage categories do not sum to 100% because sufficient information is not available to stage all cases.

Cancer survival has improved since the mid-1970s for all of the most common cancers except uterine cervix and uterine corpus,64 largely reflecting the absence of major treatment advances for these cancers.65, 66 For cervical cancer, it may also reflect an increasing proportion of adenocarcinoma over time because of widespread cytology screening, which mostly detects squamous precancerous lesions and invasive squamous cell carcinomas.67 Screening also hinders the utility of tracking trends in survival to measure progress against breast and prostate cancers because of lead-time bias and the detection of indolent cancers.68 Gains in survival have been especially rapid for hematopoietic and lymphoid malignancies due to improvements in treatment protocols, including the development of targeted therapies. For example, the 5-year relative survival rate for chronic myeloid leukemia increased from 22% in the mid-1970s to 72% for those diagnosed during 2010 through 2016,6 and most patients treated with tyrosine kinase inhibitors experience near-normal life expectancy.69

Low lung cancer survival rates reflect the large proportion of patients (57%) diagnosed with metastatic disease (Fig. 5), for which the 5-year relative survival rate is 6% (Fig. 4). However, the 5-year survival for localized stage disease is 59%, and there is potential for earlier diagnoses through annual screening with low-dose computed tomography, which demonstrated a 20% reduction in lung cancer mortality in ≥30 pack-year current and former smokers compared with chest radiography in the National Lung Screening Trial.70 More recently, the Multicentric Italian Lung Detection trial, which included more screening rounds, longer follow-up, and a more moderate risk pool (≥20 pack-years), reported a 39% reduction in lung cancer mortality compared with no intervention.71 As a result, the US Preventive Services Task Force updated their 2013 screening recommendation in a draft statement issued in July 2020 that expanded the eligibility pool from adults 55 to 80 years with a 30 pack-year smoking history to ages 50 to 80 years with a 20 pack-year history. However, the implementation of widespread screening within the general population remains challenging and inappropriate testing is not uncommon.72, 73 Broad implementation of recommended lung cancer screening will require new systems to facilitate unique aspects of the process, including the identification of eligible patients and education of physicians about the details of shared decision making, which is required for reimbursement by the Centers for Medicaid and Medicare Services.

Trends in Cancer Mortality

Mortality rates are a better indicator of progress against cancer than incidence or survival because they are less affected by biases resulting from changes in detection practices.74 The cancer death rate rose during most of the 20th century, largely because of a rapid increase in lung cancer deaths among men as a consequence of the tobacco epidemic. However, reductions in smoking as well as improvements in early detection and treatment for some cancers have resulted in a continuous decline in the cancer death rate since its peak of 215.1 (per 100,000) in 1991. The overall drop of 31% as of 2018 (149.0 per 100,000) translates to an estimated 3,188,500 fewer cancer deaths (2,170,700 in men and 1,017,800 in women) than what would have occurred if mortality rates had remained at their peak (Fig. 6). The number of averted deaths is twice as large for men than for women because the death rate in men peaked higher and declined faster (Fig. 7).

Details are in the caption following the image
Total Number of Cancer Deaths Averted During 1991 to 2018 in Men and 1992 to 2018 in Women, United States. The blue line represents the actual number of cancer deaths recorded in each year; the red line represents the number of cancer deaths that would have been expected if cancer death rates had remained at their peak.
Details are in the caption following the image
Trends in Cancer Mortality Rates by Sex Overall and for Selected Cancers, United States, 1930 to 2018. Rates are age adjusted to the 2000 US standard population. Because of improvements in International Classification of Diseases coding over time, numerator data for cancers of the lung and bronchus, colon and rectum, liver, and uterus differ from those for the contemporary time period. For example, rates for lung and bronchus include pleura, trachea, mediastinum, and other respiratory organs.

The progress against cancer reflects large decreases in mortality for the 4 major sites (lung, breast, prostate, and colorectal) (Fig. 7). Specifically, as of 2018, the death rate had dropped from its peak for lung cancer by 54% among males (since 1990) and by 30% among females (since 2002); for female breast cancer by 41% (since 1989); for prostate cancer by 52% (since 1993); and for CRC by 53% among males (since 1980) and by 59% among females (since 1969). (Although CRC death rates were declining in women before 1969, earlier data years are not exclusive of deaths from small intestine cancer.) However, in recent years, mortality declines have slowed for female breast cancer and CRC and have halted for prostate cancer (Table 5). During the late 1990s and 2000s, the prostate cancer death rate declined by 4% per year on average because of advances in treatment and earlier stage diagnosis through PSA testing.75, 76 However, PSA testing dropped by about 10 percentage points in absolute terms from 2008 to 2013,77, 78 which coincided with an uptick in distant-stage diagnoses38, 40 followed by a stable mortality trend from 2013 to 2018.

TABLE 5. Trends in Mortality Rates for Selected Cancers by Sex, United States, 1975 to 2018
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC 2009-2013 2014-2018 2009-2018
All sites
Overall 1975-1990 0.5a 1990-1993 −0.3 1993-2002 −1.1a 2002-2016 −1.5a 2016-2018 −2.3a −1.5a −1.9a −1.7a
Male 1975-1979 1.0a 1979-1990 0.3a 1990-1993 −0.5 1993-2001 −1.5a 2001-2015 −1.8a 2015-2018 −2.3a −1.8a −2.2a −2.0a
Female 1975-1990 0.6a 1990-1995 −0.2 1995-1998 −1.2a 1998-2001 −0.4 2001-2016 −1.4a 2016-2018 −2.1a −1.4a −1.7a −1.5a
Female breast 1975-1990 0.4a 1990-1995 −1.8a 1995-1998 −3.3a 1998-2013 −1.9a 2013-2018 −1.0a −1.9a −1.0a −1.4a
Colorectum
Overall 1975-1978 0.2 1978-1985 −0.8a 1985-2002 −1.8a 2002-2005 −3.8a 2005-2012 −2.5a 2012-2018 −1.8a −2.4a −1.8a −2.1a
Male 1975-1979 0.6 1979-1987 −0.6a 1987-2002 −1.9a 2002-2005 −4.0a 2005-2012 −2.6a 2012-2018 −1.9a −2.4a −1.9a −2.1a
Female 1975-1984 −1.0a 1984-2001 −1.8a 2001-2010 −3.0a 2010-2018 −2.0a −2.2a −2.0a −2.1a
Liver & intrahepatic bile duct
Overall 1975-1980 0.2 1980-1987 2.0a 1987-1995 3.8a 1995-2007 1.9a 2007-2013 3.2a 2013-2018 0.5 3.2a 0.5 1.7a
Male 1975-1985 1.5a 1985-1996 3.8a 1996-1999 0.3 1999-2013 2.7a 2013-2018 0.4 2.7a 0.4 1.4a
Female 1975-1984 0.2 1984-1995 3.1a 1995-2008 1.2a 2008-2013 3.3a 2013-2018 1.1a 3.3 1.1a 2.1
Lung & bronchus
Overall 1975-1980 3.0a 1980-1990 1.8a 1990-1995 −0.2 1995-2005 −1.0a 2005-2014 −2.4a 2014-2018 −5.0a −2.4a −5.0a −3.6a
Male 1975-1982 1.8a 1982-1991 0.4a 1991-1995 −1.9a 1995-2014 −3.1a 2014-2018 −5.5a −3.1a −5.5a −4.2a
Female 1975-1982 6.0a 1982-1990 4.2a 1990-1995 1.8a 1995-2005 −0.2a 2005-2014 −1.8a 2014-2018 −4.4a −1.8a −4.4a −3.0a
Melanoma of skin
Overall 1975-1989 1.5a 1989-2013 −0.0 2013-2018 −5.7a −0.0 −5.7a −3.2a
Male 1975-1989 2.3a 1989-2013 0.3a 2013-2018 −6.2a 0.3a −6.2a −3.4a
Female 1975-1988 0.8a 1988-2012 −0.5a 2012-2018 −4.2a −1.4a −4.2a −3.0a
Oral cavity and pharynx
Overall 1975-1979 −0.5 1979-1993 −1.7a 1993-2000 −2.7a 2000-2009 −1.3a 2009-2018 0.5a 0.5a 0.5a 0.5a
Male 1975-1980 −0.9 1980-2006 −2.2a 2006-2018 0.4a 0.4a 0.4a 0.4a
Female 1975-1990 −0.9a 1990-2003 −2.4a 2003-2013 −1.4a 2013-2016 2.4 2016-2018 −3.4 −1.4a −0.5 −0.6
Tongue, tonsil, oropharynx 1975-2000 −1.6a 2000-2009 −0.1 2009-2018 1.9a 1.9a 1.9a 1.9a
Other oral cavity 1975-1992 −1.6a 1992-2006 −2.9a 2006-2018 −0.8a −0.8a −0.8a −0.8a
Pancreas
Overall 1975-1998 −0.1a 1998-2018 0.3a 0.3a 0.3a 0.3a
Male 1975-1986 −0.8a 1986-2000 −0.3a 2000-2018 0.3a 0.3a 0.3a 0.3a
Female 1975-1984 0.8a 1984-2003 0.1 2003-2006 1.0 2006-2018 0.1 0.1 0.1 0.1
Prostate 1975-1987 0.9a 1987-1991 3.0a 1991-1994 −0.5 1994-1998 −4.2a 1998-2013 −3.5a 2013-2018 −0.4 −3.5a −0.4 −1.8a
Uterine corpus 1975-1989 −1.6a 1989-1997 −0.7a 1997-2008 0.3a 2008-2018 1.9a 1.9a 1.9a 1.9a
  • Abbreviations: AAPC, 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 4.7, allowing up to 5 joinpoints.
  • a The APC or AAPC is significantly different from zero (P < .05).

In contrast, declines in mortality for melanoma and lung cancer have accelerated in recent years, likely due to improvements in treatment.79, 80 For example, the death rate for melanoma was stable from 2009 to 2013, but decreased over the next 5 years (2014-2018) by 5.7% annually. Over the same time period, the pace of the annual decline for lung cancer doubled from 3.1% to 5.5% in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall (Table 5). Lung cancer accounted for almost one-half (46%) of the total decline in cancer mortality from 2014 to 2018 of 7.7%, which is reduced to 4.1% with the exclusion of lung cancer. Expedited progress in lung cancer mortality likely reflects improved treatment because incidence rates decreased steadily from 2008 to 2017 by about 2.2% to 2.3% per year based on cancer registry data covering 69% of the US population.7 These findings are also consistent with a recent SEER analysis by Howlader et al, who also examined stage at diagnosis and found no evidence of a shift to earlier diagnosis, suggesting little impact of lung cancer screening on population-based mortality trends, likely due to low adherence.80, 81 In contrast to steady incidence trends, the 2-year relative survival rate for lung cancer increased from 30% during 2009 through 2010 to 36% during 2015 through 2016. This progress is confined to the 80% of individuals diagnosed with nonsmall cell lung cancer (NSCLC), for whom 2-year survival increased from 34% to 42%, with absolute gains of 5% to 6% for every stage of diagnosis (Fig. 8). Meanwhile, survival for small cell lung cancer remained low and steady at 14% to 15%. Increased survival for regional-stage small cell lung cancer coincides with a steep decline for unstaged cancers and thus likely reflects improved staging (Fig. 8).

Details are in the caption following the image
Trends in 2-Year Relative Survival for Lung Cancer by Subtype and Stage at Diagnosis, 2001 to 2016. Survival is based on patients diagnosed during 2001 through 2016, all followed through 2017. NSCLC indicates nonsmall cell lung cancer; SCLC, small cell lung cancer.

Therapeutic advances that likely contributed to survival gains include epidermal growth factor receptor tyrosine kinase inhibitors that are targeted against the most common NSCLC driver mutations.82 Immunotherapy (ie, programmed cell death protein-1/programmed death ligand-1 inhibitors) may have played a small role,83 although these drugs were not approved by the US Food and Drug Administration for second-line treatment until 2015.84 Notably these therapies are directed at metastatic disease, so the comparable survival improvements for earlier stage cancers likely reflect advances in diagnostic and surgical procedures, such as pathologic staging and video-assisted thoracoscopic surgery.85, 86 In addition, increased access to care for many individuals after the 2014 implementation of the Patient Protection and Affordable Care Act and Medicaid expansion was recently found to be independently associated with survival gains for NSCLC.87

Despite the steady progress in mortality for most cancers, rates continue to increase for some common sites. The increase in death rates for uterine corpus cancer has accelerated from 0.3% per year from 1997 through 2008 to 1.9% per year from 2008 through 2018 (Table 5), twice the pace of the increase in incidence.6, 46 This may reflect the increase in nonendometrioid carcinoma, which is associated with a poor prognosis.49 Death rates are also increasing for cancers of the oral cavity and pharynx overall by 0.5% per year from 2009 to 2018, although, consistent with incidence,6, 88, 89 this trend is confined to subsites associated with HPV; the death rate rose by about 2% per year for cancers of the tongue, tonsil, and oropharynx but continued to decline by about 1% per year for other oral cavity cancers (Table 5). Pancreatic cancer death rates continued to increase slowly in men (0.3% annually since 2000) but remained stable in women, despite incidence rising by about 1% per year in both sexes. Recent liver cancer trends are promising as the long-term rise in mortality slowed among women and stabilized among men.

Recorded Number of Deaths in 2018

In total, 2,813,503 deaths were recorded in the United States in 2018, 21% of which were from cancer (Table 6). The death rate for all causes combined decreased steadily from 1975 to 2010 but remained stable through 2018 because of slowing declines for heart and cerebrovascular diseases and a sharp uptick for accidents (Table 7). In contrast, the decline in cancer mortality accelerated from about 1% annually in the 1990s to 1.5% in the 2000s and early 2010s to 2.3% during 2016 through 2018, partly driven by lung cancer (see Trends in Cancer Mortality, above). From 2017 to 2018, the cancer death rate dropped by 2.4%, the largest single-year drop since rates began declining in 1992.

TABLE 6. Ten Leading Causes of Death in the United States, 2017 and 2018
  All causes 2017 2018 RELATIVE CHANGE IN RATE
NO. PERCENT RATE NO. PERCENT RATE
2,813,503 732.6 2,839,205 723.9 −1.2%
1 Heart diseases 647,457 23% 165.2 655,381 23% 163.7 −0.9%
2 Cancer 599,108 21% 152.6 599,274 21% 149.0 −2.4%
3 Accidents (unintentional injuries) 169,936 6% 49.4 167,127 6% 47.9 −3.0%
4 Chronic lower respiratory diseases 160,201 6% 41.1 159,486 6% 39.8 −3.2%
5 Cerebrovascular disease 146,383 5% 37.6 147,810 5% 37.1 −1.3%
6 Alzheimer disease 121,404 4% 31.1 122,019 4% 30.6 −1.6%
7 Diabetes mellitus 83,564 3% 21.5 84,946 3% 21.4 −0.5%
8 Influenza and pneumonia 55,672 2% 14.3 59,120 2% 14.9 4.2%
9 Nephritis, nephrotic syndrome, & nephrosis 50,633 2% 13.0 51,386 2% 12.9 −0.8%
10 Intentional self-harm (suicide) 47,173 2% 14.0 48,344 2% 14.2 1.4%
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
Source: National Center for Health Statistics, Centers for Disease Control and Prevention.
TABLE 7. Trends in Mortality Rates for the 5 Leading Causes of Death, United States, 1975 to 2018
TREND 1 TREND 2 TREND 3 TREND 4 TREND 5 TREND 6 AAPC
YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC YEARS APC 2009-2013 2014-2018 2009-2018
All causes 1975-1979 −1.6a 1979-2002 −0.8a 2002-2010 −1.8a 2010-2018 −0.2 −0.6a −0.2 −0.4a
Heart diseases 1975-1986 −1.4a 1986-1991 −3.4a 1991-1995 −1.5a 1995-2002 −2.7a 2002-2010 −4.1a 2010-2018 −0.8a −1.7a −0.8a −1.2a
Cancer 1975-1990 0.5a 1990-1993 −0.3 1993-2002 −1.1a 2002-2016 −1.5a 2016-2018 −2.3a −1.5a −1.9a −1.7a
Accidents (unintentional injuries) 1975-1992 −2.1a 1992-2000 −0.0 2000-2006 2.0a 2006-2012 −0.8 2012-2018 4.7a 0.5 4.7a 2.8a
Chronic lower respiratory diseases 1975-1986 3.7a 1986-2000 1.7a 2000-2018 −0.5a −0.5a −0.5a −0.5a
Cerebrovascular disease 1975-1982 −5.3a 1982-1991 −3.2a 1991-2001 −0.6a 2001-2007 −5.4a 2007-2012 −3.2a 2012-2018 0.5 −2.3a 0.5 −0.7a
  • Abbreviations: AAPC, 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 4.8.0.1, allowing up to 5 joinpoints.
  • a The APC or AAPC is significantly different from zero (P < .05).

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 states90 and in people who are Hispanic, Asian American,91, 92 or Alaska Native. Cancer is the first or second leading cause of death for every age group shown in Table 8 among females, whereas, among males aged <40 years, accidents, suicide, and homicide predominate. Table 9 presents the number of deaths in 2018 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 <40 years and women aged <20 years, whereas breast cancer leads among women aged 20 to 59 years. CRC overtook leukemia in 2018 as the second leading cause of cancer death in men aged 20 to 39 years, and it is the leading cause in men <50 years, reflecting increasing trends in CRC in this age group, as well as declining mortality for leukemia. Lung cancer is the leading cause of cancer death in men aged ≥40 years and women aged ≥60 years, causing far more deaths than breast cancer, prostate cancer, and CRC combined.

TABLE 8. Ten Leading Causes of Death in the United States by Age and Sex, 2018
ALL AGES 1 TO 19 20 TO 39 40 TO 59 60 TO 79 ≥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
1,458,469 1,380,736 12,704 6,956 80,015 36,220 226,144 142,419 614,895 464,501 512,534 721,206
1

Heart diseases

354,404

Heart diseases Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Heart diseases Cancer Cancer Cancer Heart diseases Heart diseases
  300,977 3,992 2,208 33,236 12,189 51,018 45,070 175,882 144,858 146,128 189,612
2

Cancer

315,553

Cancer Intentional self-harm (suicide) Cancer Intentional self-harm (suicide) Cancer Cancer Heart diseases Heart diseases Heart diseases Cancer Cancer
  283,721 2,260 771 12,550 4,604 45,321 21,756 151,194 86,498 89,315 88,908
3

Accidents (unintentional injuries)

107,869

Chronic lower respiratory diseases Assault (homicide) Intentional self-harm (suicide) Assault (homicide) Intentional self-harm (suicide) Accidents (unintentional injuries) Accidents (unintentional injuries) Chronic lower respiratory diseases Chronic lower respiratory diseases Cerebrovascular disease Alzheimer disease
  84,236 1,910 749 8,639 3,229 32,432 13,921 39,546 37,990 29,902 72,172
4

Chronic lower respiratory diseases

75,250

Cerebrovascular disease Cancer Assault (homicide) Heart diseases Heart diseases Intentional self-harm (suicide) Chronic liver disease & cirrhosis Cerebrovascular disease Cerebrovascular disease Chronic lower respiratory diseases Cerebrovascular disease
  84,738 1,019 518 5,549 2,738 12,474 5,881 25,604 22,861 29,857 56,685
5

Cerebrovascular disease

62,843

Alzheimer disease Congenital abnormalities Congenital abnormalities Cancer Assault (homicide) Chronic liver disease & cirrhosis Chronic lower respiratory diseases Diabetes mellitus Diabetes mellitus Alzheimer disease Chronic lower respiratory diseases
  84,062 501 428 3,983 1,686 11,202 5,622 24,690 16,961 29,433 40,607
6

Diabetes mellitus

47,551

Accidents (unintentional injuries) Heart diseases Heart diseases Chronic liver disease & cirrhosis Chronic liver disease & cirrhosis Diabetes mellitus Diabetes mellitus Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries)
  60,214 335 225 1,391 911 8,947 5,084 22,782 11,972 14,738 18,479
7

Alzheimer disease

37,957

Diabetes mellitus Influenza & pneumonia Influenza & pneumonia Diabetes mellitus Diabetes mellitus Cerebrovascular disease Cerebrovascular disease Chronic liver disease & cirrhosis Alzheimer disease Influenza & pneumonia Influenza & pneumonia
  37,395 170 145 1,129 791 6,464 4,919 12,775 11,970 14,202 18,362
8

Intentional self-harm (suicide)

37,761

Influenza & pneumonia Chronic lower respiratory diseases Chronic lower respiratory diseases Cerebrovascular disease Cerebrovascular disease Chronic lower respiratory diseases Intentional self-harm (suicide) Nephritis, nephrotic syndrome, & nephrosis Nephritis, nephrotic syndrome, & nephrosis Diabetes mellitus Diabetes mellitus
  29,114 137 104 718 569 5,346 4,192 11,658 9,631 12,722 14,496
9

Influenza & pneumonia

28,682

Nephritis, nephrotic syndrome, & nephrosis Cerebrovascular disease Cerebrovascular disease HIV disease Pregnancy, childbirth, & puerperium Assault (homicide) Septicemia Influenza & pneumonia Influenza & pneumonia Parkinson disease Nephritis, nephrotic syndrome, & nephrosis
  24,889 100 86 683 533 3,561 2,498 10,660 8,961 12,258 13,264
10

Chronic liver disease & cirrhosis

27,226

Septicemia Septicemia Septicemia Influenza & pneumonia Influenza & pneumonia Influenza & pneumonia Influenza & pneumonia Septicemia Septicemia Nephritis, nephrotic syndrome, & nephrosis Hypertension & hypertensive renal diseasesa
  20,898 78 74 562 417 2,986 2,317 9,237 8,716 11,669 12,861
  • Abbreviation: HIV, human immunodeficiency virus.
  • Note: Deaths within each age group do not sum to all ages combined because of 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.
  • a Includes primary and secondary hypertension.
Source: US Final Mortality Data, 2018, National Center for Health Statistics, Centers for Disease Control and Prevention, 2020.
TABLE 9. Five Leading Causes of Cancer Death in the United States by Age and Sex, 2018
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
315,553 1,046 3,983 45,321 175,882 89,315
Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus
76,234 290 583 9,674 47,948 18,432
Prostate Leukemia Colorectum Colorectum Prostate Prostate
31,489 258 522 5,971 14,396 15,723
Colorectum Bones & joints Leukemia Pancreas Pancreas Colorectum
27,964 117 458 3,641 14,160 7,345
Pancreas Soft tissue (including heart) Non-Hodgkin lymphoma Livera Colorectum Urinary bladder
23,178 103 225 3,442 14,118 5,577
Livera Non-Hodgkin lymphoma Soft tissue (including heart) Brain & ONS Livera Pancreas
18,594 40 220 2,397 12,083 5,246
FEMALE
All sites All sites All sites All sites All sites All sites
283,721 795 4,604 45,070 144,858 88,391
Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus
65,847 242 1,102 9,847 38,866 18,412
Breast Leukemia Uterine cervix Lung & bronchus Breast Breast
42,466 201 467 8,394 19,935 11,581
Colorectum Soft tissue (including heart) Colorectum Colorectum Pancreas Colorectum
24,199 89 395 4,223 11,903 9,189
Pancreas Bones & joints Brain & ONS Ovary Colorectum Pancreas
21,737 78 340 2,708 10,386 7,176
Ovary Kidney & renal pelvis Leukemia Pancreas Ovary Leukemia
13,748 26 325 2,575 7,540 3,999
  • Abbreviation: ONS, other nervous system.
  • Note: Ranking order excludes category titles that begin with the word "other."
  • a Includes intrahepatic bile duct.

Despite being one of the most preventable cancers through screening, cervical cancer took the lives of 4138 women in 2018; this is the equivalent of 11 women per day, one-half of whom were aged ≤58 years at death. It also continues to be the second leading cause of cancer death in women aged 20 to 39 years. Although cervical cancer incidence has declined for decades overall, distant-stage disease and cervical adenocarcinoma, which is often undetected by cytology, are increasing, largely driven by trends in young women.93 These findings underscore the need for more targeted efforts to increase both HPV vaccination among all individuals aged ≤26 years and primary HPV testing or HPV/cytology cotesting every 5 years among women beginning at age 25 years, as recommended by the American Cancer Society in updated guidelines published in 2020.94, 95

Screening rates are lowest among women who have less educational attainment (high school or less), are uninsured, or do not have a primary care provider,96 consistent with cervical cancer death rates, which are 2 times higher in high-poverty versus low-poverty areas.97 HPV vaccination in the United States falls far behind that in other high-income countries.98 Among female adolescents, for example, up-to-date coverage in 2019 was 57% in the United States99 compared with 67% in Canada,100 >80% in Australia (ncci.canceraustralia.gov.au/), and >90% in the United Kingdom-Scotland.98 In 2020, the first population-based evaluation of the efficacy of the quadrivalent vaccine for preventing invasive cervical cancer reported adjusted incidence rate ratios of 0.12 (95% CI, 0.00-0.34) and 0.47 (95% CI, 0.27-0.75) for women who had been vaccinated before age 17 years and between ages 17 and 30 years, respectively, compared with women who had not been vaccinated.101

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.102, 103 These inequalities ultimately stem from hundreds of years of structural racism, including residential, educational, and occupational segregation and discriminatory policies in criminal justice and housing that have altered the balance of prosperity, security, and health.104 One of many examples is redlining, a previously legal form of lending discrimination whereby credit-worthy applicants who lived in predominantly Black neighborhoods were denied loans for home ownership or improvement, preventing people of color from integrating into suburban White neighborhoods. A recent study found that women who lived in areas of redlining had breast cancer mortality rates 2 times higher than those who did not reside in these areas.105

Overall cancer incidence rates are highest among NHWs because of their high rates of lung and female breast cancers (Table 10). However, sex-specific incidence is highest in non-Hispanic Black (NHB) men, among whom rates during 2013 through 2017 were 81% higher than those in Asian/Pacific Islander men, who have the lowest rates, and 7% higher than NHW men, who rank second. Among women, those who are NHW have the highest incidence—9% higher than those who are NHB (who rank second); however, NHB women have the highest sex-specific cancer mortality rates—12% higher than NHW women. The mortality disparity among men is larger, with the death rate in NHB men double that in Asian/Pacific Islander men and 19% higher than that in NHW men. Notably, the Black-White disparity in overall cancer mortality among men and women combined has declined from a peak of 33% in 1993 (279.0 vs 210.5 per 100,000, respectively) to 13% in 2018 (174.2 vs 154.1 per 100,000, respectively). This progress is largely due to more rapid declines in deaths from smoking-related cancers among Blacks because of the steep drop in smoking prevalence unique to Black teens from the late 1970s to the early 1990s.106

TABLE 10. Incidence and Mortality Rates for Selected Cancers by Race and Ethnicity, United States, 2013 to 2018
ALL RACES COMBINED   ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKA NATIVEa HISPANIC
NON-HISPANIC WHITE NON-HISPANIC BLACK
Incidence, 2013 to 2017
All sites 449.0 465.6 457.6 291.0 379.8 346.9
Male 489.1 501.4 534.0 294.3 399.8 371.3
Female 422.4 442.2 406.6 292.6 368.8 335.5
Breast (female) 126.0 131.6 127.3 95.6 94.9 94.8
Colon & rectum b 36.9 36.6 43.6 29.2 42.3 32.9
Male 42.6 42.0 51.6 34.6 47.2 39.6
Female 32.1 31.8 37.9 24.8 38.3 27.6
Kidney & renal pelvis 16.9 17.1 18.9 8.0 23.9 16.7
Male 22.9 23.1 26.1 11.3 31.3 21.9
Female 11.7 11.7 13.3 5.3 17.7 12.4
Liver & intrahepatic bile duct 8.5 7.1 11.0 12.6 15.7 13.5
Male 12.9 10.7 18.0 19.3 22.9 20.1
Female 4.6 3.8 5.5 7.1 9.4 7.9
Lung & bronchus 58.4 62.6 60.9 34.4 52.7 29.7
Male 67.6 70.8 79.8 43.2 59.2 37.1
Female 51.3 56.4 47.9 27.9 47.9 24.3
Prostate 104.6 97.7 171.6 53.8 67.7 85.6
Stomach 6.5 5.3 10.0 10.0 8.8 9.6
Male 8.9 7.5 13.7 13.1 11.4 12.0
Female 4.6 3.5 7.4 7.7 6.8 7.7
Uterine cervix 7.6 7.2 9.0 6.1 8.8 9.5
Mortality rates, 2014 to 2018
All sites 155.5 160.2 182.5 97.2 141.1 110.8
Male 185.5 190.2 227.2 114.6 169.3 134.0
Female 133.5 137.8 154.9 84.6 120.1 94.6
Breast (female) 20.1 20.1 28.2 11.7 14.8 13.8
Colon & rectum 13.7 13.6 18.5 9.4 15.1 10.9
Male 16.3 16.1 23.2 11.2 18.5 14.0
Female 11.5 11.5 15.3 7.9 12.4 8.6
Kidney & renal pelvis 3.6 3.8 3.6 1.7 5.5 3.4
Male 5.3 5.5 5.5 2.5 8.3 4.9
Female 2.3 2.3 2.3 1.1 3.2 2.2
Liver & intrahepatic bile duct 6.6 5.8 8.6 8.8 10.6 9.3
Male 9.7 8.4 13.4 13.1 14.8 13.3
Female 4.0 3.6 4.9 5.4 7.0 6.0
Lung & bronchus 38.5 41.7 41.3 21.2 32.1 16.8
Male 46.9 49.4 57.0 28.0 38.4 23.0
Female 32.0 35.6 30.6 16.3 27.4 12.3
Prostate 19.0 17.9 38.3 8.8 18.5 15.6
Stomach 3.0 2.2 5.3 5.0 4.7 4.9
Male 4.0 3.1 7.8 6.3 6.3 6.3
Female 2.2 1.6 3.6 4.0 3.5 3.9
Uterine cervix 2.2 2.0 3.4 1.7 2.4 2.6
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population and exclude data from Puerto Rico.
  • a Data based on Purchased/Referred Care Delivery Area (PRCDA) counties.
  • b Colorectal cancer incidence rates exclude appendix.

Geographic Variation in Cancer Occurrence

Tables 11 and 12 show cancer incidence and mortality rates for selected cancers by state. State variation reflects differences in detection practices and the prevalence of risk factors, such as smoking, obesity, and other health behaviors. The largest geographic variation is for cancers that are most preventable,27 such as lung cancer, cervical cancer, and melanoma of the skin.56 For example, lung cancer incidence and mortality rates in Kentucky, where smoking prevalence was historically highest, are 3 to 5 times higher than those in Utah and Puerto Rico, where it was lowest. Even in 2018, 1 in 4 residents of Kentucky, Arkansas, and West Virginia were current smokers compared with 1 in 10 residents of Utah and California.107

TABLE 11. Incidence Rates for Selected Cancers by State, United States, 2013 to 2017
STATE ALL SITES BREAST COLON & RECTUMa LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PROSTATE UTERINE CERVIX
MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
Alabama 517.6 403.3 121.6 48.9 36.2 84.1 50.0 19.8 13.4 121.0 9.4
Alaska 437.2 403.2 120.1 43.9 39.0 64.8 47.6 21.0 13.5 83.4 7.2
Arizona 409.8 370.1 114.3 36.3 27.1 51.2 43.0 18.5 12.9 79.1 6.5
Arkansas 537.2 424.8 118.2 49.7 36.2 95.8 62.7 22.0 15.2 112.4 9.5
California 432.9 387.6 121.5 38.9 29.7 46.4 37.8 22.4 15.1 93.0 7.2
Colorado 419.4 388.5 127.6 35.5 28.1 44.1 39.6 20.8 14.1 92.7 6.2
Connecticut 504.9 449.9 140.5 38.7 29.1 65.0 55.8 26.2 17.1 111.3 6.1
Delaware 537.5 453.1 134.7 42.1 30.8 75.3 60.8 24.5 16.8 124.5 7.8
Dist. of Columbia 452.8 417.8 139.4 38.9 34.7 49.8 44.5 19.2 12.1 127.4 8.8
Florida 499.1 425.9 118.3 40.5 30.4 66.5 50.5 28.2 20.1 93.9 8.9
Georgia 532.1 421.4 126.8 47.0 34.0 79.0 50.6 22.3 14.9 124.2 7.8
Hawaii 437.7 406.4 138.9 45.7 34.5 57.3 36.3 19.8 13.5 88.2 6.8
Idaho 473.1 419.5 126.7 38.0 29.7 54.3 45.7 23.0 16.0 105.3 6.5
Illinois 504.2 442.0 133.1 48.0 35.1 73.8 56.3 23.7 16.2 109.1 7.7
Indiana 503.6 430.7 122.9 47.4 35.8 86.4 61.4 22.3 15.6 94.2 8.2
Iowa 523.9 449.2 128.9 47.7 36.9 74.7 54.5 25.8 17.3 107.7 7.5
Kansas 493.3 425.2 126.0 43.3 32.5 64.9 49.7 23.6 16.0 108.3 7.6
Kentucky 574.4 483.3 126.7 54.3 39.1 109.0 77.5 24.5 16.6 104.1 9.6
Louisiana 556.1 425.6 125.9 51.8 37.0 82.6 53.6 23.3 15.9 131.2 9.1
Maine 500.5 458.9 127.4 38.7 30.8 80.3 65.8 25.4 16.7 88.1 5.9
Maryland 493.8 428.0 132.9 39.3 31.3 62.9 51.7 21.5 15.3 124.7 6.6
Massachusetts 483.3 443.1 137.9 38.6 29.8 65.5 59.2 23.4 15.6 102.6 5.2
Michigan 487.9 421.7 122.6 40.8 31.9 71.8 56.9 23.7 16.4 106.3 6.7
Minnesota 503.6 443 132.5 40.8 31.9 61.5 52.2 26.1 17.3 108.8 5.5
Mississippi 547.4 414.2 118.0 55.0 39.4 97.6 57.7 20.5 14.0 127.7 9.4
Missouri 490.3 431.9 130.5 45.5 33.4 83.6 63.2 22.7 15.5 91.4 8.0
Montana 490.5 435.4 128.5 43.3 30.3 53.3 54.7 22.6 15.4 118.3 6.8
Nebraska 501.9 433.6 127.2 46.4 36.1 65.4 50.8 24.7 17.0 116.7 7.8
Nevadab 405.6 379.6 110.3 40.3 31.1 53.9 51.6 17.4 12.3 85.1 8.9
New Hampshire 511.6 463.9 144.7 40.3 29.8 67.2 61.8 25.2 17.3 109.2 4.7
New Jersey 530.5 458.8 136.6 45.4 34.1 60.8 51.7 26.1 18.3 131.3 7.7
New Mexico 391.5 365.7 111.8 36.5 28.4 43.9 34.3 17.1 13.4 82.8 8.2
New York 531.6 456.3 132.8 43.3 32.2 66.2 53.4 26.3 18.0 125.0 7.8
North Carolina 522.2 431.7 134.0 41.1 31.0 82.8 56.4 21.4 14.6 117.4 7.1
North Dakota 489.6 430.1 128.6 46.8 37.2 65.4 52.3 21.9 16.4 113.5 5.5
Ohio 502.9 441.3 128.9 45.7 34.9 80.0 58.7 23.5 15.7 104.1 7.9
Oklahoma 490.8 421.2 122.7 46.9 34.7 80.5 57.1 21.0 15.6 93.8 9.2
Oregon 460.2 417.7 125.5 37.6 29.3 58.7 50.6 22.8 15.7 93.3 7.0
Pennsylvania 522.3 462.2 132.3 45.9 34.2 73.4 56.4 25.0 17.9 103.7 7.3
Rhode Island 489.8 460.4 137.8 36.3 28.2 75.4 65.6 24.7 16.5 96.5 7.0
South Carolina 511.0 413.1 129.9 42.5 31.4 80.1 52.3 20.5 13.8 114.5 7.9
South Dakota 496.7 434.1 128.3 46.2 35.4 66.7 54.1 22.6 16.1 114.8 7.3
Tennessee 520.7 422.1 122.6 44.4 33.7 91.6 61.4 21.9 14.1 111.5 8.4
Texas 450.3 378.4 112.8 43.7 30.2 61.3 42.2 20.9 14.3 94.0 9.2
Utah 439.1 375.2 114.4 31.6 25.2 30.2 22.5 23.0 14.8 112.8 5.4
Vermont 478.1 440.7 131.3 35.5 30.7 67.9 55.6 25.2 16.1 87.1 4.3
Virginia 445.6 397.4 127.3 38.5 30.2 65.9 49.2 20.7 14.2 99.4 6.0
Washington 473.6 429.8 134.3 37.7 30.1 58.8 50.3 24.1 16.0 98.7 6.7
West Virginia 512.7 457.1 117.5 51.3 39.7 94.0 68.9 22.5 16.4 92.1 9.2
Wisconsin 503.7 438.3 131.5 39.5 30.7 66.6 53.5 25.1 17.1 109.3 6.4
Wyoming 431.5 376.6 112.5 34.2 27.9 45.2 40.0 20.7 13.5 108.1 6.4
Puerto Ricoc 409.4 333.7 93.9 50.1 34.0 23.6 12.0 17.2 12.4 142.5 13.0
United States 489.1 422.4 126.0 42.6 32.1 67.6 51.3 23.3 16.0 104.6 7.6
  • Rates are per 100,000, age adjusted to the 2000 US standard population.
  • a Colorectal cancer incidence rates exclude appendix, with the exception of Nevada.
  • b Data for this state are not included in US combined rates because either the registry did not consent or incidence data did not meet inclusion standards for all years during 2013 to 2017 according to the North American Association of Central Cancer Registries (NAACCR). Rates for this state are based on data published in NAACCR's Cancer in North America, Volume II.
  • c Data for Puerto Rico are not included in US combined rates for comparability to previously published US rates. Puerto Rico incidence data for 2017 reflect diagnoses that occurred January through June only.
TABLE 12. Mortality Rates for Selected Cancers by State, United States, 2014 to 2018
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 216.6 142.3 21.5 19.0 12.6 65.5 35.7 6.7 3.8 13.6 10.2 21.0
Alaska 175.8 133.6 18.8 16.4 14.0 41.5 32.0 6.6 4.4 11.7 9.1 18.6
Arizona 162.1 118.1 18.5 15.3 10.2 36.4 27.1 5.8 3.7 11.7 8.8 17.3
Arkansas 216.8 148.0 20.3 19.0 12.8 67.6 41.0 6.9 4.1 12.9 9.4 18.4
California 164.9 122.5 19.3 14.6 10.7 33.2 24.1 6.6 4.1 11.7 9.1 19.9
Colorado 157.9 116.3 18.9 13.6 10.2 29.2 24.5 6.1 3.4 11.0 8.1 21.4
Connecticut 167.5 122.9 17.4 12.6 9.1 38.0 29.6 7.0 3.9 12.4 9.8 17.8
Delaware 195.8 141.6 21.4 15.7 11.3 51.2 37.0 7.4 4.3 14.3 10.5 17.2
Dist. of Columbia 183.5 146.3 26.2 17.9 13.1 36.4 25.8 6.0 3.4 15.6 12.2 28.2
Florida 174.9 125.3 18.8 15.3 10.8 45.3 31.0 6.4 3.9 12.2 9.0 16.6
Georgia 196.4 133.7 21.6 18.4 12.2 53.9 31.1 6.6 3.9 12.6 9.5 21.7
Hawaii 156.7 109.6 16.1 14.2 9.7 37.4 22.6 5.7 3.5 12.1 10.0 15.0
Idaho 179.2 132.5 21.5 15.0 11.2 36.9 28.6 7.4 4.9 12.8 9.5 23.1
Illinois 192.1 140.6 21.0 17.7 12.4 50.0 34.5 7.2 4.1 13.3 9.7 20.0
Indiana 209.7 146.4 20.8 17.7 12.9 60.5 39.9 8.0 4.6 13.7 9.9 19.5
Iowa 193.7 136.6 18.6 16.7 12.4 50.9 34.1 8.1 4.4 12.7 10.0 20.0
Kansas 190.7 138.7 19.8 17.6 12.2 49.9 35.3 7.0 4.6 12.8 9.8 18.7
Kentucky 233.4 160.5 21.0 19.9 13.9 75.3 49.0 8.2 4.5 13.3 10.2 19.3
Louisiana 215.6 147.0 22.8 19.8 13.6 61.6 36.6 7.6 4.3 14.4 11.0 20.5
Maine 201.1 145.4 18.0 14.6 11.4 55.3 40.0 7.6 4.6 12.4 10.3 19.2
Maryland 183.5 135.5 21.7 16.4 11.6 44.1 32.1 6.9 3.9 13.4 9.8 20.0
Massachusetts 180.1 129.2 17.3 13.8 9.9 42.7 33.2 6.8 4.2 13.0 10.0 18.3
Michigan 196.1 144.1 20.8 16.1 11.8 52.4 37.8 7.8 4.8 14.0 10.6 18.7
Minnesota 176.2 129.4 17.7 14.2 10.6 40.2 31.3 7.8 4.2 12.5 9.6 19.9
Mississippi 235.4 151.5 23.2 22.3 14.6 72.3 38.1 6.8 3.8 15.5 10.8 24.4
Missouri 204.6 144.4 20.9 17.7 11.9 59.4 40.4 7.2 4.1 13.6 9.6 17.6
Montana 174.7 132.2 18.9 15.9 10.6 37.9 34.6 7.0 4.1 11.2 9.4 22.3
Nebraska 183.9 133.6 19.6 17.3 12.5 45.3 32.3 7.3 4.1 13.2 9.4 18.1
Nevada 178.6 139.0 21.6 18.7 13.3 42.6 36.4 6.5 3.5 11.8 9.2 19.0
New Hampshire 182.1 137.0 18.3 14.3 11.0 45.9 37.5 6.4 4.3 11.8 9.0 18.6
New Jersey 172.3 132.6 20.9 16.4 11.6 39.0 29.9 7.1 4.0 12.6 10.2 17.6
New Mexico 165.1 120.5 19.7 16.2 10.8 31.7 22.9 5.9 3.9 11.1 8.0 19.3
New York 170.0 127.7 19.1 14.9 10.9 40.3 28.7 6.9 3.9 12.7 9.7 17.8
North Carolina 197.7 135.7 20.9 16.0 11.2 56.8 34.6 6.9 3.9 12.9 9.4 19.9
North Dakota 174.6 126.6 18.0 16.4 10.1 42.3 29.4 7.1 4.4 12.7 8.8 19.3
Ohio 207.2 147.3 21.9 17.9 12.9 58.3 37.9 7.9 4.6 13.7 10.6 19.3
Oklahoma 216.6 151.4 22.7 20.5 13.7 62.2 40.4 7.9 4.7 12.7 9.5 20.1
Oregon 182.3 137.9 19.7 14.8 11.0 40.9 33.3 7.5 4.7 13.7 10.3 20.9
Pennsylvania 196.3 140.5 21.0 17.4 12.3 50.2 33.8 7.7 4.5 14.3 10.4 18.6
Rhode Island 192.2 136.4 17.6 14.8 10.5 49.8 37.1 6.9 3.9 13.9 9.8 18.2
South Carolina 203.6 136.9 21.6 17.0 11.5 55.8 32.7 6.3 4.2 13.3 9.9 21.5
South Dakota 190.0 132.7 18.9 19.2 12.8 47.5 33.5 7.2 4.0 12.4 9.7 19.2
Tennessee 217.4 148.1 22.0 18.0 12.6 66.1 40.0 7.8 4.6 12.9 9.8 19.7
Texas 179.5 125.9 19.8 17.3 11.1 43.0 27.3 6.7 4.0 11.7 9.0 17.6
Utah 144.3 107.6 20.1 12.4 9.6 21.8 14.9 6.9 3.9 10.8 8.0 20.4
Vermont 193.2 140.1 18.0 15.7 13.7 47.7 36.5 8.1 4.2 12.2 9.6 19.7
Virginia 187.2 133.0 21.5 16.4 11.3 48.5 31.4 6.9 3.9 13.1 9.5 19.7
Washington 177.6 132.6 19.7 14.3 10.2 40.4 31.6 7.3 4.2 12.3 9.6 20.3
West Virginia 218.7 158.2 21.9 20.0 15.2 67.1 43.0 7.7 4.5 11.9 9.6 17.0
Wisconsin 187.9 135.0 18.8 15.1 10.9 45.7 33.0 7.5 4.4 13.5 9.9 20.6
Wyoming 160.6 122.3 18.2 13.9 10.1 33.1 29.3 6.5 4.0 12.3 8.3 16.9
Puerto Ricoa 143.9 90.9 17.9 19.0 11.7 17.9 8.1 4.7 2.6 8.1 5.3 24.7
United States 185.5 133.5 20.1 16.3 11.5 46.9 32.0 7.0 4.1 12.7 9.6 19.0
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • a Rates for Puerto Rico are for 2013 to 2017 and are not included in US combined rates.

Similarly, cervical cancer incidence and mortality currently vary 2-fold to 3-fold, with incidence rates ranging from <5 per 100,000 in Vermont and New Hampshire, to 10 per 100,000 in Arkansas and Kentucky, and 13 per 100,000 in Puerto Rico (Table 11). Ironically, advances in cancer control often exacerbate disparities, and state gaps for cervical and other HPV-associated cancers may widen in the wake of unequal uptake of the HPV vaccine. In 2019, up-to-date HPV vaccination among adolescents (aged 13-17 years) ranged from 32% in Mississippi to 78% in Rhode Island among girls and from 29% in Mississippi to 80% in Rhode Island among boys.108 The HPV vaccine was recently confirmed to reduce the risk of invasive cervical cancer by 88% among women who were inoculated with the quadrivalent vaccine before age 17 years.101 State/territory differences in other initiatives to improve health, including Medicaid expansion, may also contribute to future geographic disparities.109, 110

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 2021, an estimated 10,500 children (aged birth to 14 years) and 5090 adolescents (aged 15-19 years) will be diagnosed with cancer, and 1190 and 590, respectively, will die from the disease. These estimates require 15 years of historical incidence data (see Methods), and thus exclude benign and borderline malignant brain tumors, which were not required to be reported to cancer registries until 2004.

Leukemia is the most common childhood cancer, accounting for 28% of cases, followed by brain and other nervous system tumors (27%), more than one-quarter of which are benign/borderline malignant (Table 13). Cancer types and their distribution in adolescents differ from those in children; for example, brain and other nervous system tumors, more than one-half of which are benign/borderline malignant, are most common (21%), followed closely by lymphoma (19%). In addition, there are almost twice as many cases of Hodgkin as non-Hodgkin lymphoma among adolescents, whereas among children it is the reverse. Thyroid carcinoma and melanoma of the skin account for 11% and 3% of cancers, respectively, in adolescents, but only 2% and 1%, respectively, in children.

TABLE 13. Case Distribution (2013-2017) and 5-Year Relative Survival (2010-2016)a by Age and ICCC Type, Ages Birth to 19 Years, United States
BIRTH TO 14 15 TO 19
CASES, % 5-YEAR SURVIVAL, % CASES, % 5-YEAR SURVIVAL, %
All ICCC groups combined 84 85
Leukemias, myeloproliferative & myelodysplastic diseases 28 87 13 73
Lymphoid leukemia 21 91 6 75
Acute myeloid leukemia 4 68 4 66
Lymphomas and reticuloendothelial neoplasms 12 93 19 94
Hodgkin lymphoma 3 99 12 98
Non-Hodgkin lymphoma (including Burkitt) 6 90 7 89
Central nervous system neoplasms 27 74 21 76
Benign/borderline malignant tumorsa 8 97 13 98
Neuroblastoma & other peripheral nervous cell tumors 6 81 <1 63b
Retinoblastoma 2 96 <1 c
Nephroblastoma & other nonepithelial renal tumors 5 93 <1 c
Hepatic tumors 2 80 <1 51.9b
Hepatoblastoma 1 83 <1 c
Malignant bone tumors 4 73 5 68
Osteosarcoma 2 68 3 67
Ewing tumor & related bone sarcomas 1 75 2 58
Rhabdomyosarcoma 3 70 1 46
Germ cell & gonadal tumors 3 90 10 93
Thyroid carcinoma 2 >99 11 >99
Malignant melanoma 1 96 3 94
  • Abbreviation: ICCC, International Classification of Childhood Cancer.
  • Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2017.
  • a Benign and borderline brain tumors were excluded from survival calculations for overall central nervous system tumors but were included in the denominator for case distribution.
  • b The standard error of the survival rate is between 5 and 10 percentage points.
  • c Statistic could not be calculated due to fewer than 25 cases during 2010 through 2016.

The overall cancer incidence rate in children and adolescents has been increasing slightly (by 0.6% and 0.7% per year in children and adolescents, respectively) since 1975 for reasons that remain unclear. In contrast, death rates have declined continuously from 6.3 per 100,000 in children and 7.1 per 100,000 in adolescents in 1970 to 2.0 and 2.9 per 100,000, respectively, in 2018, for overall reductions of 68% in children and 59% in adolescents. Much of this progress reflects dramatic declines in leukemia mortality of 83% and 68%, respectively. Remission rates of 90% to 100% have been achieved for childhood acute lymphocytic leukemia over the past 4 decades, primarily through the optimization of established chemotherapeutic agents as opposed to the development of new therapies.111 However, progress among adolescents has lagged behind that among children for reasons that are complex but include differences in tumor biology, treatment protocols, and tolerance and compliance with treatment.112 Mortality reductions from 1970 to 2018 are also lower in adolescents for other common cancers, including lymphoma (91% in children and 85% in adolescents) and brain and other nervous system tumors (37% and 29%, respectively). The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 86% during 2010 through 2016 in children and from 68% to 86% in adolescents.6 However, survival varies substantially by cancer type and age at diagnosis (Table 13).

Limitations

The estimated numbers of new cancer cases and deaths expected to occur in 2021 provide a reasonably accurate portrayal of the contemporary cancer burden, but they are model-based 3-year (mortality) or 4-year (incidence) ahead projections that should not be used to track trends over time for several reasons. First, a new methodology has been employed as of the 2021 estimates to 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, 2017 for incidence and 2018 for mortality) and thus do not reflect the impact of the COVID-19 pandemic on reduced health care access and subsequent diagnosis delays. Similarly, the models 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 incidence rates from SEER, NPCR, and/or NAACCR and cancer death rates from the NCHS.

Errors in reporting race/ethnicity in medical records and on death certificates may result in underestimates of cancer incidence and mortality in persons who are not White or Black, particularly Native American 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 is approximately 50% lower in Asians/Pacific Islanders overall.92

Conclusion

The continuous decline in the cancer mortality rate since 1991 has resulted in an overall drop of 31%, translating to approximately 3.2 million fewer cancer deaths. This steady progress is largely due to reductions in smoking and subsequent declines in lung cancer mortality, which have accelerated in recent years because of improved management of NSCLC. Treatment breakthroughs are also responsible for rapid reductions in mortality from hematopoietic and lymphoid malignancies in both children and adults and, more recently, certain difficult-to-treat cancers, such as metastatic melanoma. Yet progress is slowing or halting for cancers amenable to early detection through screening, such as breast cancer, prostate cancer, and CRC. More concerning are the persistent racial, socioeconomic, and geographic disparities for highly preventable cancers, such as cervix and lung. Increased investment for both the equitable and broad application of existing cancer control interventions and basic and clinical research to further knowledge and advance treatment options would undoubtedly accelerate progress against cancer.