Volume 72, Issue 1 p. 7-33
Article
Open Access

Cancer statistics, 2022

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia

Corresponding Author: Rebecca L. Siegel, MPH, Surveillance Research, American Cancer Society, 3380 Chastain Meadows Parkway NW, Suite 200, Kennesaw, GA 30144 ([email protected]).

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Kimberly D. Miller MPH

Kimberly D. Miller MPH

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia

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Hannah E. Fuchs BS

Hannah E. Fuchs BS

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia

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Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia

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First published: 12 January 2022
Citations: 5,877
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 salaries are solely funded through American Cancer Society funds.
The authors gratefully acknowledge all cancer registry staff for their diligence in collecting cancer information, without which this research could not have been conducted.

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 and outcomes. Incidence data (through 2018) 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 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

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Cancer statistics, 2022

Introduction

Cancer is a major public health problem worldwide and the second leading cause of death in the United States. In 2020, the diagnosis and treatment of cancer was adversely affected by the coronavirus disease 2019 (COVID-19) pandemic. Reduced access to care because of health care setting closures and fear of COVID-19 exposure 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.1 However, quantifying these and other secondary consequences of the pandemic at the population level will take several years because of the lag in dissemination of population-based surveillance data. For example, reported cancer incidence and mortality are only currently available through 2018 and 2019, respectively.

In this article, we provide the estimated numbers of new cancer cases and deaths in 2022 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most currently available population-based data for cancer incidence and mortality. We also estimate the total number of cancer deaths averted through 2019 because of the continuous decline in cancer death rates since the early 1990s.

Materials and Methods

Data Sources

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 and survival data (1975-2018), which is based on cases diagnosed in 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) and represents approximately 9% of the US population.2 Contemporary survival statistics (2011-2017) were based on data from 18 SEER registries (SEER 9 plus the Alaska Native Tumor Registry and the California, Georgia, Kentucky, Louisiana, and New Jersey registries).3, 4 All 21 SEER registries (SEER 18 plus Idaho, Massachusetts, and New York)5 were the source for contemporary incidence trends and the probability of developing cancer, which was obtained from the NCI's DevCan software, version 6.7.9.6

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 2022, contemporary cross-sectional incidence rates (2014-2018), and stage distribution (2014-2018).7 Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2014-2018.8, 9

Mortality data from 1930 to 2019 were provided by the National Center for Health Statistics (NCHS).10, 11 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.11, 12 Contemporary 5-year mortality rates for Puerto Rico were obtained from the NCI and CDC's joint State Cancer Profiles website (statecancerprofiles.cancer.gov).

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.13, 14 Colorectal cancer (CRC) incidence rates presented herein exclude tumors of the appendix (C18.1), which are distinct from CRC in histology, molecular profile, and clinical characteristics. Causes of death were classified according to the International Classification of Diseases.15

Statistical Analysis

All incidence and death rates were age-standardized to the 2000 US standard population and expressed per 100,000 persons, as calculated by NCI's SEER*Stat software, version 8.3.9.16 The annual percent change (APC) in rates was quantified using NCI's Joinpoint Regression Program (version 4.9.0.1).17 Trends were described as increasing or decreasing when the APC was statistically significant based on a 2-sided P value < .05 and otherwise stable. All statistics presented herein by race, including those for Asian/Pacific Islander people and American Indian/Alaska Native people, are exclusive of Hispanic ethnicity. Life tables by Hispanic ethnicity were published in 2018 and were used for relative survival comparisons between White and Black individuals.18

Whenever possible, cancer incidence rates were adjusted for delays in reporting, which occur because of a lag in case capture and data corrections. Delay adjustment provides the most accurate portrayal of contemporary cancer rates and thus is particularly important in trend analysis.19 It has the largest effect on the most recent data years for cancers that are frequently diagnosed and/or treated in outpatient settings (eg, melanoma, leukemia, and prostate cancer). For example, the leukemia incidence rate for 2018 was 10.5% higher after adjusting for reporting delays (14.7 vs 13.3 per 100,000).4

Projected cancer cases and deaths in 2022

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 2022 to estimate the contemporary cancer burden. These estimates do not reflect the impact of COVID-19 because they are based on currently available incidence and mortality data through 2018 and 2019, respectively. In addition, basal cell and squamous cell skin cancers cannot be estimated because diagnoses are not recorded by most cancer registries.

The methodology for calculating contemporary cancer cases and deaths was updated in 2021 to take advantage of advances in statistical modeling and improved cancer registration coverage and is described in detail elsewhere.20, 21 Briefly, the first step in calculating the number of invasive cancer cases in 2022 was to estimate complete counts for every state from 2004 through 2018 using delay-adjusted, high-quality 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 model20 was used that accounted for state-level variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.22 Then, modeled state and national counts were projected forward to 2022 using a novel, data-driven joinpoint algorithm.21

New cases of ductal carcinoma in situ of the female breast and in situ melanoma of the skin diagnosed in 2022 were estimated by first approximating the number of cases occurring annually from 2009 through 2018 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 through SEER*Stat.7, 23 Counts were then adjusted for delays in reporting using SEER 21 delay factors for invasive disease (delay factors are unavailable for in situ cases)5 and projected to 2022 based on the average APC generated by the joinpoint regression model.

The number of cancer deaths expected to occur in 2022 was estimated by applying the same data-driven joinpoint algorithm described previously for the case projection to reported cancer deaths from 2005 through 2019 at the state and national levels, as reported to the NCHS.21

Other statistics

The number of cancer deaths averted in men and women because of the reduction in cancer death rates since the early 1990s was estimated by summing the difference between the annual number of cancer deaths recorded and 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 rate in the peak year for age-standardized cancer death rates (1990 in men, 1991 in women) to the corresponding populations in subsequent years through 2019.

Selected Findings

Expected Number of New Cancer Cases

Table 1 presents the estimated numbers of new invasive cancer cases in the United States in 2022 by sex and cancer type. In total, there will be approximately 1,918,030 cancer cases diagnosed, the equivalent of about 5250 new cases each day. In addition, there will be about 51,400 new cases of ductal carcinoma in situ of the female breast diagnosed in women and 97,920 new cases of melanoma in situ of the skin. The estimated numbers of new cases for selected cancers by state are shown in Table 2.

TABLE 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2022a
ESTIMATED NEW CASES ESTIMATED DEATHS
BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
All sites 1,918,030 983,160 934,870 609,360 322,090 287,270
Oral cavity & pharynx 54,000 38,700 15,300 11,230 7,870 3,360
Tongue 17,860 12,880 4,980 2,790 1,830 960
Mouth 14,490 8,490 6,000 3,020 1,810 1,210
Pharynx 19,270 15,670 3,600 3,980 3,140 840
Other oral cavity 2,380 1,660 720 1,440 1,090 350
Digestive system 343,040 193,350 149,690 171,920 99,940 71,980
Esophagus 20,640 16,510 4,130 16,410 13,250 3,160
Stomach 26,380 15,900 10,480 11,090 6,690 4,400
Small intestine 11,790 6,290 5,500 1,960 1,110 850
Colonb 106,180 54,040 52,140 52,580 28,400 24,180
Rectum 44,850 26,650 18,200
Anus, anal canal, & anorectum 9,440 3,150 6,290 1,670 740 930
Liver & intrahepatic bile duct 41,260 28,600 12,660 30,520 20,420 10,100
Gallbladder & other biliary 12,130 5,710 6,420 4,400 1,830 2,570
Pancreas 62,210 32,970 29,240 49,830 25,970 23,860
Other digestive organs 8,160 3,530 4,630 3,460 1,530 1,930
Respiratory system 254,850 131,450 123,400 135,360 72,770 62,590
Larynx 12,470 9,820 2,650 3,820 3,070 750
Lung & bronchus 236,740 117,910 118,830 130,180 68,820 61,360
Other respiratory organs 5,640 3,720 1,920 1,360 880 480
Bones & joints 3,910 2,160 1,750 2,100 1,180 920
Soft tissue (including heart) 13,190 7,590 5,600 5,130 2,740 2,390
Skin (excluding basal & squamous) 108,480 62,820 45,660 11,990 8,060 3,930
Melanoma of the skin 99,780 57,180 42,600 7,650 5,080 2,570
Other nonepithelial skin 8,700 5,640 3,060 4,340 2,980 1,360
Breast 290,560 2,710 287,850 43,780 530 43,250
Genital system 395,600 280,470 115,130 68,260 35,430 32,830
Uterine cervix 14,100 14,100 4,280 4,280
Uterine corpus 65,950 65,950 12,550 12,550
Ovary 19,880 19,880 12,810 12,810
Vulva 6,330 6,330 1,560 1,560
Vagina & other genital, female 8,870 8,870 1,630 1,630
Prostate 268,490 268,490 34,500 34,500
Testis 9,910 9,910 460 460
Penis & other genital, male 2,070 2,070 470 470
Urinary system 164,190 114,490 49,700 31,990 21,680 10,310
Urinary bladder 81,180 61,700 19,480 17,100 12,120 4,980
Kidney & renal pelvis 79,000 50,290 28,710 13,920 8,960 4,960
Ureter & other urinary organs 4,010 2,500 1,510 970 600 370
Eye & orbit 3,360 1,790 1,570 410 220 190
Brain & other nervous system 25,050 14,170 10,880 18,280 10,710 7,570
Endocrine system 47,050 13,620 33,430 3,330 1,650 1,680
Thyroid 43,800 11,860 31,940 2,230 1,070 1,160
Other endocrine 3,250 1,760 1,490 1,100 580 520
Lymphoma 89,010 48,690 40,320 21,170 12,250 8,920
Hodgkin lymphoma 8,540 4,570 3,970 920 550 370
Non-Hodgkin lymphoma 80,470 44,120 36,350 20,250 11,700 8,550
Myeloma 34,470 19,100 15,370 12,640 7,090 5,550
Leukemia 60,650 35,810 24,840 24,000 14,020 9,980
Acute lymphocytic leukemia 6,660 3,740 2,920 1,560 880 680
Chronic lymphocytic leukemia 20,160 12,630 7,530 4,410 2,730 1,680
Acute myeloid leukemia 20,050 11,140 8,910 11,540 6,730 4,810
Chronic myeloid leukemia 8,860 5,120 3,740 1,220 670 550
Other leukemiac 4,920 3,180 1,740 5,270 3,010 2,260
Other & unspecified primary sites c 30,620 16,240 14,380 47,770 25,950 21,820

Note:

  • These are model-based estimates that should be interpreted with caution and not compared with those for previous years.
  • About 51,400 cases of ductal carcinoma in situ of the female breast and 97,920 cases of melanoma in situ will be diagnosed in 2022.
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancer and in situ carcinoma except urinary bladder.
  • 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 lack of specificity in recording underlying cause of death on death certificates and/or an undercount in the case estimate.
Source: Estimated new cases are based on 2004-2018 incidence data reported by the North American Association of Central Cancer Registries (NAACCR). Estimated deaths are based on 2005-2019 US mortality data, National Center for Health Statistics, Centers for Disease Control and Prevention.
TABLE 2. Estimated New Cases for Selected Cancers by State, 2022a
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 30,210 4,280 240 2,510 800 780 4,280 1,480 1,000 4,650 1,140
Alaska 3,250 530 b 320 100 90 380 100 120 460 160
Arizona 39,970 6,110 290 3,150 1,320 1,090 4,610 3,110 1,680 4,940 1,900
Arkansas 18,610 2,440 160 1,530 570 520 2,820 900 690 2,510 710
California 189,220 31,720 1,640 15,970 7,110 5,630 17,450 10,260 8,500 26,890 7,620
Colorado 28,480 4,730 190 2,140 940 870 2,550 1,850 1,140 4,030 1,220
Connecticut 22,810 3,550 120 1,550 830 680 2,760 1,050 950 3,310 1,110
Delaware 7,080 1,010 b 500 250 230 910 470 280 940 310
Dist. of Columbia 3,440 620 b 250 160 90 370 70 120 580 110
Florida 152,600 20,920 1,230 11,490 4,860 6,630 19,560 9,650 7,980 20,680 6,890
Georgia 58,970 9,170 490 4,970 1,730 1,860 7,700 3,640 2,140 9,150 2,100
Hawaii 7,730 1,430 60 700 370 210 890 530 330 940 300
Idaho 10,440 1,490 70 750 320 330 1,100 940 440 1,480 500
Illinois 75,350 11,340 530 6,260 2,730 2,190 9,440 3,860 3,060 10,520 3,110
Indiana 39,460 5,600 290 3,290 1,340 1,160 5,920 2,250 1,520 5,020 1,720
Iowa 19,960 2,770 110 1,570 690 750 2,530 1,250 880 2,690 870
Kansas 16,580 2,410 100 1,510 540 530 2,190 920 680 2,550 680
Kentucky 30,370 3,950 200 2,600 930 850 4,990 1,680 1,110 3,840 1,280
Louisiana 28,680 3,970 230 2,440 730 800 3,800 1,010 1,070 4,170 1,020
Maine 10,060 1,420 b 700 370 300 1,640 520 420 1,180 580
Maryland 34,960 5,640 240 2,540 1,400 970 4,150 1,670 1,350 5,380 1,310
Massachusetts 42,190 6,710 210 2,940 1,530 1,120 5,600 1,900 1,780 5,670 2,030
Michigan 62,500 8,900 370 4,680 2,270 1,850 8,720 3,180 2,670 9,240 2,880
Minnesota 35,130 4,950 160 2,420 1,190 1,390 3,980 1,860 1,550 4,290 1,530
Mississippi 18,250 2,510 150 1,680 490 450 2,810 730 580 2,970 600
Missouri 37,480 5,560 250 2,970 1,290 1,160 5,690 1,690 1,480 4,830 1,550
Montana 7,030 1,000 b 510 200 240 820 510 300 1,100 340
Nebraska 11,280 1,600 70 960 360 380 1,330 630 460 1,680 480
Nevada 16,390 2,570 160 1,430 510 510 2,030 770 700 2,230 800
New Hampshire 9,430 1,360 b 670 370 260 1,270 610 410 1,280 550
New Jersey 55,730 8,410 420 4,260 2,280 1,730 5,980 2,300 2,420 8,580 2,560
New Mexico 11,030 1,700 90 890 410 350 940 670 450 1,430 400
New York 118,830 17,800 870 8,950 4,730 4,010 14,050 3,960 5,240 17,960 5,450
North Carolina 65,320 10,220 440 4,760 2,130 2,120 8,760 3,760 2,450 9,550 2,670
North Dakota 4,300 590 b 340 120 170 510 230 180 600 200
Ohio 73,700 10,610 480 5,870 2,760 1,910 10,430 4,110 2,870 9,530 3,260
Oklahoma 23,700 3,280 210 1,900 660 710 3,390 1,180 870 2,900 870
Oregon 25,130 4,070 160 1,850 860 680 2,990 1,640 1,090 3,250 1,200
Pennsylvania 85,110 12,220 500 6,610 3,270 2,600 11,170 3,540 3,740 11,740 4,130
Rhode Island 7,030 1,020 b 490 260 240 980 320 300 1,030 360
South Carolina 33,440 5,170 240 2,570 1,080 1,030 4,560 1,970 1,260 5,110 1,310
South Dakota 5,370 750 b 430 160 180 660 320 220 810 230
Tennessee 42,200 6,040 330 3,420 1,280 1,230 6,200 1,940 1,630 5,800 1,690
Texas 139,320 21,040 1,500 11,780 4,140 4,750 14,790 5,020 5,590 17,850 4,470
Utah 13,190 1,960 80 900 480 420 780 1,610 550 2,130 480
Vermont 4,260 630 b 300 170 130 590 290 190 490 220
Virginia 46,670 7,600 310 3,610 1,590 1,320 5,900 2,240 1,880 7,150 1,830
Washington 42,620 7,020 280 3,120 1,310 1,320 4,880 2,510 1,890 5,670 1,930
West Virginia 12,690 1,630 80 1,080 490 400 2,050 660 520 1,550 640
Wisconsin 37,320 5,380 200 2,680 1,380 1,320 4,500 2,170 1,590 5,590 1,730
Wyoming 3,140 460 b 240 100 90 330 250 130 590 160
United States 1,918,030 287,850 14,100 151,030 65,950 60,650 236,740 99,780 80,470 268,490 81,180

Note:

  • These are model-based estimates that should be interpreted with caution. State estimates may not add to the 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 The estimate is fewer than 50 cases.

The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (40.2%) than for women (38.5%) (Table 3), reflecting life expectancy as well as cancer risk.24 Reasons for higher cancer risk in men are not fully understood but probably largely reflect more exposure to cancer-causing environmental and biologic factors, such as smoking and height. Sex differences in endogenous hormones and immune function and response may also play a role.25

TABLE 3. Probability (%) of Developing Invasive Cancer Within Selected Age Intervals by Sex, United States, 2016 to 2018a
BIRTH TO 49 50 TO 59 60 TO 69 70 AND OLDER BIRTH TO DEATH
All sites Male 3.4 (1 in 29) 6.2 (1 in 16) 13.6 (1 in 7) 32.9 (1 in 3) 40.2 (1 in 2)
Female 5.8 (1 in 17) 6.3 (1 in 16) 10.2 (1 in 10) 26.5 (1 in 4) 38.5 (1 in 3)
Breast Female 2.1 (1 in 48) 2.4 (1 in 41) 3.5 (1 in 28) 7.0 (1 in 14) 12.9 (1 in 8)
Colorectum Male 0.4 (1 in 249) 0.7 (1 in 143) 1.1 (1 in 94) 3.1 (1 in 32) 4.2 (1 in 24)
Female 0.4 (1 in 265) 0.5 (1 in 192) 0.8 (1 in 130) 2.9 (1 in 35) 4.0 (1 in 25)
Kidney & renal pelvis Male 0.2 (1 in 413) 0.4 (1 in 259) 0.7 (1 in 151) 1.4 (1 in 73) 2.2 (1 in 46)
Female 0.2 (1 in 645) 0.2 (1 in 532) 0.3 (1 in 311) 0.8 (1 in 133) 1.3 (1 in 79)
Leukemia Male 0.3 (1 in 386) 0.2 (1 in 531) 0.4 (1 in 254) 1.5 (1 in 68) 1.9 (1 in 54)
Female 0.2 (1 in 498) 0.1 (1 in 823) 0.2 (1 in 421) 0.9 (1 in 110) 1.3 (1 in 77)
Lung & bronchus Male 0.1 (1 in 812) 0.6 (1 in 169) 1.7 (1 in 59) 5.7 (1 in 17) 6.4 (1 in 16)
Female 0.1 (1 in 690) 0.6 (1 in 175) 1.4 (1 in 71) 4.8 (1 in 21) 6.0 (1 in 17)
Melanoma of the skin b Male 0.4 (1 in 233) 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 157) 0.4 (1 in 241) 0.5 (1 in 184) 1.2 (1 in 84) 2.5 (1 in 40)
Non-Hodgkin lymphoma Male 0.3 (1 in 377) 0.3 (1 in 343) 0.6 (1 in 178) 1.8 (1 in 54) 2.4 (1 in 42)
Female 0.2 (1 in 515) 0.2 (1 in 453) 0.4 (1 in 245) 1.4 (1 in 73) 1.9 (1 in 52)
Prostate Male 0.2 (1 in 456) 1.8 (1 in 54) 5.1 (1 in 19) 9.0 (1 in 11) 12.5 (1 in 8)
Thyroid Male 0.2 (1 in 453) 0.1 (1 in 732) 0.2 (1 in 581) 0.2 (1 in 423) 0.7 (1 in 149)
Female 0.9 (1 in 117) 0.4 (1 in 271) 0.3 (1 in 294) 0.4 (1 in 264) 1.8 (1 in 55)
Uterine cervix Female 0.3 (1 in 359) 0.1 (1 in 839) 0.1 (1 in 944) 0.2 (1 in 594) 0.6 (1 in 159)
Uterine corpus Female 0.3 (1 in 320) 0.6 (1 in 157) 1.1 (1 in 94) 1.5 (1 in 66) 3.1 (1 in 32)
  • a For people free of cancer at beginning of age interval. Excludes basal cell and squamous cell skin cancers and in situ cancers except urinary bladder.
  • b Probabilities are for non-Hispanic White people.

Figure 1 depicts the most common cancers diagnosed in men and women in 2022. Prostate, lung and bronchus (lung hereafter), and colorectal cancers (CRC) account for almost one-half (48%) of all incident cases in men, with prostate cancer alone accounting for 27% of diagnoses. For women, breast cancer, lung cancer, and CRC account for 51% of all new diagnoses, with breast cancer alone accounting for almost one-third.

Details are in the caption following the image
Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths by Sex, United States, 2022. 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.

Expected Number of Cancer Deaths

An estimated 609,360 people in the United States will die from cancer in 2022, corresponding to almost 1700 deaths per day (Table 1). The greatest number of deaths are from cancers of the lung, prostate, and colorectum in men and 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.

TABLE 4. Estimated Deaths for Selected Cancers by State, 2022a
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 10,520 320 730 910 340 510 2,650 270 210 830 480
Alaska 1,030 b 70 110 b 70 220 b b 80 60
Arizona 13,200 410 910 1,210 540 710 2,280 410 310 1,120 820
Arkansas 6,460 190 390 560 210 310 1,770 190 120 450 430
California 60,970 2,070 4,690 5,470 2,340 3,680 9,660 2,150 1,390 5,080 4,130
Colorado 8,170 310 670 710 320 440 1,330 260 200 680 580
Connecticut 6,400 210 420 470 320 330 1,360 220 150 580 420
Delaware 2,200 50 160 160 100 120 530 80 50 190 100
Dist. of Columbia 1,010 b 100 90 b 80 150 b b 100 70
Florida 47,540 1,360 3,150 4,110 1,980 2,330 10,440 1,560 1,010 3,820 2,720
Georgia 18,750 500 1,410 1,590 650 930 4,180 540 410 1,450 1,070
Hawaii 2,590 60 210 240 90 160 540 100 b 240 130
Idaho 3,240 130 250 270 140 120 590 120 80 270 200
Illinois 23,200 610 1,730 2,110 900 1,100 5,140 780 530 2,010 1,160
Indiana 13,570 380 880 1,160 520 640 3,470 450 190 1,070 770
Iowa 6,470 190 380 540 270 250 1,450 240 140 520 390
Kansas 5,660 180 380 480 250 270 1,350 220 110 420 280
Kentucky 9,740 290 640 880 390 390 2,730 320 170 740 320
Louisiana 9,630 240 690 880 330 570 2,310 290 170 740 470
Maine 3,440 110 190 230 120 130 860 120 60 260 170
Maryland 11,030 290 840 980 450 510 2,230 340 240 880 680
Massachusetts 12,520 440 760 990 510 620 2,760 410 290 1,110 700
Michigan 21,260 600 1,390 1,700 820 870 5,000 740 440 1,780 1,000
Minnesota 10,340 310 640 790 460 490 1,950 460 210 840 660
Mississippi 6,790 200 450 660 230 380 1,820 160 110 520 410
Missouri 13,050 350 820 1,070 500 590 3,200 410 250 990 680
Montana 2,160 70 150 170 80 110 370 70 b 170 140
Nebraska 3,550 120 250 320 170 100 670 110 70 290 170
Nevada 5,730 130 440 470 230 300 1,170 240 120 430 410
New Hampshire 2,880 90 180 210 110 120 710 90 70 320 160
New Jersey 15,710 510 1,210 1,380 660 790 2,930 440 350 1,390 750
New Mexico 3,830 120 290 330 130 300 560 120 100 290 240
New York 32,230 980 2,460 2,670 1,340 1,280 6,660 1,170 830 2,930 1,720
North Carolina 20,480 470 1,450 1,630 800 1,000 4,750 630 390 1,590 1,120
North Dakota 1,310 b 70 110 60 50 300 50 b 100 70
Ohio 25,120 720 1,700 2,110 990 1,040 5,900 830 380 2,090 1,370
Oklahoma 8,620 240 570 770 310 450 2,260 280 180 580 450
Oregon 8,460 260 580 650 330 470 1,670 300 170 700 520
Pennsylvania 27,260 820 1,900 2,310 1,110 1,210 5,990 940 590 2,330 1,470
Rhode Island 2,170 70 130 160 90 140 480 70 b 190 100
South Carolina 10,850 340 770 890 430 590 2,560 300 180 880 630
South Dakota 1,740 70 110 160 70 80 410 60 b 150 80
Tennessee 14,390 410 1,040 1,250 550 690 3,680 460 260 1,060 750
Texas 43,490 1,280 3,440 4,280 1,610 2,790 8,270 1,400 910 3,390 2,260
Utah 3,540 150 310 310 180 160 470 130 100 290 360
Vermont 1,460 50 80 120 50 80 330 50 b 120 80
Virginia 15,280 440 1,150 1,370 610 710 3,470 490 350 1,270 940
Washington 13,270 470 940 1,110 530 730 2,720 470 320 1,070 850
West Virginia 4,460 120 290 440 190 170 1,190 170 80 340 190
Wisconsin 11,570 370 720 900 500 510 2,500 460 240 980 740
Wyoming 1,000 b 70 80 b 60 210 b b 90 60
United States 609,360 18,280 43,250 52,580 24,000 30,520 130,180 20,250 12,810 49,830 34,500

Note:

  • These are model-based estimates that should be interpreted with caution. State estimates may not add 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.

More than 350 people will die each day from lung cancer, which is more than breast, prostate, and pancreatic cancers combined and 2.5 times more than CRC, the second leading cause of cancer death. Approximately 105,840 of the 130,180 lung cancer deaths (81%) in 2022 will be caused by cigarette smoking directly, with an additional 3650 due to second-hand smoke.26 The remaining balance of approximately 20,700 nonsmoking-related lung cancer deaths would rank as the eighth leading cause of cancer death among sexes combined if classified separately.

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 a surge in the detection of asymptomatic prostate cancer as a result of widespread rapid uptake of prostate-specific antigen (PSA) testing among previously unscreened men.27 Overall cancer incidence in men generally decreased from the early 1990s until around 2013, then stabilized through 2018; whereas in women, the rate was fairly stable through the mid-2010s but has ticked up slightly (0.2% per year) in recent data years.28 Consequently, the sex gap is slowly narrowing, with the male-to-female incidence rate ratio declining from 1.39 (95% confidence interval [CI], 1.38-1.40) in 1995 to 1.14 (95% CI, 1.13-1.14) in 2018 (Fig. 2).

Details are in the caption following the image
Trends in Cancer Incidence (1975-2018) and Mortality (1975-2019) 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 incidence rate for prostate cancer dropped rapidly from 2007 to 2014 (Fig. 3) because of decreased detection of localized tumors through PSA testing, which declined following recommendations against routine screening for men aged 75 years and older in 2008 and all men in 2012 from the US Preventative Services Task Force (USPSTF).29, 30 Incidence was stable for local-stage disease from 2014 through 2018 but has increased by 4% per year for regional-stage since 2013 and by 6% per year for distant-stage disease since 2011.31 Consequently, the proportion of distant-stage diagnoses has more than doubled, from a low of 3.9% in 2007 to 8.2% in 2018. Surprisingly, this shift is not influenced by improved staging, and may even be an underestimate, because the proportion of unstaged cancers, which are usually advanced, also increased from 4.3% to 8.1% during this time period.

Details are in the caption following the image
Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2018. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. *Liver includes the intrahepatic bile duct.

Despite the USPSTF's upgraded recommendation in 2018 to informed decision making in men aged 55 to 69 years,32-34 controversy remains about the underutilized potential of the PSA test for reducing prostate cancer mortality by detecting potentially fatal disease earlier.35 The value of screening is especially salient for Black men, who have had a steeper drop in PSA testing than White men despite two-fold higher prostate cancer mortality.36 Proponents of testing are bolstered by advances in mitigating over-detection and over-treatment through more stringent diagnostic criteria and active surveillance for low-risk disease.37, 38 In addition, promising new approaches to screening that include the use of molecular markers and magnetic resonance imaging-targeted biopsy have demonstrated success in the detection of clinically significant cancer with limited over-detection.39

Female breast cancer incidence rates have been slowly increasing by about 0.5% per year since the mid-2000s, attributed at least in part to continued declines in the fertility rate and increases in excess body weight.40 These factors may also contribute to previous increases in uterine corpus cancer incidence,41 although rates appear to have stabilized in recent years.

After decades of increase, thyroid cancer incidence rates are now declining in both men and women at a combined pace of 2.5% per year from 2014 to 2018. Similar to prostate cancer, the decrease is because of recent changes in clinical practice designed to mitigate over-detection, including recommendations against thyroid cancer screening by the USPSTF and for more conservative biopsy criteria by professional societies.42, 43 These changes are supported by data from autopsy studies, which indicate that the occurrence of clinically relevant thyroid tumors has remained stable since 1970 and is generally similar in men and women, despite 3-fold higher overall incidence rates in women.44, 45

Lung cancer incidence declined from 2009 to 2018 by almost 3% annually in men and 1% annually in women. Declines began later and have been slower in women than in men because women took up cigarette smoking in large numbers later and were slower to quit, including upturns in smoking prevalence in some birth cohorts.46, 47 As a result, the sex gap in lung cancer incidence has narrowed from more than 3-fold higher rates in men in the 1970s to just 24% higher in 2018,2, 7 with higher rates in women among some younger age groups.48

Lung cancer incidence trends reflect temporal trends in smoking prevalence because cigarette smoking causes >80% of lung cancer cases in the United States.26 Although this proportion is gradually attenuating as fewer people smoke,49 still 72% of women and 81% of men aged 20 to 49 years recently diagnosed with lung cancer had smoked.50 As a result, the CDC has recently redoubled efforts to boost cessation, including publication of a new Surgeon General's report in 2020.51, 52 Whether the incidence of lung cancer is changing among never-smokers is unknown because the smoking status of individuals diagnosed with cancer has only recently begun to be collected by a few cancer registries.

In contrast to lung cancer, CRC incidence patterns are similar by sex but differ by age, with rates from 2014 to 2018 declining by about 2% per year in people aged 50 years and older while increasing by 1.5% per year in adults younger than 50 years. Declines in screening-aged adults began in the mid-1980s and accelerated during the 2000s in the wake of widespread colonoscopy uptake. Reasons for rising incidence since the mid-1990s in younger adults in the United States and several other high-income countries53 is unknown but likely relates to lifestyle exposures that began with generations born circa 1950.54

Non-Hodgkin lymphoma incidence has finally begun to decline after increasing since at least the mid-1970s. Similarly, melanoma and liver cancer incidence appear to have stabilized in recent years, especially in men, after decades of incline; rates in adults younger than 50 years, which typically foreshadow trends in older age groups, declined from 2014 to 2018 by 1% annually for melanoma and by 2% annually for liver cancer. In contrast, incidence continued to increase by about 1% annually for cancers of the oral cavity and pharynx (driven by human papillomavirus [HPV]-associated oropharyngeal cancers in non-Hispanic White people) and for cancers of the kidney and pancreas.

Cancer Stage at Diagnosis and Survival

The 5-year relative survival rate for all cancers combined increased between the mid-1970s and 2011 through 2017 from 49% to 68% overall, from 50% to 68% in White individuals, and from 39% to 63% in Black individuals.3, 4 Figure 4 shows 5-year relative survival rates for selected cancer types by stage 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 (11%), liver and esophagus (20%), and lung (22%).

Details are in the caption following the image
Five-Year Relative Survival for Selected Cancers by Race and Stage at Diagnosis, United States, 2011 to 2017. White and Black race categories are exclusive of Hispanic ethnicity. aThe standard error of the survival rate is between 5 and 10 percentage points. bThe survival rate for carcinoma in situ of the urinary bladder is 96% in all races, 96% in White patients, and 93% in Black patients.

Survival rates are lower for Black individuals than for White individuals for every cancer type in Figure 4 except pancreas and kidney, for which they are similar. However, Black patients have lower kidney cancer survival for every histologic subtype of the disease and only have similar overall survival because of a higher proportion of papillary and chromophobe renal cell carcinoma, both of which have a better prognosis than clear cell renal cell carcinoma, which is more common among White patients.55 The largest Black-White survival differences in absolute terms are for melanoma (22%) and cancers of the uterine corpus (21%), oral cavity and pharynx (18%), and urinary bladder (13%). Although these disparities partly reflect later stage diagnosis (Fig. 5), Black individuals also have lower stage-specific survival for most cancer types (Fig. 4). Compared with White people, the risk of death after adjusting for sex, age, and stage at diagnosis is 33% higher in Black people and 51% higher in American Indian/Alaska Native people.56

Details are in the caption following the image
Stage Distribution for Selected Cancers by Race, United States, 2014 to 2018. White and Black race categories are exclusive of Hispanic ethnicity. 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 the most common cancers except uterine cervix and uterine corpus,56 largely reflecting a lack of major treatment advances.57, 58 For cervical cancer, it may also reflect an increased proportion of adenocarcinoma, which has lower survival and is less easily detected by cytology screening than cervical intraepithelial neoplasia and invasive squamous cell carcinoma.59 Screening also influences the interpretation of temporal improvements in breast and prostate cancer survival because of lead-time bias and the detection of indolent cancers.60

Survival gains have been especially rapid for hematopoietic and lymphoid malignancies because of 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 71% for those diagnosed during 2011 through 2017, with most patients treated with tyrosine-kinase inhibitors experiencing near-normal life expectancy.61 More recently, immunotherapy—most notably combined anti-CTLA4 and anti–PD-1 checkpoint inhibition—has been a game-changer in the treatment of metastatic melanoma,62, 63 boosting 5-year relative survival for distant-stage disease from 15% in 2004 to 30% for patients diagnosed during 2011 through 2017.

After decades of stagnant survival, the outlook is also more promising for lung cancer at all stages of disease. Overall, the percentage of people living at least 3 years after diagnosis rose from 19% in 2001 to 21% in 2004 and 31% in 2015 through 2017, and median survival increased from 8 to 13 months.3 Survival gains are largely confined to nonsmall cell lung cancer and reflect advances in diagnostic and surgical procedures, such as pathologic staging and video-assisted thoracoscopic surgery,64, 65 as well as medical therapies targeted against the most common driver mutations,66 such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors. Immunotherapy (ie, programmed cell death protein-1/programmed death ligand-1 inhibitors)67 was approved by the US Food and Drug Administration in 2015 for second-line treatment and may also be a factor in more recent years.68

Improved lung cancer outcomes may also reflect increased access to care through the Patient Protection and Affordable Care Act (ACA), as one study has reported an independent association between Medicaid expansion and stage at diagnosis and survival.69 Nationally, the proportion of disease diagnosed at a localized stage increased from 17% during the mid-2000s to 20% in 2013 and 28% in 2018.7 The more abrupt stage shift from 2013 to 2018 coincides with an increase in the incidence of localized-stage disease of 4.5% per year alongside even steeper declines for advanced-stage diagnoses after the USPSTF first recommended lung cancer screening in 2013 (Fig. 6). Earlier diagnosis has a large impact on lung cancer outcomes, with 5-year relative survival increasing from 6% for distant-stage disease to 33% for regional stage and 60% for localized-stage disease (Fig. 4).

Details are in the caption following the image
Trends in Lung Cancer Incidence Rates by Stage at Diagnosis, United States, 2004 to 2018. AAPC indicates average annual percent change; USPSTF, US Preventive Services Task Force. Incidence rates are age adjusted to the 2000 US standard population. Three-year relative survival is presented for patients followed through 2018. aThe AAPC is significantly different from zero (P < .05). bPatients were diagnosed from 2015 to 2017.

National lung cancer screening prevalence has only increased from 3% of eligible individuals in 201070 to 5% in 2018, but is as high as 10% to 15% in Kentucky—which has the highest lung cancer incidence—and some northeastern states.71 The evidence in support of annual screening with low-dose computed tomography for high-risk individuals has strengthened in recent years, including a reported 39% reduction in lung cancer mortality compared with no intervention among current or former smokers with a >20 pack-year smoking history.72 As a result, the USPSTF issued an updated recommendation in March 2021 that expanded eligibility among people who currently smoke or have quit within 15 years from adults aged 55 to 80 years with a 30 pack-year smoking history to those aged 50 to 80 years with a 20 pack-year history.73

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 from changes in detection practice.74 The cancer death rate rose during most of the 20th century (Fig. 7), 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 in 1991 at 215.1 per 100,000 people. The overall drop of 32% as of 2019 (146.0 per 100,000) translates to an estimated 3,495,700 fewer cancer deaths (2,371,500 in men and 1,124,200 in women) than if mortality had remained at peak rates (Fig. 8). The number of averted deaths in men is twice that in women because the male death rate peaked higher and declined faster (Fig. 7).

Details are in the caption following the image
Trends in Cancer Mortality Rates by Sex Overall and for Selected Cancers, United States, 1930 to 2019. 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 the contemporary time period. For example, rates for lung and bronchus include pleura, trachea, mediastinum, and other respiratory organs.
Details are in the caption following the image
Total Number of Cancer Deaths Averted During 1991 to 2019 in Men and 1992 to 2019 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.

The pace of decline in cancer mortality has slowly accelerated from about 1% per year during the late 1990s to 1.5% per year during the 2000s and 2% per year from 2015 through 2019 (Table 5). Overall mortality trends are largely driven by lung cancer, for which declines steepened in recent years because of earlier detection and treatment advances that have extended survival, as mentioned in the previous section. For example, the decrease in lung cancer mortality accelerated from 3.1% per year during 2010 through 2014 to 5.4% per year during 2015 through 2019 in men and from 1.8% to 4.3% in women (Table 5). Overall, the lung cancer death rate has dropped by 56% from 1990 to 2019 in men and by 32% from 2002 to 2019 in women.

TABLE 5. Trends in Mortality Rates for Selected Cancers by Sex, United States, 1975 to 2019
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 2010-2014 2015-2019 2010-2019
All sites
Overall 1975-1984 0.5a 1984-1991 0.3a 1991-1994 −0.6 1994-2002 −1.1a 2002-2016 −1.5a 2016-2019 −2.3a −1.5a −2.1a −1.8a
Male 1975-1979 1.0a 1979-1990 0.3a 1990-1993 −0.5 1993-2001 −1.5a 2001-2015 −1.8a 2015-2019 −2.3a −1.8a −2.3a −2.0a
Female 1975-1990 0.6a 1990-1995 −0.2 1995-1998 −1.2a 1998-2001 −0.4 2001-2016 −1.4a 2016-2019 −2.0a −1.4a −1.9a −1.6a
Female breast 1975-1990 0.4a 1990-1995 −1.8a 1995-1998 −3.3a 1998-2013 −1.9a 2013-2019 −1.1a −1.7a −1.1a −1.3a
Colorectum
Overall 1975-1978 0.2 1978-1985 −0.8a 1985-2002 −1.8a 2002-2005 −3.8a 2005-2012 −2.5a 2012-2019 −1.9a −2.2a −1.9a −2.0a
Male 1975-1979 0.6 1979-1987 −0.6a 1987-2002 −1.9a 2002-2005 −4.0a 2005-2012 −2.6a 2012-2019 −2.0a −2.3a −2.0a −2.1a
Female 1975-1984 −1.0a 1984-2001 −1.8a 2001-2010 −3.0a 2010-2019 −2.0a −2.0a −2.0a −2.0a
Liver & intrahepatic bile duct
Overall 1975-1980 0.2 1980-1987 2.0a 1987-1995 3.8a 1995-2007 1.9a 2007-2013 3.3a 2013-2019 0.3 2.5a 0.3 1.3a
Male 1975-1985 1.5a 1985-1995 3.7a 1995-2006 2.0a 2006-2013 3.1a 2013-2019 0.0 2.3a 0.0 1.1a
Female 1975-1984 0.2 1984-1995 3.1a 1995-2008 1.2a 2008-2014 3.1a 2014-2019 0.5 3.1a 0.5 1.6a
Lung & bronchus
Overall 1975-1980 3.0a 1980-1990 1.8a 1990-1995 −0.2 1995-2005 −0.9a 2005-2014 −2.4a 2014-2019 −4.9a −2.4a −4.9a −3.8a
Male 1975-1978 2.4a 1978-1984 1.2a 1984-1991 0.3a 1991-2005 −1.9a 2005-2014 −3.1a 2014-2019 −5.4a −3.1a −5.4a −4.4a
Female 1975-1982 6.0a 1982-1990 4.2a 1990-1995 1.8a 1995-2005 0.2a 2005-2014 −1.8a 2014-2019 −4.3a −1.8a −4.3a −3.2a
Melanoma of skin
Overall 1975-1988 1.6a 1988-2013 0.0 2013-2017 −6.2a 2017-2019 −1.6 −1.6a −3.9a −3.2a
Male 1975-1989 2.3a 1989-2013 0.3a 2013-2017 −6.7a 2017-2019 −1.9 −1.5a −4.4a −3.4a
Female 1975-1988 0.8a 1988-2012 −0.5a 2012-2019 −4.0a −2.3a −4.0a −3.3a
Oral cavity and pharynx
Overall 1975-1979 −0.5 1979-1993 −1.7a 1993-2000 −2.7a 2000-2009 −1.3a 2009-2019 0.4a 0.4a 0.4a 0.4a
Male 1975-1980 −0.9 1980-2006 −2.2a 2006-2019 0.4a 0.4a 0.4a 0.4a
Female 1975-1989 −0.9a 1989-2009 −2.2a 2009-2019 0.2 0.2 0.2 0.2
Tongue, tonsil, oropharynx 1975-1983 −1.0a 1983-1999 −1.8a 1999-2009 −0.1 2009-2019 1.8a 1.8a 1.8a 1.8a
Other oral cavity 1975-1992 −1.6a 1992-2006 −2.9a 2006-2019 −0.8a −0.8a −0.8a −0.8a
Pancreas
Overall 1975-2002 −0.1a 2002-2005 1.0 2005-2019 0.2a 0.2a 0.2a 0.2a
Male 1975-1986 −0.8a 1986-2000 −0.2a 2000-2019 0.3a 0.3a 0.3a 0.3a
Female 1975-1984 0.8a 1984-2003 0.1 2003-2006 1.0 2006-2019 0.1 0.1 0.1 0.1
Prostate 1975-1987 0.9a 1987-1991 3.0a 1991-1994 −0.5 1994-1999 −4.1a 1999-2013 −3.4a 2013-2019 −0.6a −2.7a −0.6a −1.5a
Uterine corpus 1975-1989 −1.6a 1989-1997 −0.7a 1997-2009 0.4a 2009-2016 2.3a 2016-2019 0.5 2.3a 1.0a 1.7a

Note:

  • Trends were analyzed using the Joinpoint Regression Program, version 4.9.0.1, allowing up to 5 joinpoints.
  • Abbreviations: AAPC, average annual percent change; APC, annual percent change based on mortality rates adjusted to the 2000 US standard population.
  • a The APC or AAPC is significantly different from zero (P < .05).

Long-term reductions in mortality for CRC—the second-most common cause of cancer death in men and women combined—also contribute to overall progress, with rates dropping by 55% among males since 1978 and by 60% among females since 1969. (CRC death rates were declining in women before 1969, but earlier data are not exclusive of deaths from small intestine cancer.) The CRC mortality rate decreased during the most recent decade (2010-2019) by about 2% per year. However, similar to incidence, this trend masks increasing mortality among young adults; the CRC death rate rose from 2005 through 2019 by 1.2% per year in individuals younger than 50 years and by 0.6% per year in those aged 50 to 54 years.

Female breast cancer mortality peaked in 1989 and has since decreased by 42% because of both earlier diagnosis, through increased awareness as well as mammography screening, and improvements in treatment. Declines in breast cancer mortality have slowed in recent years, from 2% to 3% annually during the 1990s and 2000s to 1% annually from 2013 to 2019, perhaps reflecting the slight but steady increase in incidence and stagnant mammography uptake in recent years. Similarly, the slowing decline in prostate cancer mortality likely reflects the recent uptick in advanced-stage diagnoses associated with reductions in PSA testing since 2008.75, 76 The widespread uptake of PSA testing during the 1990s and early 2000s, as well as advances in treatment, are thought to have contributed to the 53% decline in prostate cancer mortality since 1993.77, 78

The third leading cause of death in men and women combined is pancreatic cancer, for which mortality has increased slowly in men, from 12.1 (per 100,000) in 2000 to 12.7 per in 2019, but remained relatively stable in women at 9.3 to 9.6 per 100,000. Liver cancer had the fastest increasing mortality for decades, but rates have stabilized during the most recent 5 years in both men and women (Table 5). Similarly, uterine corpus cancer death rates had risen since the mid-1990s but may be leveling off in recent years. The mortality rate for cancers of the oral cavity and pharynx increased by 0.4% per year from 2010 to 2019 overall, but trends differ by subsite, mirroring incidence; sites associated with HPV-infection (cancers of the tongue, tonsil, and oropharynx) rose by about 2% per year in men and 1% per year in women, whereas those more strongly associated with smoking (eg, lip and gums) declined by 0.8% per year (Table 5).

Recorded Number of Deaths in 2019

In total, 2,854,838 deaths were recorded in the United States in 2019 (Table 6). In contrast to the accelerated declines in cancer mortality, decreases in allߚcause mortality have slowed from 1% to 2% per year during 1975 through 2010 to 0.2% per year during 2010 through 2019. This deceleration reflects slowing declines in mortality for heart and chronic lower respiratory diseases, plateaued rates for cerebrovascular diseases, and a steep increase for accidents, although this trend may be leveling off (Table 7). All-cause mortality rates are stable over the past decade when cancer is excluded.

TABLE 6. Leading Causes of Death in the United States in 2019 Versus 2018
2019 2018 ABSOLUTE CHANGE IN NO. OF DEATHS
NO. RATE PERCENT NO. RATE
All causes 2,854,838 715.4 2,839,205 724.6 15,633
1 Heart diseases 659,041 161.6 23% 655,381 163.8 3,660
2 Cancer 599,601 146.0 21% 599,274 149.2 327
3 Accidents (unintentional injuries) 173,040 49.2 6% 167,127 48.0 5,913
4 Chronic lower respiratory diseases 156,979 38.2 5% 159,486 39.8 −2,507
5 Cerebrovascular disease 150,005 37.0 5% 147,810 37.2 2,195
6 Alzheimer disease 121,499 29.9 4% 122,019 30.6 −520
7 Diabetes mellitus 87,647 21.6 3% 84,946 21.4 2,701
8 Nephritis, nephrotic syndrome, & nephrosis 51,565 12.7 2% 51,386 12.9 179
9 Influenza and pneumonia 49,783 12.3 2% 59,120 14.9 −9,337
10 Intentional self-harm (suicide) 47,511 13.9 2% 48,344 14.2 −833
  • Includes unknown age. Rates for 2018 may differ from those published previously due to updated population denominators.
  • 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 Five Leading Causes of Death, United States, 1975 to 2019
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 2010-2014 2015-2019 2010-2019
All causes 1975-1979 −1.6a 1979-2002 −0.8a 2002-2010 −1.8a 2010-2019 −0.2a −0.2a −0.2a −0.2a
Heart diseases 1975-1986 −1.4a 1986-1991 −3.4a 1991-1995 −1.5a 1995-2002 −2.7a 2002-2010 −4.1a 2010-2019 −0.8a −0.8a −0.8a −0.8a
Cancer 1975-1984 0.5a 1984-1991 0.3a 1991-1994 −0.6 1994-2002 −1.1a 2002-2016 −1.5a 2016-2019 −2.3a −1.5a −2.1a −1.8a
Accidents (unintentional injuries) 1975-1992 −2.1a 1992-2000 0.0 2000-2006 1.9a 2006-2013 −0.5 2013-2017 6.5a 2017-2019 −0.7 1.2a 2.9 2.5a
Chronic lower respiratory diseases 1975-1986 3.7a 1986-2000 1.7a 2000-2019 −0.5a −0.5a −0.5a −0.5a
Cerebrovascular disease 1975-1982 −5.3a 1982-1991 −3.2a 1991-2001 −0.6a 2001-2007 −5.5a 2007-2012 −3.1a 2012-2019 0.4 −1.4a 0.4 −0.4
  • Note: Trends analyzed by the Joinpoint Regression Program, version 4.9.0.1, allowing up to 5 joinpoints.
  • Abbreviations: AAPC, average annual percent change; APC, annual percent change based on mortality rates age adjusted to the 2000 US standard population.
  • a The APC or AAPC is significantly different from zero (P < .05).

Cancer accounts for 21% of all deaths in both men and women and is the second leading cause of death after heart diseases. However, it is the leading cause of death among women aged 40 to 79 years and men aged 60 to 79 years (Table 8). Table 9 presents the number of deaths in 2019 for the 5 leading cancer types by age and sex. Brain and other nervous system tumors lead in cancer deaths among men younger than 40 years and women younger than 20 years, whereas breast cancer leads among women aged 20 to 59 years. Lung cancer is the leading cause of cancer death in men aged 40 years and older and in women aged 60 years and older.

TABLE 8. Ten Leading Causes of Death in the United States by Age and Sex, 2019
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
1,473,823 1,381,015 12,588 6,843 80,979 36,350 224,097 139,097 627,613 473,923 516,769 715,511
1 Heart diseases Heart diseases Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Accidents (unintentional injuries) Heart diseases Cancer Cancer Cancer Heart diseases Heart diseases
357,761 301,280 4,063 2,115 33,392 12,348 49,951 43,278 178,161 146,171 147,643 188,183
2 Cancer Cancer Intentional self-harm (suicide) Cancer Intentional self-harm (suicide) Cancer Cancer Heart diseases Heart diseases Heart diseases Cancer Cancer
315,876 283,725 2,038 733 12,723 4,570 43,257 21,218 154,337 88,829 89,576 88,947
3 Accidents (unintentional injuries) Cerebrovascular 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
112,720 85,658 2,014 718 8,553 3,034 34,179 13,710 39,075 38,058 30,699 70,762
4 Chronic lower respiratory diseases Alzheimer disease Cancer Assault (homicide) Heart diseases Heart diseases Intentional self-harm (suicide) Chronic liver disease & cirrhosis Cerebrovascular disease disease Cerebrovascular disease Alzheimer disease Cerebrovascular disease
73,724 83,516 916 493 5,324 2,651 12,068 5,985 26,151 23,472 29,397 56,624
5 Cerebrovascular diseases Chronic lower respiratory diseases Congenital anomalies Congenital anomalies Cancer Assault (homicide) Chronic liver disease & cirrhosis Chronic lower respiratory diseases Diabetes mellitus Diabetes mellitus Chronic lower respiratory diseases Chronic lower respiratory diseases
64,347 83,255 533 452 3,925 1,598 11,210 5,617 26,049 17,698 29,039 39,146
6 Diabetes mellitus 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)
49,512 60,320 327 272 1,619 974 9,080 5,110 24,591 12,698 15,732 18,932
7 Alzheimer disease Diabetes mellitus Chronic lower respiratory diseases Influenza & pneumonia Diabetes mellitus Pregnancy, childbirth, & puerperium Cerebrovascular disease Cerebrovascular disease Chronic liver disease & cirrhosis Alzheimer disease Parkinson Influenza & pneumonia
37,983 38,135 162 161 1,197 929 6,615 4,807 13,286 12,498 13,289 14,597
8 Intentional self-harm (suicide) Influenza & pneumonia Influenza & pneumonia Cerebrovascular disease Cerebrovascular disease Diabetes mellitus Chronic lower respiratory diseases Intentional self-harm (suicide) Nephritis, nephrotic syndrome, & nephrosis Nephritis, nephrotic syndrome, & nephrosis Diabetes mellitus Diabetes mellitus
37,256 25,139 155 85 713 732 5,042 4,087 11,744 9,665 13,146 14,545
9 Chronic liver disease & cirrhosis Nephritis, nephrotic syndrome, & nephrosis Cerebrovascular disease Chronic lower respiratory diseases HIV disease Cerebrovascular disease Assault (homicide) Septicemia Influenza & pneumonia Septicemia Nephritis, nephrotic syndrome, & nephrosis Nephritis, nephrotic syndrome, & nephrosis
28,105 24,896 110 85 629 622 3,441 2,304 9,623 8,310 11,548 12,870
10 Nephritis, nephrotic syndrome, & nephrosis Hypertension & hypertensive renal diseasea In situ/benign neoplasms Septicemia Influenza & pneumonia Influenza & pneumonia Nephritis, nephrotic syndrome, & nephrosis Influenza & pneumonia Septicemia Influenza & pneumonia Influenza & pneumonia Hypertension & hypertensive renal diseasea
26,669 19,911 76 82 531 442 2,988 2,078 8,966 7,794 11,503 12,844
  • Abbreviation: HIV, 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.
  • a Includes primary and secondary hypertension.
TABLE 9. Five Leading Causes of Cancer Death in the United States by Age and Sex, 2019
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
315,876 948 3,925 43,257 178,161 89,576
Lung & bronchus Brain & ONS Brain & ONS Lung & bronchus Lung & bronchus Lung & bronchus
74,860 274 535 8,838 47,592 18,238
Prostate Leukemia Leukemia Colorectum Prostate Prostate
31,638 212 492 5,893 14,651 15,656
Colorectum Bones & joints Colorectum Pancreas Pancreas Colorectum
27,674 124 484 3,698 14,629 7,052
Pancreas Soft tissue (including heart) Non-Hodgkin lymphoma Livera Colorectum Urinary bladder
23,732 85 218 3,092 14,239 5,675
Livera Non-Hodgkin lymphoma Soft tissue (including heart) Brain & ONS Livera Pancreas
18,692 39 218 2,392 12,365 5,272
FEMALE
All sites All sites All sites All sites All sites All sites
283,725 756 4,570 43,278 146,171 88,947
Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus
64,743 239 1,200 9,727 38,393 18,543
Breast Leukemia Uterine cervix Lung & bronchus Breast Breast
42,281 193 423 7,641 19,874 11,478
Colorectum Bones & joints Colorectum Colorectum Pancreas Colorectum
24,222 67 379 4,088 12,286 9,276
Pancreas Soft tissue (including heart) Brain & ONS Pancreas Colorectum Pancreas
22,154 52 354 2,613 10,478 7,182
Ovary Kidney & renal pelvis Leukemia Ovary Ovary Leukemia
13,445 27 318 2,448 7,482 4,109
  • 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, cervical cancer is persistently the second leading cause of cancer death in women aged 20 to 39 years (Table 9). In total, 4152 women died from cervical cancer in 2019, one-half of whom were in their 50s or younger. Moreover, diagnoses among young women is driving rising incidence for advanced disease and cervical adenocarcinoma,79 for which cytology is less effective at prevention and early detection compared with squamous cell carcinoma.80, 81 Women of low socioeconomic status are about 2 times more likely than affluent women both to be infected with oncogenic HPV subtypes not included in vaccines (18.3% vs 8.9%)82 and to die from cervical cancer.83, 84 Due to this excess burden, near-elimination of cervical cancer is estimated to occur 14 years later among women living in high-poverty versus low-poverty counties, despite comparable HPV vaccination uptake.84 Thus, improved cervical cancer control requires more targeted efforts to increase the prevalence of both HPV vaccination and screening with primary HPV testing or HPV/cytology cotesting as recommended in recently updated guidelines by the American Cancer Society.85, 86 Notably, HPV vaccination in the United States lags far behind that in other high-income countries, with 2019 up-to-date prevalence among female adolescents at 57%87 compared with 67% in Canada,88 >80% in Australia (ncci.canceraustralia.gov.au/), and >90% in the United Kingdom-Scotland.89

Cancer Disparities by Race/Ethnicity

Cancer occurrence and outcomes vary considerably between racial and ethnic groups, largely because of longstanding inequalities in wealth that lead to differences in risk factor exposures and barriers to equitable cancer prevention, early detection, and treatment.90, 91 Ultimately, disproportionate wealth stems from longstanding persistent structural racism, including residential, educational, judicial, and occupational segregationist and discriminatory policies, that has altered the balance of prosperity, security, and other social determinants of health.92 The social determinants of health are defined by the World Health Organization as the conditions in which an individual is born, grows, lives, works, and ages93 because they are consistently and strongly associated with life-expectancy and disease mortality.94, 95 A prime example is the disproportionate impact of the COVID-19 pandemic on people of color in the United States.96

One example of a form of structural racism that has been shown to be associated with poor health is redlining. Redlining is 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. This normalized practice of disinvestment prevented people of color from integrating into suburban White neighborhoods and advancing economically. Although these policies have formally ended, affected neighborhoods remain impoverished and residents experience residual effects, including poorer mental and physical health,97 later stage cancer diagnosis, lower likelihood of appropriate treatment, and worse outcomes,98-100 including 2-fold higher breast cancer mortality rates.101

Overall cancer incidence is highest among White people in part because of high rates of female breast cancer, some part of which may be overdiagnosis (Table 10). However, sex-specific incidence is highest in Black men, among whom rates during 2014 through 2018 were 79% higher than those in Asian/Pacific Islander men, who have the lowest rates, and 6% higher than White men, who rank second. Among women, the highest incidence during 2014 through 2018 was in those who were White, 9% higher than in Black women, who rank second. However, Black women have the highest cancer mortality rates—12% higher than White women. Even more striking, Black women have 4% lower breast cancer incidence than White women but 41% higher breast cancer mortality. Disparities are also larger for mortality than for incidence among men, with the death rate in Black men double that in Asian/Pacific Islander men and 19% higher than that in White men. Although still large, 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 14% in 2019 (171.3 vs 150.9 per 100,000, respectively). This progress is largely due to more rapid declines in deaths from smoking-related cancers among Black men because of the steep drop in smoking initiation among Black teens from the late 1970s to the early 1990s.102

TABLE 10. Incidence and Mortality Rates for Selected Cancers by Race and Ethnicity, United States, 2014-2019
ALL RACES COMBINED WHITE BLACK ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKA NATIVEa HISPANIC/LATINO
Incidence rates, 2014-2018
All sites 449.0 466.0 455.0 294.5 452.6 348.3
Male 487.9 501.3 529.2 295.3 477.3 370.2
Female 423.0 442.8 405.3 297.9 438.5 339.2
Breast (female) 126.9 132.5 127.1 98.8 110.5 96.3
Colon & rectum b 36.5 36.1 42.6 29.0 49.2 32.8
Male 42.1 41.5 50.4 34.4 55.8 39.2
Female 31.6 31.3 37.1 24.6 43.9 27.6
Kidney & renal pelvis 17.1 17.3 18.9 8.1 29.6 17.0
Male 23.2 23.5 26.1 11.3 39.0 22.3
Female 11.8 11.8 13.5 5.5 21.9 12.7
Liver & intrahepatic bile duct 8.6 7.2 10.9 12.4 18.1 13.8
Male 13.1 10.9 17.8 19.1 26.4 20.3
Female 4.7 3.9 5.5 7.1 11.1 8.1
Lung & bronchus 57.3 61.6 59.5 34.3 62.3 29.2
Male 65.8 69.0 77.4 42.5 68.5 36.1
Female 50.8 56.0 47.2 28.0 57.7 24.2
Prostate 106.4 99.9 172.6 55.0 79.8 85.3
Stomach 6.5 5.3 9.8 9.7 9.9 9.5
Male 8.7 7.4 13.3 12.6 12.8 12.0
Female 4.6 3.5 7.4 7.4 7.6 7.7
Uterine cervix 7.7 7.2 8.8 6.1 10.8 9.6
Mortality rates, 2015-2019
All sites 152.4 157.2 178.6 96.4 161.4 109.7
Male 181.4 186.2 221.4 113.2 193.2 132.2
Female 131.1 135.4 152.1 84.2 138.1 93.9
Breast (female) 19.9 19.9 28.0 11.7 17.8 13.7
Colon & rectum 13.4 13.4 18.1 9.3 17.4 10.8
Male 16.0 15.8 22.7 11.1 21.3 13.7
Female 11.3 11.3 14.8 7.9 14.4 8.5
Kidney & renal pelvis 3.6 3.7 3.5 1.6 6.3 3.4
Male 5.2 5.4 5.3 2.4 9.4 4.9
Female 2.2 2.3 2.2 1.0 3.8 2.2
Liver & intrahepatic bile duct 6.6 5.9 8.5 8.6 12.2 9.3
Male 9.7 8.5 13.3 12.9 17.1 13.2
Female 4.1 3.6 4.8 5.3 8.3 6.0
Lung & bronchus 36.7 39.9 39.2 20.6 35.9 16.2
Male 44.5 47.0 54.0 26.9 42.3 22.1
Female 30.7 34.2 29.2 15.9 31.0 11.8
Prostate 18.9 17.8 37.9 8.6 21.0 15.6
Stomach 2.9 2.2 5.1 4.9 5.4 4.8
Male 3.9 3.0 7.5 6.2 7.2 6.1
Female 2.1 1.5 3.5 3.9 3.9 3.9
Uterine cervix 2.2 2.0 3.4 1.7 3.1 2.5
  • Rates are per 100,000 population and age adjusted to the 2000 US standard population and exclude data from Puerto Rico.
  • All race groups are exclusive of Hispanic origin.
  • a Data based on Purchased/Referred Care Delivery Area (PRCDA) counties and are not comparable to previous years due to the exclusion of Hispanic ethnicity. Mortality rates for American Indians and Alaska Natives are underestimated because Indian Health Service-linked data are not publicly available.
  • 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. Geographic variation reflects differences in the prevalence of cancer risk factors, such as smoking and obesity, as well as prevention and early detection practices, such as screening. The largest geographic variation is for the most preventable cancers,26 such as lung cancer, cervical cancer, and melanoma of the skin.103 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 smoking was lowest. Even in 2019, 1 in 4 residents of Kentucky and West Virginia were current smokers compared to 1 in 10 in Utah, California, District of Columbia, Massachusetts, Connecticut, Washington, New York, Maryland, and Hawaii.104 Similarly, cervical cancer incidence rates range from 4 (per 100,000 women) in Vermont and 5 in New Hampshire to almost 10 in Arkansas and Kentucky and 13 in Puerto Rico (Table 11).

TABLE 11. Incidence Rates for Selected Cancers by State, United States, 2014 to 2018
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 515.2 404.1 121.4 47.8 35.7 81.9 49.6 19.5 12.9 121.9 9.4
Alaska 440.7 403.8 121.9 43.9 37.5 62.6 48.5 20.1 13.5 88.4 7.9
Arizona 410.3 368.5 114.2 35.8 26.7 49.2 41.6 18.5 12.7 79.6 6.5
Arkansas 543.5 430.9 119.5 49.5 36.0 93.7 62.9 22.1 14.8 117.1 9.5
California 428.4 387.4 121.8 38.6 29.3 44.9 36.9 22.1 15.1 92.3 7.3
Colorado 415.5 387.3 129.0 34.6 27.3 43.1 38.5 20.5 14.1 92.3 6.3
Connecticut 499.5 443.7 140.2 37.9 29.1 62.8 54.2 25.3 17.2 114.4 5.8
Delaware 524.9 447.2 133.7 41.2 31.2 71.4 59.7 23.7 16.1 122.9 8.3
Dist. of Columbia 456.1 410.2 140.4 40.4 32.6 49.0 42.1 18.7 11.8 130.3 8.2
Florida 499.9 431.0 120.4 40.3 30.2 65.2 50.1 27.6 19.7 95.2 9.1
Georgia 531.4 424.1 128.4 46.4 33.4 76.2 50.0 22.3 14.8 126.6 8.0
Hawaii 439.8 402.1 139.6 44.5 33.2 54.5 35.5 19.1 13.1 95.6 7.0
Idaho 478.2 420.3 128.8 37.5 29.7 54.2 45.1 23.6 15.7 108.5 7.1
Illinois 503.6 444.5 133.7 47.1 34.7 71.8 56.7 23.4 16.4 111.5 7.7
Indiana 499.0 431.5 124.5 46.4 34.7 82.2 60.5 22.2 15.5 96.5 8.3
Iowa 527.1 455.5 132.6 46.2 36.4 72.9 54.8 26.0 17.3 112.1 8.0
Kansas 495.5 433.5 131.6 43.5 33.0 63.0 50.0 23.5 15.8 111.0 8.3
Kentucky 568.4 484.5 127.6 53.7 38.7 104.6 76.9 23.7 16.5 105.1 9.8
Louisiana 556.8 427.3 127.4 51.0 37.1 80.6 52.2 23.1 15.6 134.7 9.4
Maine 504.9 458.0 127.2 37.8 30.2 77.5 66.7 25.5 16.7 92.6 5.6
Maryland 493.1 426.1 132.2 39.5 30.9 60.9 50.9 21.4 15.2 128.1 6.7
Massachusetts 486.3 440.6 136.9 38.0 28.7 64.5 58.1 23.6 15.7 107.7 5.5
Michigan 487.2 422.6 123.1 40.1 31.6 70.5 57.1 23.7 16.2 107.3 6.9
Minnesota 506.1 445.5 134.2 40.3 31.1 60.3 51.7 26.4 17.1 110.5 5.4
Mississippi 549.8 418.9 120.9 54.6 39.8 95.6 57.6 20.6 14.0 131.5 9.5
Missouri 486.8 430.0 130.2 44.4 33.1 81.7 62.3 22.4 15.2 93.0 8.1
Montana 496.7 435.9 135.4 42.0 29.6 52.0 50.9 22.2 15.0 124.2 7.0
Nebraska 508.7 440.3 130.5 45.9 36.6 63.4 50.3 23.8 17.0 123.3 7.6
Nevadab 395.5 374.1 110.4 40.2 30.0 53.9 51.6 17.4 12.3 85.1 8.9
New Hampshire 509.4 460.1 143.1 39.7 29.0 65.7 60.8 24.5 17.2 109.2 5.1
New Jersey 531.8 459.2 137.2 44.4 33.4 59.5 51.2 26.5 18.4 134.5 7.9
New Mexico 390.3 363.2 111.0 36.5 28.4 42.4 33.0 17.1 13.2 82.7 8.5
New York 528.0 454.8 133.9 42.4 31.5 64.8 53.2 26.0 18.1 126.5 7.7
North Carolina 521.1 433.3 136.5 40.6 30.7 80.2 55.9 21.5 14.6 119.3 7.1
North Dakota 490.1 428.2 129.4 45.6 34.3 64.5 53.2 21.9 15.6 118.2 6.0
Ohio 505.2 443.7 129.6 45.3 34.7 78.7 58.7 23.4 15.8 107.2 7.9
Oklahoma 488.8 424.3 124.2 46.3 33.9 78.4 57.4 20.6 15.6 95.7 9.5
Oregon 450.3 419.0 128.0 36.4 29.0 56.0 50.2 22.4 15.5 93.3 7.0
Pennsylvania 515.6 459.0 132.2 44.4 33.3 71.5 56.2 24.8 17.8 104.3 7.3
Rhode Island 503.9 456.8 139.8 36.9 27.5 75.3 64.6 24.0 16.1 105.1 7.3
South Carolina 502.6 411.0 129.9 42.0 30.8 77.6 51.4 20.4 13.7 113.0 7.8
South Dakota 500.9 430.3 124.8 46.4 33.9 64.4 53.0 23.2 16.3 118.3 6.9
Tennessee 523.1 425.0 123.1 45.1 33.5 89.5 62.2 21.9 14.5 113.9 8.5
Texas 454.4 381.2 114.2 44.0 30.2 59.4 41.8 21.0 14.2 97.6 9.3
Utah 444.5 376.2 115.5 30.5 24.8 30.4 22.5 22.6 14.5 115.0 5.4
Vermont 477.0 447.0 132.4 35.9 30.6 66.0 55.9 22.9 15.7 92.1 4.0
Virginia 439.2 393.6 126.4 37.9 29.7 63.2 48.4 20.5 13.9 98.0 6.1
Washington 469.3 426.5 133.5 37.3 29.5 56.9 49.6 23.6 16.0 98.1 6.7
West Virginia 513.7 464.1 118.7 50.5 38.9 91.3 69.3 22.6 16.5 94.3 9.7
Wisconsin 509.5 440.5 132.9 39.1 30.3 65.7 53.6 25.7 17.4 112.6 6.6
Wyoming 429.4 382.0 114.3 33.8 28.5 44.0 40.6 20.2 13.3 111.4 7.4
Puerto Ricoc 410.0 334.3 95.2 48.8 33.6 22.6 11.5 17.8 12.4 144.3 12.9
United States 487.9 423.0 126.9 42.1 31.6 65.8 50.8 23.1 15.9 106.4 7.7
  • 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 2014 through 2018 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, 2015-2019
STATE ALL SITES BREAST COLON & RECTUM LUNG & BRONCHUS NON-HODGKIN LYMPHOMA PANCREAS PROSTATE
MALE FEMALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE
Alabama 212.1 139.2 21.4 18.6 12.4 62.6 33.9 6.6 3.6 13.7 10.2 20.6
Alaska 172.0 131.3 17.8 15.7 13.8 38.9 30.7 6.9 4.9 11.6 8.8 19.1
Arizona 159.0 116.1 18.3 15.0 9.9 34.3 25.8 5.8 3.4 12.0 8.8 17.2
Arkansas 212.3 145.2 19.5 18.5 12.9 64.4 39.8 6.9 3.8 12.9 9.4 18.8
California 161.5 120.4 19.1 14.3 10.6 31.6 22.9 6.5 3.9 11.8 9.1 19.8
Colorado 154.6 114.7 18.8 13.1 10.0 28.2 23.1 6.0 3.4 10.8 8.3 21.2
Connecticut 164.6 120.3 17.3 12.6 8.8 36.2 28.1 6.8 3.8 12.4 9.7 18.0
Delaware 192.7 138.1 21.3 15.6 11.1 49.3 34.8 7.3 4.0 14.4 10.4 17.0
Dist. of Columbia 177.6 141.4 25.4 17.0 12.4 35.7 23.2 5.0 3.5 15.1 12.4 26.5
Florida 170.8 123.4 18.7 15.1 10.6 43.0 29.8 6.3 3.8 12.2 9.0 16.3
Georgia 192.1 131.5 21.1 17.7 11.9 51.0 30.0 6.5 3.8 12.7 9.5 21.5
Hawaii 152.8 108.6 16.7 13.6 9.9 35.9 22.2 6.0 3.6 12.1 9.7 14.6
Idaho 174.7 129.4 21.1 14.9 11.0 34.4 27.0 6.7 4.8 12.7 9.2 22.0
Illinois 187.8 138.1 20.9 17.3 12.2 47.2 33.1 7.1 4.1 13.4 9.8 19.7
Indiana 205.5 143.8 20.4 17.7 12.6 57.2 38.6 7.7 4.5 13.7 10.0 19.4
Iowa 190.0 133.8 18.4 16.2 11.9 48.8 33.2 7.9 4.3 12.9 9.9 20.2
Kansas 186.7 137.4 20.2 16.7 12.0 47.1 34.3 7.2 4.5 13.0 9.6 18.4
Kentucky 226.6 157.5 21.2 19.5 13.8 71.3 47.0 7.9 4.5 13.1 10.3 18.7
Louisiana 211.2 143.9 22.4 19.6 13.1 59.0 35.3 7.5 4.1 14.3 11.1 20.0
Maine 198.8 144.9 18.2 14.9 11.4 53.0 39.8 7.8 4.4 12.9 10.4 19.3
Maryland 178.9 132.6 21.0 15.8 11.6 41.5 30.6 6.7 3.6 13.1 10.0 20.3
Massachusetts 176.3 126.8 16.8 13.4 9.6 40.7 31.9 6.6 4.1 13.2 10.1 18.2
Michigan 191.7 141.7 20.4 15.9 11.5 50.0 36.4 7.8 4.6 14.0 10.8 18.4
Minnesota 173.9 127.3 17.7 14.1 10.1 38.1 29.7 7.9 4.2 12.5 9.8 19.9
Mississippi 232.2 148.9 22.9 21.9 14.4 70.1 37.3 6.8 3.7 15.4 10.7 24.7
Missouri 199.8 141.7 20.4 17.4 11.7 56.3 38.8 7.0 4.1 13.6 9.5 17.8
Montana 171.8 129.1 19.3 15.4 10.3 35.1 31.3 6.4 3.7 11.7 9.5 22.2
Nebraska 179.3 133.1 19.8 17.1 12.2 42.6 31.3 7.3 3.8 13.3 9.7 17.8
Nevada 174.6 136.4 22.0 17.8 12.9 39.8 34.3 6.5 3.8 12.0 9.2 19.0
New Hampshire 181.8 133.6 18.1 14.7 10.3 43.3 36.2 6.5 4.2 12.3 9.4 19.4
New Jersey 167.3 129.1 20.6 16.0 11.3 37.1 28.1 6.7 3.9 12.8 10.0 16.9
New Mexico 162.4 118.8 20.2 15.8 10.3 30.0 21.6 5.8 3.6 11.5 8.1 19.1
New York 164.7 124.9 18.9 14.4 10.5 38.0 27.5 6.7 3.8 12.5 9.7 17.2
North Carolina 192.6 133.3 20.5 15.5 11.0 53.5 33.3 6.8 3.7 12.7 9.5 19.7
North Dakota 172.5 124.0 18.1 17.1 9.7 41.3 28.2 6.6 3.9 12.5 9.0 18.0
Ohio 203.2 145.1 21.6 17.7 12.5 55.8 36.8 7.6 4.4 13.9 10.8 19.4
Oklahoma 214.3 150.5 22.5 20.0 13.7 60.6 39.4 7.9 4.6 12.9 9.5 20.4
Oregon 177.6 135.5 19.6 14.4 11.1 38.6 31.8 7.1 4.4 13.4 10.1 20.7
Pennsylvania 191.7 138.1 20.8 16.8 12.0 47.9 32.7 7.5 4.4 14.1 10.4 18.5
Rhode Island 188.7 134.5 17.6 13.9 10.6 46.9 35.3 6.6 3.9 14.9 9.9 18.2
South Carolina 198.2 134.3 21.2 16.9 11.1 53.2 31.5 6.2 4.0 13.3 10.0 21.0
South Dakota 184.9 132.3 18.8 17.5 12.6 44.5 33.7 7.6 4.0 12.4 10.2 19.1
Tennessee 212.5 145.4 21.8 18.1 12.5 62.7 38.6 7.6 4.5 12.8 9.6 19.6
Texas 176.4 124.2 19.9 17.2 11.1 40.7 26.0 6.6 3.9 11.8 9.0 17.7
Utah 142.8 105.1 19.8 12.2 9.8 21.0 14.3 6.7 3.6 10.9 7.9 21.1
Vermont 187.9 137.2 17.6 15.9 13.2 43.7 33.8 7.3 4.4 12.4 9.9 19.7
Virginia 183.2 130.1 20.9 16.1 11.2 46.4 29.9 6.7 3.9 12.9 9.5 19.7
Washington 174.1 130.9 19.5 14.3 10.3 38.2 30.5 7.1 4.2 12.3 9.4 20.2
West Virginia 213.8 154.3 21.7 20.0 14.4 64.1 41.7 7.9 4.5 12.3 9.8 16.8
Wisconsin 184.6 133.0 18.5 14.8 10.5 43.4 32.0 7.6 4.3 13.5 9.9 20.8
Wyoming 160.2 121.8 18.9 13.5 11.0 33.7 27.8 6.0 4.3 12.8 8.3 17.2
Puerto Ricoa 134.4 87.7 17.3 17.8 11.0 15.4 7.4 4.5 2.6 8.0 5.4 22.0
United States 181.4 131.1 19.9 16.0 11.3 44.5 30.7 6.9 4.0 12.7 9.6 18.9
  • Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • a Rates for Puerto Rico are not included in US combined rates.

Ironically, advances in cancer control, such as the availability of screening tests and improved treatment, typically exacerbate disparities. Thus state differences for cervical and other HPV-associated cancers will likely widen in the wake of unequal uptake of the HPV vaccine. In 2020, up-to-date HPV vaccination among boys and girls aged 13 to 17 years ranged from 32% in Mississippi and 43% in West Virginia to 73% in Massachusetts, 74% in Hawaii, and 83% in Rhode Island.105 State/territory differences in initiatives to improve health, such as Medicaid expansion, may also contribute to future geographic disparities.106, 107

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, and is the fourth most common cause of death among adolescents (aged 15-19 years). In 2022, approximately 10,470 children (birth to 14 years) and 5,480 adolescents (aged 15-19 years) will be diagnosed with cancer and 1050 and 550, respectively, will die from the disease. Leukemia is the most common childhood cancer, accounting for 28% of cases, followed by brain and other nervous system tumors (26%), nearly one-third of which are benign or borderline malignant (Table 13). Cancer types and their distribution differ in adolescents; for example, brain and other nervous system tumors, more than one-half of which are benign or borderline malignant, are most common (21%), followed closely by lymphoma (19%). In addition, there are almost twice as many cases of Hodgkin lymphoma as non-Hodgkin lymphoma among adolescents whereas among children the reverse is true. Thyroid carcinoma and melanoma of the skin account for 12% and 3% of cancers, respectfully, in adolescents, but only 2% and 1%, respectively, in children.

TABLE 13. Case Distribution (2014-2018) and 5-Year Relative Survival (2011-2017) by Age and International Classification of Childhood Cancer Type, Ages Birth to 19 Years, United States
BIRTH TO 14 15 TO 19
% OF CASES 5-YEAR SURVIVAL, % % OF CASES 5-YEAR SURVIVAL, %
All ICCC groups combined 85 86
Leukemias, myeloproliferative & myelodysplastic diseases 28 87 13 75
Lymphoid leukemia 21 92 7 76
Acute myeloid leukemia 4 68 3 67
Lymphomas & reticuloendothelial neoplasms 12 95 19 94
Hodgkin lymphoma 3 99 11 97
Non-Hodgkin lymphoma (including Burkitt) 6 91 7 89
Central nervous system neoplasms 26 74 21 76
Benign/borderline malignant tumorsa 8 97 13 98
Neuroblastoma & other peripheral nervous cell tumors 6 82 <1 66b
Retinoblastoma 2 96 <1 c
Nephroblastoma & other nonepithelial renal tumors 4 93 <1 c
Hepatic tumors 2 80 <1 56b
Hepatoblastoma 1 82 <1 c
Malignant bone tumors 4 73 5 68
Osteosarcoma 2 68 3 68
Ewing tumor & related bone sarcomas 1 76 2 59
Rhabdomyosarcoma 3 70 1 50b
Germ cell & gonadal tumors 3 90 10 93
Thyroid carcinoma 2 >99 12 >99
Malignant melanoma 1 96 3 95
  • Abbreviations:ICCC, International Classification of Childhood Cancer.
  • Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2018.
  • a Benign and borderline brain tumors were excluded from survival calculations for overall central nervous system tumors and all cancers combined 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 <25 cases during 2011 through 2017.

The overall cancer incidence rate in children and adolescents has been increasing slightly (by 0.8 per year in both children and adolescents) since 1975, although trends vary by cancer type. In contrast, death rates per 100,000 declined from 1970 through 2019 continuously from 6.3 to 1.8 in children and from 7.2 to 2.8 in adolescents, for overall reductions of 71% and 61%, respectively. Much of this progress reflects the dramatic declines in mortality for leukemia of 84% in children and 75% in adolescents. 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.108 Progress among adolescents has lagged somewhat behind that in children for reasons that are complex but include differences in tumor biology, clinical trial enrollment, treatment protocols, and tolerance and compliance with treatment.109 Mortality reductions from 1970 to 2019 are also lower in adolescents for other common cancers, including non-Hodgkin lymphoma (91% in children and 67% in adolescents) and brain and other nervous system tumors (41% and 23%, respectively). The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 85% during 2011 through 2017 in children and from 68% to 86% in adolescents.2, 110 However, survival varies substantially by cancer type and age at diagnosis (Table 13).

Limitations

The estimated numbers of new cancer cases and deaths in 2022 are model-based 3-year or 4-year (incidence) ahead projections that should not be used to track trends over time for several reasons. First, new methodologies are adopted regularly, most recently as of the 2021 estimates, to take advantage of improved 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, 2018 for incidence and 2019 for mortality) and thus do not reflect reduced access to cancer care because of the COVID-19 pandemic. Similarly, the models cannot anticipate abrupt fluctuations for cancers affected by changes in detection practice, such as those that occur for prostate cancer because of changes in PSA testing. Third, the model can be over-sensitive 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, 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 White men but about 50% lower in Asian/Pacific Islander men overall.111

Conclusion

The risk of death from cancer has decreased continuously since 1991, resulting in an overall drop of 32% and approximately 3.5 million cancer deaths averted as of 2019. This success is largely because of reductions in smoking that resulted in downstream declines in lung and other smoking-related cancers. Adjuvant chemotherapies for colon and breast cancer and combination therapies for many cancers also contributed. Progress against cancer has accelerated in the past decade because of advances in early detection, surgical techniques, and targeted therapies, despite slowing momentum for other leading causes of death. Some recent treatment breakthroughs are particularly notable because they are for historically difficult-to-treat cancers, such as metastatic melanoma and lung cancer. Also promising is a plateau in liver cancer occurrence, which is one of the most fatal cancers and was the fastest increasing malignancy just a few years ago. However, rising incidence for breast and advanced stage prostate cancers, both of which are amenable to early detection, is concerning. Even more alarming is the persistent racial, socioeconomic, and geographic disparities for highly preventable cancers that may be exacerbated by uneven access to interventions such as HPV vaccination and expanded health care. Increased investment in the 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 and mitigate racial and socioeconomic inequalities.