Volume 73, Issue 1 p. 17-48
ARTICLE
Open Access

Cancer statistics, 2023

Rebecca L. Siegel MPH

Corresponding Author

Rebecca L. Siegel MPH

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

Correspondence

Rebecca L. Siegel, Surveillance Research, American Cancer Society, 3380 Chastain Meadows Parkway NW, Suite 200, Kennesaw, GA 30144, USA.

Email: [email protected]

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Kimberly D. Miller MPH

Kimberly D. Miller MPH

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

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Nikita Sandeep Wagle MBBS, MHA, PhD

Nikita Sandeep Wagle MBBS, MHA, PhD

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

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Ahmedin Jemal DVM, PhD

Ahmedin Jemal DVM, PhD

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

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First published: 12 January 2023
Citations: 794

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 using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.

Author-Provided Video

Cancer statistics, 2023

by Siegel et al.

INTRODUCTION

Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. The coronavirus disease 2019 (COVID-19) pandemic caused delays in the diagnosis and treatment of cancer because of health care setting closures, disruptions in employment and health insurance, and fear of COVID-19 exposure. Although the impact was largest during the COVID-19 peak in mid-2020, the provision of health care has not fully rebounded. For example, surgical oncology procedures at Massachusetts General Hospital were 72% of 2019 levels during the last one half of 2020 and were only 84% in 2021, the lowest recovery of any surgical specialty.1 Delays in diagnosis and treatment may lead to an uptick in advanced-stage disease and mortality.2 These and other secondary consequences of the pandemic will occur gradually over time and will require many years to quantify at the population level because of the 2-year to 3-year lag in population-based cancer incidence and mortality data. However, what is already well established is the disproportionate direct and indirect impact of the pandemic on communities of color.3, 4

In this article, we provide the estimated numbers of new cancer cases and deaths in 2023 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on up-to-date population-based data for cancer incidence and mortality. We also estimate the total number of cancer deaths averted through 2020 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) Surveillance, Epidemiology, and End Results (SEER) program since 1973 and by the Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR) since 1995. The SEER program is the only source for historic, population-based cancer incidence (1975–2019), which is currently based on data from the eight oldest SEER areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, San Francisco–Oakland, and Seattle–Puget Sound) and represent approximately 8% of the US population.5 Historic survival data (1975–1977 and 1995–1997) are based on the SEER 8 areas plus the Detroit metropolitan area,6 as published previously. Contemporary survival statistics (2012–2018) were based on data from the 17 SEER registries (SEER 8 plus the Alaska Native Tumor Registry and the California, Georgia, Kentucky, Louisiana, and New Jersey registries), representing 27% of the US population.7, 8 All 22 SEER registries (SEER 17 plus Idaho, Illinois, Massachusetts, New York, and Texas), covering 48% of the United States, were the source for the probability of developing cancer, which was obtained using the NCI's DevCan software, version 6.8.0.9

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 and achieve high-quality data standards. 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 2023, contemporary incidence trends (1998–2019) and cross-sectional incidence rates (2015–2019), and stage distribution (2015–2019).10 The incidence rates presented herein differ slightly from those published in Cancer in North America: 20152019 because of the use of 19 versus 20 age groups, respectively, for age adjustment.11, 12

Mortality data from 1930 to 2020 were provided by the National Center for Health Statistics (NCHS).13, 14 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.14, 15 Contemporary 5-year mortality rates for Puerto Rico were obtained from the NCI and the Centers for Disease Control and Prevention joint website, State Cancer Profiles (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.16-18 Causes of death were classified according to the International Classification of Diseases.19

Statistical analysis

All incidence and death rates were age standardized to the 2000 US standard population (19 age groups) and expressed per 100,000 persons (or per million for childhood cancer incidence), as calculated using the NCI's SEER*Stat software, version 8.4.0.20 The annual percent change in rates was quantified using the NCI's Joinpoint Regression software program (version 4.9.1.0).21 Trends were described as increasing or decreasing when the annual percent change was statistically significant based on a 2-sided p value < .05 and otherwise were described as stable. All statistics presented herein by race, including those for Asian American/Pacific Islander (AAPI) and American Indian/Alaska Native (AIAN) individuals, are exclusive of Hispanic ethnicity for improved accuracy of classification. Racial misclassification for AIAN individuals has been further reduced by restricting incidence rates to Purchased/Referred Care Delivery Area counties and adjusting mortality rates (for the entire United States) using classification ratios previously published by the NCHS.22 Life tables by Hispanic ethnicity were published in 2018 and were used for relative survival comparisons between White and Black individuals.23

Whenever possible, cancer incidence rates were adjusted for delays in reporting, which occur because of lags 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.24 It has the largest effect on the most recent data years for cancers that are frequently diagnosed in outpatient settings (e.g., melanoma, leukemia, and prostate cancer). For example, the leukemia incidence rate for 2019 was 13% higher after adjusting for reporting delays (14.9 vs. 13.2 per 100,000 persons).25

Projected cancer cases and deaths in 2023

The most recent year for which incidence and mortality data are available lags 2–4 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 2023 to estimate the contemporary cancer burden using two-step statistical modeling, as described in detail elsewhere.26, 27 Briefly, complete cancer diagnoses were estimated for every state from 2005 through 2019 based on delay-adjusted, high-quality incidence data from 50 states and the District of Columbia (99.7% population coverage; recent data were unavailable for Nevada) and state-level variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.28 Modeled state and national counts were then projected forward to 2023 using a novel, data-driven joinpoint algorithm.27 Ductal carcinoma in situ of the female breast and in situ melanoma of the skin were estimated by approximating annual case counts from 2010 through 2019 based on NAACCR age-specific incidence rates, delay factors for invasive disease (delay factors are unavailable for in situ cases),29 and US population estimates obtained using SEER*Stat software.10, 30 Counts were then projected four years ahead based on the average annual percent change generated by the joinpoint regression model.

The number of cancer deaths expected to occur in 2023 was estimated by applying the previously described data-driven joinpoint algorithm to reported cancer deaths from 2006 through 2020 at the state and national levels as reported by the NCHS.27 Please note that the estimated cases for 2023 reported herein are based on currently available incidence data through 2019 and do not account for the impact of the COVID-19 pandemic on cancer diagnoses, whereas the projected cancer deaths in 2023 are based on data through 2020 and only account for the first year. In addition, basal cell and squamous cell skin cancers cannot be estimated because diagnoses are not recorded by most cancer registries.

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 annual difference between the 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-specific and sex-specific cancer death rates in the peak year for age-standardized cancer death rates (1990 in men, 1991 in women) to the corresponding age-specific and sex-specific populations in subsequent years through 2020.

SELECTED FINDINGS

Expected number of new cancer cases

Table 1 presents the estimated numbers of new invasive cancer cases in the United States in 2023 by sex and cancer type. In total, there will be approximately 1,958,310 new cancer cases, the equivalent of about 5370 cases each day. In addition, there will be about 55,720 new cases of ductal carcinoma in situ in women and 89,070 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, 2023a
Estimated new cases Estimated deaths
Cancer site Both sexes Male Female Both sexes Male Female
All sites 1,958,310 1,010,310 948,000 609,820 322,080 287,740
Oral cavity & pharynx 54,540 39,290 15,250 11,580 8140 3440
Tongue 18,040 13,180 4860 2940 1950 990
Mouth 14,820 8680 6140 3090 1870 1220
Pharynx 20,070 16,340 3730 4140 3260 880
Other oral cavity 1610 1090 520 1410 1060 350
Digestive system 348,840 194,980 153,860 172,010 99,350 72,660
Esophagus 21,560 17,030 4530 16,120 12,920 3200
Stomach 26,500 15,930 10,570 11,130 6690 4440
Small intestine 12,070 6580 5490 2070 1170 900
Colon & rectumb 153,020 81,860 71,160 52,550 28,470 24,080
Colon 106,970 54,420 52,550
Rectum 46,050 27,440 18,610
Anus, anal canal, & anorectum 9760 3180 6580 1870 860 1010
Liver & intrahepatic bile duct 41,210 27,980 13,230 29,380 19,000 10,380
Gallbladder & other biliary 12,220 5750 6470 4510 1900 2610
Pancreas 64,050 33,130 30,920 50,550 26,620 23,930
Other digestive organs 8450 3540 4910 3830 1720 2110
Respiratory system 256,290 131,150 125,140 132,330 71,170 61,160
Larynx 12,380 9900 2480 3820 3070 750
Lung & bronchus 238,340 117,550 120,790 127,070 67,160 59,910
Other respiratory organs 5570 3700 1870 1440 940 500
Bones & joints 3970 2160 1810 2140 1200 940
Soft tissue (including heart) 13,400 7400 6000 5140 2720 2420
Skin (excluding basal & squamous) 104,930 62,810 42,120 12,470 8480 3990
Melanoma of the skin 97,610 58,120 39,490 7990 5420 2570
Other nonepithelial skin 7320 4690 2630 4480 3060 1420
Breast 300,590 2800 297,790 43,700 530 43,170
Genital system 414,350 299,540 114,810 69,660 35,640 34,020
Uterine cervix 13,960 13,960 4310 4310
Uterine corpus 66,200 66,200 13,030 13,030
Ovary 19,710 19,710 13,270 13,270
Vulva 6470 6470 1670 1670
Vagina & other female genital 8470 8470 1740 1740
Prostate 288,300 288,300 34,700 34,700
Testis 9190 9190 470 470
Penis & other male genital 2050 2050 470 470
Urinary system 168,560 117,590 50,970 32,590 22,680 9910
Urinary bladder 82,290 62,420 19,870 16,710 12,160 4550
Kidney & renal pelvis 81,800 52,360 29,440 14,890 9920 4970
Ureter & other urinary organs 4470 2810 1660 990 600 390
Eye & orbit 3490 1900 1590 430 240 190
Brain & other nervous system 24,810 14,280 10,530 18,990 11,020 7970
Endocrine system 47,230 14,340 32,890 3240 1560 1680
Thyroid 43,720 12,540 31,180 2120 970 1150
Other endocrine 3510 1800 1710 1120 590 530
Lymphoma 89,380 49,730 39,650 21,080 12,320 8760
Hodgkin lymphoma 8830 4850 3980 900 540 360
Non-Hodgkin lymphoma 80,550 44,880 35,670 20,180 11,780 8400
Myeloma 35,730 19,860 15,870 12,590 7000 5590
Leukemia 59,610 35,670 23,940 23,710 13,900 9810
Acute lymphocytic leukemia 6540 3660 2880 1390 700 690
Chronic lymphocytic leukemia 18,740 12,130 6610 4490 2830 1660
Acute myeloid leukemia 20,380 11,410 8970 11,310 6440 4870
Chronic myeloid leukemia 8930 5190 3740 1310 780 530
Other leukemiac 5020 3280 1740 5210 3150 2060
Other & unspecified primary sites c 32,590 16,810 15,780 48,160 26,130 22,030
  • Note: These are model-based estimates that should be interpreted with caution and not compared with those for previous years.
  • Source: Estimated new cases are based on 2005–2019 incidence data reported by the North American Association of Central Cancer Registries. Estimated deaths are based on 2006–2020 US mortality data reported by the National Center for Health Statistics, Centers for Disease Control and Prevention.
  • a Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancer and in situ carcinoma except urinary bladder. Approximately 55,720 cases of female breast ductal carcinoma in situ and 89,070 cases of melanoma in situ will be diagnosed in 2023.
  • b Includes appendiceal cancer; deaths for colon and rectal cancers are combined because a large number of deaths from rectal cancer are misclassified as colon cancer.
  • c More deaths than cases may reflect a lack of specificity in recording underlying cause of death on death certificates and/or an undercount in the case estimate.
TABLE 2. Estimated new cases for selected cancers by state, 2023a
State All sites Female breast Colon & rectum Leukemia Lung & bronchus Melanoma of the skin Non-Hodgkin lymphoma Prostate Urinary bladder Uterine cervix Uterine corpus
Alabama 30,730 4500 2570 780 4280 1510 1030 5320 1180 240 830
Alaska 3390 520 330 90 450 100 140 470 160 b 110
Arizona 41,120 6240 3220 1190 4450 2800 1710 5060 1960 280 1260
Arkansas 18,670 2510 1630 520 2950 1080 720 2500 750 160 520
California 192,770 32,020 16,420 5510 17,040 10,950 8280 26,970 7250 1610 7050
Colorado 28,920 4910 2120 870 2600 2000 1150 4220 1220 200 920
Connecticut 23,480 3620 1560 810 2750 830 1020 3990 1160 120 800
Delaware 7240 1050 500 200 920 350 310 1330 350 50 250
District of Columbia 3520 570 240 60 350 80 120 540 110 b 130
Florida 162,410 22,670 11,750 6080 19,340 9640 8200 24,000 7210 1200 5050
Georgia 61,170 9440 4880 1700 7610 3310 2090 9140 2160 470 1760
Hawaii 8460 1480 770 210 930 520 330 1190 300 50 340
Idaho 10,810 1560 810 380 1080 760 440 1700 540 70 350
Illinois 74,580 11,530 6200 2090 9670 3380 2990 10,580 3160 520 2770
Indiana 40,270 5810 3430 1230 6020 2180 1580 5580 1780 280 1340
Iowa 20,460 2810 1630 740 2680 1310 860 2970 940 120 690
Kansas 16,840 2470 1430 500 2240 640 680 2680 720 120 550
Kentucky 30,270 4030 2640 850 5170 1490 1120 3520 1240 230 830
Louisiana 28,580 4050 2560 820 3850 1260 1040 4970 1060 230 820
Maine 10,490 1450 690 340 1550 490 450 1210 580 b 390
Maryland 35,200 5760 2560 1050 4290 1840 1380 5980 1340 230 1320
Massachusetts 42,880 6770 2880 1280 5790 1540 1750 6430 1890 210 1470
Michigan 61,910 8980 4630 1820 8690 2680 2580 8360 2980 380 2420
Minnesota 34,380 5220 2430 1200 3970 1140 1510 4880 1530 150 1190
Mississippi 18,210 2610 1750 460 2830 720 600 2790 620 150 530
Missouri 37,910 5700 3030 1190 5760 1610 1500 5000 1570 280 1320
Montana 7100 1030 540 220 720 550 290 1370 350 b 220
Nebraska 11,530 1670 950 380 1340 640 470 2180 470 60 370
Nevada 17,370 2620 1490 540 2030 800 720 2180 820 150 550
New Hampshire 9580 1390 650 290 1280 560 410 1410 520 b 360
New Jersey 56,150 8580 4220 1790 5920 2250 2420 9460 2540 350 2120
New Mexico 11,280 1730 940 350 960 610 470 1680 410 100 360
New York 123,810 18,780 8970 3560 14,150 4000 5150 20,390 5440 850 4620
North Carolina 67,690 10,730 4,740 2100 8810 3950 2560 10,040 2760 420 2180
North Dakota 4370 610 370 160 530 290 170 740 200 b 120
Ohio 74,140 11,200 5910 1980 10,680 3880 2900 10,980 3400 510 2570
Oklahoma 23,420 3330 1950 710 3390 1220 890 3100 920 200 700
Oregon 26,030 4220 1840 680 3030 1540 1090 3400 1210 140 830
Pennsylvania 88,450 12,830 6610 2600 11,320 3630 3690 13,210 4270 510 3330
Rhode Island 7030 1050 470 220 940 290 310 1030 340 b 260
South Carolina 33,890 5430 2550 890 4650 1800 1230 5770 1390 240 1040
South Dakota 5340 760 440 190 690 310 220 1040 240 b 170
Tennessee 43,790 6210 3450 1200 6580 1990 1600 6280 1730 320 1320
Texas 139,100 22,280 12,220 4780 14,510 5530 5540 17,230 4490 1510 4460
Utah 13,840 2030 940 440 800 1550 510 2500 500 90 470
Vermont 4370 630 300 130 590 230 210 630 200 b 150
Virginia 47,100 7810 3630 1230 6010 2360 1910 7580 1830 310 1590
Washington 44,630 7050 3160 1360 5030 2680 1900 6450 1940 270 1430
West Virginia 12,840 1620 1120 390 2170 560 550 1780 620 90 450
Wisconsin 37,640 5460 2650 1320 4630 1970 1630 5800 1780 180 1390
Wyoming 3170 460 260 90 330 210 110 690 170 b 110
United States 1,958,310 297,790 153,020 59,610 238,340 97,610 80,550 288,300 82,290 13,960 66,200
  • Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US totals because of 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 unavailable.
  • b The estimate is fewer than 50 cases.

The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (40.9%) than for women (39.1%; Table 3). Higher risk in men for most cancer types is thought to largely reflect greater exposure to carcinogenic environmental and behavioral factors, such as smoking, although a recent study suggests that other differences also play a large role.31 These may include height,32, 33 endogenous hormone exposure, and immune function and response.34

TABLE 3. Probability (%) of developing invasive cancer within selected age intervals by sex, United States, 2017–2019a
Probability, %
Cancer site Sex Birth to 49 years 50–59 years 60–69 years 70 years and older Birth to death
All sitesb Male 3.5 (1 in 29) 6.2 (1 in 16) 13.8 (1 in 7) 34.0 (1 in 3) 40.9 (1 in 2)
Female 5.8 (1 in 17) 6.4 (1 in 16) 10.4 (1 in 10) 27.2 (1 in 4) 39.1 (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)
Colon & rectum Male 0.4 (1 in 241) 0.7 (1 in 138) 1.1 (1 in 90) 3.1 (1 in 33) 4.3 (1 in 23)
Female 0.4 (1 in 267) 0.5 (1 in 191) 0.8 (1 in 130) 2.8 (1 in 36) 3.9 (1 in 26)
Kidney & renal pelvis Male 0.3 (1 in 389) 0.4 (1 in 250) 0.7 (1 in 144) 1.4 (1 in 69) 2.3 (1 in 44)
Female 0.2 (1 in 609) 0.2 (1 in 504) 0.3 (1 in 292) 0.8 (1 in 124) 1.3 (1 in 75)
Leukemia Male 0.3 (1 in 380) 0.2 (1 in 538) 0.4 (1 in 263) 1.4 (1 in 69) 1.8 (1 in 55)
Female 0.2 (1 in 495) 0.1 (1 in 820) 0.2 (1 in 425) 0.9 (1 in 111) 1.3 (1 in 78)
Lung & bronchus Male 0.1 (1 in 848) 0.6 (1 in 178) 1.7 (1 in 59) 5.6 (1 in 18) 6.2 (1 in 16)
Female 0.1 (1 in 746) 0.5 (1 in 183) 1.4 (1 in 72) 4.7 (1 in 21) 5.8 (1 in 17)
Melanoma of the skinc Male 0.4 (1 in 246) 0.5 (1 in 205) 0.9 (1 in 114) 2.6 (1 in 38) 3.5 (1 in 28)
Female 0.6 (1 in 162) 0.4 (1 in 247) 0.5 (1 in 191) 1.1 (1 in 88) 2.4 (1 in 41)
Non-Hodgkin lymphoma Male 0.3 (1 in 400) 0.3 (1 in 354) 0.6 (1 in 181) 1.8 (1 in 55) 2.3 (1 in 43)
Female 0.2 (1 in 535) 0.2 (1 in 473) 0.4 (1 in 250) 1.3 (1 in 74) 1.9 (1 in 53)
Prostate Male 0.2 (1 in 457) 1.8 (1 in 55) 5.2 (1 in 19) 9.2 (1 in 11) 12.6 (1 in 8)
Thyroid Male 0.2 (1 in 487) 0.1 (1 in 767) 0.2 (1 in 599) 0.2 (1 in 416) 0.6 (1 in 155)
Female 0.8 (1 in 125) 0.3 (1 in 290) 0.3 (1 in 318) 0.4 (1 in 276) 1.7 (1 in 59)
Uterine cervix Female 0.3 (1 in 340) 0.1 (1 in 803) 0.1 (1 in 934) 0.2 (1 in 593) 0.7 (1 in 153)
Uterine corpus Female 0.3 (1 in 305) 0.6 (1 in 161) 1.0 (1 in 97) 1.5 (1 in 68) 3.1 (1 in 33)
  • a For people free of cancer at beginning of age interval.
  • b All sites exclude basal cell and squamous cell skin cancers and in situ cancers except urinary bladder.
  • c Probability for non-Hispanic White individuals.

Figure 1 depicts the most common cancers diagnosed in men and women in 2023. Prostate, lung and bronchus (hereinafter lung), and colorectal cancers (CRCs) account for almost one half (48%) of all incident cases in men, with prostate cancer alone accounting for 29% of diagnoses. For women, breast cancer, lung cancer, and CRC account for 52% of all new diagnoses, with breast cancer alone accounting for 31% of female cancers.

Details are in the caption following the image

Ten leading cancer types for the estimated new cancer cases and deaths by sex, United States, 2023. Estimates are rounded to the nearest 10, and cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder. Ranking is based on modeled projections and may differ from the most recent observed data.

Expected number of cancer deaths

An estimated 609,820 people in the United States will die from cancer in 2023, corresponding to 1670 deaths per day (Table 1). The greatest number of deaths are from cancers of the lung, prostate, and colorectum in men and cancers of the lung, breast, and colorectum in women (Figure 1). Table 4 provides the estimated number of deaths for these and other common cancers by state.

TABLE 4. Estimated deaths for selected cancers by state, 2023a
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 10,640 330 720 900 370 520 2610 290 200 840 540
Alaska 1,150 b 60 110 b 70 220 b b 90 60
Arizona 13,460 420 920 1300 530 690 2290 430 320 1140 850
Arkansas 6340 190 390 550 200 310 1680 190 120 460 340
California 59,830 2180 4680 5530 2290 3450 9380 2180 1450 4970 4090
Colorado 8650 310 690 740 340 430 1450 280 210 790 740
Connecticut 6440 230 480 550 290 320 1320 230 160 540 400
Delaware 2230 60 160 170 90 90 500 80 50 210 100
District of Columbia 990 b 60 90 b 80 160 b b 100 70
Florida 47,410 1450 3170 3810 1970 2230 10,230 1580 1060 3910 2650
Georgia 18,510 590 1400 1640 660 820 4060 500 430 1520 1020
Hawaii 2620 60 180 240 90 170 480 90 50 240 150
Idaho 3120 100 160 270 140 170 580 120 80 280 200
Illinois 23,380 680 1720 2110 910 1080 5000 780 550 2080 1270
Indiana 13,660 330 930 1170 510 650 3250 460 260 1170 760
Iowa 6310 190 380 540 260 230 1410 200 140 460 370
Kansas 5690 190 370 500 240 250 1330 190 120 410 280
Kentucky 10,090 280 790 890 400 380 2710 320 160 740 410
Louisiana 9420 250 690 870 390 530 2240 290 170 730 470
Maine 3500 110 190 270 120 120 870 120 70 270 170
Maryland 11,090 320 850 980 420 510 1950 350 260 910 680
Massachusetts 12,420 450 760 880 490 530 2570 350 300 1120 680
Michigan 21,380 620 1370 1740 800 920 4930 760 460 1810 1210
Minnesota 10,280 320 640 830 450 380 2090 400 210 870 630
Mississippi 6690 190 470 640 230 300 1740 170 110 440 370
Missouri 13,090 370 810 940 470 590 3210 420 250 1010 650
Montana 2200 80 150 170 80 160 380 70 b 170 140
Nebraska 3540 130 270 320 160 100 630 110 70 300 170
Nevada 5850 190 440 470 200 300 1260 220 120 450 440
New Hampshire 2910 100 180 190 100 140 560 100 b 320 170
New Jersey 15,230 520 1200 1360 640 600 2800 530 350 1410 730
New Mexico 3840 120 300 290 130 300 560 130 70 310 280
New York 31,320 950 2440 2770 1200 1210 6330 1000 850 2940 1650
North Carolina 20,400 560 1450 1640 760 1010 4660 640 370 1630 1150
North Dakota 1320 b 70 110 70 50 290 50 b 110 70
Ohio 24,770 720 1670 2120 1060 1010 5730 830 470 2080 1310
Oklahoma 8660 250 580 800 340 460 2090 290 190 590 400
Oregon 8430 270 570 640 330 470 1650 310 150 710 500
Pennsylvania 27,460 740 1870 2280 1140 1260 5720 950 610 2340 1440
Rhode Island 2150 80 130 160 80 130 470 70 b 190 110
South Carolina 11,250 360 800 910 410 500 2630 310 190 900 640
South Dakota 1760 60 110 170 130 90 380 60 b 150 80
Tennessee 14,590 420 1030 1240 520 620 3700 460 330 1090 740
Texas 44,140 1330 3340 4350 1590 2750 8330 1440 950 3510 2290
Utah 3710 200 320 310 160 180 460 140 110 310 340
Vermont 1460 60 80 120 50 80 280 50 b 110 90
Virginia 15,800 500 1150 1410 590 680 3320 510 350 1320 960
Washington 13,350 490 960 1050 510 680 2630 480 320 1100 840
West Virginia 4610 120 230 440 180 220 1290 150 90 330 190
Wisconsin 11,670 380 720 880 480 510 2460 410 220 1020 730
Wyoming 1020 50 70 110 b 60 200 b b 90 80
United States 609,820 18,990 43,170 52,550 23,710 29,380 127,070 20,180 13,270 50,550 34,700
  • Note: These are model-based estimates that should be interpreted with caution. State estimates may not add to US totals because of rounding and the exclusion of states with fewer than 50 deaths.
  • a Rounded to the nearest 10; estimates for Puerto Rico are not available.
  • b The estimate is <50 deaths.

Approximately 350 people die each day from lung cancer—nearly 2.5 times more than the number of people who die from CRC, which is the second leading cause of cancer death overall. Approximately 103,000 of the 127,070 lung cancer deaths (81%) in 2023 will be caused by cigarette smoking directly, with an additional 3560 caused by second-hand smoke.35 The remaining balance of approximately 20,500 nonsmoking-related lung cancer deaths would rank as the eighth leading cause of cancer death among the sexes combined if it was 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.36 Thereafter, cancer incidence in men generally decreased until around 2013, then stabilized through 2019. In women, the rate was fairly stable until the mid-1980s but has since increased slowly by <0.5% per year.5, 37 Consequently, the sex gap is slowly narrowing, with the male-to-female incidence rate ratio declining from 1.59 (95% confidence interval [CI], 1.57–1.61) in 19926 to 1.14 (95% CI, 1.14–1.15) in 2019.25 However, differences in risk vary widely by age. For example, rates among individuals aged 20–49 years are about 80% higher in females than in males, whereas, among those aged 75 years and older, they are nearly 50% higher in men.

Details are in the caption following the image

Trends in cancer incidence (1975–2019) and mortality (1975–2020) 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 by about 40% from 2007 to 2014 (Figure 3) because of declines in the diagnosis of localized tumors through PSA testing, the prevalence of which decreased after the United States Preventive Services Task Force (USPSTF) recommended against screening for men aged 75 years and older in 2008 and for all men in 2012.38, 39 However, the prostate cancer incidence rate has risen by 3% per year from 2014 through 2019, translating to 99,000 more cases than would have occurred if rates had remained stable, approximately half of which were advanced. This uptick is driven by increases of about 4.5% annually for regional-stage and distant-stage diagnoses that began as early as 2011 and are being watched closely.37 Localized-stage disease has also begun to tick up, although the trend is not yet statistically significant. These patterns are consistent with continued reports of a shift toward higher grade and stage at prostate cancer diagnosis since circa 2010.40 Efforts to recoup the benefit of early prostate cancer detection while mitigating overdiagnosis and overtreatment include a USPSTF upgrade to informed decision making in men aged 55–69 in 201841, 42 and more targeted screening for clinically significant tumors using molecular markers and magnetic resonance imaging-targeted biopsy.43, 44 Black men benefit more from screening in general45, 46 and from the integration of personalized biomarkers because they are more likely to harbor genomically aggressive cancer, even with clinically low-risk disease.47 Prostate cancer mortality rates in Black men are approximately two to four times higher than those in every other racial and ethnic group (Table 5).

Details are in the caption following the image

Trends in incidence rates for selected cancers by sex, United States, 1975–2019. Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. aLiver includes intrahepatic bile duct.

TABLE 5. Incidence and mortality rates for selected cancers by race and ethnicity, United States, 2015–2020
All races and ethnicities White Black American Indian/Alaska Nativeb Asian American/Pacific Islander Hispanic/Latino
Incidence, 2015–2019
All sites 449.4 466.6 453.7 456.8 295.5 352.2
Male 488.2 502.1 527.5 481.2 294.9 372.1
Female 423.3 442.8 404.2 443.6 300.1 344.8
Breast (female) 128.1 133.7 127.8 111.3 101.3 99.2
Colon & rectuma 35.9 35.7 41.7 48.6 28.6 32.5
Male 41.5 41.0 49.6 56.2 33.9 38.8
Female 31.2 30.9 35.9 42.5 24.3 27.4
Kidney & renal pelvis 17.3 17.5 19.1 31.0 8.1 17.5
Male 23.5 23.8 26.2 41.2 11.4 22.8
Female 12.0 11.9 13.6 22.5 5.5 13.1
Liver & intrahepatic bile duct 8.6 7.3 10.7 18.4 12.2 13.8
Male 13.1 11.0 17.4 26.8 18.9 20.3
Female 4.8 4.0 5.5 11.5 6.8 8.2
Lung & bronchus 56.3 60.6 58.2 61.6 34.2 29.1
Male 64.1 67.3 74.8 66.9 42.1 35.6
Female 50.3 55.5 46.9 57.9 28.3 24.4
Prostate 109.9 103.5 176.2 82.6 57.2 87.2
Stomach 6.4 5.2 9.7 9.6 9.4 9.4
Male 8.5 7.2 13.0 12.5 12.2 11.6
Female 4.6 3.4 7.4 7.5 7.2 7.8
Uterine cervix 7.7 7.2 8.8 10.9 6.1 9.7
Uterine corpus 27.7 27.9 28.4 29.4 21.2 25.5
Mortality, 2016–2020
All sites 149.4 154.4 174.7 179.3 94.5 108.2
Male 177.5 182.5 216.0 216.5 110.4 129.6
Female 128.7 133.0 149.2 153.7 82.9 93.2
Breast (female) 19.6 19.7 27.6 20.5 11.7 13.7
Colon & rectum 13.1 13.1 17.6 18.6 9.1 10.7
Male 15.7 15.5 22.3 22.6 10.9 13.5
Female 11.0 11.1 14.3 15.6 7.7 8.5
Kidney & renal pelvis 3.5 3.6 3.4 6.5 1.6 3.3
Male 5.1 5.3 5.2 9.7 2.4 4.8
Female 2.2 2.3 2.1 4.1 1.0 2.1
Liver & intrahepatic bile duct 6.6 5.9 8.3 13.3 8.4 9.2
Male 9.6 8.4 12.9 19.5 12.5 13.1
Female 4.1 3.6 4.8 8.5 5.1 6.0
Lung & bronchus 35.0 38.0 37.2 42.3 19.8 15.4
Male 42.2 44.7 51.0 51.1 25.6 20.9
Female 29.3 32.8 27.8 36.0 15.4 11.4
Prostate 18.8 17.8 37.5 21.9 8.6 15.3
Stomach 2.8 2.1 5.0 5.5 4.6 4.8
Male 3.8 2.9 7.2 7.5 5.9 5.9
Female 2.1 1.5 3.5 4.0 3.7 3.9
Uterine cervix 2.2 2.0 3.3 3.2 1.6 2.5
Uterine corpus 5.1 4.6 9.1 4.9 3.5 4.3
  • Note: Rates are per 100,000 population and age adjusted to the 2000 US standard population. All race groups are exclusive of Hispanic origin.
  • a Colorectal cancer incidence rates exclude appendix.
  • b To reduce racial misclassification, incidence rates are limited to Purchased/Referred Care Delivery Area counties and mortality rates (for the entire United States) are adjusted using factors published by the National Center for Health Statistics.22

Female breast cancer incidence rates have been slowly increasing by about 0.5% per year since the mid-2000s, largely driven by diagnoses of localized-stage and hormone receptor-positive disease.48 This trend has been attributed at least in part to continued declines in the fertility rate and increases in excess body weight,49 which may also contribute to increased uterine corpus cancer incidence of about 1% per year since the mid-2000s among women aged 50 years and older and nearly 2% per year since at least the mid-1990s in younger women.37, 50 After decades of increase, thyroid cancer incidence rates have declined since 2014 by about 2% per year because of changes in clinical practice designed to mitigate over detection, including recommendations against thyroid cancer screening by the USPSTF, and for more restrictive criteria for performing and interpreting biopsies by professional societies.51, 52 Data from autopsy studies indicate that the occurrence of clinically relevant thyroid tumors has remained stable since 1970 and is generally similar in men and women, despite three-fold higher overall incidence rates in women.53, 54

Lung cancer incidence has declined at a steady pace since 2006–2007 by 2.6% annually in men and by 1.1% annually in women.37 Declines in lung cancer incidence began later and have been slower in women than in men because women took up cigarette smoking in large numbers later and were also slower to quit, including upturns in smoking prevalence in some birth cohorts.55, 56 In contrast, CRC incidence patterns have been similar by sex since at least the mid-1970s, with rates declining by 1.4%–1.5% per year since 2012 in both men and women.37 However, these rates are driven by cancer occurrence in older age groups, for whom screening has been recommended, and mask increasing trends in young adults. Compared with declines of 2% per year in people aged 50 years and older during that time period, rates increased by almost 2% per year in adults younger than 50 years. Rising incidence in the United States and several other high-income countries since the mid-1990s57 remains unexplained but likely reflects changes in lifestyle exposures that began with generations born circa 1950.58

After a long history of increase, incidence of non-Hodgkin lymphoma decreased by about 1% per year during 2015 through 2019, and melanoma and liver cancer have stabilized. However, progress for the latter two cancers is mostly confined to men, among whom rates declined by about 1% per year for melanoma and by 2.6% per year for liver cancer in those younger than 50 years and were stable in older men. In women, melanoma was stable in those younger than 50 years but continued to increase by about 1% per year in older women, whereas liver cancer increased by 1.6%–1.7% per year in both age groups.37 The decline in urinary bladder cancer since the mid-2000s accelerated from 0.6% per year to 1.8% per year during 2015 through 2019 overall; however, trends vary widely by race and ethnicity, and incidence continues to increase by 1.3% per year in AIAN individuals. Incidence also continued to increase by about 1% annually in both men and women for cancers of the kidney and pancreas and by 2.8% and 1.3% per year, respectively, for human papillomavirus (HPV)-associated oral cavity cancers.

Cervical cancer incidence has decreased by more than one half since the mid-1970s because of the widespread uptake of screening. Although rates were stable during 2015 through 2019 overall, trends vary by age, race, and ethnicity. For example, rates continued to decline by about 2% annually in Black, Hispanic, and Asian American/Pacific Islander (AAPI) women 50 years and older and by 1% annually in younger Black and AAPI women; however, rates among younger Hispanic women increased by 2% per year from 2012 through 2019. This may at least in part reflect a change in the composition of the young Hispanic population in the United States through immigration and/or migration. For example, cervical cancer incidence rates among women in Puerto Rico are 30% higher than those among mainland Hispanic women59 and were recently reported to be increasing in women younger than 65 years, perhaps due to increased HPV prevalence and suboptimal screening.60

The first vaccine against the two strains of HPV that cause 70% of cervical cancers (HPV-16 and HPV-18) was approved in 2006 by the US Food and Drug Administration for use in females aged 9–26 years.61, 62 Thus, the first cohort of vaccinated adolescents is now in their 20s. Among women aged 20–24 years, invasive cervical cancer incidence rates declined by 3% annually from 1998 (2.1 per 100,000 persons) through 2012 (1.3 per 100,000 persons), then by 11.4% annually from 2012 through 2019 (0.5 per 100,000 persons; Figure 4). The overall reduction during 2012 through 2019 was 65%, compared with 33% during the previous 7-year period (2005–2012). Although a new joinpoint is not yet evident among women of color because of sparse data, the decrease in rates during 2012 through 2019 was similar across race and ethnicity (White, 64%; Black, 69%; Hispanic, 70%). Data for AAPI and AIAN women were too sparse to analyze.

Details are in the caption following the image

Trends in cervical cancer incidence rates among women aged 20–24 years by race and ethnicity, United States, 1998–2019. Rates are age adjusted to the 2000 US standard population and adjusted for reporting delays. White and Black race are exclusive of Hispanic ethnicity. aThe APC is statistically significant (p < .05). APC indicates annual percent change.

These findings are consistent with those of Mix et al., who reported declines in cervical squamous cell carcinoma of 22.5% per year from 2010 through 2017 among women aged 15–20 years.63 Surprisingly large herd immunity has also been shown in the United States based on data from the National Health Examination Survey during 2003 through 2018, with reductions in HPV-16 and HPV-18 infection among sexually active females aged 14–24 years of 90% among those who were vaccinated and 74% among those who were unvaccinated.64 Sweden was first to report a population-level reduction in invasive cervical cancer incidence of 78% among women who were vaccinated before age 17 years in 2020.65 Shortly thereafter, an 87% reduction in cervical cancer and a 97% reduction in grade 3 cervical intraepithelial neoplasia was demonstrated among women aged 20–29 years who were vaccinated at ages 12 to 13 years in England.66 Although up-to-date (three-dose) HPV vaccination coverage in the United States has lagged behind other countries, accumulating evidence suggests that a single dose offers substantial protection67, 68 and may even be preferable in low-income, high-burden populations.69 In April, 2022, the World Health Organization's Strategic Advisory Group of Experts on Immunization endorsed single-dose vaccination among girls aged 9–14 years to address the global shortfall and optimize cancer prevention.70 In 2021, 79% of adolescent girls in the United States had received at least one dose, and 64% were up to date.71

Cancer survival

The 5-year relative survival rate for all cancers combined has increased from 49% for diagnoses during the mid-1970s to 68% for diagnoses during 2012 through 2018 (Table 6).6, 7 Current survival is highest for cancers of the thyroid (98%), prostate (97%), testis (95%) and for melanoma (94%), and lowest for cancers of the pancreas (12%), liver and esophagus (21%). Screening influences the interpretation of survival improvements for breast and prostate cancers because of lead-time bias and the detection of indolent cancers,72 which is likely also a factor for thyroid and other cancers that can be detected incidentally through imaging.73

TABLE 6. Trends in 5-year relative survival rates (%) by race, United States, 1975–2019a
Cancer site All races & ethnicities White Black
1975–1977 1995–1997 2012–2018 1975–1977 1995–1997 2012–2018 1975–1977 1995–1997 2012–2018
All sites 49 63 68 50 64 69 39 54 64
Brain & other nervous system 23 32 33 22 31 29 25 39 40
Breast (female) 75 87 91 76 89 92 62 75 83
Colon & rectum 50 61 65 50 62 65 45 54 60
Colon 51 61 63 51 62 64 45 54 58
Rectum 48 62 68 48 62 67 44 55 65
Esophagus 5 13 21 6 14 22 4 9 15
Hodgkin lymphoma 72 84 89 72 85 90 70 82 87
Kidney & renal pelvis 50 62 77 50 62 76 49 62 77
Larynx 66 66 61 67 68 62 58 52 53
Leukemia 34 48 66 35 50 67 33 42 62
Liver & intrahepatic bile duct 3 7 21 3 7 20 2 4 19
Lung & bronchus 12 15 23 12 15 23 11 13 21
Melanoma of the skin 82 91 94 82 91 94 57b 76b 70
Myeloma 25 32 58 24 32 57 29 32 60
Non-Hodgkin lymphoma 47 56 74 47 57 75 49 49 70
Oral cavity & pharynx 53 58 68 54 60 70 36 38 52
Ovary 36 43 50 35 43 49 42 36 41
Pancreas 3 4 12 3 4 11 2 4 11
Prostate 68 97 97 69 97 97 61 94 97
Stomach 15 22 33 14 20 33 16 22 34
Testis 83 96 95 83 96 96 73b,c, b,c 86b 92
Thyroid 92 95 98 92 96 99 90 95 97
Urinary bladder 72 80 77 73 81 78 50 63 65
Uterine cervix 69 73 67 70 74 67 65 66 56
Uterine corpus 87 84 81 88 86 84 60 62 64
  • a Rates are age adjusted for normal life expectancy and are based on cases diagnosed in the Surveillance, Epidemiology, and End Results (SEER) 9 areas for 1975–1977 and 1995–1997 and in the SEER 17 areas for 2012–2018; all cases were followed through 2019. Rates for White and Black patients diagnosed during 2012 through 2018 are exclusive of Hispanic ethnicity.
  • b The standard error is between 5 and 10 percentage points.
  • c The survival rate is for cases diagnosed from 1978 to 1980.
Details are in the caption following the image

Stage distribution for selected cancers by race, United States, 2015 to 2019. White and Black race categories are exclusive of Hispanic ethnicity. aColorectum excludes appendiceal cancer. bThe proportion of melanoma patients with unknown stage increased after 2015 when collaborative staging rules were no longer in effect.

Details are in the caption following the image

Five-year relative survival for selected cancers by race and stage at diagnosis, United States, 2012 to 2018. White and Black race categories are exclusive of Hispanic ethnicity. aColorectum excludes appendiceal cancer. bThe standard error of the survival rate is between 5 and 10 percentage points. cThe survival rate for carcinoma in situ of the urinary bladder is 96% in all races, 96% in White patients, and 94% in Black patients.

Gains in survival 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 has increased from 22% in the mid-1970s to 70% for those diagnosed during 2012 through 2018, and most patients who were treated with tyrosine-kinase inhibitors are experiencing near normal life expectancy.74 More recently, a cascade of new therapies has been game-changing in the treatment of metastatic melanoma, including first-generation and second-generation immunotherapies (anti-CTLA4 and anti-PD-1 checkpoint inhibition) and BRAF and MEK inhibitors.75, 76 As a result, 3-year relative survival for distant-stage melanoma has doubled over the past decade, from 20.6% for patients diagnosed during 2004 through 2006 to 39.3% during 2016 through 2018.7 Investigators at the NCI recently reported that the number of individuals living with metastatic melanoma increased by 258% from 1990 to 2018, by far the largest increase among the six common cancers studied.77

Immunotherapy has also shown promise in the neoadjuvant setting for resectable stage II–IV cutaneous squamous cell carcinoma78 and nonsmall cell lung cancer. A phase 3 trial among patients with stage I–III nonsmall cell lung cancer reported a median progression-free survival of 20.8 months with standard chemotherapy versus 31.6 months with the addition of nivolumab, including a pathologic complete response in one of four patients.79 At the population level, 3-year relative survival for all stages of lung cancer combined increased from 22% for diagnoses during 2004 through 2006 to 33% for diagnoses during 2016 through 2018, with progress against nonsmall cell lung cancer (from 25% to 38%) far exceeding that for small cell lung cancer (from 9% to 12%). Gains not only reflect improved therapies80, 81 but also earlier lung cancer detection82, 83 and advances in staging84 and surgical procedures.85 Checkpoint inhibitors and targeted therapies are also showing promise in difficult-to-treat advanced renal cell carcinoma.86

Unlike most common cancers, survival has not improved over the past 4 decades for women with uterine malignancies (Table 6), largely reflecting a lack of major treatment advances.87, 88 Uterine corpus cancer is the fourth most commonly diagnosed cancer in women, yet there is a dearth of research activity89 and it ranked 24th in NCI research funding in 2018.90 The lack of progress has disproportionately affected Black women, who are substantially less likely to be diagnosed with localized-stage disease (57% versus 72% of White women; Figure 5) and have lower survival for every stage (Figure 6). Black women have the highest mortality rate of all racial and ethnic groups for every histologic subtype of uterine corpus cancer.91 The recent identification of distinct molecular subtypes offers opportunities for the development of targeted therapies, which could have a large impact because almost one half of early stage, recurrent endometrial cancers have targetable molecular alterations.92, 93 However, equitable dissemination of future advances will be critical to avoid exacerbating the current disparity, which is already one of the largest of all cancers. Stagnant survival trends for cervical cancer likely reflect in part an increased proportion of adenocarcinoma, which has poorer survival than squamous cell carcinoma,94 because of the disproportionate detection of cervical intraepithelial neoplasia and early invasive squamous cell carcinoma during cytology screening.95

Survival rates are lower for Black individuals than for White individuals for every cancer type shown in Figure 6 except pancreas and kidney cancers, for which they are similar. However, kidney cancer survival is lower in Black patients for every histologic subtype of the disease and is only similar overall because of a higher proportion than Whites of papillary and chromophobe renal cell carcinoma (RCC), which have a better prognosis than other types of RCC.96 The largest Black–White survival differences in absolute terms are for melanoma (24%) and cancers of the uterine corpus (20%), the oral cavity and pharynx (18%), and the urinary bladder (13%). Although these disparities partly reflect a later stage at diagnosis (Figure 5), Black individuals have lower stage-specific survival for most cancer types (Figure 6). After adjusting for stage, sex, and age, the risk of cancer death is 33% higher in Black people and 51% higher in AIAN people compared with White people.97

Trends in cancer mortality

Mortality rates are a better indicator of progress against cancer than incidence or survival rates because they are less affected by biases that result from changes in detection practice.98 The cancer death rate rose during most of the 20th century (Figure 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 persons. The overall drop of 33% through 2020 (143.8 per 100,000 persons) translates to an estimated 3,820,800 fewer cancer deaths (2,582,800 in men and 1,238,000 in women) than if mortality had remained at its peak (Figure 8). The number of averted deaths is twice as large for men than for women because the death rate in men peaked higher and declined faster (Figure 7).

Details are in the caption following the image

Trends in cancer mortality rates by sex overall and for selected cancers, United States, 1930–2020. 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 from 1991 through 2020 in men and from 1992 to 2020 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 1990s, to 1.5% per year during the 2000s, and to 2% per year from 2015 through 2020 (Table 7). Overall mortality trends are largely driven by lung cancer, for which declines steepened similarly in men and women in recent years because of treatment advances that have extended survival, as mentioned earlier, as well as earlier detection.83 For example, the annual decrease in lung cancer mortality accelerated from 3.1% during 2005 through 2014 to 5.3% during 2014 through 2020 in men and from 1.8% to 4.3% in women (Table 7). Overall, the lung cancer death rate dropped by 58% from 1990 to 2020 in men and by 36% from 2002 to 2020 in women.

TABLE 7. Trends in mortality rates for selected cancers by sex, United States, 1975–2020
Trend 1 Trend 2 Trend 3 Trend 4 Trend 5 Trend 6 AAPC
Cancer site Years APC Years APC Years APC Years APC Years APC Years APC 2011–2015 2016–2020 2011–2020
All sites
Overall 1975–1984 0.6a 1984–1992 0.3a 1992–2001 −1.0a 2001–2015 −1.5a 2015–2020 −2.0a −1.5a −2.0a −1.8a
Male 1975–1979 1.0a 1979–1990 0.3a 1990–1993 −0.5 1993–2001 −1.5a 2001–2015 −1.8a 2015–2020 −2.2a −1.8a −2.2* −2.0a
Female 1975–1990 0.6a 1990–1995 −0.2 1995–1998 −1.2a 1998–2001 −0.4 2001–2016 −1.4a 2016–2020 −1.9a −1.4a −1.9a −1.6a
Female breast 1975–1990 0.4a 1990–1995 −1.8a 1995–1998 −3.3a 1998–2011 −1.9a 2011–2020 −1.3a −1.3a −1.3a −1.3a
Colon & rectum
Overall 1975–1978 0.2 1978–1985 −0.8a 1985–2002 −1.8a 2002–2005 −3.8a 2005–2012 −2.5a 2012–2020 −1.9a −2.1a −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 2012–2020 −2.0a −2.1a −2.0a −2.0a
Female 1975–1984 −1.0a 1984–2001 −1.8a 2001–2010 −2.9a 2010–2020 −2.1a −2.1a −2.1a −2.1a
Liver & intrahepatic bile duct
Overall 1975–1980 0.2 1980–1987 2.0a 1987–1996 3.8a 1996–2000 0.7 2000–2015 2.5a 2015–2020 −0.5a 2.5a −0.5a 0.8a
Male 1975–1985 1.5a 1985–1996 3.8a 1996–1999 0.3 1999–2013 2.7a 2013–2017 0.7 2017–2020 −1.3a 1.7a −0.8 0.4
Female 1975–1984 0.2 1984–1995 3.1a 1995–2008 1.2a 2008–2014 3.1a 2014–2020 0.5 2.5a 0.5 1.4a
Lung & bronchus
Overall 1975–1980 3.0a 1980–1990 1.8a 1990–1995 −0.2 1995–2005 −0.9a 2005–2014 −2.4a 2014–2020 −4.8a −3.0a −4.8a −4.0a
Male 1975–1982 1.8a 1982–1991 0.4a 1991–2005 −1.9a 2005–2014 −3.1a 2014–2020 −5.3a −3.6a −5.3a −4.6a
Female 1975–1982 6.0a 1982–1990 4.2a 1990–1995 1.8a 1995–2005 0.2a 2005–2014 −1.8a 2014–2020 −4.3a −2.4a −4.3a −3.5a
Melanoma of skin
Overall 1975–1988 1.6a 1988–2013 0.0 2013–2017 −6.3a 2017–2020 −1.3 −3.2a −2.6a −3.3a
Male 1975–1989 2.3a 1989–2013 0.3a 2013–2017 −6.8a 2017–2020 −1.5 −3.3a −2.9a −3.5a
Female 1975–1988 0.8a 1988–2012 −0.5a 2012–2020 −3.8a −3.0a −3.8a −4.0a
Ovary 1975–1982 −1.2a 1982–1992 0.3a 1992–1998 −1.2a 1998–2003 0.6 2003–2017 −2.3a 2017–2020 −3.8a −2.3a −3.4a −2.8a
Oral cavity & pharynx
Overall 1975–1991 −1.5a 1991–2000 −2.6a 2000–2009 −1.3a 2009–2020 0.4a 0.4a 0.4a 0.4a
Male 1975–1980 −0.9 1980–2006 −2.2a 2006–2020 0.4a 0.4a 0.4a 0.4a
Female 1975–1989 −0.9a 1989–2009 −2.2a 2009–2020 0.3 0.3 0.3 0.3
Tongue, tonsil, oropharynx 1975–2000 −1.6a 2000–2009 −0.1 2009–2020 1.8a 1.8a 1.8a 1.8a
Other oral cavity 1975–1992 −1.6a 1992–2006 −2.9a 2006–2020 −0.8a −0.8a −0.8a −0.8a
Pancreas
Overall 1975–2002 −0.1a 2002–2005 1.0 2005–2020 0.1a 0.1a 0.1a 0.1a
Male 1975–1986 −0.8a 1986–1998 −0.3a 1998–2020 0.2a 0.2a 0.2a 0.2a
Female 1975–1984 0.8a 1984–2003 0.1 2003–2006 1.0 2006–2020 0.1 0.1 0.1 0.1
Prostate 1975–1987 0.9a 1987–1991 3.0a 1991–1994 −0.5 1994–1998 −4.3a 1998–2013 −3.5a 2013–2020 −0.6a −2.0a −0.6a −1.2a
Uterine corpus 1975–1989 −1.6a 1989–1997 −0.7a 1997–2009 0.4a 2009–2016 2.3a 2016–2020 0.7a 2.3a 0.7a 1.6a
  • Note: Trends were analyzed using the Joinpoint Regression Program, version 4.9.1.0, allowing up to five joinpoints.
  • Abbreviations: APC, annual percent change (based on mortality rates age adjusted to the 2000 US standard population); AAPC, average annual percent change.
  • 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 1980 and by 61% among females since 1969. (CRC death rates were declining in women before 1969, but earlier data years are not exclusive of deaths from small intestine cancer.) The CRC mortality rate decreased during the most recent decade (2011–2020) by about 2% per year. However, similar to incidence, this trend masks increasing mortality among young adults; the CRC death rate continued to rise by 1.2% per year in individuals younger than 50 years and by 0.6% per year in those aged 50–54 years from 2005 through 2020.

Female breast cancer mortality peaked in 1989 and has since decreased by 43% because of earlier diagnosis through mammography screening and increased awareness, coupled with 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 2011 to 2020, perhaps reflecting the slight but steady increase in incidence and stagnant mammography uptake in recent years. Similarly, the slowing decline in prostate cancer mortality, from 3% to 4% annually during 1994 through 2013 to 0.6% during 2013 through 2020, likely reflects the uptick in advanced-stage diagnoses associated with reductions in PSA testing since 2008.99, 100 Prostate cancer mortality has declined by 53% since the peak in 1993 because of earlier detection through widespread screening with the PSA test and advances in treatment.101, 102

The third leading cause of cancer death in men and women combined is pancreatic cancer, for which mortality has increased slowly in men, from 12.1 (per 100,000 men) in 2000 to 12.7 per 100,000 men in 2020, but remained relatively stable in women at 9.3–9.6 per 100,000 women. Liver cancer had the fastest increasing mortality for decades, but rates have stabilized in women and began a downturn in men (1.3% decline from 2017 to 2020; Table 7), mirroring patterns in incidence. Mortality declines of about 2% per year during 2016 through 2020 for leukemia, melanoma, and kidney cancer, despite stable or increasing incidence, highlight the impact of improved treatment. In contrast, accelerated declines in ovarian cancer mortality, from 2% per year to almost 4% per year from 2017 through 2020 (Table 7), likely reflect steeper incidence reductions, from 1.5% per year during the 2000s to 2.9% per year from 2015 through 2019.37 Mortality rates continue to increase for uterine corpus cancer, by about 1% per year, and, for oral cavity cancers associated with HPV-infection (cancers of the tongue, tonsil, and oropharynx), by about 2% per year in men and 1% per year in women.

Recorded number of deaths in 2020

In total, 3,383,729 deaths were recorded in the United States in 2020, an increase of 528,891 deaths over 2019 (Table 8); this was 34 times larger than the increase from 2018 to 2019 (15,633 deaths). COVID-19 infection was the underlying cause of death for only two thirds of the increase, highlighting a substantial excess burden in 2020 for other causes. Most notably, the increase in heart disease deaths from 2019 to 2020 was 10-fold larger than the increase from 2018 to 2019. Among all leading causes, only chronic lower respiratory diseases had a drop in deaths from 2019 to 2020, with a decrease in the age-standardized death rate of 4.7%; cancer was the only other cause for which the death rate declined (by 1.5%). The impact of the pandemic on mortality will continue to unfold over many years and will likely parallel the disproportionate COVID-19 burden in the United States compared with other countries. For example, a recent study found that life expectancy continued to decline in the United States between 2020 and 2021 (based on provisional data) versus a slight recovery on average in 21 peer countries, widening the gap in life expectancy between the United States and peer countries to >5 years (76.4 vs. 81.9 years).103

TABLE 8. Leading causes of death in the United States in 2020 versus 2019
2020 2019 Absolute change in the no. of deaths
Cause of death No.a Rateb Percentage No.a Rateb
All causes 3,383,729 835.2 2,854,838 715.7 528,891
1. Heart diseases 696,962 168.2 21 659,041 161.6 37,921
2. Cancer 602,350 143.8 18 599,601 146.0 2749
3. COVID-19 350,831 85.0 10 0 350,831
4. Accidents (unintentional injuries) 200,955 57.5 6 173,040 49.2 27,915
5. Cerebrovascular diseases 160,264 38.9 5 150,005 37.0 10,259
6. Chronic lower respiratory diseases 152,657 36.4 5 156,979 38.2 −4322
7. Alzheimer disease 134,242 32.6 4 121,499 29.9 12,743
8. Diabetes mellitus 102,188 24.8 3 87,647 21.6 14,541
9. Influenza and pneumonia 53,544 13.1 2 49,783 12.3 3761
10. Nephritis, nephrotic syndrome, & nephrosis 52,547 12.7 2 51,565 12.7 982
  • Abbreviation: COVID-19, coronavirus disease 2019 (the respiratory disease caused by severe acute respiratory syndrome coronavirus 2).
  • a Counts include unknown age. Rates for 2019 may differ from those published previously because of updated population denominators.
  • b Rates are per 100,000 and are age adjusted to the 2000 US standard population.
  • Source: National Center for Health Statistics, Centers for Disease Control and Prevention

In 2020, cancer accounted for 18% of all deaths and remained the second leading cause of death after heart diseases. However, it is the leading cause of death among women aged 40–79 years and men aged 60–79 years (Table 9). Table 10 presents the number of deaths in 2020 for the five leading cancer types by age and sex. Brain and other nervous system tumors are the leading cause of cancer death among children and adolescents younger than 20 years. However, CRC has surpassed brain tumors in men aged 20–39 years and is the leading cause of cancer death among men aged 20–49 years, whereas breast cancer leads among women in that age group. Despite being one of the most preventable cancers, cervical cancer is consistently the second leading cause of cancer death in women aged 20–39 years (Table 10). Lung cancer is the leading cause of cancer death in both men and women aged 50 years and older, causing far more deaths than breast cancer, prostate cancer, and CRC combined.

TABLE 9. Ten leading causes of death in the United States by age and sex, 2020
All ages Age 1–19 years Aged 20–39 years Age 40–59 years Aged 60–79 years Aged ≥80 years
Ranking Male Female Male Female Male Female Male Female Male Female Male Female
All causes 1,769,884 1,613,845 14,339 7091 101,431 43,674 269,932 160,847 765,217 564,802 608,027 828,671
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
382,776 314,186 5061 2312 42,831 15,525 54,798 42,175 181,355 149,254 151,989 190,889
2 Cancer Cancer Assault (homicide) Cancer Intentional self-harm (suicide) Cancer Cancer Heart diseases Heart diseases Heart diseases Cancer Cancer
317,731 284,619 2714 738 13,061 4463 41,968 23,295 169,371 96,674 89,624 87,955
3 COVID-19 COVID-19 Intentional self-harm (suicide) Intentional self-harm (suicide) Assault (homicide) Intentional self-harm (suicide) Accidents (unintentional injuries) Accidents (unintentional injuries) COVID-19 COVID-19 COVID-19 COVID-19
192,512 158,319 2079 738 11,584 3073 41,328 16,461 90,751 58,186 73,670 85,688
4 Accidents (unintentional injuries) Alzheimer disease Cancer Assault (homicide) Heart diseases Heart diseases COVID-19 COVID-19 Chronic lower respiratory diseases Chronic lower respiratory diseases Cerebrovascular disease Alzheimer disease
133,205 92,969 910 623 6150 2956 24,704 12,703 39,066 37,041 32,573 77,896
5 Chronic lower respiratory diseases Cerebrovascular diseases Congenital anomalies Congenital Anomalies Cancer Assault (homicide) Chronic liver disease & cirrhosis Chronic liver disease & cirrhosis Diabetes mellitus Cerebrovascular disease Alzheimer disease Cerebrovascular disease
72,942 90,627 465 422 3851 2039 13,050 7152 30,043 25,694 31,549 59,003
6 Cerebrovascular diseases Chronic lower respiratory diseases Heart diseases Heart diseases COVID-19 COVID-19 Intentional self-harm (suicide) Diabetes mellitus Cerebrovascular disease Diabetes mellitus Chronic lower respiratory diseases Chronic lower respiratory diseases
69,637 79,715 334 239 3263 1641 11,154 6010 28,677 20,860 28,121 36,721
7 Diabetes mellitus Accidents (unintentional injuries) Chronic lower respiratory diseases Influenza & pneumonia Chronic liver disease & cirrhosis Chronic liver disease & cirrhosis Diabetes mellitus Chronic lower respiratory diseases Accidents (unintentional injuries) Alzheimer disease Accidents (unintentional injuries) Accidents (unintentional injuries)
57,532 67,750 156 116 2417 1424 10,791 5489 27,169 14,780 16,111 19,359
8 Alzheimer disease Diabetes mellitus Influenza & pneumonia Cerebrovascular disease Diabetes mellitus Pregnancy, childbirth, & puerperium Cerebrovascular disease Cerebrovascular disease Chronic liver disease & cirrhosis Accidents (unintentional injuries) Diabetes mellitus Diabetes mellitus
41,273 44,656 137 109 1591 1051 7384 5145 15,028 13,581 15,022 16,752
9 Intentional self-harm (suicide) Influenza & pneumonia COVID-19 Chronic lower respiratory diseases Cerebrovascular disease Diabetes mellitus Chronic lower respiratory diseases Intentional self-harm (suicide) Nephritis, nephrotic syndrome, & nephrosis Nephritis, nephrotic syndrome, & nephrosis Parkinson disease Hypertension & hypertensive renal diseasea
36,551 25,799 98 100 849 964 5160 3402 12,127 10,054 14,778 14,384
10 Chronic liver disease & cirrhosis Nephritis, nephrotic syndrome, & nephrosis Cerebrovascular disease COVID-19 Influenza & pneumonia Cerebrovascular disease Assault (homicide) Septicemia Influenza & pneumonia Influenza & pneumonia Influenza & pneumonia Influenza & pneumonia
32,546 25,254 97 88 675 627 4258 2709 11,678 9066 11,931 13,641
  • Note: Deaths within each age group do not sum to all ages combined due to the inclusion of unknown ages and deaths occurring in individuals aged younger than 1 year. 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, and assault excludes legal intervention.
  • Abbreviations: COVID-19 coronavirus disease 2019 (the respiratory disease caused by severe acute respiratory syndrome coronavirus 2).
  • a Includes primary and secondary hypertension.
  • Source: US Final Mortality Data, 2020: National Center for Health Statistics, Centers for Disease Control and Prevention, 2022.
TABLE 10. Five leading causes of cancer death in the United States by age and sex, 2020
Ranking All ages Birth to 19 years Aged 20–39 years Aged 40–49 years Aged 50–64 years Aged 65–79 years Aged 80 years and older
Male
All sites 317,731 932 3851 8655 70,248 144,420 89,624
1 Lung & bronchus Brain & ONS Colon & rectum Colon & rectum Lung & bronchus Lung & bronchus Lung & bronchus
72,949 282 562 1574 16,517 37,860 17,329
2 Prostate Leukemia Brain & ONS Lung & bronchus Colon & rectum Prostate Prostate
32,707 218 541 1059 7860 13,407 15,995
3 Colon & rectum Bones & joints Leukemia Brain & ONS Pancreas Pancreas Colon & rectum
28,043 107 433 813 6024 12,080 7159
4 Pancreas Soft tissue (including heart) Testis Pancreas Livera Colon & rectum Urinary bladder
24,279 88 212 696 5650 10,884 5751
5 Livera Livera Non-Hodgkin lymphoma Esophagus Esophagus Livera Pancreas
18,636 27 198 405 3614 9298 5369
Female
All sites 284,619 770 4463 10,241 62,434 118,754 87,955
1 Lung & bronchus Brain & ONS Breast Breast Lung & bronchus Lung & bronchus Lung & bronchus
63,135 240 1062 2823 13,771 30,643 17,658
2 Breast Leukemia Uterine cervix Colon & rectum Breast Breast Breast
42,275 174 487 1158 11,337 15,461 11,590
3 Colon & rectum Bones & joints Colon & rectum Lung & bronchus Colon & rectum Pancreas Colon & rectum
23,826 89 394 902 5236 10,375 8862
4 Pancreas Soft tissue (including heart) Brain & ONS Uterine cervix Pancreas Colon & rectum Pancreas
22,495 66 333 709 4322 8173 7285
5 Ovary Kidney & renal pelvis Leukemia Ovary Ovary Ovary Leukemia
13,438 31 314 553 3532 5898 4108
  • Note: Ranking order excludes "other" categories.
  • Abbreviation: ONS, other nervous system.
  • a Includes intrahepatic bile duct.

Cancer disparities by race and ethnicity

Overall cancer incidence is highest among White people, followed closely by AIAN and Black people (Table 5). However, sex-specific incidence is highest in Black men, among whom rates during 2015 through 2019 were 79% higher than those in AAPI men, who have the lowest rates, and 5% higher than those in White men, who rank second. High overall cancer incidence in Black men is largely because of prostate cancer, which is 70% higher than in White men, two times higher than in AIAN and Hispanic men, and three times higher than in AAPI men. Among women, AIAN and White women have the highest incidence, which is 10% higher than that in Black women, who rank third. However, AIAN and Black women have the highest cancer mortality rates—16% and 12% higher, respectively—than White women. Even more striking, Black women have 4% lower breast cancer incidence than White women but 40% higher breast cancer mortality, a disparity that has remained stagnant for the past decade.

The highest mortality rate for both sexes combined is among AIAN people, followed closely by Black people. The death rate in AIAN and Black men is double that in AAPI men and 18% higher than that in White men. Among men and women combined, the Black–White disparity in overall cancer mortality has declined from a peak of 33% in 1993 (279.0 vs. 210.5 per 100,000 persons, respectively) to 12% in 2020 (166.8 vs. 149.3 per 100,000 persons). Notably, progress is driven by faster declines in smoking-related cancers because of the steep drop in smoking initiation among Black teens from the late 1970s to the early 1990s,104 as opposed to targeted efforts to reduce inequalities.

Racial disparities are largely a consequence of less access to high-quality care across the cancer continuum. However, increasing access alone is insufficient to close these gaps. For example, even among individuals with a median annual household income of ≥$75,000, 5-year relative cancer survival is lower among Black people (67%) than among White people (72%).105 Similarly, a recent study based on information in the National Cancer Database found that Black individuals residing in neighborhoods with the highest socioeconomic status are more likely than White individuals residing in neighborhoods with the lowest socioeconomic status to be diagnosed with advanced-stage lung cancer.106 Even for childhood cancer, Black children are 24% more likely to be diagnosed with distant-stage disease than White children, regardless of family insurance status.107

Racial disparities in cancer occurrence and outcomes are largely the result of longstanding inequalities in wealth that lead to differences in both risk factor exposures and access to equitable cancer prevention, early detection, and treatment.108, 109 Ultimately, disproportionate wealth stems from hundreds of years of structural racism, including segregationist and discriminatory policies in criminal justice, housing, education, and employment that have altered the balance of prosperity, security, and other social determinants of health.110 The social determinants of health are defined by the World Health Organization as the conditions in which individuals are born, grow, live, work, and age111 because these influences are consistently and strongly associated with life expectancy and disease mortality.112, 113 The most recent example is the disproportionate impact of the COVID-19 pandemic on people of color in the United States.3, 4, 114 A recent study by researchers at the NCI observed that Black, AIAN, and Hispanic individuals had double the rate of overall excess deaths in 2020 compared with White individuals and had two to four times the rate of non–COVID-19–related excess deaths.115 Furthermore, routine health care, such as mammography screening, that was suspended early in the pandemic has been slower to rebound among people of color.116

Geographic variation in cancer occurrence

Tables 11 and 12 show cancer incidence and mortality rates for selected cancers by state. State variation reflects differences in the prevalence of cancer risk factors, such as smoking and obesity; prevention and early detection practices, such as screening; and access to care. The largest geographic variation is for the most preventable cancers, such as lung cancer, cervical cancer, and melanoma of the skin. For example, lung cancer incidence and mortality rates in Kentucky, where smoking prevalence was historically highest, are three to four times higher than those in Utah and Puerto Rico, where it was lowest. These patterns are also consistent with contemporary smoking prevalence. In 2020, the highest smoking prevalence was in West Virginia (23%), Kentucky (21%), Mississippi (20%), and Arkansas (20%) compared with 8% in Utah and California and 10% in New Jersey, Maryland, and Puerto Rico.117

TABLE 11. Incidence rates for selected cancers by state, United States, 2015–2019a
All sites Breast Colon & rectumb Lung & bronchus Non-Hodgkin lymphoma Prostate Uterine cervix
State Male Female Female Male Female Male Female Male Female Male Female
Alabama 514.5 406.1 122.8 47.1 35.2 79.5 49.3 19.6 12.8 124.0 9.5
Alaska 435.0 406.0 122.0 42.5 36.4 59.4 49.2 21.1 14.6 92.0 7.7
Arizona 404.5 367.2 114.6 34.5 26.1 47.3 40.6 18.3 12.0 77.6 6.5
Arkansas 547.3 436.3 122.3 49.8 36.1 91.8 62.4 22.9 15.0 118.5 9.5
California 427.9 387.7 123.1 37.9 28.9 43.8 36.0 21.7 14.9 95.2 7.4
Colorado 414.1 387.8 130.4 34.3 26.9 41.5 38.1 20.8 13.9 93.2 6.2
Connecticut 511.0 445.6 141.1 38.0 28.0 61.9 54.2 25.9 17.6 123.2 5.6
Delaware 520.0 442.0 136.1 40.7 30.2 68.8 56.2 22.6 15.2 125.9 7.7
District of Columbia 447.7 400.6 136.3 37.4 30.6 48.6 40.8 17.8 11.8 131.3 7.8
Florida 498.2 433.1 122.3 39.7 30.0 63.6 49.9 26.6 19.0 97.9 9.2
Georgia 531.8 423.6 129.1 45.6 32.8 72.9 49.8 22.0 14.7 132.6 8.0
Hawaii 442.2 402.2 140.2 43.9 32.0 52.9 35.5 18.4 12.4 100.3 6.8
Idaho 487.0 418.2 129.4 38.0 28.9 51.6 45.2 23.0 15.9 115.5 7.4
Illinois 501.4 443.0 134.0 46.0 33.9 69.1 55.6 23.2 16.2 113.3 7.5
Indiana 497.8 430.3 124.3 45.4 34.1 80.5 60.7 22.1 15.1 99.9 8.4
Iowa 535.8 460.2 135.1 45.5 35.1 72.2 54.8 25.8 17.4 119.0 7.7
Kansas 496.1 435.5 133.1 43.4 32.7 61.5 49.5 23.6 15.5 114.0 8.1
Kentucky 564.0 484.5 128.3 52.4 38.4 100.9 76.7 23.1 16.7 108.0 9.8
Louisiana 557.3 429.7 128.4 51.1 36.7 78.2 51.9 22.6 15.6 138.5 9.2
Maine 506.6 457.3 128.2 37.6 30.3 76.0 66.3 26.2 15.6 97.0 5.4
Maryland 494.9 427.5 133.6 38.6 30.8 59.2 50.1 21.7 14.8 132.7 6.7
Massachusetts 484.9 437.6 137.6 36.7 27.9 63.2 58.2 23.4 15.5 111.6 5.3
Michigan 485.1 420.2 124.2 39.8 31.0 68.7 56.3 23.5 16.1 110.6 6.9
Minnesota 508.2 447.2 135.6 39.8 30.2 60.2 52.1 26.5 17.1 113.2 5.6
Mississippi 552.0 419.9 123.3 54.8 39.6 92.9 57.5 20.6 14.0 135.6 9.3
Missouri 484.6 433.2 131.9 43.5 32.9 79.8 62.0 22.1 15.4 95.6 8.4
Montana 503.9 435.7 136.8 42.0 28.9 50.4 49.9 21.3 14.7 130.7 7.0
Nebraska 510.1 442.6 131.6 44.2 35.8 61.2 49.8 23.7 17.2 127.9 7.7
Nevadac 394.4 367.2 109.4 38.6 29.8 46.9 46.2 17.5 11.9 86.4 8.5
New Hampshire 517.1 459.9 142.1 38.9 28.9 65.4 60.8 25.0 17.8 114.1 5.3
New Jersey 536.3 458.8 138.8 44.1 32.8 58.5 50.1 26.6 18.2 140.1 7.7
New Mexico 389.7 365.2 114.4 36.4 27.9 40.5 32.5 17.0 12.5 84.2 8.4
New York 529.4 456.6 135.7 41.7 31.1 63.7 53.4 25.8 18.1 130.7 7.7
North Carolina 522.0 434.2 137.7 39.8 30.0 77.8 55.4 21.7 14.6 122.9 7.0
North Dakota 487.0 433.2 135.2 44.7 33.8 61.6 53.5 22.1 15.1 121.6 5.9
Ohio 510.8 446.2 130.6 44.6 33.6 77.1 58.8 23.5 15.9 112.5 7.9
Oklahoma 490.4 423.7 124.2 45.9 34.1 76.5 57.2 20.3 15.0 100.4 9.7
Oregon 449.2 415.8 130.6 36.2 28.2 54.7 48.7 22.1 14.8 96.4 6.8
Pennsylvania 513.6 454.4 132.0 43.7 33.0 69.9 55.6 24.2 17.3 109.2 7.4
Rhode Island 511.7 456.0 142.2 36.0 27.2 74.5 63.7 23.4 15.7 114.9 6.9
South Carolina 494.0 407.1 130.9 41.5 30.4 74.6 50.7 20.0 12.9 113.3 7.9
South Dakota 487.5 428.3 125.4 44.4 32.9 60.7 53.2 22.3 15.5 120.3 6.3
Tennessee 524.2 424.7 123.8 44.6 32.8 87.3 61.9 21.7 14.5 117.2 8.1
Texas 458.9 384.9 117.0 44.0 30.2 57.6 41.0 20.9 14.3 102.7 9.4
Utah 445.9 378.3 115.8 30.2 24.1 30.2 23.0 22.2 14.8 117.2 5.5
Vermont 479.1 444.6 132.6 37.8 27.9 64.2 54.2 22.7 16.1 98.6 4.8
Virginia 437.9 391.3 126.1 37.6 28.9 61.3 47.7 20.0 13.9 100.3 6.0
Washington 467.7 425.7 133.3 37.0 28.8 54.9 49.1 23.3 15.9 100.0 6.7
West Virginia 517.7 467.5 121.7 49.8 38.0 89.1 69.2 23.4 16.9 98.3 9.4
Wisconsin 512.2 441.9 135.1 38.6 29.9 65.3 53.4 25.6 17.3 118.3 6.5
Wyoming 433.1 384.8 113.0 36.0 28.8 43.2 40.8 19.9 13.9 113.6 8.2
Puerto Ricod 411.7 337.5 98.5 47.7 32.6 21.7 11.4 17.3 12.5 148.6 12.6
United States 488.2 423.3 128.1 41.5 31.2 64.1 50.3 22.9 15.7 109.9 7.7
  • a Rates are per 100,000, age adjusted to the 2000 US standard population.
  • b Rates exclude appendix except for Nevada.
  • c Data for this state are not included in US combined rates because it did not meet high-quality standards for all years during 2015 through 2019 according to the North American Association of Central Cancer Registries (NAACCR). Rates for this state are based on data published in the NAACCR's Cancer in North America, Volume II.
  • d Data for Puerto Rico are not included in US combined rates for comparability with previously published US rates. Puerto Rico incidence data for 2017 reflect diagnoses from January through June due to disruptions caused by hurricane Irma.
TABLE 12. Mortality rates for selected cancers by state, United States, 2016–2020a
State All sites Breast Colorectum Lung & bronchus Non-Hodgkin lymphoma Pancreas Prostate
Male Female Female Male Female Male Female Male Female Male Female Male
Alabama 207.4 137.2 20.9 18.1 12.0 59.6 33.1 6.7 3.5 14.0 10.1 20.2
Alaska 170.3 127.2 17.1 16.0 13.8 36.8 29.1 6.3 4.6 12.2 8.8 19.6
Arizona 154.8 113.6 18.0 14.6 10.0 31.9 24.2 5.8 3.3 11.8 8.8 17.1
Arkansas 206.5 141.7 19.5 17.9 12.4 61.0 38.5 6.8 3.8 13.0 9.5 18.6
California 158.3 118.2 18.8 14.2 10.3 29.8 21.6 6.4 3.8 11.7 9.1 19.8
Colorado 152.8 113.1 18.7 13.1 9.8 27.0 22.0 6.0 3.3 10.9 8.6 21.9
Connecticut 162.2 118.2 17.5 12.6 8.5 34.9 26.9 6.5 3.7 12.4 9.6 18.1
Delaware 190.4 133.8 20.8 15.6 10.8 45.8 33.1 7.5 3.9 14.7 10.4 17.7
District of Columbia 171.5 136.3 23.5 15.9 12.4 33.2 22.4 5.3 3.3 14.0 12.2 26.9
Florida 166.5 121.2 18.5 14.8 10.3 40.6 28.4 6.1 3.7 12.2 8.9 16.1
Georgia 186.7 129.5 20.8 17.1 11.6 48.2 28.9 6.1 3.6 12.7 9.5 21.2
Hawaii 151.4 105.5 15.9 14.1 9.8 33.6 20.8 5.8 3.5 12.2 9.4 14.9
Idaho 169.7 126.7 20.0 14.4 10.9 32.4 25.5 6.6 4.7 12.6 9.3 21.1
Illinois 183.3 135.7 20.5 16.8 11.7 44.7 31.8 6.8 4.0 13.5 10.1 19.5
Indiana 201.3 142.2 20.4 17.4 12.4 55.3 36.9 7.6 4.5 13.9 10.3 19.5
Iowa 185.3 131.4 18.1 16.2 11.4 45.8 31.8 7.5 4.2 12.6 9.7 20.3
Kansas 183.7 134.9 19.8 16.8 11.9 44.7 32.9 7.1 4.4 13.0 9.4 18.1
Kentucky 220.3 155.3 21.6 19.2 13.6 67.0 45.3 7.7 4.6 13.0 10.2 18.3
Louisiana 205.6 140.6 22.4 19.2 12.8 56.4 33.5 7.0 4.0 13.8 10.8 19.9
Maine 196.4 140.8 17.7 14.6 11.5 50.0 38.8 7.4 4.1 12.9 10.0 19.0
Maryland 175.4 130.6 21.0 15.7 11.3 39.1 29.3 6.6 3.5 13.1 9.8 20.1
Massachusetts 172.6 123.1 16.5 13.1 9.3 38.4 30.2 6.5 3.8 13.5 9.9 18.2
Michigan 189.4 139.6 20.2 15.7 11.5 48.0 35.0 7.6 4.6 14.1 10.9 18.6
Minnesota 169.9 125.0 17.4 14.0 9.9 36.1 28.7 7.8 4.0 12.6 9.7 19.6
Mississippi 225.9 148.5 23.5 21.9 14.0 67.0 36.3 6.5 3.6 14.3 11.0 24.3
Missouri 195.7 139.0 19.8 16.7 11.3 53.8 37.3 7.0 4.1 13.7 9.5 17.8
Montana 167.9 125.6 18.3 14.4 9.8 32.8 28.8 6.4 3.5 11.4 9.2 22.3
Nebraska 175.6 132.2 20.4 16.8 12.2 39.6 29.3 7.1 3.7 13.9 10.1 18.1
Nevada 171.1 133.6 21.8 17.1 12.4 37.3 32.8 6.5 3.9 11.8 9.3 19.4
New Hampshire 178.5 130.0 18.0 14.7 10.1 41.2 34.0 6.4 4.1 12.6 9.7 19.2
New Jersey 162.7 126.4 20.3 15.3 11.1 35.0 26.8 6.4 3.7 12.8 10.1 16.7
New Mexico 159.1 116.2 19.9 15.3 10.2 28.4 19.8 5.6 3.4 11.4 8.2 19.3
New York 159.8 121.7 18.6 14.0 10.2 35.7 26.0 6.4 3.7 12.6 9.7 16.8
North Carolina 187.5 131.0 20.0 14.9 10.7 50.7 31.9 6.7 3.6 12.5 9.6 19.7
North Dakota 167.8 122.8 17.2 16.3 10.4 39.4 28.1 6.5 3.5 12.1 9.0 17.7
Ohio 199.6 142.0 21.0 17.4 12.2 53.1 35.2 7.5 4.3 14.0 10.6 19.3
Oklahoma 209.2 149.6 22.4 19.6 13.5 57.0 38.2 7.7 4.7 12.8 9.7 20.0
Oregon 174.0 132.6 19.3 14.2 10.6 36.7 30.4 7.3 4.3 12.9 10.0 20.3
Pennsylvania 187.7 135.9 20.3 16.5 11.5 45.3 31.2 7.3 4.4 14.0 10.4 18.4
Rhode Island 182.6 130.9 17.3 12.6 10.9 43.3 33.5 7.1 3.9 14.7 9.4 18.4
South Carolina 193.7 132.4 21.5 16.8 10.7 50.7 30.3 6.0 3.9 13.5 9.8 20.8
South Dakota 181.4 132.4 18.9 16.9 12.2 41.4 32.6 7.5 4.3 12.9 9.9 19.1
Tennessee 207.7 142.7 21.6 17.9 12.2 59.5 37.3 7.4 4.2 12.8 9.8 19.5
Texas 173.8 122.5 19.7 17.1 11.0 39.1 25.1 6.6 3.8 12.0 9.1 17.6
Utah 140.5 104.7 19.8 11.9 9.4 19.8 13.8 6.5 3.5 11.1 8.2 21.8
Vermont 185.0 134.3 16.4 15.9 12.7 41.5 32.2 7.5 4.4 11.9 10.3 21.1
Virginia 179.8 127.9 20.6 15.9 10.9 44.0 28.7 6.6 3.8 13.0 9.6 20.0
Washington 170.0 127.5 19.2 14.0 9.9 35.8 28.7 6.9 4.1 12.2 9.7 20.0
West Virginia 211.3 151.4 21.2 20.0 13.7 60.6 41.0 7.9 4.3 12.6 9.6 17.0
Wisconsin 181.5 131.2 18.4 14.2 10.4 41.1 31.2 7.5 4.2 13.7 10.0 20.8
Wyoming 159.8 120.3 18.6 13.6 10.9 32.4 26.2 6.2 4.0 12.6 8.6 18.4
Puerto Ricob 132.1 86.4 19.6 17.7 10.7 14.8 7.2 4.3 2.6 7.9 5.2 21.4
United States 177.5 128.7 19.6 15.7 11.0 42.2 29.3 6.7 3.9 12.7 9.6 18.8
  • a Rates are per 100,000 and age adjusted to the 2000 US standard population.
  • b Rates for Puerto Rico are not included in US combined rates.

Despite being one of the most preventable cancers, cervical cancer incidence varies 2-fold by state, ranging from 5 or less per 100,000 women in Vermont, New Hampshire, Massachusetts, and Maine to 10 per 100,000 women in Kentucky, Oklahoma, and Alabama and 13 per 100,000 women in Puerto Rico (Table 11). Ironically, advances in cancer control typically exacerbate disparities because of the unequal dissemination of interventions across populations. Although HPV vaccination can virtually eliminate cervical cancer,66 large state differences in coverage will likely widen existing disparities. In 2020, up-to-date HPV vaccination among boys and girls aged 13–17 years ranged from 32% in Mississippi and 43% in West Virginia to 73% in Massachusetts, 74% in Hawaii, and 83% in Rhode Island.118 State/territory differences in initiatives to improve health, such as Medicaid expansion, may also contribute to future geographic disparities.119, 120

Cancer in children and adolescents

Cancer is the second most common cause of death among children aged 1–14 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 2023, an estimated 9910 children (from birth to age 14 years) and 5280 adolescents (aged 15–19 years) will be diagnosed with cancer, and 1040 and 550, respectively, will die from the disease. About 1 in 260 children and adolescents will be diagnosed with cancer before age 20 years.9

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 in adolescents differ from those in children; for example, brain and other nervous system tumors, more than one half of which are benign or borderline malignant, are the most common cancer (21%), followed closely by lymphoma (19%). In addition, there are one half as many cases of non-Hodgkin lymphoma as 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 for only 2% and 1% of cancers in children.

TABLE 13. Incidence rates, case distribution, and 5-year relative survival by age and International Classification of Childhood Cancer type, ages birth to 19 years, United Statesa
Cancer site Birth to 14 years Aged 15–19 years
Incidence rate per millionb Distribution, % Survival,c % Incidence rate per millionb Distribution, % Survival,c %
All ICCC groups combined (malignant only) 173.4 100 85 242.3 100 86
Leukemias, myeloproliferative & myelodysplastic diseases 53.1 28 88 35.6 13 76
Lymphoid leukemia 40.3 21 92 18.6 7 77
Acute myeloid leukemia 7.8 4 68 9.1 3 68
Lymphomas and reticuloendothelial neoplasms 22.2 12 95 53.0 19 94
Hodgkin lymphoma 5.8 3 99 31.8 11 98
Non-Hodgkin lymphoma (including Burkitt) 10.3 5 91 19.3 7 89
Central nervous system neoplasms 48.6 26 74 59.4 21 75
Benign/borderline malignant tumors 15.2 8 97 37.7 13 98
Neuroblastoma & other peripheral nervous cell tumors 11.6 6 82 1.1 <1 78d
Retinoblastoma 4.2 2 97 <0.1 <1 e
Nephroblastoma & other nonepithelial renal tumors 8.2 4 93 0.3 <1 e
Hepatic tumors 3.1 2 79 1.4 <1 46d
Hepatoblastoma 2.7 1 82 <0.1 <1 e
Malignant bone tumors 7.8 4 74 14.6 5 69
Osteosarcoma 4.3 2 69 8.0 3 67
Ewing tumor & related bone sarcomas 2.7 1 78 4.6 2 64
Rhabdomyosarcoma 5.2 3 71 3.7 1 54d
Germ cell & gonadal tumors 5.7 3 91 27.0 10 94
Thyroid carcinoma 3.6 2 >99 33.8 12 >99
Malignant melanoma 1.8 1 96 8.7 3 96
  • Abbreviation: ICCC, International Classification of Childhood Cancer.
  • a Benign and borderline brain tumors were excluded from survival rates but included in incidence rates for central nervous system neoplasms and denominators for case distribution.
  • b Incidence rates are based on diagnoses during 2015-2019 and age-adjusted to the US standard population.
  • c Survival rates are adjusted for normal life expectancy and are based on diagnoses during 2012-2018 and follow-up of all patients through 2019.
  • d The standard error of the survival rate is between 5 and 10 percentage points.
  • e The statistic could not be calculated because there were <25 cases during 2012 through 2018.

The overall cancer incidence rate stabilized in children during 2010 through 2019 after increasing since at least 1975, but continued to rise in adolescents by 1% per year. In contrast, death rates per 100,000 persons declined from 1970 through 2020 continuously from 6.3 to 1.9 per 100,000 persons in children and from 7.2 to 2.6 per 100,000 persons in adolescents, for overall reductions of 70% and 64%, 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%–100% have been achieved for childhood acute lymphocytic leukemia over the past 4 decades, primarily through the optimization of established chemotherapeutic regimens as opposed to the development of new therapies.121 However, progress among adolescents has lagged behind that in children, partly because of differences in tumor biology, clinical trial enrollment, treatment protocols, and tolerance and compliance with treatment.122 Mortality reductions from 1970 to 2020 are also lower in adolescents for other common cancers, including non-Hodgkin lymphoma (94% in children and 88% in adolescents) and brain and other nervous system tumors (39% and 25%, respectively). The 5-year relative survival rate for all cancers combined improved from 58% during the mid-1970s to 85% during 2012 through 2018 in children and from 68% to 86% in adolescents, but varies substantially by cancer type and age at diagnosis (Table 13).

LIMITATIONS

The estimated numbers of new cancer cases and deaths in 2023 provide a reasonably accurate portrayal of the contemporary cancer burden. However, they are model-based, 3-year (mortality) and 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,26, 27 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, 2019 for incidence and 2020 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 oversensitive to sudden or steep changes in observed data. The most informative metrics for tracking cancer trends are age-standardized or age-specific cancer incidence rates from the SEER Program, the NPCR, and/or the NAACCR and cancer death rates from the NCHS.

Errors in reporting race and ethnicity in medical records and on death certificates result in underestimated cancer incidence and mortality in persons who are not White, particularly Native American populations. Although racial misclassification in mortality data among Native Americans is somewhat mitigated because of newly available adjustment factors published by researchers at the NCHS, these are currently only available for all cancers combined.22 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, although lung cancer incidence is approximately 50% lower in AAPI men than in White men overall, it is equivalent in Native Hawaiian men, who are classified within this broad category.123

CONCLUSION

The cancer mortality rate has decreased continuously since 1991, resulting in an overall drop of 33% and approximately 3.8 million cancer deaths averted. This steady progress is because of reductions in smoking; uptake of screening for breast, colorectal, and prostate cancers; and improvements in treatment, such as adjuvant chemotherapies for colon and breast cancers. More recently, advances in the development of targeted treatment and immunotherapy have accelerated progress in lung cancer mortality well beyond reductions in incidence and are reflected in large mortality reductions for cancers with increasing or stable incidence (leukemia, melanoma, and kidney cancer). Treatment breakthroughs have particularly improved the management of some difficult-to-treat cancers, such as nonsmall cell lung cancer and metastatic melanoma. Of concern are rising incidence for breast, prostate, and uterine corpus cancers, all of which have a wide racial disparity in mortality and are amenable to early detection. Expanding access to care and increasing investment for the broad application of existing cancer control interventions and for research to advance treatment options and develop successful interventions to reduce inequalities would help mitigate disparities and accelerate progress against cancer.

ACKNOWLEDGMENTS

The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been accomplished.

    CONFLICTS OF INTEREST

    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.