Cancer statistics, 2022
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.
Cancer statistics, 2022
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
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 126.96.36.199
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
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 188.8.131.52 The annual percent change (APC) in rates was quantified using NCI's Joinpoint Regression Program (version 184.108.40.206).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
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.
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.
|ESTIMATED NEW CASES||ESTIMATED DEATHS|
|BOTH SEXES||MALE||FEMALE||BOTH SEXES||MALE||FEMALE|
|Oral cavity & pharynx||54,000||38,700||15,300||11,230||7,870||3,360|
|Other oral cavity||2,380||1,660||720||1,440||1,090||350|
|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|
|Other digestive organs||8,160||3,530||4,630||3,460||1,530||1,930|
|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|
|Vagina & other genital, female||8,870||8,870||1,630||1,630|
|Penis & other genital, male||2,070||2,070||470||470|
|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|
|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 & unspecified primary sites c||30,620||16,240||14,380||47,770||25,950||21,820|
- 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.
|STATE||ALL CASES||FEMALE BREAST||UTERINE CERVIX||COLON & RECTUM||UTERINE CORPUS||LEUKEMIA||LUNG & BRONCHUS||MELANOMA OF THE SKIN||NON-HODGKIN LYMPHOMA||PROSTATE||URINARY BLADDER|
|Dist. of Columbia||3,440||620||b||250||160||90||370||70||120||580||110|
- 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
|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.
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.
|STATE||ALL SITES||BRAIN & OTHER NERVOUS SYSTEM||FEMALE BREAST||COLON & RECTUM||LEUKEMIA||LIVER & INTRAHEPATIC BILE DUCT||LUNG & BRONCHUS||NON-HODGKIN LYMPHOMA||OVARY||PANCREAS||PROSTATE|
|Dist. of Columbia||1,010||b||100||90||b||80||150||b||b||100||70|
- 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).
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.
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%).
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
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).
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).
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.
|TREND 1||TREND 2||TREND 3||TREND 4||TREND 5||TREND 6||AAPC|
|Liver & intrahepatic bile duct|
|Lung & bronchus|
|Melanoma of skin|
|Oral cavity and pharynx|
|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|
- Trends were analyzed using the Joinpoint Regression Program, version 220.127.116.11, 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.
|2019||2018||ABSOLUTE CHANGE IN NO. OF DEATHS|
|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|
|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.
|TREND 1||TREND 2||TREND 3||TREND 4||TREND 5||TREND 6||AAPC|
|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|
- Note: Trends analyzed by the Joinpoint Regression Program, version 18.104.22.168, 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.
|ALL AGES||AGES 1 to 19||AGES 20 TO 39||AGES 40 TO 59||AGES 60 TO 79||AGES ≥80|
|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||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|
|2||Cancer||Cancer||Intentional self-harm (suicide)||Cancer||Intentional self-harm (suicide)||Cancer||Cancer||Heart diseases||Heart diseases||Heart diseases||Cancer||Cancer|
|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|
|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|
|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|
|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)|
|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|
|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|
|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|
|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|
- 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.
|ALL AGES||<20||20 TO 39||40 TO 59||60 TO 79||≥80|
|All sites||All sites||All sites||All sites||All sites||All sites|
|Lung & bronchus||Brain & ONS||Brain & ONS||Lung & bronchus||Lung & bronchus||Lung & bronchus|
|Colorectum||Bones & joints||Colorectum||Pancreas||Pancreas||Colorectum|
|Pancreas||Soft tissue (including heart)||Non-Hodgkin lymphoma||Livera||Colorectum||Urinary bladder|
|Livera||Non-Hodgkin lymphoma||Soft tissue (including heart)||Brain & ONS||Livera||Pancreas|
|All sites||All sites||All sites||All sites||All sites||All sites|
|Lung & bronchus||Brain & ONS||Breast||Breast||Lung & bronchus||Lung & bronchus|
|Breast||Leukemia||Uterine cervix||Lung & bronchus||Breast||Breast|
|Colorectum||Bones & joints||Colorectum||Colorectum||Pancreas||Colorectum|
|Pancreas||Soft tissue (including heart)||Brain & ONS||Pancreas||Colorectum||Pancreas|
|Ovary||Kidney & renal pelvis||Leukemia||Ovary||Ovary||Leukemia|
- 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
|ALL RACES COMBINED||WHITE||BLACK||ASIAN/PACIFIC ISLANDER||AMERICAN INDIAN/ALASKA NATIVEa||HISPANIC/LATINO|
|Incidence rates, 2014-2018|
|Colon & rectum b||36.5||36.1||42.6||29.0||49.2||32.8|
|Kidney & renal pelvis||17.1||17.3||18.9||8.1||29.6||17.0|
|Liver & intrahepatic bile duct||8.6||7.2||10.9||12.4||18.1||13.8|
|Lung & bronchus||57.3||61.6||59.5||34.3||62.3||29.2|
|Mortality rates, 2015-2019|
|Colon & rectum||13.4||13.4||18.1||9.3||17.4||10.8|
|Kidney & renal pelvis||3.6||3.7||3.5||1.6||6.3||3.4|
|Liver & intrahepatic bile duct||6.6||5.9||8.5||8.6||12.2||9.3|
|Lung & bronchus||36.7||39.9||39.2||20.6||35.9||16.2|
- 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).
|STATE||ALL SITES||BREAST||COLON & RECTUMa||LUNG & BRONCHUS||NON-HODGKIN LYMPHOMA||PROSTATE||UTERINE CERVIX|
|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|
- 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.
|STATE||ALL SITES||BREAST||COLON & RECTUM||LUNG & BRONCHUS||NON-HODGKIN LYMPHOMA||PANCREAS||PROSTATE|
|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|
- 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.
|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|
|Acute myeloid leukemia||4||68||3||67|
|Lymphomas & reticuloendothelial neoplasms||12||95||19||94|
|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|
|Nephroblastoma & other nonepithelial renal tumors||4||93||<1||c|
|Malignant bone tumors||4||73||5||68|
|Ewing tumor & related bone sarcomas||1||76||2||59|
|Germ cell & gonadal tumors||3||90||10||93|
- 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).
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
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.
- 1, , , , , , , , Association of the COVID-19 Pandemic with Patterns of Statewide Cancer Services. J Natl Cancer Inst. June 28 2021.
- 2 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence-SEER 9 Registries Research Data with Delay-Adjustment, Malignant Only, November 2020 Submission (1975-2018) <Katrina/Rita Population Adjustment>-Linked To County Attributes-Total U.S., 1969-2018 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Surveillance Systems Branch; 2021.
- 3 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence-SEER 18 Registries Research Data + Hurricane Katrina Impacted Louisiana Cases, November 2020 Submission (2000-2018) <Katrina/Rita Population Adjustment>-Linked To County Attributes-Total U.S., 1969-2018 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Surveillance Systems Branch; 2021.
- 4 Surveillance Research Program. SEER*Explorer: an interactive website for SEER cancer statistics. National Cancer Institute; 2021. Accessed April 15, 2021. seer.cancer.gov/explorer/
- 5 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence-SEER Research Limited-Field Data With Delay-Adjustment, 21 Registries, Malignant Only, November 2020 Submission (2000-2018)-Linked To County Attributes-Time Dependent (1990-2018) Income/Rurality, 1969-2019 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program; 2021.
- 6 Surveillance Research Program, Statistic Methodology and Applications. DevCan: Probability of Developing or Dying of Cancer Software. Version 6.7.9. National Cancer Institute; 2021.
- 7 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: North American Association of Central Cancer Registries (NAACCR) Incidence Data-Cancer in North America Analytic File, 1995-2018, With Race/Ethnicity, Custom File With County, American Cancer Society Facts and Figures Projection Project (which includes data from the Center for Disease Control and Prevention's National Program of Cancer Registries, the Canadian Council of Cancer Registries' Provincial and Territorial Registries, and the National Cancer Institute's SEER Registries, certified by the NAACCR as meeting high-quality incidence data standards for the specified time periods). National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program; 2021.
- 8 R Sherman, R Firth, M Charlton, et al, eds. Cancer in North America: 2014-2018. Volume One: Combined Cancer Incidence for the United States, Canada and North America. North American Association of Central Cancer Registries, Inc; 2021.
- 9 R Sherman, R Firth, M Charlton, et al, eds. Cancer in North America: 2014-2018. Volume Two: Registry-Specific Cancer Incidence in the United States and Canada. North American Association of Central Cancer Registries, Inc; 2021.
- 10 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Mortality-All Causes of Death, Total U.S. (1969-2019) <Katrina/Rita Population Adjustment>-Linked To County Attributes-Total U.S., 1969-2019 Counties (underlying mortality data provided by the National Center for Health Statistics). National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program; 2021.
- 11, , , et al. Long-term trends in cancer mortality in the United States, 1930-1998. Cancer. 2003; 97(12 suppl): 3133-3275.
- 12, , , . Deaths: Final Data for 2012. National Vital Statistics Reports. Vol 63, No. 9. National Center for Health Statistics; 2015.
- 13, , , . International Classification of Childhood Cancer, third edition. Cancer. 2005; 103: 1457-1467.
- 14 A Fritz, C Percy, A Jack, et al, eds. International Classification of Diseases for Oncology. 3rd ed. World Health Organization; 2000.
- 15 World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems, 10th revision. Vol I-III. WHO; 2011.
- 16 Surveillance Research Program. SEER*Stat software, version 8.3.8. National Cancer Institute; 2020.
- 17 Surveillance Research Program. Joinpoint Regression Program, version 22.214.171.124. National Cancer Institute, Statistical Research and Applications Branch; 2021.
- 18, , , , , . Geographical, racial and socio-economic variation in life expectancy in the US and their impact on cancer relative survival. PLoS One. 2018; 13:e0201034.
- 19, , , , . Impact of reporting delay and reporting error on cancer incidence rates and trends. J Natl Cancer Inst. 2002; 94: 1537-1545.
- 20, , , et al. Updated methodology for projecting U.S.- and state-level cancer counts for the current calendar year: part I: spatio-temporal modeling for cancer incidence. Cancer Epidemiol Biomarkers Prev. 2021; 30: 1620-1626.
- 21, , , et al. Updated methodology for projecting U.S.- and state-level cancer counts for the current calendar year: part II: evaluation of incidence and mortality projection methods. Cancer Epidemiol Biomarkers Prev. Published online August 17, 2021. doi:10.1158/1055-9965.EPI-20-1780
- 22, , , et al. A new method of estimating United States and state-level cancer incidence counts for the current calendar year. CA Cancer J Clin. 2007; 57: 30-42.
- 23 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Populations-Total U.S. (1969-2019) <Katrina/Rita Adjustment>-Linked To County Attributes-Total U.S., 1969-2019 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program; 2020.
- 24, , , et al. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin. 2019; 69: 452-467.
- 25, . Sex differences in immune responses. Nat Rev Immunol. 2016; 16: 626-638.
- 26, , , et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable factors in the United States. CA Cancer J Clin. 2018; 68: 31-54.
- 27, , , . The role of increasing detection in the rising incidence of prostate cancer. JAMA. 1995; 273: 548-552.
- 28, , , et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. J Natl Cancer Inst. Published online July 8, 2021. doi:10.1093/jnci/djab131
- 29, , , et al. Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA. 2015; 314: 2054-2061.
- 30, US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157: 120-134.
- 31 Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence-SEER 18 Registries Research Data With Delay-Adjustment, Malignant Only, November 2020 Submission (2000-2018) <Katrina/Rita Population Adjustment>-Linked To County Attributes-Total U.S., 1969-2018 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Surveillance Systems Branch; 2021.
- 32 US Preventive Services Task Force. Draft Recommendation Statement: Screening for Prostate Cancer. US Preventive Services Task Force; 2017. Accessed September 27, 2017. www.screeningforprostatecancer.org
- 33, , , , , . Prostate-Specific Antigen-Based Screening for Prostate Cancer: A Systematic Evidence Review for the US Preventive Services Task Force. Report No. 17-05229-EF-1. Agency for Healthcare Research and Quality (US); 2018.
- 34 US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018; 319: 1901-1913.
- 35, , , , . Reconsidering the trade-offs of prostate cancer screening. N Engl J Med. 2020; 382: 2465-2468.
- 36, , , et al. Racial and ethnic variation in PSA testing and prostate cancer incidence following the 2012 USPSTF recommendation. J Natl Cancer Inst. 2021; 113: 719-726.
- 37, , , et al. A randomized trial of early detection of clinically significant prostate cancer (ProScreen): study design and rationale. Eur J Epidemiol. 2017; 32: 521-527.
- 38, , , et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018; 378: 1767-1777.
- 39, , , et al. Prostate cancer screening using a combination of risk-prediction, MRI, and targeted prostate biopsies (STHLM3-MRI): a prospective, population-based, randomised, open-label, non-inferiority trial. Lancet Oncol. 2021; 22: 1240-1249.
- 40, , , . Proportion of US trends in breast cancer incidence attributable to long-term changes in risk factor distributions. Cancer Epidemiol Biomarkers Prev. 2018; 27: 1214-1222.
- 41, , , . International patterns and trends in endometrial cancer incidence, 1978-2013. J Natl Cancer Inst. 2018; 110: 354-361.
- 42 US Preventive Services Task Force. Screening for thyroid cancer: US Preventive Services Task Force recommendation statement. JAMA. 2017; 317: 1882-1887.
- 43. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed? Cancer. 2017; 123: 372-381.
- 44, , , , . Prevalence of differentiated thyroid cancer in autopsy studies over six decades: a meta-analysis. J Clin Oncol. 2016; 34: 3672-3679.
- 45, , , , , . Evaluation of gender inequity in thyroid cancer diagnosis: differences by sex in US thyroid cancer incidence compared with a meta-analysis of subclinical thyroid cancer rates at autopsy. JAMA Intern Med. 2021; 181: 1351-1358.
- 46. Cigarette smoking among successive birth cohorts of men and women in the United States during 1900-80. J Natl Cancer Inst. 1983; 71: 473-479.
- 47, , , , . Increasing lung cancer death rates among young women in southern and midwestern states. J Clin Oncol. 2012; 30: 2739-2744.
- 48, , , et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med. 2018; 378: 1999-2009.
- 49, , , et al. Smoking and lung cancer mortality in the United States from 2015 to 2065: a comparative modeling approach. Ann Intern Med. 2018; 169: 684-693.
- 50, , , , . Proportion of never smokers among men and women with lung cancer in 7 US states. JAMA Oncol. 2021; 7: 302-304.
- 51, , . Redoubling efforts to help Americans quit smoking—federal initiatives to tackle the country's longest-running epidemic. N Engl J Med. 2020; 383: 1606-1609.
- 52 US Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.
- 53, , , et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019; 68: 2179-2185.
- 54, , . Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014. JAMA. 2017; 318: 572-574.
- 55, , , . Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics. Cancer. 2013; 119: 388-394.
- 56, , , et al. Annual report to the nation on the status of cancer, 1975-2014, featuring survival. J Natl Cancer Inst. 2017; 109:djx030.
- 57, , . Endometrial cancer: not your grandmother's cancer. Cancer. 2016; 122: 2787-2798.
- 58. The role of topotecan in the treatment of advanced cervical cancer. Gynecol Oncol. 2003; 90(3 pt 2): S16-S21.
- 59, , , . Mortality trends for cervical squamous and adenocarcinoma in the United States. Relation to incidence and survival. Cancer. 2005; 103: 1258-1264.
- 60, , . Principles of cancer screening: lessons from history and study design issues. Semin Oncol. 2010; 37: 202-215.
- 61, , , et al. Relative survival in patients with chronic-phase chronic myeloid leukaemia in the tyrosine-kinase inhibitor era: analysis of patient data from six prospective clinical trials. Lancet Haematol. 2015; 2: e186-e193.
- 62, , . Immune checkpoint inhibitors in melanoma. Lancet. 2021; 398: 1002-1014.
- 63, , , , . New systematic therapies and trends in cutaneous melanoma deaths among US Whites, 1986-2016. Am J Public Health. 2020; 110: 731-733.
- 64, , , et al. Lung cancer staging: a concise update. Eur Respir J. 2018; 51:1800190.
- 65, . Recent advances in the management of lung cancer. Clin Med (Lond). 2018; 18(suppl 2): s41-s46.
- 66, , . Targeted therapies for treatment of non-small cell lung cancer—recent advances and future perspectives. Int J Cancer. 2016; 138: 2549-2561.
- 67, , , et al. Nivolumab versus docetaxel in previously treated patients with advanced non-small-cell lung cancer: two-year outcomes from two randomized, open-label, phase III trials (CheckMate 017 and CheckMate 057). J Clin Oncol. 2017; 35: 3924-3933.
- 68, , . Current state of immunotherapy for non-small cell lung cancer. Transl Lung Cancer Res. 2017; 6: 196-211.
- 69, , , et al. Association of Medicaid expansion under the Patient Protection and Affordable Care Act with non–small cell lung cancer survival. JAMA Oncol. 2020; 6: 1289-1290.
- 70, . Lung cancer screening with low-dose computed tomography in the United States—2010 to 2015. JAMA Oncol. 2017; 3: 1278-1281.
- 71, , , et al. State variation in low-dose computed tomography scanning for lung cancer screening in the United States. J Natl Cancer Inst. 2021; 113: 1044-1052.
- 72, , , et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol. 2019; 30: 1162-1169.
- 73 US Preventive Services Task Force, , , et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021; 325: 962-970.
- 74, , . Are increasing 5-year survival rates evidence of success against cancer? JAMA. 2000; 283: 2975-2978.
- 75, , , et al. Annual report to the nation on the status of cancer, part II: recent changes in prostate cancer trends and disease characteristics. Cancer. 2018; 124: 2801-2814.
- 76, , , , . Prostate cancer incidence 5 years after US Preventive Services Task Force recommendations against screening. J Natl Cancer Inst. 2021; 113: 64-71.
- 77, , , et al. Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control. 2008; 19: 175-181.
- 78, , , et al. Reconciling the effects of screening on prostate cancer mortality in the ERSPC and PLCO trials. Ann Intern Med. 2017; 167: 449-455.
- 79, , . Trends in cervical cancer incidence rates by age, race/ethnicity, histological subtype, and stage at diagnosis in the United States. Prev Med. 2019; 123: 316-323.
- 80, , , et al. Incidence trends of adenocarcinoma of the cervix in 13 European countries. Cancer Epidemiol Biomarkers Prev. 2005; 14: 2191-2199.
- 81, , , et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012; 62: 147-172.
- 82, , , , , . Reducing poverty-related disparities in cervical cancer: the role of HPV vaccination. Cancer Epidemiol Biomarkers Prev. 2021; 30: 1895-1903.
- 83, . Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950-2014: over six decades of changing patterns and widening inequalities. J Environ Public Health. 2017; 2017:2819372.
- 84, , . Cancer statistics, 2019. CA Cancer J Clin. 2019; 69: 7-34.
- 85, , , , , American Cancer Society Guideline Development Group. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. 2020; 70: 274-280.
- 86, , , et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020; 70: 321-346.
- 87, , , et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2019. MMWR Morb Mortal Wkly Rep. 2020; 69: 1109-1116.
- 88, , , et al. Moving toward the elimination of cervical cancer: modelling the health and economic benefits of increasing uptake of human papillomavirus vaccines. Curr Oncol. 2019; 26: 80-84.
- 89, , , . The uptake of human papillomavirus vaccination and its associated factors among adolescents: a systematic review. J Prim Care Community Health. 2017; 8: 349-362.
- 90, , , et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004; 54: 78-93.
- 91, , , , , . Survival of blacks and whites after a cancer diagnosis. JAMA. 2002; 287: 2106-2113.
- 92, , , , , . Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017; 389: 1453-1463.
- 93 Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. World Health Organization; 2008.
- 94, . The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014; 129(suppl 2): 19-31.
- 95, , , , . Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer. Published online September 3, 2021. doi:10.1002/cncr.33894
- 96, , . Racial and ethnic health disparities related to COVID-19. JAMA. 2021; 325: 719-720.
- 97, , , , , . The legacy of structural racism: associations between historic redlining, current mortgage lending, and health. SSM Popul Health. 2021; 14:100793.
- 98, , , et al. Mortgage lending bias and breast cancer survival among older women in the United States. J Clin Oncol. 2021; 39: 2749-2757.
- 99, , , , , . Cancer stage at diagnosis, historical redlining, and current neighborhood characteristics: breast, cervical, lung, and colorectal cancers, Massachusetts, 2001-2015. Am J Epidemiol. 2020; 189: 1065-1075.
- 100, , , et al. The impact of residential racial segregation on non-small cell lung cancer treatment and outcomes. Ann Thorac Surg. Published online May 22, 2021. doi:10.1016/j.athoracsur.2021.04.096
- 101, , , et al. Neighborhood-level redlining and lending bias are associated with breast cancer mortality in a large and diverse metropolitan area. Cancer Epidemiol Biomarkers Prev. 2021; 30: 53-60.
- 102, , , et al. Long-term trends in adolescent and young adult smoking in the United States: metapatterns and implications. Am J Public Health. 2008; 98: 905-915.
- 103, . Melanoma incidence among non-Hispanic Whites in all 50 US states from 2001 through 2015. J Natl Cancer Inst. 2020; 112: 533-539.
- 104 American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2021-2022. American Cancer Society; 2021.
- 105 Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Human Papillomavirus Vaccination Coverage Among Adolescents (13-17 years). Accessed September 21, 2021. data.cdc.gov/Teen-Vaccinations/Vaccination-Coverage-among-Adolescents-13-17-Years/ee48-w5t6/data
- 106, , , . Diet quality, risk factors and access to care among low-income uninsured American adults in states expanding Medicaid vs. states not expanding under the Affordable Care Act. Prev Med. 2016; 91: 169-171.
- 107, , . Health insurance coverage and health—what the recent evidence tells us. N Engl J Med. 2017; 377: 586-593.
- 108, , . Toward the potential cure of leukemias in the next decade. Cancer. 2018; 124: 4301-4313.
- 109, . Optimal therapy for acute lymphoblastic leukemia in adolescents and young adults. Nat Rev Clin Oncol. 2011; 8: 417-424.
- 110, , , et al. SEER Cancer Statistics Review, 1975-2018. National Cancer Institute; 2021.
- 111, , , , , . Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: converging incidence in males and females. CA Cancer J Clin. 2016; 66: 182-202.