Cancer

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Cancer Statistics, 2006 Ahmedin Jemal, Rebecca Siegel, Elizabeth Ward, Taylor Murray, Jiaquan Xu, Carol Smigal and Michael J. Thun CA Cancer J Clin 2006;56;106-130
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CA: A Cancer Journal for Clinicians is published six times per year for the American Cancer Society by Lippincott Williams & Wilkins. A bimonthly publication, it has been published continuously since November 1950. CA is owned, published, and trademarked by the American Cancer Society, 1599 Clifton Road, NE, Atlanta, Georgia 30329. (American Cancer Society, Inc.) All rights reserved. Print ISSN: 0007-9235. Online ISSN: 1542-4863.
Cancer Statistics, 2006

Ahmedin Jemal, DVM, PhD; Rebecca Siegel, MPH; Elizabeth Ward, PhD; Taylor Murray; Jiaquan Xu; Carol Smigal, MPH; Michael J. Thun, MD, MS
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Dr. Jemal is Program Director, Cancer Occurrence, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Ms. Siegel is Manager, Surveillance Information Services, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Dr. Ward is Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Mr. Murray is Manager, Surveillance Data Systems, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Mr. Xu is Epidemiologist, Mortality Statistics Branch, Division of Vital Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Ms. Smigal is Epidemiologist, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Dr. Thun is Vice-President, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. This article is available online at http://CAonline.AmCancerSoc.org
ABSTRACT
Each year, the American Cancer Society estimates the number of new cancer cases
and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,399,790 new cancer cases and 564,830 deaths from cancer are expected in the United States in 2006. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for those younger than age 85 since 1999. Delay-adjusted cancer incidence rates stabilized in men from 1995 through 2002, but continued to increase by 0.3% per year from 1987 through 2002 in women. Between 2002 and 2003, the actual number of recorded cancer deaths decreased by 778 in men, but increased by 409 in women, resulting in a net decrease of 369, the first decrease in the total number of cancer deaths since national mortality record keeping was instituted in 1930. The death rate from all cancers combined has decreased by 1.5% per year since 1993 among men and by 0.8% per year since 1992 among women. The mortality rate has also continued to decrease for the three most common cancer sites in men (lung and bronchus, colon and rectum, and prostate) and for breast and colon and rectum cancers in women. Lung cancer mortality among women continues to increase slightly. In analyses by race and ethnicity, African American men and women have 40% and 18% higher death rates from all cancers combined than White men and women, respectively. Cancer incidence and death rates are lower in other racial and ethnic groups than in Whites and African Americans for all sites combined and for the four major cancer sites. However, these groups generally have higher rates for stomach, liver, and cervical cancers than Whites. Furthermore, minority populations are more likely to be diagnosed with advanced stage disease than are Whites. Progress in reducing the burden of suffering and death from cancer can be accelerated by applying existing cancer control knowledge across all segments of the population. (CA Cancer J Clin 2006;56:106130.) American Cancer Society, Inc., 2006.
INTRODUCTION
Cancer is a major public health problem in the United States and other developed countries. Currently, one in four deaths in the United States is due to cancer. In this article, we provide an overview of cancer statistics, including updated incidence, mortality, and survival rates and expected number of new cancer cases and deaths in 2006.
MATERIALS AND METHODS Data Sources
Mortality data from 1930 to 2003 in the United States were obtained from the National Center for Health Statistics (NCHS).1 Incidence data (1975 to 2002), 5-year relative survival rates, and data on lifetime probability of
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A Cancer Journal for Clinicians
CA Cancer J Clin 2006;56:106130
TABLE 1
Estimated New Cancer Cases and Deaths by Sex, United States, 2006*
*Rounded to the nearest 10; estimated new cases exclude basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 61,980 carcinoma in situ of the breast and 49,710 melanoma in situ will be newly diagnosed in 2006. Estimated deaths for colon and rectum cancers are combined. More deaths than cases suggests lack of specificity in recording underlying causes of death on death certificates. Source: Estimates of new cases are based on incidence rates from 1979 to 2002, National Cancer Institutes Surveillance, Epidemiology and End Results program, nine oldest registries. Estimates of deaths are based on data from US Mortality Public Use Data Tapes, 1969 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
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TABLE 2 Age-standardized Incidence Rates for All Cancers Combined, 1998-2002, and Estimated New Cases* for Selected Cancers by State, United States, 2006
*Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Average annual rates for 1998 2002, age-adjusted to the 2000 US standard population; source: Cancer in North America; 1998 2002, Vol. One: Incidence, NAACCR, based on data collected by cancer registries participating in NCIs SEER Program and CDCs National Program of Cancer Registries. Estimate is fewer than 50 cases. Note: These estimates are offered as a rough guide and should be interpreted with caution. State estimates are calculated according to the distribution of estimated cancer deaths in 2006 by state. State estimates may not add to US total due to rounding and exclusion of state estimates fewer than 50 cases. Combined incidence rate is not available. Incidence rate is for the Metropolitan Atlanta area.
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FIGURE 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths, by Sex, US, 2006. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10. Note: Percentage may not total 100% due to rounding.
developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, covering about 14% of the US population.25 State-specific incidence rates were abstracted from Cancer in North America (19982002) Volume One, based on data collected by cancer registries participating in the SEER program and Centers for Disease Control and Prevention (CDC)s National Program of Cancer Registries. Population data were obtained from the US Census Bureau.6 Causes of death were
coded and classified according to the International Classification of Diseases (ICD-8, ICD-9, and ICD-10).79 Cancer cases were classified according to the International Classification of Diseases for Oncology.10
Estimated New Cancer Cases
The precise number of cancer cases diagnosed each year in the nation is unknown because complete cancer registration has not yet been achieved in many states. Consequently, for the national estimate
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TABLE 3 Age-standardized Death Rates for All Cancers Combined, 1998 to 2002, and Estimated Deaths* from All Cancers Combined and Selected Sites by State, United States, 2006
*Rounded to the nearest 10. Average annual rates for 1998 to 2002 are age-adjusted to the 2000 US standard population. Estimate is fewer than 50 deaths. Note: State estimates may not add to US total due to rounding and exclusion of state estimates fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
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TABLE 4 Cancer Incidence Rates* by Site and State, US, 1998 to 2002
*Per 100,000, age-adjusted to the 2000 US standard population. Not all states submitted data for all years. This states registry has submitted five years of data and passed rigorous criteria for each single years data including: completeness of reporting, non-duplication of records, percent unknown in critical data fields, percent of cases registered with information from death certificates only, and internal consistency among data items. This states registry did not submit incidence data to the North American Association of Central Cancer Registries (NAACCR) for 1998 to 2002. Source: Cancer in North America: 1998 to 2002, Volume One: Incidence, North American Association of Central Cancer Registries.
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FIGURE 2 Annual Age-adjusted Cancer Incidence and Death Rates* for All Sites, by Sex, US, 1975 to 2002. *Rates are age-adjusted to the 2000 US standard population. Incidence rates are delay-adjusted. Source: Incidence data from Surveillance, Epidemiology, and End Results (SEER) program, nine oldest registries, 1975 to 2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005. Mortality data from US Mortality Public Use Data Tapes, 1960 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 2002, using age-specific cancer incidence rates collected by the SEER program2 and population data reported by the US Census Bureau.6 We then forecast the number of cancer cases expected to be diagnosed in the United States in the year 2006
using an autoregressive quadratic time-trend model fitted to the annual cancer case estimates.11 For estimates of new cancer cases in individual states, we projected the number of deaths from cancer in each state in 2006 and assumed that the ratio of estimated cancer deaths to cases in each state equaled that in the United States.
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FIGURE 3 Annual Age-adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancers, US, 1975 to 2002. *Rates are age-adjusted to the 2000 US standard population and adjusted for delays in reporting with the exception of melanoma. Source: Surveillance, Epidemiology, and End Results (SEER) program, nine oldest registries, 1975 to 2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005.
Estimated Cancer Deaths
We used the state-space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2006. Projections arebased on underlying cause-of-death from death certificates as reported to the NCHS.1 This model projects the number of cancer deaths expected to occur in 2006 based on the number that occurred each year from 1969 to 2003 in the United States and in each state separately.
Other Statistics
12
We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2003. Causes of death for
2003 were coded and classified according to ICD-10.7 This report also provides updated statistics on trends in cancer incidence and mortality rates, the probability of developing cancer, and 5-year relative survival rates for selected cancer sites based on data from 1974 through 2002.3 All age-adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population. The long-term incidence rates and trends (1975 to 2002) are adjusted for delays in reporting where possible. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 2000 to 2002), especially for cancers such as melanoma and prostate that are frequently diagnosed in outpatient settings.
FIGURE 4 Annual Age-adjusted Cancer Death Rates* Among Males for Selected Cancers, US, 1930 to 2002. *Rates are age-adjusted to the 2000 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US Mortality Public Use Data Tapes, 1960 to 2002, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and several specific cancer sites when long-term incidence trends are analyzed.13 Delay-adjusted incidence provides a more accurate assessment of trends in the most recent years for which data are available.
SELECTED FINDINGS Expected Numbers of New Cancer Cases
Table 1 presents estimated numbers of new cancer cases expected among men and women in the United States in 2006. The estimate of about 1.4 million new cases of
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invasive cancer does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell and squamous cell cancers of the skin. Over 1 million cases of basal cell and squamous cell skin cancer, about 61,980 cases of breast carcinoma in situ, and 49,710 cases of in situ melanoma are expected to be newly diagnosed in 2006. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2. Figure 1 indicates the most common cancers expected to occur in men and women in 2006. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for over 56% of all newly diagnosed cancer. Pros-
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FIGURE 5 Annual Age-adjusted Cancer Death Rates* Among Females for Selected Cancers, US, 1930 to 2002. *Rates are age-adjusted to the 2000 US standard population. Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Uterus includes uterine cervix and uterine corpus. Source: US Mortality Public Use Data Tapes, 1960 to 2002, US Mortality Volumes 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
tate cancer alone accounts for about 33% (234,460) of incident cases in men. Based on cases diagnosed between 1995 and 2001, an estimated 91% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which 5-year relative survival approaches 100%. The three most commonly diagnosed cancers among women in 2006 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for about 54% of estimated cancer cases in women. Breast cancer alone is expected to account for 31% (212,920) of all new cancer cases among women.
Expected Number of New Cancer Deaths
Table 1 also shows the expected number of cancer deaths in 2006 for men, women, and both sexes combined. It is estimated that about 564,830 Americans will die from cancer, corresponding to over 1,500 deaths per day. Cancers of the lung and bronchus, colon and rectum, and prostate in men, and cancers of the lung and bronchus, breast, and colon and rectum in women continue to be the most common fatal cancers. These four cancers account for half of the total cancer deaths among men and women (Figure 1). Lung cancer surpassed breast cancer as the
TABLE 5
Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, US, 1975 to 2002
Line Segment 1 Year APC* Line Segment 2 Year APC* Line Segment 3 Year APC* Line Segment 4 Year APC*
All sites Incidence Male and female Male Female Death Male and female Male Female Lung & bronchus Incidence Male and female Male Female Death Male and female Male Female Colon & rectum Incidence Male and female Male Female Death Male and female Male Female Female breast Incidence Death Prostate Incidence Death
19751983 19751989 19751979 19751990 19751979 19751992
0.9 1.3 -0.2 0.5 1.0 0.5
19831992 19891992 19791987 19901993 19791990 19922002
1.8 5.2 1.5 -0.3 0.3 -0.8
19921995 19921995 19872002 19932002 19901993
-1.7 -4.7 0.3 -1.1 -0.4
19952002 19952002
0.3 0.2
19932002
-1.5
19751982 19751982 19751982 19751980 19751978 19751982
2.5 1.5 5.5 3.0 2.4 6.0
19821991 19821991 19821990 19801990 19781984 19821990
1.0 -0.4 3.5 1.8 1.2 4.2
19912002 19912002 19901998 19901994 19841991 19901995
-0.7 -1.8 1.0 -0.1 0.3 1.7
19982002 19942002 19912002 19952002
-0.5 -0.9 -1.9 0.3
19751985 19751986 19751985 19751984 19751978 19751984 19751980 19751990 19751988 19751987
0.8 1.1 0.3 -0.5 0.8 -1.0 -0.4 0.4 2.6 0.9
19851995 19861995 19851995 19842002 19781984 19842002 19801987 19902002 19881992 19871991
-1.8 -2.1 -1.8 -1.8 -0.4 -1.8 3.7 -2.3 16.5 3.1
19951998 19951998 19951998
1.1 1.0 1.5
19982002 19982002 19982002
-1.8 -2.5 -1.5
19841990
-1.3
19902002
-2.0
19872002
0.4
19921995 19911994
-11.2 -0.6
19952002 19942002
1.7 -4.0
*APC, annual percent change based on rates age-adjusted to the 2000 standard population. The APC is significantly different from zero. Note: Trends were analyzed by Joinpoint Regression Program, version 3.0, with a maximum of three joinpoints (ie, four line segments). Trends in incidence are based on rates adjusted for delay in reporting. Source: Ries LAG, Eisner MP, Kosary CL, et al.3
leading cause of cancer death in women in 1987. Lung cancer is expected to account for 26% of all cancer deaths among females in 2006. Table 3 provides the estimated number of cancer deaths in 2006 by state for selected cancer sites.
Regional Variations in Cancer Rates
Table 4 depicts cancer incidence for select cancers by state. Rates vary widely across states. For example, among the cancers listed in Table 4, the largest variation in the incidence rates (in proportionate terms) occurred in lung cancer in which rates (cases per 100,000 population) ranged from 42.3 in men and
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21.5 in women in Utah to 138.2 in men and 72.3 in women in Kentucky. In contrast, the variation in female breast cancer incidence rates was small, ranging from 116.6 cases per 100,000 populations in New Mexico to 149.5 cases in Washington. Factors that contribute to the state variations in the incidence rates include differences in the prevalence of risk factors, access to and utilization of early detection services, and completeness of reporting. For example, the state variation in lung cancer incidence rates reflects differences in smoking prevalence; Utah ranks lowest in adult smoking prevalence and Kentucky highest.
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TABLE 6 Fifteen Leading Causes of Death, United States, 2003
Rates are per 100,000 population and age-adjusted to the 2000 US standard population. Note: Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities, events of undetermined intent, and pneumonitis due to solids and liquids were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tape, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
Trends in Cancer Incidence and Mortality
Figures 2 to 5 depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates stabilized in men from 1995 to 2002 and increased in women by 0.3% per year from 1987 to 2002. Death rates for all cancer sites combined decreased by 1.5% per year from 1993 to 2002 in males and by 0.8% per year in females from 1992 to 2002. Mortality rates have continued to decrease across all four major cancer sites in men and in women, except for female lung cancer in which rates continued to increase by 0.3% per year from 1995 to 2002 (Table 5). The incidence trends are mixed, however. Lung cancer incidence rates are declining in men and have leveled off after increasing for many decades in women. The lag in the temporal trend of lung cancer incidence rates in women compared to men reflects historical differences in cigarette smoking between men
and women; cigarette smoking in women peaked about 20 years later than in men. Colorectal cancer incidence rates have decreased from 1998 through 2002 in both males and in females. Prostate and female breast cancer incidence rates have continued to increase, although at a slower rate than in previous years. The continuing increase may be attributable to increased screening through prostate-specific antigen (PSA) testing for prostate cancer and mammography for breast cancer. Use of postmenopausal hormone therapy and increased prevalence of obesity may also be factors influencing the increase in female breast cancer incidence.14
Changes in the Recorded Number of Deaths from Cancer from 2002 to 2003
A total of 556,902 cancer deaths were recorded in the United States in 2003, the most recent year for which actual dates are available. About 369 fewer deaths were recorded in 2003 than in 2002, the first decrease since national mortality record keeping was instituted in 1930. Cancer accounted for about 23% of all deaths, ranking second only to heart disease (Table 6). When cause of death is ranked
TABLE 7 Ten Leading Causes of Death by Age and Sex, United States, 2003
Note: Symptoms, signs, and abnormalities, events of undetermined intent, certain perinatal conditions, and pneumonitis due to solids and liquids were excluded from the cause of death ranking order. All ages excludes deaths with unknown age. Source: US Mortality Public Use Data Tapes, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
within each age group, categorized in 20-year age intervals, cancer is one of the five leading causes of death in each age group among both males and females (Table 7). Cancer is the leading cause of death among women ages 40
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to 79 and among men ages 60 to 79. When age-adjusted death rates are considered (Figure 6), cancer is the leading cause of death among men and women under age 85. A total of 476,844 people under age 85 died from cancer
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FIGURE 6 Death Rates* From Cancer and Heart Disease for Ages Younger than 85 and 85 and Older. *Rates are age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 1960 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
in the US in 2003, compared with 436,258 deaths from heart disease. Table 8 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among males under age 40, leukemia is the most common cause of cancer death, whereas cancer of the lung and bronchus predominates in men age 40 years and older. Colon and rectum and prostate cancer are the second most common causes of cancer death among men 40 to 79 years old and age 80 years and older, respectively. Among females, leukemia is the leading cause of cancer death before age 20, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at age 60 years and older.
From 2002 to 2003, the number of recorded cancer deaths decreased by 778 in men, but increased by 409 in women (Table 9). The largest change in the total number of deaths from the major cancers was for prostate cancer in men (decreased by 892) and for lung cancer in women (increased by 575).
CANCER OCCURRENCE BY RACE/ETHNICITY
Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 10). For all cancer sites combined, African American men have a 23% higher incidence rate and 40% higher death rate than White men. African American women have a 7% lower inciVolume 56 Y Number 2 Y March/April 2006 119
TABLE 8 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, United States, 2003
*ONS Other nervous system. Note: Others and Unspecified Primary excluded from cause of death ranking order. All ages excludes deaths with unknown age. Source: US Mortality Public Use Data Tapes, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
dence rate but an 18% higher death rate than White women for all cancer sites combined. For the specific cancer sites listed in Table 10, incidence and death rates are consistently higher in African Americans than in Whites, except for breast cancer (incidence) and lung cancer (mortality) among women. Death rates from prostate, stomach, and cervical cancers among African Americans are more than twice those in Whites. Factors known to contribute to racial disparities in mortality include differences in exposure (eg, Helicobacter pylori for stomach cancer), access to high-quality reg120
ular screening (breast, cervical, and colorectal cancers), and timely treatment (for many cancers). The higher breast cancer incidence rate among Whites is thought to reflect a combination of factors that affect diagnosis, such as more frequent mammography in White women, and factors that affect disease risk, such as later age at first birth and greater use of hormone replacement therapy among White than African American women.14 Among other racial and ethnic groups, cancer incidence and death rates are lower for all cancer sites combined and for the four most common
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TABLE 9 to 2003
Trends in the Recorded Number of Deaths for Selected Cancers by Sex, United States, 1989
Note: Effective with the mortality data for 1999, causes of death are classified by ICD-10, replacing ICD-9 used for 1979 to 1998 data. Source: US Mortality Public Use Data Tapes, 1989 to 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
cancer sites than are rates in Whites and African Americans. However, incidence and death rates for cancers of the uterine cervix, stomach, and liver are generally higher in minority population than in Whites. Stomach and liver cancer incidence and death rates are more than twice as high in Asian/Pacific Islanders as in Whites, reflecting increased exposure to infectious agents such as H. pylori and Hepatitis B virus.15 Trends in cancer incidence can only be adjusted for delayed reporting in Whites and African Americans, and not in other racial and ethnic subgroups because the long-term incidence data required for delay adjustment are available only for Whites and for African Americans. From 1992 to 2002, incidence rates for all cancer sites combined, not adjusted for delayed reporting, decreased by 2.7% per year among American Indians/Alaskan Natives, by 1.0% per year in African Americans, by 0.6% among Asian/Pacific Islanders, and by 0.4% among Hispanic-Latinos and Whites. Similarly, the death rate for all cancers combined decreased from 1992 through 2002 by 1.7% per year in Asian/Pacific Islanders, by 1.5% among African Americans, by 0.9% among Whites, and by 0.6% among HispanicLatinos. The death rate from all cancers combined stabilized during this time period among American Indians/Alaskan Natives.3
Lifetime Probability of Developing Cancer
The lifetime probability of developing cancer is higher for men (46%) than for women (38%) (Table 11). However, because of the relatively early age of onset of breast cancer, women have a slightly higher probability of developing cancer before the age of 60 years. It is noteworthy that these estimates are based on the average experience of the general population and may over or under estimate individual risk because of differences in exposure and/or genetic susceptibility.
Cancer Survival by Race
Compared with Whites, African American men and women have poorer survival once a cancer diagnosis is made. As shown in Figure 7, African Americans are less likely than Whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated, and are more likely to be diagnosed with cancer at a regional or distant stage of disease. Five-year relative survival is lower in African Americans than Whites within each stratum of stage of diagnosis for nearly every cancer site (Figure 8). These disparities may result from inequalities in access to and receipt of quality health care and/or from difVolume 56 Y Number 2 Y March/April 2006 121
TABLE 10 Age-standardized Incidence and Death Rates* for Selected Cancers by Race and Ethnicity, US, 1998 to 2002 Asian American/ Pacific Islander American Indian/ Alaskan Native
All Races
White
African American
Incidence Rates
HispanicLatino
All sites Male Female Breast (Female) Colon & rectum Male Female Lung & bronchus Male Female Prostate Stomach Male Female Liver & bile duct Male Female Uterine cervix
553.3 413.5 134.4 62.1 46.0 77.8 48.9 173.8 12.3 6.1 9.3 3.6 8.9
556.4 429.3 141.1 61.7 45.3 76.7 51.1 169.0 10.7 5.0 7.4 2.9 8.7
682.6 398.5 119.4 72.5 56.0 113.9 55.2 272.0 17.7 9.6 12.1 3.7 11.1 Death Rates
383.5 303.6 96.6 56.0 39.7 59.4 28.3 101.4 21.0 12.0 21.4 7.9 8.9
255.4 220.5 54.8 36.7 32.2 42.6 23.6 50.3 15.9 9.1 8.7 5.2 4.9
420.7 310.9 89.9 48.3 32.3 44.6 23.3 141.9 17.2 10.1 14.1 6.1 15.8
All sites Male Female Breast (Female) Colon & rectum Male Female Lung & bronchus Male Female Prostate Stomach Male Female Liver & bile duct Male Female Uterine cervix
247.5 165.5 26.4 24.8 17.4 76.3 40.9 30.3 6.3 3.2 6.8 3.0 2.8
242.5 164.5 25.9 24.3 16.8 75.2 41.8 27.7 5.6 2.8 6.2 2.7 2.5
339.4 194.3 34.7 34.0 24.1 101.3 39.9 68.1 12.8 6.3 9.5 3.8 5.3
148.0 99.4 12.7 15.8 10.6 39.4 18.8 12.1 11.2 6.8 15.4 6.5 2.7
159.7 113.8 13.8 16.2 11.8 47.0 27.1 18.3 7.3 4.1 7.9 4.3 2.6
171.4 111.0 16.7 17.7 11.6 38.7 14.8 23.0 9.5 5.3 10.7 5.1 3.5
*Rates are per 100,000 and age-adjusted to the 2000 US standard population. Hispanics-Latinos are not mutually exclusive from Whites, African Americans, Asian Americans/Pacific Islanders, and American Indians/Alaskan Natives. Source: Ries LAG, Eisner MP, Kosary CL, et al.3
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TABLE 11 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, US, 2000 to 2002*
Birth to 39 (%) All sites Urinary bladder Breast Colon & rectum Leukemia Lung & bronchus Melanoma of the skin Non-Hodgkin lymphoma Prostate Uterine cervix Uterine corpus Male Female Male Female Female Male Female Male Female Male Female Male Female Male Female Male Female Female 1.43 (1 in 70) 1.99 (1 in 50) .02 (1 in 4375) .01 (1 in 9513) .48 (1 in 209) .07 (1 in 1399) .06 (1 in 1567) .15 (1 in 650) .13 (1 in 788) .03 (1 in 3244) .03 (1 in 3103) .13 (1 in 800) .21 (1 in 470) .14 (1 in 722) .09 (1 in 1158) .01 (1 in 10149) .15 (1 in 657) .06 (1 in 1641) 40 to 59 (%) 8.57 (1 in 12) 9.06 (1 in 11) .40 (1 in 250) .12 (1 in 816) 4.11 (1 in 24) .90 (1 in 111) .70 (1 in 143) .22 (1 in 459) .14 (1 in 721) 1.00 (1 in 100) .80 (1 in 125) .51 (1 in 195) .40 (1 in 248) .47 (1 in 215) .31 (1 in 320) 2.66 (1 in 38) .28 (1 in 353) .72 (1 in 139) 60 to 69 (%) 16.46 (1 in 6) 10.54 (1 in 9) .93 (1 in 108) .25 (1 in 402) 3.82 (1 in 26) 1.66 (1 in 60) 1.16 (1 in 86) .35 (1 in 284) .19 (1 in 513) 2.45 (1 in 41) 1.68 (1 in 60) .51 (1 in 195) .26 (1 in 381) .56 (1 in 178) .42 (1 in 237) 7.19 (1 in 14) .15 (1 in 671) .83 (1 in 120) 70 and Older (%) 39.61 (1 in 3) 26.72 (1 in 4) 3.35 (1 in 30) .96 (1 in 104) 7.13 (1 in 14) 4.94 (1 in 20) 4.61 (1 in 22) 1.17 (1 in 85) .78 (1 in 129) 6.33 (1 in 16) 4.17 (1 in 24) 1.25 (1 in 80) .56 (1 in 178) 1.57 (1 in 64) 1.29 (1 in 77) 14.51 (1 in 7) .22 (1 in 464) 1.36 (1 in 74) Birth to Death (%) 45.67 (1 in 2) 38.09 (1 in 3) 3.58 (1 in 28) 1.14 (1 in 88) 13.22 (1 in 8) 5.84 (1 in 17) 5.51 (1 in 18) 1.50 (1 in 67) 1.07 (1 in 93) 7.58 (1 in 13) 5.72 (1 in 17) 1.94 (1 in 52) 1.30 (1 in 77) 2.18 (1 in 46) 1.82 (1 in 55) 17.93 (1 in 6) .74 (1 in 135) 2.61 (1 in 38)
*For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002. The 1 in statistic and the inverse of the percentage may not be equivalent due to rounding. All sites excludes basal and squamous cell skin cancers and in situ cancers except urinary bladder. Source: DevCan Software, Probability of Developing or Dying of Cancer Software, Version 6.0. Statistical Research and Applications Branch, National Cancer Institute, 2005. http://srab.cancer.gov/devcan.
ferences in comorbidities. The extent to which these factors, individually or collectively, contribute to the overall differential survival is unclear.16 However, recent findings suggest that African Americans who receive similar cancer treatment and medical care as Whites experience similar outcomes.17 There have been notable improvements over time in relative five-year survival rates for many cancer sites and for all cancers combined (Table 12). This is true for both Whites and African Americans. However, 5-year relative survival is still very poor (less than 25%) for many cancers, including pancreas, liver, esophagus, lung, and stomach. Relative survival rates cannot be calculated for other racial and ethnic populations because accurate life expectancies are not available. However, based on cause-specific survival rates of cancer patients diagnosed from 1992 to 2000 in SEER areas of the United States, all minority populations, except Asian/Pacific Islander women, have a greater probability of dying from cancer within 5 years of diagnosis than non-Hispanic Whites after accounting for dif-
ferences in age at diagnosis.18,19 For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely to be diagnosed at distant stage, compared with non-Hispanic Whites.19
CANCER IN CHILDREN
Cancer is the second leading cause of death among children between the ages of 1 and 14 years in the United States; accidents are the most frequent cause of death in this age group (Table 13). The most common cancers in children (0 to 14 years) are leukemia (particularly acute lymphocytic leukemia), cancer of the brain and other nervous system, soft tissue sarcomas, nonHodgkin Lymphoma, and renal (Wilms) tumors.3 Over the past 25 years, there have been significant improvements in the 5-year relative survival rate for many childhood cancers (Table 14). The 5-year relative survival rate among children for all cancer sites combined improved from
FIGURE 7 Distribution of Selected Cancers by Race and Stage at Diagnosis, US, 1995 to 2001. *The distribution for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each type and race, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Source: Ries LAG, Eisner MP, Kosary Cl. et al.3
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FIGURE 8 Five-year Relative Survival Rates Among Patients Diagnosed with Selected Cancers, by Race and Stage at Diagnosis, US, 1995 to 2001. *Data for distant stage melanoma of the skin for African American is not shown. The rate for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Source: Ries LAG, Eisner MP, Kosary Cl, et al.3
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TABLE 12 Trends in Five-year Relative Survival Rates* (%) for Selected Cancers by Race and Year of Diagnosis, US, 1974 to 2001. Relative Five-year Survival Rate (%) White 1974 to 1976
51 22 75 51 5 72 52 66 35 4 13 81 24 48 55 37 3 68 49 15 79 92 74 70 89
African American 1995 to 2001

66 33 90 65 16 86 65 68 49 9 16 92 32 61 62 44 4 100 65 21 96 97 83 75 86
All Races 1974 to 1976

50 22 75 50 5 71 52 66 34 4 12 80 25 47 54 37 3 67 49 15 79 92 73 69 88
Site
All sites Brain Breast (female) Colon Esophagus Hodgkin lymphoma Kidney Larynx Leukemia Liver & bile duct Lung & bronchus Melanoma of the skin Multiple myeloma Non-Hodgkin lymphoma Oral cavity Ovary Pancreas Prostate Rectum Stomach Testis Thyroid Urinary bladder Uterine cervix Uterine corpus
1983 to 1985
54 26 79 58 9 79 56 68 42 6 14 85 27 54 56 40 3 76 56 16 91 93 78 71 85
1974 to 1976
39 26 63 46 4 69 49 60 31 1 11 67 28 48 36 41 3 58 42 16 76 88 48 64 62
1983 to 1985
40 32 64 49 6 78 55 55 34 4 11 74 31 45 35 42 5 64 44 19 88 91 60 61 55
1995 to 2001
56 38 76 55 10 80 64 51 38 5 13 76 33 52 40 38 4 97 56 23 88 95 64 66 62
1983 to 1985
53 27 78 58 8 79 56 67 41 6 14 85 28 54 54 41 3 75 55 17 91 93 78 69 83
1995 to 2001
65 33 88 64 15 85 65 66 48 9 15 92 32 60 59 45 5 100 65 23 96 97 82 73 84
*Survival rates are adjusted for normal life expectancy and are based on cases diagnosed from 1974 to 1976, 1983 to 1985, and 1995 to 2001, and followed through 2002. The difference in rates between 1974 to 1976 and 1995 to 2001 is statistically significant (P 0.05). The standard error of the survival rate is between 5 and 10 percentage points. The standard error of the survival rate is greater than 10 percentage points. Recent changes in classification of ovarian cancer, namely excluding borderline tumors, have affected 1995 to 2001 survival rates. Source: Ries LAG, Eisner MP, Kosary CL, et al.3
56% for patients diagnosed in 1974 to 1976 to 79% for those diagnosed in 1995 to 2001.3
CANCER AROUND THE WORLD
reflecting the high prevalence of Hepatitis B virus in that country. The death rate for cervical cancer in Zimbabwe (43.1 per 100,000) is about 20 times that in the United States (2.3 per 100,000) and more than 25 times the rate in Australia (1.7 per 100,000).
Table 15 provides cancer death rates for 50 selected countries around the world for all sites combined and for 9 major sites, by sex. The highest lung cancer death rates are found in Hungary for men and in Denmark for women. China has the highest mortality rate for liver cancer in both men and women,
126
LIMITATIONS AND FUTURE CHALLENGES
Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously. These estimates may vary
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TABLE 13 Fifteen Leading Causes of Death Among Children Ages 1 to 14, United States, 2003
* Rates are per 100,000 population and age-adjusted to the 2000 US standard population. Note: Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities, events of undetermined intent, certain perinatal conditions, and pneumonitis due to solids and liquids were excluded from ranking order. Source: US Mortality Public Use Data Tape, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.
TABLE 14 Trends in Five-year Relative Cancer Survival Rates* (%) for Children Under Age 15, US, 1974 to 2001 Five-year Relative Survival Rates (%) Year of Diagnosis 1974 to 1976 1977 to 1979 1980 to 1982 1983 to 1985 1986 to 1988 1989 to 1991 1995 to 2001
Site
All sites Acute lymphocytic leukemia Acute myeloid leukemia Bones & joints Brain & other nervous system Hodgkin disease Neuroblastoma Non-Hodgkin lymphoma Soft tissue Wilms tumor
56 53 14 55 55 78 53 45 61 74
62 68 27 53 56 83 53 50 68 78
65 71 25 54 56 91 53 61 65 86
68 69 29 57 62 90 55 71 76 87
71 78 33 63 63 90 60 70 67 91
74 80 37 62 63 94 68 75 78 93
79 86 52 71 73 95 66 86 73 92
*Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2002. The difference in rates between 1974 to 1976 and 1995 to 2001 is statistically significant (P 0.05). The standard error of the survival rate is between 5 and 10 percentage points. Note: All sites excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: Ries LAG, Eisner MP, Kosary CL, et al.3
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TABLE 15 Cancer Around the World, 2002, Death Rates* Per 100,000 Population for 50 Countries
Note: Figures in parentheses are rank order within site and gender group. *Rates are age-adjusted to the World Health Organization world standard population. Source: Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality, and Prevalence Worldwide IARC CancerBase No. 5, version 2.0. IARC Press, Lyon, 2004.
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considerably from year to year, particularly for less common cancers and in states with smaller populations. Unanticipated changes may occur that are not captured by our modeling efforts. The estimates of new cancer cases are based on incidence rates for the geographic locations that participate in the SEER program and, therefore, may not be representative of the entire United States. For these reasons, we discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. Age-standardized or age-specific cancer death rates from the NaREFERENCES 1. National Center for Health Statistics, Division of Vital Statistics, Centers for Disease Control. Available at: http://www.cdc.gov/nchs/ nvss.htm. Accessed January 2006. 2. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: IncidenceSEER 9 Regs Public-Use, Nov 2004 Sub (1973-2002), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission. 3. Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 19752002. Bethesda, MD: National Cancer Institute. Available at: http://seer.cancer. gov/csr/1975_2002/. 4. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: IncidenceSEER 12 Regs Public-Use, Nov 2004 Sub for Expanded Races (1992-2002), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission. 5. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov)
tional Center for Health Statistics and cancer incidence rates from SEER are the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, by the time that they become available. Despite their limitations, the American Cancer Society estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States. Such estimates will assist in continuing efforts to reduce the public health burden of cancer.
mortality counts for the current calendar year. CA Cancer J Clin 2004;54:3040. 13. Clegg LX, Feuer EJ, Midthune DN, et al. Impact of reporting delay and reporting error on cancer incidence rates and trends. J Natl Cancer Inst 2002;94:1537. 14. Ghafoor A, Jemal A, Ward E, et al. Trends in breast cancer by race and ethnicity. CA Cancer J Clin 2003;53:342355. 15. Ward E, Jemal A, Cokkinides V, et al. Cancer Disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:7893. 16. Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin 2002;52:326341. 17. Bach PB, Schrag D, Brawley OW, et al. Survival of Blacks and Whites After a Cancer Diagnosis. JAMA 2002;287:21062112. 18. Jemal A, Clegg LX, Ward E, et al. Annual Report to the Nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer 2004;101:327. 19. Clegg LX, Li FP, Hankey BF, et al. Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med 2002;162:19851993.
SEER*Stat Database: IncidenceSEER 11 Regs Public-Use, Nov 2004 Sub for Hispanics (1992-2002), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission. 6. US Census Bureau. Available at: http://www. census.gov. Accessed September 2005. 7. World Health Organization. International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol. 1, 10th Rev. Geneva: WHO, 1992. 8. World Health Organization. International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol. 1, 9th Rev. Geneva: WHO, 1975. 9. World Health Organization. International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol. 1, 8th Rev. Geneva: WHO, 1967. 10. Fritz A, Percy C, Jack A, et al (eds.). International Classification of Diseases for Oncology, 3rd Ed. Geneva: World Health Organization, 2000. 11. Wingo PA, Landis S, Parker S, et al. Using cancer registry and vital statistics data to estimate the number of new cancer cases and deaths in the US for the upcoming year. J Reg Management 1998;25:4351. 12. Tiwari RC, Ghosh K, Jemal A, et al. A new method of predicting US and state-level cancer
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Cancer Statistics, 2006

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Volume 56 Y Number 2 Y March/April 2006

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Volume 56 Y Number 2 Y March/April 2006

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Estimated Cancer Deaths

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Expected Number of New Cancer Deaths

Cancer Statistics, 2006

19751983 19751989 19751979 19751990 19751979 19751992

0.9 1.3 -0.2 0.5 1.0 0.5

19831992 19891992 19791987 19901993 19791990 19922002

1.8 5.2 1.5 -0.3 0.3 -0.8

19921995 19921995 19872002 19932002 19901993

-1.7 -4.7 0.3 -1.1 -0.4

19751982 19751982 19751982 19751980 19751978 19751982

2.5 1.5 5.5 3.0 2.4 6.0

19821991 19821991 19821990 19801990 19781984 19821990

1.0 -0.4 3.5 1.8 1.2 4.2

19912002 19912002 19901998 19901994 19841991 19901995

-0.7 -1.8 1.0 -0.1 0.3 1.7

19982002 19942002 19912002 19952002

-0.5 -0.9 -1.9 0.3

19951998 19951998 19951998

1.1 1.0 1.5

19982002 19982002 19982002

-1.8 -2.5 -1.5

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

TABLE 6 Fifteen Leading Causes of Death, United States, 2003

Trends in Cancer Incidence and Mortality

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

CANCER OCCURRENCE BY RACE/ETHNICITY

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Lifetime Probability of Developing Cancer

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Cancer Statistics, 2006

A Cancer Journal for Clinicians

CA Cancer J Clin 2006;56:106130

Volume 56 Y Number 2 Y March/April 2006

Cancer Statistics, 2006

African American 1995 to 2001

All Races 1974 to 1976