Cancer Statistics, 2010
2010;60;277-300; originally published online Jul 7, 2010;
DOI: 10.3322/caac.20073
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Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) CACANCERJCLIN2010;60:277–300
CancerStatistics,2010
AhmedinJemal,DVM,PhD1;RebeccaSiegel,MPH2;JiaquanXu,MD3;ElizabethWard,PhD4Abstract
Eachyear,theAmericanCancerSocietyestimatesthenumberofnewcancercasesanddeathsexpectedintheUnitedStatesinthecurrentyearandcompilesthemostrecentdataregardingcancerincidence,mortality,andsurvivalbasedonincidencedatafromtheNationalCancerInstitute,theCentersforDiseaseControlandPrevention,andtheNorthAmericanAssociationofCentralCancerRegistriesandmortalitydatafromtheNationalCenterforHealthStatistics.Incidenceanddeathratesareage-standardizedtothe2000USstandardmillionpopulation.Atotalof1,529,560newcancercasesand569,490deathsfromcancerareprojectedtooccurintheUnitedStatesin2010.Overallcancerincidenceratesdecreasedinthemostrecenttimeperiodinbothmen(1.3%peryearfrom2000to2006)andwomen(0.5%peryearfrom1998to2006),largelyduetodecreasesinthe3majorcancersitesinmen(lung,prostate,andcolonandrectum[colorectum])and2majorcancersitesinwomen(breastandcolorectum).Thisdecreaseoccurredinallracial/ethnicgroupsinbothmenandwomenwiththeexceptionofAmericanIndian/AlaskaNativewomen,inwhomrateswerestable.Amongmen,deathratesforallracescombineddecreasedby21.0%between1990and2006,withdecreasesinlung,prostate,andcolorectalcancerratesaccountingfornearly80%ofthetotaldecrease.Amongwomen,overallcancerdeathratesbetween1991and2006decreasedby12.3%,withdecreasesinbreastandcolorectalcancerratesaccountingfor60%ofthetotaldecrease.Thereductionintheoverallcancerdeathratestranslatestotheavoidanceofapproximately767,000deathsfromcanceroverthe16-yearperiod.Thisreportalsoexaminescancerincidence,mortality,andsurvivalbysite,sex,race/ethnicity,geographicarea,andcalendaryear.Althoughprogresshasbeenmadeinreducingincidenceandmortalityratesandimprovingsurvival,cancerstillaccountsformoredeathsthanheartdiseaseinpersonsyoungerthan85years.Furtherprogresscanbeacceleratedbyapplyingexistingcancercontrolknowledgeacrossallsegmentsofthepopulationandbysupportingnewdiscoveriesincancerprevention,earlydetection,andtreatment.CACancerJClin2010;60:277-300.©2010AmericanCancerSociety,Inc.
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) Introduction
CancerisamajorpublichealthproblemintheUnitedStatesandmanyotherpartsoftheworld.Currently,1in4deathsintheUnitedStatesisduetocancer.Inthisarticle,weprovideanoverviewofcancerstatistics,includingupdatedincidence,mortality,andsurvivalrates,andexpectednumbersofnewcancercasesanddeathsin2010.
MaterialsandMethods
DataSources
Mortalitydatafrom1930to2007intheUnitedStateswereobtainedfromtheNationalCenterforHealthStatistics(NCHS).1Incidencedataforlong-termtrends(1975-2006),5-yearrelativesurvivalrates,andlifetimeprobabilityofdevelopingcancerwereobtainedfromtheSurveillance,Epidemiology,andEndResults(SEER)programofthe
StrategicDirector,CancerSurveillance,SurveillanceandHealthPolicyResearch,AmericanCancerSociety,Atlanta,GA;2Manager,SurveillanceInformationServices,SurveillanceandHealthPolicyResearch,AmericanCancerSociety,Atlanta,GA;3Epidemiologist,MortalityStatisticsBranch,DivisionofVitalStatis-tics,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention,Hyattsville,MD;4VicePresident,SurveillanceandHealthPolicyResearch,AmericanCancerSociety,Atlanta,GA.
Correspondingauthor:AhmedinJemal,DVM,PhD,SurveillanceandHealthPolicyResearch,AmericanCancerSociety,250WilliamsStreet,NW,Atlanta,GA30303-1002;ahmedin.jemal@cancer.orgDISCLOSURES:ThefindingsandconclusionsinthisreportarethoseoftheauthorsanddonotnecessarilyrepresenttheviewsoftheCentersforDiseaseControlandPrevention.Theauthorsreportnoconflictsofinterest.
2010AmericanCancerSociety,Inc.doi:10.1002/caac.20073.Availableonlineat:http://cajournal.organdhttp://cacancerjournal.org
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TABLE1.EstimatedNewCancerCasesandDeathsbySex,UnitedStates,2010*
ESTIMATEDNEWCASES
BOTHSEXES
MALE
FEMALE
BOTHSEXES
ESTIMATEDDEATHS
MALE
FEMALE
AllSites
Oralcavity&pharynxTongueMouthPharynx
OtheroralcavityDigestivesystemEsophagusStomach
SmallintestineColon†Rectum
Anus,analcanal,&anorectumLiver&intrahepaticbileductGallbladder&otherbiliaryPancreas
OtherdigestiveorgansRespiratorysystemLarynx
Lung&bronchus
OtherrespiratoryorgansBones&joints
Softtissue(includingheart)
Skin(excludingbasal&squamous)Melanoma-skin
OthernonepithelialskinBreast
GenitalsystemUterinecervixUterinecorpusOvaryVulva
Vagina&othergenital,femaleProstateTestis
Penis&othergenital,maleUrinarysystemUrinarybladder
Kidney&renalpelvis
Ureter&otherurinaryorgansEye&orbit
Brain&othernervoussystemEndocrinesystemThyroid
OtherendocrineLymphoma
HodgkinlymphomaNon-HodgkinlymphomaMyelomaLeukemia
AcutelymphocyticleukemiaChroniclymphocyticleukemiaAcutemyeloidleukemiaChronicmyeloidleukemiaOtherleukemia‡
Other&unspecifiedprimarysites‡1,529,56036,54010,99010,84012,6602,050274,33016,64021,0006,960102,90039,6705,26024,1209,76043,1404,880240,61012,720222,5205,3702,65010,52074,01068,1305,880209,060311,21012,20043,47021,8803,9002,300217,7308,4801,250131,26070,53058,2402,4902,48022,02046,93044,6702,26074,0308,49065,54020,18043,0505,33014,99012,3304,8705,53030,680
789,62025,4207,6906,4309,8801,420148,54013,13012,7303,68049,47022,6202,00017,4304,45021,3701,660130,60010,110116,7503,7401,5305,68042,61038,8703,7401,970227,460
739,94011,1203,3004,4102,780630125,7903,5108,2703,28053,43017,0503,2606,6905,31021,7703,220110,0102,610105,7701,6301,1204,84031,40029,2602,140207,09083,75012,20043,47021,8803,9002,300
569,4907,8801,9901,8302,4101,650139,58014,50010,5701,10051,37072018,9103,32036,8002,290161,6703,600157,300
7701,4603,92011,7908,7003,09040,23060,4204,2107,95013,85092078032,05035031028,55014,68013,04083023013,1402,5701,69088021,5301,32020,21010,65021,8401,4204,3908,9504406,64044,030
299,2005,4301,3001,1401,7301,26079,01011,6506,35061026,58028012,7201,24018,77081089,5502,87086,2204608302,0207,9105,6702,24039032,710
270,2902,45069069068039060,5702,8504,22049024,7904406,1902,08018,0301,48072,12073071,0803106301,9003,8803,03085039,84027,7104,2107,95013,850920780
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 217,7308,4801,25089,62052,76035,3701,4901,24011,98011,89010,7401,15040,0504,67035,38011,17024,6903,1508,8706,5902,8003,28015,170
41,64017,77022,8701,0001,24010,04035,04033,9301,11033,9803,82030,1609,01018,3602,1806,1205,7402,0702,25015,510
32,05035031019,11010,4108,2104901207,4201,14073041011,45074010,7105,76012,6607902,6505,2801903,75023,690
9,4404,2704,8303401105,7201,43096047010,0805809,5004,8909,1806301,7403,6702502,89020,340
*Roundedtothenearest10;estimatednewcasesexcludebasalandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.About54,010femalecarcinomainsituofthebreastand46,770melanomainsituwillbenewlydiagnosedin2010.†Estimateddeathsforcolonandrectumcancersarecombined.
‡Moredeathsthancasesmayreflectlackofspecificityinrecordingunderlyingcauseofdeathondeathcertificatesoranundercountinthecaseestimate.
Source:Estimatednewcasesarebasedon1995-2006incidenceratesfrom41statesandtheDistrictofColumbiaasreportedbytheNorthAmericanAssociationofCentralCancerRegistries(NAACCR),basedondatacollectedbycancerregistriesparticipatinginNCI’sSEERprogramandCDC’sNationalProgramofCancerRegistries,representingabout89%oftheUSpopulation.EstimateddeathsarebasedonUSMortalityData,1969to2007,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
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TABLE2.Age-standardizedIncidenceRatesforAllCancersCombined,2002-2006,andEstimatedNewCases*forSelected
CancersbyState,UnitedStates,2010
INCIDENCERATE†
ALLCASES
COLON
FEMALEUTERINE&BREASTCERVIXRECTUM
UTERINECORPUS
LUNG&BRONCHUS
MELANOMAOFTHESKIN
NON-HODGKINURINARYLYMPHOMAPROSTATEBLADDER
STATELEUKEMIA
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelaware
Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhioOklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming
UnitedStates453.6468.3§459.3441.0438.1509.4511.9§462.4462.2425.7461.7488.8469.4481.0§511.2496.0530.3§507.8503.4479.3§468.9466.2476.8466.2508.1511.0416.0491.0460.9465.1§478.3471.2503.7515.5476.4460.2§451.5408.5§444.5494.9494.2§447.6472.923,6403,4502002,3005202,860410‡2607029,7803,9502102,62071015,3201,7701401,500330157,32021,1301,54013,9504,47021,3403,1001501,77057020,7502,9601201,7706504,890690‡4401402,760390‡26080107,00014,08094010,5002,71040,4806,1303903,8409506,670910506802207,2209106060020063,8908,7704906,3401,96033,0204,3502303,33096017,2602,0201001,76055013,5501,780901,27041024,2403,2902102,37061020,9502,5301802,0604408,6501,1605080028027,7004,1502002,63081036,0405,3202003,1201,15055,6607,3403305,1701,70025,0803,3301402,41085014,3301,9701301,48030031,1603,8802103,0809105,570680‡4901509,2301,1606091029012,2301,3501301,0902907,810990‡72024048,1006,8204204,4301,5809,2101,18090790230103,34014,6109309,7803,43045,1206,5003604,2201,1903,300400‡34010064,4508,2804105,9602,01018,6702,3001501,73046020,7502,9101301,71060075,26010,0005407,4402,4505,970790‡54019023,2403,2601702,1405604,220530‡45013033,0704,7002703,130750101,12012,9201,0709,1902,4209,9701,260807402803,720520‡32011036,4105,4702803,3701,04034,5004,9002202,7401,01010,6101,310801,06033029,6104,1202002,7601,0402,540330‡220701,529,560207,09012,200142,57043,470560707604204,460650510120603,3301,0401602301,8608905604006305902606209101,6008303408701602903202001,3302802,9801,1501001,8105605302,0701605901308503,240310908801,0002809407043,0504,1603604,0302,62018,4902,2702,64080036018,3906,2807708609,1905,4302,4501,9904,7803,3201,3704,1705,0208,1503,1502,3605,3607401,2001,9201,0706,26092013,7207,52041010,7103,2502,81010,5208403,9705405,98014,0306204905,5104,3202,0703,990320222,5201,210801,4304608,0301,1801,090210704,9802,0203103602,0601,2009006501,4406004101,2901,7702,2409704701,3202004504103902,6504204,0502,1301202,2006401,2003,5502901,0601701,7203,5706101901,8101,9304401,05011068,1309401301,2106407,0109208602001004,6601,6002303102,6901,3707505901,0309203601,1101,4602,4001,1005401,2602404104803102,1303704,6801,8001502,7208109303,4302409501801,3604,4104301501,4701,6004501,34011065,5403,3009204401403,8501,5302,33061022,6406,6203,4309602,9401,1107102504509014,6105,6006,3801,4701,0602001,3003808,7303,0504,1601,5102,4208401,6305503,1801,0303,4108501,4105304,0101,1804,8202,0008,4902,7903,8701,1602,2605103,6001,3609602801,4704201,7506201,1004306,7902,5101,61035014,8405,2306,9101,8905801808,0102,9702,4407703,0101,0409,8004,0507403503,6009507602304,6001,35013,7403,6501,7303906002105,5501,5205,2201,7201,4405304,6701,510420130217,73070,530
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Roundedtothenearest10;excludesbasalandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.†Ratesareper100,000andageadjustedtothe2000USstandardpopulation.‡Estimateisfewerthan50cases.§Combinedincidencerateisnotavailable.
Source:DataasofJune2009reportedbytheNorthAmericanAssociationofCentralCancerRegistries(NAACCR)asmeetinghighqualitystandardsfor2002-2006andincludedatacollectedbycancerregistriesparticipatinginNCI’sSEERProgramandCDC’sNationalProgramofCancerRegistries.ToaccountforpopulationanomaliescausedbyHurricaneKatrinain2005,statisticsexcludedataforAL,LA,andTXfromJuly2005-December2005.
Note:Thesemodel-basedestimatesarecalculatedusingincidenceratesfrom41statesandtheDistrictofColumbia;theyareofferedasaroughguideandshouldbeinterpretedwithcaution.StateestimatesmaynotaddtoUStotalduetoroundingandexclusionofstateswithfewerthan50cases.
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Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) FIGURE1.TenLeadingCancerTypesfortheEstimatedNewCancerCasesandDeathsbySex,2010.
*Excludesbasalandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.Estimatesareroundedtothenearest10.
NationalCancerInstitute(NCI),coveringapproxi-mately26%oftheUSpopulation.2-5Incidencedata(1995-2006)forprojectingnewcancercaseswereob-tainedfromcancerregistriesthatparticipateintheSEERprogramortheCentersforDiseaseControlandPrevention(CDC)’sNationalProgramofCancerRegistries(NPCR),throughtheNorthAmericanAs-sociationofCentralCancerRegistries(NAACCR)coveringapproximately89%oftheUSpopulation.State-specificincidencerateswereobtainedfromNAACCRbasedondatacollectedbycancerregistriesparticipatingintheSEERprogramandtheNPCR.6PopulationdatawereobtainedfromtheUSCensusBureau.7Causesofdeathwerecodedandclassified
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accordingtotheInternationalClassificationofDiseases(ICD-8,ICD-9,andICD-10).8-10CancercaseswereclassifiedaccordingtotheInternationalClassificationofDiseasesforOncology.11EstimatedNewCancerCasesandDeaths
Theprecisenumberofcancercasesdiagnosedeachyearinthenationandineverystateisunknownbecausecancercasereportingisincompleteinsomestates.Furthermore,themostrecentyearforwhichincidenceandmortalitydataareavailablelags3to4yearsbehindthecurrentyearduetothetimere-quiredfordatacollectionandcompilation.There-fore,weprojecttheexpectednumberofnewcancer
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TABLE3.Age-standardizedDeathRatesforAllCancersCombined,2002-2006,andEstimatedDeaths*forSelected
CancersbyState,UnitedStates,2010
BRAIN&OTHERNERVOUSSYSTEM
STATE
DEATHRATE†ALLSITESFEMALEBREASTCOLON&RECTUM
LEUKEMIALIVER
LUNG&BRONCHUSNON-HODGKINLYMPHOMA
OVARYPANCREASPROSTATE
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelaware
Dist.ofColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhioOklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennesseeTexasUtahVermontVirginiaWashingtonWestVirginiaWisconsinWyoming
UnitedStates203.7182.0163.9205.0169.7163.5182.6198.7204.9177.3190.3150.3171.6194.5202.7184.3184.7219.3217.0204.1193.3190.9193.4176.6211.3200.1182.7178.2193.0190.6189.4165.2176.1194.3175.5202.3198.1189.2196.4191.4197.7178.8208.8181.7139.2179.4191.9183.4211.4184.3176.7186.910,15088010,6306,46055,7106,8806,8501,90096040,88015,5702,3302,53023,36012,9006,3705,3709,6708,4803,17010,25012,99020,7409,2006,06012,6201,9803,5004,6402,66016,5203,40034,54019,1001,28024,9807,6607,51028,6902,1709,1801,67013,60036,5402,8201,28014,23011,6404,67011,3101,000569,490210‡2801501,490210150‡‡800340‡804703401701401802108021028050024013028060901207034080800350‡54017021055050200‡340840100‡300370100270‡13,140690707404304,230500490120802,6501,1001401601,7908603803705806201708007801,3206104008601102103301901,4302302,4901,340801,7305204901,9801306401008902,780250901,1207902706906039,840950801,0206004,9706605401601003,5401,4302202202,3101,1306205308809202709501,0501,7407806301,1201703605302101,6003403,1201,5201202,2807006902,6101507701601,1903,3402501201,30098044090011051,370350310‡‡4203802402002,2202,6002702302302007050‡‡1,5601,36056043080120120709007005203403001602601403202503103401108039036047044081060039028023019054038090501408011018090806004701201501,3801,27065050060‡9306802902202802301,100840907033027070‡4903801,4101,6601408050‡510410480440150120490330‡‡21,84018,9103,1902502,6701,90012,6301,6701,76058023011,6204,6205706406,4904,0001,7701,5903,4102,5509602,7603,5305,8302,4502,0103,9505809001,3007504,2207808,7205,6503207,2602,3902,1007,9606002,8704504,5209,6004803704,0503,1101,4802,940260157,300320‡3602002,11028023060‡1,48050090907404402902003102809031040070033019045080150150706401201,480570‡8402803101,10060300604701,280100‡4504401904105020,210260‡2901401,500210180‡‡93039050605703001701402002007025033050022013025050801106043080910390‡540160210730602205025084080‡370330110290‡13,850590607404303,900460540120702,5609401801901,5807903803305405402007109201,3306003607901202003001901,1302302,4401,160901,5304004902,0101205601007502,200200809307602207207036,800600‡6504603,710390410100702,5909301201801,4206203703004704401506506001,0104403307101302402701409402401,690980701,4403204301,660804901006901,82020050710770130600‡32,050
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Roundedtothenearest10.
†Ratesareper100,000andageadjustedtothe2000USstandardpopulation.‡Estimateisfewerthan50deaths.
Note:StateestimatesmaynotaddtoUStotalduetoroundingandexclusionofstateswithfewerthan50deaths.
Source:USMortalityData,1969to2007,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
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TABLE4.CancerIncidenceRates*bySiteandState,UnitedStates,2002to2006
ALLSITES
STATE
MALE
FEMALE
BREASTFEMALE
COLORECTUMMALE
FEMALE
LUNG&BRONCHUSMALE
FEMALE
NON-HODGKINLYMPHOMAMALE
FEMALE
PROSTATEMALE
URINARYBLADDERMALE
FEMALE
Alabama†AlaskaArizona‡ArkansasCaliforniaColoradoConnecticutDelaware
Dist.ofColumbia‡FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana†MaineMaryland§MassachusettsMichiganMinnesotaMississippi†‡MissouriMontanaNebraskaNevada
NewHampshireNewJerseyNewMexicoNewYorkNorthCarolinaNorthDakotaOhio§OklahomaOregonPennsylvaniaRhodeIslandSouthCarolinaSouthDakotaTennessee‡¶Texas†UtahVermont§VirginiaWashingtonWestVirginiaWisconsin§Wyoming
UnitedStates561.2529.4465.9562.8510.1501.5591.0607.7556.0537.3566.4486.7538.4579.8551.3558.9557.2608.4619.2620.9—591.8597.5567.2574.7544.3541.9561.8531.2584.3603.9480.5577.5553.4549.3—561.4529.3592.7608.9587.4547.8548.3539.6486.8—529.5566.9578.6—516.5556.5379.6417.7364.0383.5393.3394.1455.5440.8412.1404.2392.4383.0401.7429.1415.1429.2417.2446.4409.6465.8—452.9437.9416.4382.1417.2406.3418.2412.0455.3449.5366.1434.4398.1402.7—422.2429.7444.6455.3397.5395.3400.6389.9346.6—385.8443.3437.1—392.9414.8114.6126.4108.8113.1122.3123.1135.0123.9132.7114.1118.5121.4117.5123.1115.3124.0126.1119.8119.6128.6—132.2124.2126.4108.2121.9119.6126.4112.1131.2128.0109.6124.5120.3122.8—127.2131.9124.5128.3119.2119.6116.4114.9110.0—120.7134.8114.7—117.8121.861.760.048.958.852.250.062.862.057.455.258.761.349.967.262.864.461.368.068.565.9—63.958.856.464.562.352.567.655.259.065.449.460.857.266.6—60.152.866.165.761.260.258.457.545.3—55.552.669.5—52.059.042.045.636.042.739.239.546.544.846.341.742.341.538.048.346.449.643.649.847.348.8—45.744.642.346.344.940.347.543.444.548.035.845.841.643.1—43.741.148.346.244.144.543.239.733.7—41.840.150.7—43.043.6107.884.669.6111.365.160.581.897.681.489.2101.768.868.792.3103.689.987.6133.1109.599.2—83.793.069.8111.7105.275.384.683.382.179.657.579.4101.374.6—105.679.491.092.2102.278.7113.688.337.8—88.578.7117.7—62.186.452.964.349.159.547.045.260.170.046.660.353.340.148.358.863.353.153.276.957.966.0—62.461.549.554.563.457.449.369.062.756.039.054.156.048.0—65.160.456.462.253.046.360.651.223.0—53.659.570.1—47.755.520.522.618.921.822.421.025.823.522.821.620.819.021.424.122.824.424.123.123.224.5—23.425.226.420.921.822.824.722.223.525.617.924.721.222.7—22.924.425.124.820.722.121.622.322.4—20.627.222.9—21.423.113.817.613.515.615.516.218.116.113.715.414.112.617.216.216.417.618.016.916.719.2—16.518.717.713.515.514.917.415.318.217.714.317.315.115.8—17.517.017.517.514.617.015.816.116.3—13.418.316.8—15.816.3154.2141.4118.9161.3149.0156.4164.6179.9175.2138.4162.4128.6165.8157.9135.9144.9159.6142.5176.8164.8—164.6179.4184.6166.7129.3174.5157.6144.2159.5177.9146.1166.3153.2169.5—150.0148.0159.7152.2171.5171.0132.7144.0182.2—155.0165.3138.6—168.0155.531.841.635.333.034.033.645.442.824.037.432.726.237.040.737.440.736.239.035.249.4—46.741.940.129.635.840.837.240.748.046.226.742.334.939.6—34.939.244.853.132.439.134.030.228.3—33.341.339.8—42.137.97.67.38.98.68.28.812.611.18.39.78.06.28.810.59.49.68.59.98.613.4—12.910.510.37.58.99.19.511.013.412.27.011.18.810.0—8.610.011.213.07.88.18.37.36.1—8.410.211.4—10.09.6
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Per100,000,ageadjustedtothe2000USstandardpopulation.
†DuetothedisplacementofpopulationsafterHurricaneKatrinainSeptember2005,2005statisticsarebasedoncasesdiagnosedinJanuarytoJune.
‡Thisstate’sregistrydidnotachievehighqualitydatastandardsforoneormoreyearsduring2002-2006accordingtotheNorthAmericanAssociationofCentralCancerRegistry(NAACCR)dataqualityindicators.
§Thisstate’sregistrydidnotsubmitincidencedatatoNAACCRfor2002-2006.¶Caseassertainmentforthisstate’sregistryisincompletefortheyears2002-2006.
Source:NAACCR,2009.DataarecollectedbycancerregistriesparticipatingintheNationalCancerInstitute’sSEERprogramandtheCentersforDiseaseControlandPrevention’sNationalProgramofCancerRegistries.
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700Male Incidence600Male and Female Incidence500Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) Rate per 100,000 PopulationFemale Incidence400300Male MortalityMale and Female Mortality200Female Mortality10001975
1980
1985
1990
1995
2000
2005
Year of Diagnosis/Death
FIGURE2.AnnualAge-AdjustedCancerIncidenceandDeathRates*bySex,UnitedStates,1975to2006.
*Ratesareageadjustedtothe2000USstandardpopulation.Incidencesratesareadjustedfordelaysinreporting.Sources:Incidence:Surveillance,Epidemiology,andEndResults(SEER)program(availableat:www.seer.cancer.gov).Delay-adjustedincidencedatabase:SEERIncidenceDelay-AdjustedRates,9Registries,1975-2006.Bethesda,MD:NationalCancerInstitute,DivisionofCancerControlandPopulationSciences,SurveillanceResearchProgram,StatisticalResearchandApplicationsBranch;2009.ReleasedApril2009,basedontheNovember2008SEERdatasubmission.Mortality:USMortalityData,1975to2006.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
casesanddeathsintheUnitedStatesin2010toprovideanestimateofthecurrentcancerburden.Estimatednewcancercasesinthecurrentyear(2010)wereprojectedusingaspatiotemporalmodelbasedonincidencedatafrom1995through2006from44statesandtheDistrictofColumbiathatmettheNAACCR’shigh-qualitydatastandardforincidence,coveringapproximately89%oftheUSpopulation.12Themethodalsoconsidersgeo-graphicvariationsinsociodemographicandlife-stylefactors,medicalsettings,andcancerscreeningbehaviorsaspredictorsofincidence,andaccountsforex-pecteddelaysincasereporting.
Weusedthestate-spacepredictionmethodtoesti-matethenumberofcancerdeathsexpectedtooccurintheUnitedStatesandineachstateintheyear2010.13Projectionsarebasedonunderlyingcause-of-deathfromdeathcertificatesasreportedtotheNCHS.1Thismodelprojectsthenumberofcancerdeathsex-pectedtooccurin2010basedonthenumberthatoc-curredeachyearfrom1969to2007intheUnitedStatesandineachstateseparately.
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260240220200
MaleProstate260240220200180FemaleRate per 100,000 Population180160140120
Lung and BronchusDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 1601401201008060Urinary BladderNon-Hodgkin LymphomaColon and RectumLung and BronchusBreast100806040200
1999197519771979198119831985198719891991199319951997200120052003Colon and Rectum40Uterine CorpusMelanoma of the Skin200Non-Hodgkin LymphomaMelanoma of the Skin1979197519771981198319851987198919911993199519991997200120032005Year of DiagnosisYear of Diagnosis
FIGURE3.AnnualAge-AdjustedCancerIncidenceRates*forSelectedCancersbySex,UnitedStates,1975to2006.
*Ratesareageadjustedtothe2000USstandardpopulationandadjustedfordelaysinreporting.Source:Surveillance,Epidemiology,andEndResults(SEER)program(availableat:www.seer.cancer.gov).Delay-adjustedincidencedatabase:SEERIncidenceDelay-AdjustedRates,9Registries,1975-2006.Bethesda,MD:NationalCan-cerInstitute,DivisionofCancerControlandPopulationSciences,SurveillanceResearchProgram,StatisticalResearchandApplicationsBranch;2009.ReleasedApril2009,basedontheNovember2008SEERdatasubmission.
OtherStatistics
Weprovidemortalitystatisticsfortheleadingcausesofdeathaswellasdeathsfromcancerintheyear2007.Causesofdeathfor2007werecodedandclassifiedaccordingtoICD-10.10Thisreportalsoprovidesup-datedstatisticsregardingtrendsincancerincidenceandmortalityrates,theprobabilityofdevelopingcan-cer,and5-yearrelativesurvivalratesforselectedcan-cersitesbasedondatafrom1975through2006.2,6Allage-adjustedincidenceanddeathratesarestandard-izedtothe2000USstandardpopulationandex-pressedper100,000population.
Theincidencerates(2002-2006)andlong-termtrends(1975-2006)areadjustedfordelaysinreportingwhenpossible.Delayedreportingprimarilyaffectsthemostrecent1to3yearsofincidencedata(inthiscase,2004-2006),especiallyforcancerssuchasmelanoma,
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leukemia,andprostatethatarefrequentlydiagnosedinoutpatientsettings.TheNCIhasdevelopedamethodtoaccountforexpectedreportingdelaysinSEERregistriesforallcancersitescombinedandmanyspecificcancersites.14Delay-adjustedratesprovideamoreaccurateas-sessmentoftrendsinthemostrecentyearsforwhichdataareavailable.Long-termincidenceandmortalitytrendsforselectedcancersiteswerepreviouslypublishedinthe2010AnnualReporttotheNationontheStatusofCancer.15Wealsoprovidethecontributionofindividualcancersitestothetotaldecreaseinoverallcancerdeathratessince1990inmenand1991inwomenandestimatesofthetotalnumberofcancerdeathsavoidedbecauseofthereductioninoverallage-standardizedcancerdeathratesthrough2006.Thetotalnumberofcancerdeathsavoidedwascalculatedbyapplyingtheage-specific
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100
Lung and Bronchus90
80
70
Rate per 100,000 MalesDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 60
50
Stomach40
Colon and Rectum30
Prostate20
Pancreas10
Leukemia0
1985193019351945195519601965197019751980199019952000194019502005LiverYear of Death
FIGURE4.AnnualAge-AdjustedCancerDeathRates*AmongMalesforSelectedCancers,UnitedStates,1930to2006.
*Ratesareageadjustedtothe2000USstandardpopulation.DuetochangesinInternationalClassificationofDiseases(ICD)coding,numeratorinformationhaschangedovertime.Ratesforcancersofthelungandbronchus,colonandrectum,andliverareaffectedbythesechanges.Source:USMortalityData,1960to2006,USMortalityVol.1930to1959.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
cancerdeathratesinthepeakyearfortheage-standardizedcancerdeathrates(1990formalesand1991forfemales)tothecorrespondingage-specificpop-ulationsinthesubsequentyearsthrough2006toobtainthenumberofexpecteddeathsineachcalendaryearifthedeathrateshadnotdecreased.Wethensummedthedifferencebetweenthenumberofexpectedandobserveddeathsineachagegroupandcalendaryearformenandwomenseparatelytoobtainthetotalnumberofcancerdeathsavoidedoverthe15-year(women)or16-year(men)interval.
SelectedFindings
ExpectedNumbersofNewCancerCasesin2010
Table1presentsestimatesofthenumberofnewcasesofinvasivecancerexpectedamongmenandwomenin
theUSin2010.Theoverallestimateofapproximately1.53millionnewcasesdoesnotincludecarcinomainsituofanysiteexcepturinarybladder,nordoesitin-cludebasalcellandsquamouscellcancersoftheskin.Greaterthan2millionunreportedcasesofbasalcellandsquamouscellskincancer,approximately54,010casesofbreastcarcinomainsitu,and46,770casesofmelanomainsituareexpectedtobenewlydiagnosedin2010.TheestimatednumbersofnewcancercasesforeachstateandselectedcancersitesareshowninTable2.
Figure1indicatesthemostcommoncancersex-pectedtooccurinmenandwomenin2010.Amongmen,cancersoftheprostate,lungandbronchus,andcolorectumaccountfor52%ofallnewlydiagnosedcancers.Prostatecanceraloneaccountsfor28%(217,730)ofincidentcasesinmen.Basedoncases
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100
90
80
70
Rate per 100,000 FemalesDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 60
50
Lung and Bronchus40
Breast30
Uterus†Pancreas10
OvaryColon and Rectum20
Stomach0
1935194019501955196019701930194519651975198019902000198519952005Year of Death
FIGURE5.AnnualAge-AdjustedCancerDeathRates*AmongFemalesforSelectedCancers,UnitedStates,1930to2006.
*Ratesareageadjustedtothe2000USstandardpopulation.
†Uterusincludesuterinecervixanduterinecorpus.DuetochangesinInternationalClassificationofDiseases(ICD)coding,numeratorinformationhaschangedovertime.Ratesforcancersoftheuterus,ovary,lungandbronchus,andcolonandrectumareaffectedbythesechanges.Source:USMortalityData,1960to2006,USMortalityVolumes1930to1959.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
diagnosedbetween1999and2005,anestimated92%ofthesenewcasesofprostatecancerareexpectedtobediagnosedatlocalorregionalstages,forwhichthe5-yearrelativesurvivalapproaches100%.
The3mostcommonlydiagnosedtypesofcanceramongwomenin2010willbecancersofthebreast,lungandbronchus,andcolorectum,accountingfor52%ofestimatedcancercasesinwomen.Breastcanceraloneisexpectedtoaccountfor28%(207,090)ofallnewcancercasesamongwomen.
ExpectedNumberofCancerDeathsin2010
Table1alsoshowstheexpectednumberofdeathsfromcancerprojectedfor2010formen,women,andbothsexescombined.Itisestimatedthatapproximately569,490Americanswilldiefromcancer,corresponding
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togreaterthan1500deathsperday.Cancersofthelungandbronchus,prostate,andcolorectuminmen,andcan-cersofthelungandbronchus,breast,andcolorectuminwomencontinuetobethemostcommonfatalcancers.These4cancersaccountforapproximatelyhalfofthetotalcancerdeathsamongmenandwomen(Fig.1).Lungcancersurpassedbreastcancerastheleadingcauseofcancerdeathinwomenin1987andisexpectedtoaccountfor26%ofallfemalecancerdeathsin2010.Table3providestheestimatednumberofcancerdeathsin2010bystateforselectedcancersites.
RegionalVariationsinCancerRates
Table4depictscancerincidenceratesforselectedcan-cersitesbystate.Byfar,thelargestvariationininci-denceamongthecancersiteslistedinTable4isfor
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TABLE5.TrendsinCancerIncidenceandDeathRatesforSelectedCancersbySex,UnitedStates,1975to2006
TREND1YEARS
APC*
TREND2YEARS
APC*
TREND3YEARS
APC*
TREND4YEARS
APC*
TREND5YEARS
APC*
AllsitesIncidence
MaleandfemaleMaleFemaleDeath
MaleandfemaleMaleFemale
Lung&bronchusIncidenceMaleFemaleDeathMaleFemaleColorectumIncidenceMaleFemaleDeathMaleFemaleFemalebreastIncidenceDeathProstateIncidenceDeath
1975-19891975-19891975-19791975-19901975-19791975-19901975-19821975-19821975-19781975-19821975-19851975-19851975-19841975-19841975-19801975-19901975-19881975-1987
1.2†1.3†-0.30.5†1.0†0.6†1.4†5.6†2.5†6.0†1.1†0.3-0.1-1.0†-0.50.4†2.6†0.9†
1989-19921989-19921979-19871990-19931979-19901990-19941982-19911982-19911978-19841982-19901985-19911985-19951984-19901984-20011980-19871990-19951988-19921987-1991
2.8†5.2†1.6†-0.30.3†-0.1-0.43.4†1.2†4.2†-1.2†-1.8†-1.4†-1.8†4.0†-1.8†16.5†3.0†
1992-19951992-19951987-19951993-20011990-19931994-20021991-20061991-20061984-19901990-19951991-19951995-19981990-20022001-20061987-19941995-19981992-19951991-1994
-2.4-4.9†0.1-1.1†-0.5-0.8†-1.8†0.4†0.4†1.7†-3.2†1.9-2.0†-3.4†-0.1-3.3†-11.7†-0.6
1995-19991995-20001995-19982001-20061993-20012002-2006
0.90.51.4-1.6†-1.5†-1.5†
1999-20062000-20061998-20062001-2006
-0.7†-1.3†-0.5†
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) -2.0†
1990-19941995-20031995-19981998-20062002-20061994-19991998-20061995-20001994-2006
-1.3†0.3†2.1-2.2†-3.9†1.6†-1.9†2.4-4.1†
1994-20062003-20061998-2006
-2.0†-0.9-3.0†
1999-20062000-2006
-2.0†-2.4†
*Annualpercentchange(APC)basedonincidence(delay-adjusted)andmortalityratesageadjustedtothe2000USstandardpopulation.†TheAPCissignificantlydifferentfromzero(PϽ0.05).
Note:TrendswereanalyzedbyJoinpointRegressionProgram,version3.3.1,withamaximumoffourjoinpoints(ie,fivelinesegments).Source:Edwards,etal.15lungcancer,forwhichrates(casesper100,000popu-lation)rangefrom37.8inmenand23.0inwomeninUtahto133.1inmenand76.9inwomeninKentucky.Thisvariationreflectsthelargeandcontinuingdiffer-encesinsmokingprevalenceamongstates.UtahrankslowestinadultsmokingprevalenceandKentuckyhighest.Incontrast,statevariationintheincidenceratesofothercancersitesshowninTable4issmallerinbothabsoluteandproportionateterms.Forscreen-ablecancers,suchasthoseoftheprostateandfemalebreast,variationinincidenceratesreflectsdifferencesintheuseofscreeningtestsinadditiontodifferencesindiseaseoccurrence.
TrendsinCancerIncidenceandMortality
Figures2to5depictlong-termtrendsincancerincidenceanddeathratesforallcancerscombinedandforselectedcancersitesbysex.Table5showsincidenceandmortalitypatternsforallcancersites
andforthe4mostcommoncancersitesbasedonjoinpointanalysis.Trendsinincidenceweread-justedfordelayedreporting.Delay-adjustedcancerincidenceratesdecreasedby1.3%peryearfrom2000through2006inmalesandby0.5%peryearfrom1998through2006infemales.15Incidencetrendsdecreasedforall4majorcancersitesexceptforlungcancerinwomen,inwhomratesarestillincreasing,thoughatamuchslowerratethaninpreviousyears.Thelaginthetemporaltrendoflungcancerratesinwomencomparedwithmenreflectshistoricaldifferencesincigarettesmokingbetweenmenandwomen;cigarettesmokinginwomenpeakedapproximately20yearslaterthaninmen.Theaccelerateddecreaseincolorectalcancerinci-denceratesfrom1998to2006largelyreflectsincreasesinscreeningthatcandetectandremoveprecancerouspolyps.15Thedecreaseinprostatecancerincidencerates(by2.4%peryearfrom
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TABLE6.TheContributionofIndividualCancerSitestotheDecreaseinCancerDeathRates,1990-2006
DEATHRATE(PER100,000)
MALE
1990*
2006
ABSOLUTE
CHANGE
%
%CONTRIBUTION†
AllmalignantcancersDecreasingLung&bronchusProstateColorectumStomach
Oralcavity&pharynxNon-HodgkinlymphomaLeukemia
Brain&othernervoussystemLarynxMyeloma
Kidney&renalpelvisUrinarybladderHodgkinlymphomaOtherTotalIncreasingEsophagus
Liver&IntrahepaticBileDuctMelanomaoftheSkinTotal
279.8290.5638.5630.778.865.619.9710.715.972.974.836.167.970.8539.79263.597.165.273.8016.23
221.1167.4523.5620.515.043.788.419.615.132.194.365.747.570.5637.56201.467.8527.734.0719.65
-58.71-23.11.15.01-10.27-3.82-1.83-1.56-1.10-0.84-0.78-0.47-0.42-0.40-0.30-2.23-62.130.692.450.273.42
CHANGE
ABSOLUTE
-20.98-25.52-38.91-33.36-43.12-32.61-15.63-10.31-14.10-26.22-9.70-6.86-5.00-34.70-5.61
37.224.216.56.12.92.51.81.41.30.80.70.60.53.6100.0
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 9.7046.547.07
DEATHRATE(PER100,000)
FEMALE
1991*
2006
%%CONTRIBUTION†
AllmalignantcancersDecreasingBreastColorectum
Non-HodgkinLymphomaStomachCervixUteriOvaryLeukemia
Brain&OtherNervousSystemOralCavity&PharynxOtherTotalIncreasingLung&bronchus
Liver&intrahepaticbileductPancreasTotal
175.3032.6920.306.744.013.499.516.324.112.0336.69125.9037.612.529.2849.40
153.66-21.64-9.24-5.77-1.37-1.36-1.07-0.97-0.92-0.72-0.64-3.08-25.15
-12.34-28.26-28.40-20.30-33.98-30.65-10.24-14.61-17.63-31.56-8.40-19.986.8229.982.10
36.722.95.45.44.33.93.72.92.512.3100.0
40.173.279.4852.922.560.750.203.51
*Deathratesforcancerpeakedin1990inmenandin1991inwomen.
†Thiscalculationisbasedoneachcancersite’scontributiontotheincreasingordecreasingportionofthetotalcancerdeathrate,dependingontheindividualsite’strend;itdoesnotrepresentthecontributiontothenetdecreaseincancerdeathrates.
2000-2006)mayreflectrecentstabilizationofprostate-specificantigentesting,resultinginde-creaseddetectionorareducednumberofundiag-nosedcases.16-18Thedecreaseinthebreastcancerincidenceratesince1999likelyreflectsthelargediscontinuityintheuseofmenopausalhormonetherapyamongpostmenopausalwomenbeginningin2001,anditmayalsoreflectdelayeddiagnosis
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duetodecreasedmammographyuse.19-20However,closeinspectionofincidencedatabyindividualyear(Fig.3)showsthataftera6%decreasefrom2002to2003,incidenceratesfrom2003to2006re-mainedrelativelyunchanged.Thismaysupportthehypothesisthatpostmenopausalhormonesmaybeactingaspromotersratherthaninitiatorsofbreastcancer.20CACANCERJCLIN2010;60:277–300
TABLE7.FifteenLeadingCausesofDeath,UnitedStates,2007
RANK
CAUSEOFDEATH
NUMBEROFDEATHS
PERCENT(%)OFTOTALDEATHS
DEATHRATE*
123456789101112131415
AllCausesHeartdiseasesCancer
Cerebrovasculardiseases
ChroniclowerrespiratorydiseasesAccidents(unintentionalinjuries)AlzheimerdiseaseDiabetesmellitus
Influenza&pneumonia
Nephritis,nephroticsyndrome,&nephrosisSepticemia
Intentionalself-harm(suicide)Chronicliverdisease&cirrhosis
Essentialhypertension&hypertensiverenaldisease†ParkinsondiseaseAssault(homicide)
Allother&ill-definedcauses2,423,712616,067562,875135,952127,924123,70674,63271,38252,71746,44834,82834,59829,16523,96520,05818,361451,034100.025.423.25.65.35.13.12.92.21.91.41.41.21.00.80.818.6
760.2190.9178.442.240.840.022.722.516.214.511.011.39.17.46.46.1
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Ratesareper100,000populationandageadjustedtothe2000USstandardpopulation.†Includesprimaryandsecondaryhypertension.
Note:Percentagesmaynottotal100duetorounding.InaccordancewiththeNationalCenterforHealthStatistics’cause-of-deathranking,“Symptoms,signs,andabnormalclinicalorlaboratoryfindings”andcategoriesthatbeginwith“Other”and“Allother”werenotranked.Source:USMortalityData,2007.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
TABLE8.TrendsintheRecordedNumberofDeathsfromSelectedCancersbySex,UnitedStates,1990to2007
ALLSITES
YEAR
MALE
FEMALE
LUNGANDBRONCHUSMALE
FEMALE
MALE
COLORECTUM
FEMALE
PROSTATEMALE
BREASTFEMALE
199019911992199319941995199619971998199920002001200220032004200520062007268,283272,380274,838279,375280,465281,611281,898281,110282,065285,832286,082287,075288,768287,990286,830290,422290,069292,857237,039242,277245,740250,529253,845256,844257,635258,467259,467264,006267,009266,693268,503268,912267,058268,890269,819270,01891,01491,60391,32292,49391,82591,80091,55991,27891,39989,40190,41590,36790,12189,90889,57590,14189,24388,33150,13652,02254,48556,23457,53559,30460,35161,92263,07562,66265,01665,60667,50968,08468,43169,07969,35770,35528,48428,02628,28028,19928,47128,40927,98928,07528,02428,31328,48428,22928,47227,99126,88126,78326,80327,00528,67428,75328,71429,20628,93629,23728,76628,62128,95028,90928,95028,57928,13227,79326,69926,22426,39626,21632,37833,56434,24034,86534,90234,47534,12332,89132,20331,72931,07830,71930,44629,55429,00228,90528,37229,09343,39143,58343,06843,55543,64443,84443,09141,94341,73741,14441,87241,39441,51441,62040,95441,11640,82140,599
Note:Effectivewiththemortalitydatafor1999,causesofdeathareclassifiedbyICD-10,replacingICD-9usedfor1990to1998data.Source:USMortalityData,1990to2007.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
Deathratesforallcancersitescombineddecreasedby2.0%peryearinmenfrom2001through2006andby1.5%peryearinwomenfrom2002to2006,com-paredwithdeclinesof1.5%peryearinmenfrom1993to2001and0.8%peryearinwomenfrom1994through2002(Table5).Mortalityrateshavecontinuedtodecreaseacrossall4majorcancersitesinbothmenandwomen,exceptforfemalelungcancer,forwhichratesstabilizedfrom2003to2006afterincreasingformanydecades.Table6showsthecontributionofindividualcancersitestothede-creasingportionofthetotalcancerdeathratefor
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TABLE9.TenLeadingCausesofDeathbyAgeandSex,UnitedStates,2007
ALLAGESMALEAllCauses1,203,9681
Heartdiseases309,821Cancer292,857
FEMALEAllCauses1,219,744Heartdiseases306,246Cancer270,018
AGES1TO19MALEAllCauses15,777
FEMALEAllCauses8,372
AGES20TO39MALEAllCauses65,305
FEMALEAllCauses28,831
AGES40TO59MALEAllCauses226,396Cancer54,054
FEMALEAllCauses139,473Cancer50,640
AGES60TO79MALEAllCauses460,041Cancer152,231
FEMALEAllCauses372,878Cancer126,918
AGES80؉MALEAllCauses420,000Heartdiseases130,779Cancer81,403
FEMALEAllCauses657,300Heartdiseases204,138
AccidentsAccidentsAccidentsAccidents(unintentional(unintentional(unintentional(unintentionalinjuries)injuries)injuries)injuries)6,8753,40024,3297,789Assault(homicide)2,355Intentionalself-harm(suicide)1,352Cancer1,085
Cancer911
Intentionalself-harm(suicide)8,901Assault(homicide)8,170
Cancer4,639
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 2
Heartdiseases53,779Heartdiseases21,389Heartdiseases119,209Chroniclowerrespiratorydiseases30,237Cerebro-vasculardisease20,454Diabetesmellitus16,722
Heartdiseases77,703Chroniclowerrespiratorydiseases29,321Cerebro-vasculardisease20,281Diabetesmellitus14,621
Cancer86,873
3
Accidents(unintentionalinjuries)79,827Chroniclowerrespiratorydiseases61,235Cerebro-vasculardisease54,111Diabetesmellitus35,478
Cerebro-vasculardisease81,841Chroniclowerrespiratorydiseases66,689Alzheimerdisease52,832
Assault(homicide)613Heartdiseases2,508
AccidentsAccidents(unintentional(unintentionalinjuries)injuries)25,40111,208Intentionalself-harm(suicide)10,828Chronicliverdisease&cirrhosis10,296Diabetesmellitus7,304
Cerebro-vasculardisease5,524Diabetesmellitus4,769
Cerebro-vasculardisease25,747Chroniclowerrespiratorydiseases25,616Alzheimerdisease16,780
Cerebro-vasculardisease55,234Alzheimerdisease45,458
4
Congenitalanomalies518Heartdiseases5,351
Intentionalself-harm(suicide)2,058Assault(homicide)1,534
5
Congenitalanomalies593Heartdiseases315
Cancer4,041
Chroniclowerrespiratorydiseases32,524Influenza&pneumonia20,555
6
Accidents(unintentionalinjuries)43,879Diabetesmellitus35,904
Heartdiseases445
Intentionalself-harm(suicide)313Influenza&pneumonia134
HIVdisease1,650HIVdisease950
Chroniclowerrespiratorydiseases4,475Chronicliverdisease&cirrhosis4,229Intentionalself-harm(suicide)3,612Septicemia2,321
Nephritis,Accidents
(unintentionalnephrotic
syndrome&injuries)
12,311nephrosis
7,935
Influenza&pneumonia14,099
7
Intentionalself-harm(suicide)27,269Influenza&pneumonia24,071
Chroniclowerrespiratorydiseases151Influenza&pneumonia130
Diabetesmellitus905
Cerebro-vasculardisease636Pregnancy,childbirth&puerperium598Diabetesmellitus567
Cerebro-vasculardisease7,006HIVdisease5,451
AccidentsNephritis,Nephritis,
nephrotic(unintentionalnephrotic
syndrome&injuries)syndrome&
nephrosis7,457nephrosis
10,8688,665Influenza&
pneumonia7,046
Alzheimerdisease7,191
Diabetesmellitus10,495
Diabetesmellitus15,909
8
Influenza&pneumonia28,646
Cerebro-vasculardisease109Chroniclowerrespiratorydiseases95Septecemia
92
Chronicliverdisease&cirrhosis765Cerebro-vasculardisease726Congenitalanomalies490
Nephritis,nephroticsyndrome&nephrosis13,479
9
Nephritis,nephroticsyndrome&nephrosis22,616Alzheimerdisease21,800
Nephritis,nephroticsyndrome&nephrosis23,832Septicemia18,989
Septecemia113
Chroniclowerrespiratorydiseases4,887
Chronicliverdisease&cirrhosis6,859Septicemia6,608
Septicemia6,639
AccidentsAccidents(unintentional(unintentionalinjuries)injuries)10,16413,453Parkinsondisease7,422
Hypertension&hypertensiverenaldisease*10,126
10
Cerebro-vasculardisease97
ChronicliverViralhepatitisNephritis,disease&3,463nephroticcirrhosissyndrome&388nephrosis
2,036
Influenza&pneumonia5,997
*Includesprimaryandsecondaryhypertension.
Note:Deathswithineachagegroupdonotsumtoallagescombinedduetotheinclusionofunknownages.InaccordancewiththeNationalCenterforHealthStatistics’cause-of-deathranking,“Symptoms,signs,andabnormalclinicalorlaboratoryfindings”andcategoriesthatbeginwith“Other”and“Allother”werenotranked.
Source:USMortalityData,2007,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
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340320300280260
Youngerthan85Years8,00085yearsandOlder7,000
Heart DiseaseHeart Disease6,000
Rate per 100,000 Population240220200180160140120100806040200
19791983198719891991199520011975197719811985199319971999200320050
19811985197519771979199119951997199920012003198319871989199320051,0002,0003,0004,0005,000
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) CancerCancerYear of DeathYear of Death
FIGURE6.DeathRates*ForCancerandHeartDiseaseforAgesYoungerThan85Yearsand85YearsandOlder,1975to2006.
*Ratesareageadjustedtothe2000USstandardpopulation.Source:USMortalityData,1975to2006.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
eachsex.Deathratesfromallcancerscombinedpeakedin1990formenandin1991forwomen.Between1990-1991and2006,deathratesforcan-cerdecreasedby21.0%amongmenandby12.3%amongwomen.Amongmen,reductionindeathratesfromlung,prostate,andcolorectalcancersac-countedfornearly80%ofthetotaldecreaseinthecancerdeathrate,whereasreductionindeathratesfrombreastandcolorectalcancersaccountedfor60%ofthedecreasenotedamongwomen.Lungcancerinmenandbreastcancerinwomeneachaccountfornearly40%ofthesex-specificdecreasesincancerdeathrates.Thede-creaseinlungcancerdeathratesamongmenisduetoareductionintobaccouseoverthepast50years,whereasthedecreaseindeathratesforfemalebreast,colorectal,andprostatecancerlargelyreflectsimprovementsinearlydetectionand/ortreatment.Between1990-1991and2006,deathratesincreasedforlivercancerinbothmenandwomen,esophagealcancerandmelanomain
men,andlungandpancreaticcancerinwomen.Fig-ure7showsthetotalnumberofcancerdeathsavoidedsincedeathratesbegantodecreasein1991inmenandin1992inwomen.Approximately767,000cancerdeaths(561,400inmenand205,700inwomen)wereavertedbetween1991-1992and2006.
RecordedNumberofDeathsfromCancerin2007
Atotalof562,875cancerdeathswererecordedintheUnitedStatesin2007,themostrecentyearforwhichactualdataareavailable,accountingforapproximately23%ofalldeaths(Table7).Despiteadecreaseinage-standardizeddeathrates,from180.7in2006to178.4in2007,therewere2987morecancerdeathsreportedin2007thanin2006duetotheinfluenceoftheagingandgrowthofthepopulation(Table8).Whencausesofdeatharerankedwithin20-yearagegroups,cancerisoneofthe5leadingcausesofdeathin
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TABLE10.ReportedDeathsfortheFiveLeadingCancerSitesbyAgeandSex,UnitedStates,2007
ALLAGES
<20
20TO39
MALE
ALLSITES292,857
ALLSITES1,124
ALLSITES4,041
ALLSITES54,054
ALLSITES152,231
ALLSITES81,403
40TO59
60TO79
>80
Lung&bronchus
88,331
Prostate29,093Colorectum27,005Pancreas17,132Leukemia12,435
Leukemia365Brain&ONS*
260Bones&joints
92Otherendocrine
system92Softtissue72
Leukemia522Brain&ONS*
502Colorectum395Non-Hodgkinlymphoma301Lung&bronchus
268
FEMALE
Lung&bronchus
15,174Colorectum5,434Liver&bileduct
3,944Pancreas3,638Esophagus2,695
Lung&bronchus
53,125Colorectum13,370Prostate12,187Pancreas9,293Esophagus5,958
Lung&bronchus
19,751
Prostate15,670Colorectum7,795Urinarybladder
4,216Pancreas4,084
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) ALLSITES270,018ALLSITES944ALLSITES4,639ALLSITES50,640ALLSITES126,918ALLSITES86,873
Lung&bronchus
70,355
Breast40,599Colorectum26,216Pancreas16,985Ovary14,621
*ONSϭOthernervoussystem.
Leukemia278Brain&ONS*
261Otherendocrine
system81Bones&joints
80Softtissue68
Breast1,094Uterinecervix
468Leukemia393Colorectum304Brain&ONS*
300
Breast11,630Lung&bronchus
11,412Colorectum4,150Ovary3,151Pancreas2,417
Lung&bronchus
40,187
Breast16,900Colorectum10,459Pancreas8,211Ovary7,195
Lung&bronchus
18,519Colorectum11,298Breast10,973Pancreas6,283Non-Hodgkinlymphoma4,171
Note:Deathswithineachagegroupdonotsumtoallagescombinedduetotheinclusionofunknownages.“Otherandunspecifiedmalignantneoplasm”isexcludedfromcauseofdeathrankingorder.
Source:USMortalityData,2007,NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
allagegroupsamongbothmalesandfemales;itistheleadingcauseofdeathamongmenandwomenages40to79years(Table9).Canceristheleadingcauseofdeathamongmenandwomenagedyoungerthan85years(Fig.6).Atotalof475,211personsagedyoungerthan85yearsdiedfromcancerintheUnitedStatesin2007,comparedwith380,791deathsfromheartdis-ease,whichistheleadingcauseofdeathoverallintheUnitedStates.1Table10presentsthenumberofdeathsfromallcancerscombinedandfromthe5mostcommoncan-cersitesforeach20-yearagegroup.Amongmalesagedyoungerthan40years,leukemiaisthemostcommonfatalcancer,whereascancerofthelungandbronchuspredominatesinmenaged40yearsandolder.
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Colorectalcanceristhesecondmostcommoncauseofcancerdeathamongmenages40to79years,andpros-tatecanceramongmenaged80yearsandolder.Amongfemales,leukemiaistheleadingcauseofcancerdeathbeforeage20years,breastcancerranksfirstatages20to59years,andlungcancerranksfirstatages60yearsandolder.
CancerOccurrencebyRace/Ethnicity
Cancerincidenceanddeathratesvaryconsiderablyamongracialandethnicgroups(Table11),althoughtheextentofvariationmaybeaffectedbymisclassifica-tionofraceandethnicityonmedicalrecords,including
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400,000
Male400,000Female360,000
360,000320,000
320,000280,000
Number of Deaths561,400Cancer Deaths240,000
280,000240,000205,700Cancer DeathsDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) 200,000
200,000160,000
160,000120,000
120,00080,000
80,00040,000
40,0000
197719791993199519751981198319851987198919911997199920012003200501975197919811997200119831985198719891991197719952003199319992005Year of DeathYear of Death
FIGURE7.TotalNumberofCancerDeathsAvoidedFrom1991to2006inMalesandFrom1992to2006inFemales.
Thebluelinerepresentstheactualnumberofcancerdeathsrecordedineachyear,andtheboldredlinerepresentstheexpectednumberofcancerdeathsifcancermortalityrateshadremainedthesamesince1990and1991.
deathcertificates.26Forallcancersitescombined,Afri-canAmericanmenhavea14%higherincidencerateanda34%higherdeathratethanwhitemen,whereasAfri-canAmericanwomenhavea7%lowerincidencerate,buta17%higherdeathratethanwhitewomen.ForthespecificcancersiteslistedinTable11,incidenceanddeathratesareconsistentlyhigherinAfricanAmericanscomparedwithwhitesexceptforcancersofthebreast(incidence)andlung(incidenceandmortal-ity)amongwomen,andkidney(mortality)amongbothmenandwomen.Factorsknowntocontributetoracialdisparitiesinmortalityvarybycancersiteandincludedifferencesinexposuretounderlyingriskfactors(eg,historicalsmokingprevalenceforlungcanceramongmen),accesstohigh-qualityscreening(breast,cervical,andcolorectalcancers),andtimelydiagnosisandtreatment.Thehigherbreastcancerincidenceratesobservedamongwhitewomenarebelievedtoreflectacombinationoffac-torsthataffectbothdiagnosis(eg,morefrequentmammographyinwhitewomen)andunderlyingdiseaseoccurrence(eg,laterageatfirstbirthandgreateruseofmenopausalhormonetherapyamongwhitecomparedwithblackwomen).21CancerincidenceanddeathratesarelowerinotherracialandethnicgroupsthaninwhitesandAfricanAmericansforallcancersitescombinedandforthe4mostcommoncancersites.However,incidenceanddeathratesforcancersitesrelatedtoinfectiousagents,suchasthoseoftheuterinecervix,stomach,andliver,aregenerallyhigherinminoritypopulationsthaninwhites.StomachandlivercancerincidenceanddeathratesaretwiceashighinAsianAmerican/PacificIslanderscom-paredwithwhites,reflectinganincreasedprevalenceofchronicinfectionwithHelicobacterpyloriandhepatitisBandCviruses,respectively,inthispopulation.22KidneycancerdeathratesarethehighestamongAmericanIndians/AlaskanNatives;thehigherprevalenceofobe-sityandsmokinginthispopulationmaycontributetothisdisparity.16VOLUME60ԽNUMBER5ԽSEPTEMBER/OCTOBER2010
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TABLE11.IncidenceandDeathRates*bySite,Race,andEthnicity,UnitedStates,2002-2006
WHITE
AFRICANAMERICAN
ASIANAMERICANANDPACIFICISLANDER
AMERICANINDIANANDALASKANATIVE†
HISPANIC/LATINO‡
Incidence
AllsitesMaleFemale
Breast(female)ColorectumMaleFemale
Kidney&renalpelvisMaleFemale
Liver&bileductMaleFemale
Lung&bronchusMaleFemaleProstateStomachMaleFemale
Uterinecervix
550.1420.0123.558.242.619.710.38.02.885.957.1146.38.94.27.9
626.0389.5113.068.451.720.610.612.53.8104.850.7231.916.78.511.1
334.5276.381.644.133.19.04.521.48.150.627.682.317.59.87.6
Mortality
AllsitesMaleFemale
Breast(female)ColorectumMaleFemale
Kidney&renalpelvisMaleFemale
Liver&bileductMaleFemale
Lung&bronchusMaleFemaleProstateStomachMaleFemale
Uterinecervix
226.7157.323.921.414.96.12.86.82.969.941.923.64.82.42.2
304.2183.733.031.421.66.02.710.83.990.140.056.311.05.34.6
135.495.112.513.810.02.41.215.06.636.918.210.69.65.82.2
183.3140.117.620.013.79.04.210.36.548.033.520.09.84.63.4
154.8103.915.516.110.75.22.411.35.133.914.419.68.34.83.1
318.4265.167.238.130.716.610.68.94.657.941.382.79.44.76.6
430.3326.890.250.035.118.210.315.96.249.226.5131.114.38.612.7
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Per100,000population,ageadjustedtothe2000USstandardpopulation.
†DatabasedonContractHealthServiceDeliveryAreas,compromisingabout55%oftheUSAmericanIndian/AlaskaNativepopulation;formoreinformationpleasesee:EspeyDK,etal.16‡PersonsofHispanic/Latinooriginmaybeofanyrace.Source:Edwards,etal.15TrendsincancerincidencecanbeadjustedfordelayedreportingonlyinwhitesandAfricanAmer-icansbecausethelong-termincidencedatarequiredfordelayadjustmentarenotavailableforotherra-cialandethnicsubgroups.From1997through2006,incidence(unadjustedfordelayedreporting)anddeathratesforallcancersitescombined
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decreasedamongwhites,AfricanAmericans,AsianAmericans/PacificIslanders,andHispanicsinbothmalesandfemales.AmongAmericanIndians/AlskaNativesresidinginIndianHealthServiceContractHealthServiceDeliveryAreas,incidenceandmortalityratesdecreasedinmenbutremainedstableinwomenduringthistimeperiod.15CACANCERJCLIN2010;60:277–300
TABLE12.ProbabilityofDevelopingInvasiveCancersWithinSelectedAgeIntervalsbySex,UnitedStates,2004-2006*
BIRTHTO39
(%)
40TO59(%)
60TO69(%)
70ANDOLDER
(%)
BIRTHTODEATH(%)
Allsites†Urinarybladder‡Breast
ColorectumLeukemiaLung&bronchusMelanomaoftheskin§Non-HodgkinlymphonaProstate
UterinecervixUterinecorpusMaleFemaleMaleFemaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleFemale1.43(1in70)2.10(1in48)0.02(1in4,741)0.01(1in10,613)0.49(1in206)0.08(1in1,269)0.08(1in1,300)0.17(1in603)0.13(1in798)0.03(1in3,461)0.03(1in3,066)0.16(1in638)0.28(1in360)0.13(1in782)0.09(1in1,172)0.01(1in9,422)0.15(1in648)0.07(1in1,453)8.42(1in12)8.97(1in11)0.39(1in257)0.12(1in815)3.75(1in27)0.91(1in110)0.72(1in139)0.21(1in475)0.15(1in690)0.95(1in105)0.79(1in126)0.64(1in155)0.55(1in183)0.44(1in225)0.32(1in315)2.44(1in41)0.27(1in374)0.73(1in136)15.61(1in6)10.18(1in10)0.95(1in106)0.26(1in385)3.40(1in29)1.48(1in67)1.07(1in94)0.33(1in299)0.20(1in504)2.35(1in43)1.75(1in57)0.72(1in138)0.36(1in274)0.59(1in171)0.44(1in227)6.45(1in16)0.13(1in755)0.83(1in121)37.84(1in3)26.47(1in4)3.66(1in27)1.01(1in99)6.50(1in15)4.50(1in22)4.09(1in24)1.19(1in84)0.78(1in128)6.71(1in15)4.83(1in21)1.77(1in56)0.79(1in126)1.71(1in58)1.39(1in72)12.48(1in8)0.19(1in552)1.23(1in81)44.05(1in2)37.63(1in3)3.81(1in26)1.18(1in84)12.08(1in8)5.39(1in19)5.03(1in20)1.51(1in66)1.08(1in92)7.73(1in13)6.31(1in16)2.67(1in37)1.79(1in56)2.28(1in44)1.92(1in52)15.90(1in6)0.69(1in145)2.53(1in40)
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Forpeoplefreeofcanceratbeginningofageinterval.
†Allsitesexcludesbasalandsquamouscellskincancersandinsitucancersexcepturinarybladder.‡Includesinvasiveandinsitucancercases§Statisticsforwhitesonly.
Source:DevCan:ProbabilityofDevelopingorDyingofCancerSoftware,Version6.4.0.StatisticalResearchandApplicationsBranch,NationalCancerInstitute,2009.www.srab.cancer.gov/devcan
LifetimeProbabilityofDevelopingCancer
Thelifetimeprobabilityofbeingdiagnosedwithaninvasivecancerishigherformen(44%)thanwomen(38%)(Table12).However,becauseoftheearlierme-dianageofdiagnosisforbreastcancercomparedwithothermajorcancers,womenhaveaslightlyhigherprobabilityofdevelopingcancerbeforeage60years.Theseestimatesarebasedontheaverageexperienceofthegeneralpopulationandmayoverestimateorun-derestimateindividualriskbecauseofdifferencesinexposureand/orgeneticsusceptibility.
CancerSurvivalByRace
Comparedwithwhites,AfricanAmericanmenandwomenhavepoorersurvivaloncecancerisdiagnosed.The5-yearrelativesurvivalislowerinAfricanAmer-icansthaninwhitesforeverystageofdiagnosisfornearlyeverycancersite(Fig.8).Thesedisparitiesmayresultfrominequalitiesinaccesstoandreceiptofqualityhealthcareand/orfromdifferencesincomor-bidities.AsshowninFigure9,AfricanAmericansarelesslikelythanwhitestobediagnosedwithcanceratalocalizedstage,whenthediseasemaybemoreeasilyandsuccessfullytreated.Theextenttowhichfactors
otherthanstageatdiagnosiscontributetotheoveralldifferentialsurvivalisunclear.23However,somestud-iessuggestthatAfricanAmericanswhoreceivecancertreatmentandmedicalcaresimilartothatofwhitesexperiencesimilaroutcomes.24Therehavebeennotableimprovementssince1975intherelative5-yearsurvivalratesformanycancersitesforbothwhitesandAfricanAmericans(Table13).Cancersforwhichsurvivalhasnotimprovedsubstantiallyoverthepast30yearsincludethoseofthelungandpancreas.Theimprovementinsurvivalreflectsacombinationofearlierdiagnosisandimprovedtreatments.
RelativesurvivalratescannotbecalculatedforracialandethnicpopulationsotherthanwhitesandAfricanAmeri-cansbecauseaccuratelifeexpectancies(theaveragenumberofyearsofliferemainingforpersonswhohaveattainedagivenage)arenotavailable.However,basedoncause-specificsurvivalratesofcancerpatientsdiagnosedbetween1999and2005inSEERareasoftheUnitedStates,allmi-noritymalepopulationshaveagreaterprobabilityofdyingfromcancerwithin5yearsofdiagnosisthanwhites.Amongwomen,AfricanAmericanshavethelowest5-year,cancer-specificsurvival(55.8%),followedbyAmericanIndians/AlaskaNatives(60.0%),whites(65.5%),Hispanics(66.4%),andAsians/PacificIslanders(68.0%).2Forall4
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CancerStatistics2010All RacesWhiteAfrican American1009899948990908485788072706050403023252016100esaledagntlizontiaagcstl SDiReAlLo100919190868070707065666360565040302011128100esaledagntliztoniaagcstl SAlLoDiRe1009080706050403739302119201718201111103320esaledagntliztoniaagcstl SLoDiAlReDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) Survival (%)1009080706053535045403024242020161612104330sldgetnaizeanlotagicastl SReLoAlDi10098989591919077807062626048*504029*30201515100sldgetnaizeanlotagicastl SReAlDiLo1009083838074706163605456504336403232302520100sdalgetnizeanlotagicastl SReAlLoDi1009494929080737370576046465037402928302020100sldgetnaizeanltoagicastl SAlDiReLoUrinary Bladder†1009080706050403022231720998665102230esaledagntlizontiaagcstl SLoReDiAl100908070605040302010010010010010010010010010097313029LalocizedogiRelnasDinttaAtall Sges1009080706360586050402725282624253020103330esaledagntlizontiaagcstl SReAlLoDi1009080818074756770636050363740303020106680esaledagntliztoniaagcstl SReLoAlDi1009293908480717270615859605150403017182011100sldgetnaizeanlotagicastl SLoDiReAl1009696908583858067707061604650403017192011100sldgetnaizeanltoagicastl SDiAlReLoStage of DiagnosisFIGURE8.Five-YearRelativeSurvivalRatesAmongPatientsDiagnosedwithSelectedCancersbyRaceandStageatDiagnosis,UnitedStates,1999to2005.*Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.†Thesurvivalrateforinsituurinarybladdercanceris97%forallracescombined,whites,andAfricanAmericans.StagingwasperformedaccordingtoSurveillance,Epidemiology,andEndResults(SEER)historicstagecategoriesratherthantheAmericanJointCommitteeonCancer(AJCC)stagingsystem.Source:HornerMJ,RiesLAG,KrapchoM,etal.2296CA:ACancerJournalforClinicians
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All Races
White
African American
1009080706050403020100606151333239548cLoizaledReoginalsDi1009080706050403020100t393934373735191924ntacLoizealdnaiogRelsDi1009080706050403020100232420303031323132ntatcLoizaledReaongilstDitanDownloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) Stage Distribution (%)1009080706050403020100555559151512222222LolcaizedReongialD100908070605040302010084846021881344tantsiLoelizcadReoginalDaist1009080706050403020100464534362251141220ntLoedlizacReongialD1009080706050403020100626362151415171715tantsiLolcadizeReoginalDistantUrinary Bladder*
10090807060504030201001009080706050403020100808078535255262624779121212446LolcaizedReoginalsDintatLolcadizeReaongil1009080706050403020100t323231232323333433anstiDedlizacLoReaongilD10090807060504030201003635408712447anisttLolizcaedaiongRelstDitan1009080706050403020100505143353438111112LolcadizeRealonig10090807060504030201006970531918241687DaistntLolcaizedReongialtantsDiStage of Diagnosis
FIGURE9.DistributionofSelectedCancersbyRaceandStageatDiagnosis,UnitedStates,1999to2005.
*Theproportionofinsituurinarybladdercancercasesis50%,51%,and36%inallracescombined,whites,andAfricanAmericans,respectively.StagingwasperformedaccordingtoSurveillance,Epidemiology,andEndResults(SEER)historicstagecategoriesratherthantheAmericanJointCommitteeonCancer(AJCC)stagingsystem.Foreachcancertype,stagecategoriesdonottotal100%becausesufficientinformationisnotavailabletoassignastagetoallcancercases.Source:HornerMJ,RiesLAG,KrapchoM,etal.2VOLUME60ԽNUMBER5ԽSEPTEMBER/OCTOBER2010
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TABLE13.Trendsin5-YearRelativeSurvivalRates*(%)byRaceandYearofDiagnosis,UnitedStates,1975-2005
ALLRACES
1975TO1977
1984TO1986
1999TO2005
1975TO1977
WHITE1984TO1986
1999TO2005
1975TO1977
AFRICANAMERICAN
1984TO1986
1999TO2005
AllsitesBrain
Breast(female)ColonEsophagus
HodgkinlymphomaKidneyLarynxLeukemia
Liver&bileductLung&bronchusMelanomaoftheskinMyeloma
Non-HodgkinlymphomaOralcavityOvaryPancreasProstateRectumStomachTestisThyroid
UrinarybladderUterinecervixUterinecorpus5024755257451673541382264853373694916839374708854297959107956664261387295355403765718939478688468†36†90†66†19†86†69†63†54†14†16†93†37†69†63†46†6†100†69†27†96†97†82†72†84†5123765267451673641382254855373704915839375718955288060118056684361487275457393775818939479708569†35†91†67†20†87†69†6655†13†17†93†38†70†64†46†6†100†69†25†97†98†83†7387†4027624637150593421260‡31493643261451673‡#915165614132655087554533451170§32483641566462087‡9061585859†41†79†56†13†81†66†5046†10†13†78‡36†60†46†375†98†61†26†879668†6562
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *SurvivalratesareadjustedfornormallifeexpectancyandarebasedoncasesdiagnosedintheSEER9areasfrom1975-77,1984-86,and1999-2005andfollowedthrough2006.
†Thedifferenceinratesbetween1975-1977and1999-2005isstatisticallysignificant(PϽ0.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.§Thestandarderrorofthesurvivalrateisgreaterthan10percentagepoints.#Survivalrateisfor1978-1980.
Source:HornerMJ,RiesLAG,KrapchoM,etal.2TABLE14.TenLeadingCausesofDeathAmongChildrenAges1to14,UnitedStates,2007
CAUSEOFDEATH
RANK
ALLCAUSES
NUMBEROFDEATHS
10,850
%OFTOTALDEATHS
100.0
DEATHRATE*
18.9
12345678910
Accidents(unintentionalinjuries)Cancer
CongenitalanomaliesAssault(homicide)Heartdiseases
Influenza&pneumonia
Intentionalself-harm(suicide)ChroniclowerrespiratorydiseasesSepticemia
Insitu,benign,&unknownneoplasmsAllothercauses3,7821,3239207444142121841751521432,80134.912.28.56.93.82.01.71.61.41.325.8
6.62.31.61.30.70.40.30.30.30.3
*Ratesareper100,000populationandageadjustedtothe2000USstandardpopulation.
Note:‘Symptoms,signs,andabnormalclinicalorlaboratoryfindings’and‘Otherrespiratorydiseases’wereexcludedfromrankingorder.Source:USMortalityData,2007.NationalCenterforHealthStatistics,CentersforDiseaseControlandPrevention.
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TABLE15.TrendsinFive-yearRelativeSurvivalRates*(%)forChildrenUnderAge15,US,1975to2005
YEAROFDIAGNOSIS
1975TO1977
1978TO1980
1981TO1983
1984TO1986
1987TO1989
1990TO1992
1993TO1995
1996TO1998
1999TO2005
SITE
Allsites
AcutelymphocyticleukemiaAcutemyeloidleukemiaBone&joint
Brain&othernervoussystemHodgkinlymphomaNeuroblastoma
Non-HodgkinlymphomaSofttissueWilmstumor58581950‡57815244617363662648588857537579677127‡57‡568855676987687331‡58‡629152707391727837‡67‡64876271669276834167649776768092778442‡747095678177927987497075966683709281†89†60†72†74†95†74†86†81†91†
Downloaded from caonline.amcancersoc.org by on February 8, 2011 (©American Cancer Society, Inc.) *Survivalratesareadjustedfornormallifeexpectancyandarebasedonfollow-upofpatientsthrough2006.†Thedifferenceinratesbetween1975to1977and1999to2005isstatisticallysignificant(PϽ0.05).‡Thestandarderrorofthesurvivalrateisbetween5and10percentagepoints.
Note:Excludesbasalandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.Source:HornerMJ,RiesLAG,KrapchoM,etal.2majorcancersites(prostate,femalebreast,lungandbron-chus,andcolorectum),minoritypopulationsaregenerallymorelikelytobediagnosedatdistantstage,comparedwithwhites(Fig.9).25CancerinChildren
Canceristhesecondmostcommoncauseofdeathamongchildrenbetweentheagesof1and14yearsintheUnitedStates,surpassedonlybyaccidents(Table14).Nearlyone-thirdofthecancersdiagnosedinchildrenagesbirthto14yearsareleukemias(particularlyacutelympho-cyticleukemia),followedbycancerofthebrainandothernervoussystem(21%),softtissuesarcomas(includingneuroblastoma[7%]andrhabdomyosar-coma[3%]),renal(Wilms)tumors(5%),andnon-Hodgkinlymphoma(4%).Overthepast25years,therehavebeensignificantimprovementsinthe5-yearrelativesurvivalrateforallofthemajorchildhoodcancers(Table15).The5-yearrelativesurvivalrateamongchildrenforallcancersitescombinedimprovedfrom58%forpatientsdiag-nosedbetween1975and1977to81%forthosedi-agnosedbetween1999and2005.2Limitations
Estimatesoftheexpectednumbersofnewcancercasesandcancerdeathsshouldbeinterpretedcautiously
becausetheseestimatesarebasedonmodelsandmayvaryconsiderablyfromyeartoyear.Estimatesarealsoaffectedbychangesinmethod.Theintroductionofanewmethodforprojectingincidentcancercasesbegin-ningwiththe2007estimatessubstantiallyaffectedtheestimatesforseveralcancers,particularlyleukemiaandfemalebreast.12Notallchangesincancertrendsarecap-turedbymodelingtechniquesandsometimesthemodelmaybetoosensitivetorecenttrends,resultinginover-orunderestimates.Forthesereasons,wediscouragetheuseoftheseestimatestotrackyear-to-yearchangesincanceroccurrenceanddeath.Thepreferreddatasourcesfortrackingcancertrendsareage-standardizedorage-specificcancerincidenceratesfromSEERorNPCRandcancerdeathratesfromtheNCHS.Nevertheless,theAmericanCancerSocietyestimatesofthenumberofnewcancercasesanddeathsinthecurrentyearprovidereasonablyaccurateestimatesoftheburdenofnewcan-cercasesanddeathsintheUnitedStates.
Errorsinreportingrace/ethnicityinmedicalrecordsanddeathcertificatesmayresultinunder-estimatesofcancerincidenceandmortalityratesinnonwhiteandnonblackpopulations.Itisalsoim-portanttonotethatcancerdataintheUnitedStatesareprimarilyreportedforbroadracialandethnicminoritygroupsthatarenothomogenous,andthussignificantdifferencesinthecancerbur-denwithinracial/ethnicsubgroupsmaybemasked.26VOLUME60ԽNUMBER5ԽSEPTEMBER/OCTOBER2010
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