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Cancer Statistics, 2005

Cancer Statistics, 2005


Ahmedin Jemal, DVM, PhD; Taylor Murray; Elizabeth Ward, PhD; Alicia Samuels, MPH; Ram C. Tiwari, PhD; Asma Ghafoor, MPH; Eric J. Feuer, PhD; Michael J. Thun, MD, MS

Dr. Jemal is Program Director, Cancer Occurrence, 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. Dr. Ward is Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Ms. Samuels is Manager, Surveillance Information Services, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Dr. Tiwari is Mathematical Statistician, Statistical Research and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD. Ms. Ghafoor is Epidemiologist, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA. Dr. Feuer is Branch Chief, Statistical Research and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD. 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 1,372,910 new cancer cases and 570,280 deaths are expected in the United States in 2005. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for persons younger than 85 since 1999. When adjusted to delayed reporting, cancer incidence rates stabilized in men from 1995 through 2001 but continued to increase by 0.3% per year from 1987 through 2001 in women. 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 from the three most common cancer sites in men (lung and bronchus, colon and rectum, and prostate) and from breast and colorectal cancers in women. Lung cancer mortality among women has leveled off after increasing for many decades. In analyses by race and ethnicity, African American men and women have 40% and 20% 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 2005;55:10 30.) American Cancer Society, Inc., 2005.
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 2005.

MATERIALS AND METHODS Data Sources

Mortality data from 1930 to 2002 were obtained from the National Center for Health Statistics (NCHS).1 Incidence data (1975 to 2001), 5-year relative survival rates, and data on lifetime probability of developing cancer
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TABLE 1

Estimated New Cancer Cases and Deaths by Sex, United States, 2005*
Estimated New Cases Both Sexes Male
710,040 19,100 5,050 5,370 6,520 2,160 134,370 11,220 13,510 2,840 48,290 23,530 1,750 12,130 3,330 16,100 1,670 102,420 7,920 93,010 1,490 1,480 5,530 37,580 33,580 4,000 1,690 241,570

Estimated Deaths Female


662,870 10,270 2,610 4,700 2,070 890 119,130 3,300 8,350 2,580 56,660 16,810 2,240 5,420 4,150 16,080 3,540 82,380 1,960 79,560 860 1,090 3,890 28,420 26,000 2,420 211,240 79,480 10,370 40,880 22,220 3,870 2,140

Both sexes
570,280 7,320 1,730 1,890 2,130 1,570 136,060 13,570 11,550 1,070 56,290 620 15,420 3,340 31,800 2,400 168,140 3,770 163,510 860 1,210 3,490 10,590 7,770 2,820 40,870 59,920 3,710 7,310 16,210 870 810 30,350 390 270 26,590 13,180 12,660 750 230 12,760 2,370 1,490 880 20,610 1,410 19,200 11,300 22,570 1,490 4,600 9,000 850 6,630 46,250

Male
295,280 4,910 1,120 1,100 1,490 1,200 75,020 10,530 6,770 580 28,540 230 10,330 1,270 15,820 950 93,990 2,960 90,490 540 670 1,910 6,920 4,910 2,010 460 31,010

Female
275,000 2,410 610 790 640 370 61,040 3,040 4,780 490 27,750 390 5,090 2,070 15,980 1,450 74,150 810 73,020 320 540 1,580 3,670 2,860 810 40,410 28,910 3,710 7,310 16,210 870 810

All Sites Oral cavity & pharynx Tongue Mouth Pharynx Other oral cavity Digestive system Esophagus Stomach Small intestine Colon Rectum Anus, anal canal, & anorectum Liver & intrahepatic bile duct Gallbladder & other biliary Pancreas Other digestive organs Respiratory system Larynx Lung & bronchus Other respiratory organs Bones & joints Soft tissue (including heart) Skin (excluding basal & squamous) Melanoma-skin Other nonepithelial skin Breast Genital system Uterine cervix Uterine corpus Ovary Vulva Vagina & other genital, female Prostate Testis Penis & other genital, male Urinary system Urinary bladder Kidney & renal pelvis Ureter & other urinary organs Eye & orbit Brain & other nervous system Endocrine system Thyroid Other endocrine Lymphoma Hodgkin disease Non-Hodgkin lymphoma Multiple myeloma Leukemia Acute lymphocytic leukemia Chronic lymphocytic leukemia Acute myeloid leukemia Chronic myeloid leukemia Other leukemia Other & unspecified primary sites

1,372,910 29,370 7,660 10,070 8,590 3,050 253,500 14,520 21,860 5,420 104,950 40,340 3,990 17,550 7,480 32,180 5,210 184,800 9,880 172,570 2,350 2,570 9,420 66,000 59,580 6,420 212,930 321,050 10,370 40,880 22,220 3,870 2,140 232,090 8,010 1,470 101,880 63,210 36,160 2,510 2,120 18,500 27,650 25,690 1,960 63,740 7,350 56,390 15,980 34,810 3,970 9,730 11,960 4,600 4,550 28,590

232,090 8,010 1,470 71,090 47,010 22,490 1,590 1,090 10,620 7,550 6,500 1,050 33,050 3,980 29,070 8,600 19,640 2,180 5,780 6,530 2,640 2,510 14,660

30,790 16,200 13,670 920 1,030 7,880 20,100 19,190 910 30,690 3,370 27,320 7,380 15,170 1,790 3,950 5,430 1,960 2,040 13,930

30,350 390 270 17,420 8,970 8,020 430 110 7,280 1,080 630 450 10,930 780 10,150 5,660 12,540 850 2,520 5,040 430 3,700 25,370

9,170 4,210 4,640 320 120 5,480 1,290 860 430 9,680 630 9,050 5,640 10,030 640 2,080 3,960 420 2,930 20,880

*Rounded to the nearest 10; excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 58,490 carcinoma in situ of the breast and 46,170 melanoma in situ will be newly diagnosed in 2005. 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 2001, 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 2002, National Center for Health Statistics, Center for Disease Control and Prevention, 2004.

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TABLE 2

Estimated New Cancer Cases for Selected Cancers by State, United States, 2005*
All Cases 24,320 1,930 23,880 14,950 135,030 16,080 16,920 3,800 2,820 96,200 35,650 4,790 5,490 59,730 31,900 15,910 12,930 23,020 23,280 7,750 25,450 33,030 50,220 22,890 14,970 30,210 4,910 8,330 11,120 6,310 43,000 7,780 87,050 40,520 3,080 59,680 18,460 17,720 71,840 5,870 21,860 3,900 31,080 86,880 6,380 3,030 33,680 27,350 11,190 26,340 2,380 1,372,910 Female Breast 3,820 260 3,760 2,090 21,170 2,560 2,720 630 520 13,430 5,850 680 940 9,300 4,600 2,300 1,990 3,290 3,870 890 4,390 4,910 7,210 3,240 2,350 4,550 680 1,200 1,620 890 7,740 990 14,430 6,330 520 9,670 2,820 2,610 11,340 780 3,290 520 4,230 12,860 1,150 470 6,010 3,920 1,410 4,130 260 211,240 Uterine Cervix 200 200 170 1,090 80 220 730 360 60 60 500 170 110 80 220 220 220 110 340 110 140 170 60 80 340 60 840 310 390 140 140 390 60 170 280 1,030 200 110 110 80 10,370 Colon & Rectum 2,300 210 2,500 1,630 14,070 1,650 1,680 410 340 9,860 3,480 540 540 6,610 3,410 1,700 1,570 2,350 2,580 800 2,760 3,560 4,830 2,220 1,630 3,230 460 1,030 1,240 620 4,670 880 9,700 4,100 360 6,500 2,010 1,760 8,130 650 2,300 460 3,150 9,270 670 340 3,560 2,660 1,260 2,760 280 145,290 Uterine Corpus 670 60 500 340 4,250 450 500 110 170 2,520 890 170 170 2,010 1,010 500 390 500 500 220 780 1,010 1,450 670 340 840 170 280 220 170 1,790 280 3,240 1,170 110 1,850 450 450 2,570 110 500 110 730 2,400 220 110 1,010 890 280 840 60 40,880 Lung & Bronchus 3,340 220 2,870 2,530 15,150 1,750 1,950 490 310 13,130 4,800 510 630 7,220 4,410 1,790 1,630 3,680 3,090 990 3,210 4,010 6,110 2,620 2,180 4,070 620 1,000 1,530 790 4,830 760 9,870 5,520 330 7,790 2,580 2,160 8,470 720 2,880 430 4,630 11,210 460 390 4,400 3,440 1,700 3,060 280 172,570 Melanoma of the Skin 920 80 1,300 540 5,440 920 690 230 80 4,600 1,610 150 380 2,300 1,460 540 540 1,150 770 380 1,070 1,530 1,840 1,000 460 1,460 230 380 540 310 1,920 310 3,220 1,920 80 2,450 1,000 1,000 2,990 310 770 150 1,300 3,830 460 150 1,610 1,380 460 1,230 150 59,580 NonHodgkin Lymphoma 940 90 1,060 650 5,700 880 730 210 90 3,470 1,380 260 210 2,200 1,410 760 650 970 1,060 260 1,030 1,260 2,140 1,380 530 1,530 210 380 440 320 1,760 320 2,940 1,760 180 1,970 680 1,000 2,880 290 940 230 1,350 3,050 380 180 1,170 1,410 500 1,120 90 56,390 Urinary Bladder 860 100 1,200 620 6,380 720 860 190 190 4,890 1,530 190 340 2,640 1,390 670 720 910 770 430 1,150 1,870 2,350 1,150 480 1,150 240 340 530 380 2,060 340 4,320 1,580 140 3,070 820 1,010 3,600 340 860 190 1,150 3,410 290 190 1,390 1,250 580 1,340 100 63,210

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY US

Leukemia 560 50 620 400 3,380 460 400 120 50 2,620 820 120 150 1,620 820 480 350 480 540 150 680 770 1,250 660 370 830 140 250 260 170 1,100 170 2,170 990 110 1,510 460 420 1,630 120 510 110 760 2,250 220 90 830 720 220 770 60 34,810

Prostate 4,360 310 3,900 2,060 25,010 2,680 3,360 610 610 19,650 5,660 920 1,150 9,410 4,890 3,060 2,060 2,520 3,440 1,300 4,210 5,350 7,650 4,360 3,210 3,060 990 1,380 1,990 1,150 6,420 1,680 14,220 6,810 610 10,860 2,450 2,980 13,150 840 4,210 920 4,280 13,380 1,150 460 5,740 5,510 1,450 4,050 610 232,090

*Rounded to the nearest 10. Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. 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 2005 by state. State estimates may not add to US total due to rounding and exclusion of state estimates fewer than 50 cases.

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were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), covering about 10% to 14% of the US population.25 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 and in every state is unknown because complete cancer registration has not yet been achieved in many states. Consequently, for the national estimate we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 2001 using agespecific cancer incidence rates collected by the SEER program2 and population data reported by
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TABLE 3 Age-standardized Death Rates from All Cancers Combined and Estimated Cancer Deaths from All Causes and Selected Sites by State, United States, 2005*
Death Rate per STATE 100,000 AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY US 214.4 199.2 176.5 211.5 183.7 172.2 191.5 217.4 241.2 191.0 205.1 158.0 179.8 208.9 214.1 189.7 189.4 227.0 230.4 212.2 211.1 205.4 203.9 187.5 222.3 207.9 195.0 184.8 209.5 205.2 208.3 171.9 194.1 204.9 184.7 212.4 206.2 198.9 207.1 208.4 209.5 191.0 216.3 196.8 151.0 200.8 207.1 195.3 223.3 194.3 190.8 199.8 Brain/Other Colon NonNervous Female & Lung & Hodgkin System Breast Rectum Leukemia Liver Bronchus Lymphoma Ovary Pancreas Prostate 210 240 160 1,460 180 140 930 300 70 480 320 160 130 160 190 80 200 280 450 250 170 260 50 90 90 70 320 70 720 340 530 170 190 520 50 180 50 320 910 90 270 350 90 260 12,760 730 50 720 400 4,050 490 520 120 100 2,570 1,120 130 180 1,780 880 440 380 630 740 170 840 940 1,380 620 450 870 130 230 310 170 1,480 190 2,760 1,210 100 1,850 540 500 2,170 150 630 100 810 2,460 220 90 1,150 750 270 790 50 40,410 890 80 970 630 5,450 640 650 160 130 3,820 1,350 210 210 2,560 1,320 660 610 910 1,000 310 1,070 1,380 1,870 860 630 1,250 180 400 480 240 1,810 340 3,760 1,590 140 2,520 780 680 3,150 250 890 180 1,220 3,590 260 130 1,380 1,030 490 1,070 110 56,290 360 400 260 2,190 300 260 80 1,700 530 80 100 1,050 530 310 230 320 350 100 440 500 810 430 240 540 90 160 170 110 710 110 1,410 640 70 980 300 270 1,060 80 330 70 490 1,460 140 60 540 470 140 500 22,570 290 290 200 2,070 170 170 1,110 340 100 50 680 250 120 120 200 310 70 260 370 530 210 150 290 50 60 120 70 410 130 1,010 380 570 170 160 730 60 220 300 1,280 60 340 340 110 290 15,420 3,160 210 2,720 2,400 14,350 1,660 1,850 460 290 12,440 4,550 480 600 6,840 4,180 1,700 1,540 3,490 2,930 940 3,040 3,800 5,790 2,480 2,070 3,860 590 950 1,450 750 4,580 720 9,350 5,230 310 7,380 2,440 2,050 8,030 680 2,730 410 4,390 10,620 440 370 4,170 3,260 1,610 2,900 270 163,510 320 360 220 1,940 300 250 70 1,180 470 90 70 750 480 260 220 330 360 90 350 430 730 470 180 520 70 130 150 110 600 110 1,000 600 60 670 230 340 980 100 320 80 460 1,040 130 60 400 480 170 380 19,200 300 290 160 1,720 220 200 50 1,120 420 50 80 650 380 210 160 230 220 100 310 380 590 270 160 340 70 100 120 60 540 90 1,080 470 660 180 240 880 60 190 60 350 960 90 400 390 140 320 16,210 530 50 550 310 3,150 400 430 100 60 2,250 770 150 130 1,470 690 390 290 420 520 180 590 850 1,140 550 330 670 100 180 230 140 1,050 180 2,270 910 80 1,300 360 410 1,670 140 510 90 680 1,950 170 70 750 690 200 650 50 31,800 570 510 270 3,270 350 440 80 80 2,570 740 120 150 1,230 640 400 270 330 450 170 550 700 1,000 570 420 400 130 180 260 150 840 220 1,860 890 80 1,420 320 390 1,720 110 550 120 560 1,750 150 60 750 720 190 530 80 30,350

All Sites 10,100 800 9,920 6,210 56,090 6,680 7,030 1,580 1,170 39,960 14,810 1,990 2,280 24,810 13,250 6,610 5,370 9,560 9,670 3,220 10,570 13,720 20,860 9,510 6,220 12,550 2,040 3,460 4,620 2,620 17,860 3,230 36,160 16,830 1,280 24,790 7,670 7,360 29,840 2,440 9,080 1,620 12,910 36,090 2,650 1,260 13,990 11,360 4,650 10,940 990 570,280

*Rounded to the nearest 10; excludes in situ carcinomas except urinary bladder. Average annual rates for 1997-2001 and 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 for fewer than 50 deaths. Source: US Mortality Public Use Data Tapes, 1969 to 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

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the US Census Bureau.6 We then forecasted the number of cancer cases expected to be diagnosed in the United States in the year 2005 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 2005 and assumed that the ratio of estimated cancer deaths to cases in each state equaled that in the United States.

Estimated Cancer Deaths

We used the state-space prediction method12 to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2005. Projections are based 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 2005 based on the number that occurred each
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year from 1969 to 2002 in the United States and in each state separately.

Other Statistics

We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2002. Causes of death for 2002 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 1973 through 2001.3 All age-adjusted incidence and death rates are
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standardized to the 2000 US standard population and expressed per 100,000 population. The long-term incidence trends (1975 to 2001) presented in Table 4 are adjusted for delays in reporting. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 1999 to 2001), especially for cancers such as melanoma and prostate cancer that are frequently diagnosed in outpatient settings. 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 trends provide a more accurate assessment of trends in the most recent years for which data are available.

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SELECTED FINDINGS

Expected Numbers of New Cancer Cases

Table 1 presents the estimated number of new cancer cases expected among men and women in the United States in 2005. The estimate of about 1.4 million new cases of invasive cancer does not include carcinoma in situ of any site except urinary bladder, nor does it include basal and squamous cell

cancers of the skin. More than 1 million cases of basal and squamous cell skin cancer, approximately 58,490 cases of breast carcinoma in situ, and 46,170 cases of in situ melanoma are expected to be newly diagnosed in 2005. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2. Figure 1 indicates the most common cancers expected to occur in men and women in 2005. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for
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more than 56% of all newly diagnosed cancers. Prostate cancer alone accounts for approximately 33% (232,090) of incident cases in men. Based on cases diagnosed between 1995 and 2000, about 90% of these estimated 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 2005 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for approximately 55% of
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estimated cancer cases in women. Breast cancer alone is expected to account for 32% (211,240) of all new cancer cases among women.
Expected Number of New Cancer Deaths

Table 1 also shows the expected number of cancer deaths in 2005 for men, women, and both sexes combined. It is estimated that approximately 570,280 Americans will die from cancer, corresponding to more than 1,500 deaths per day. Cancers of the lung and

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TABLE 4 2001

Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, All Races, 1975 to
Line Segment 1 Year APC* Line Segment 2 Year APC* Line Segment 3 Year APC* Line Segment 4 Year APC*

All Cancers 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

19751989 19751989 19751979 19751990 19751979 19751992

1.2 1.3 0.2 0.5 1.0 0.5

19891992 19891992 19791987 19901993 19791990 19922001

2.8 5.2 1.5 0.3 0.3 0.8 1.0 0.4 3.5 1.8 0.4 4.2 1.8 2.1 1.9 1.8 1.4 1.8 3.7 2.3 16.5 3.0

19921995 19921995 19872001 19932001 19901993

2.1 4.7 0.3 1.1 0.4

19952001 19952001

0.4 0.2

19932001

1.5

19751982 19751982 19751982 19751980 19751982 19751982

2.5 1.4 5.5 3.0 1.8 6.0

19821991 19821991 19821990 19801990 19821991 19821990

19912001 19912001 19901998 19901995 19912001 19901995

0.8 1.9 1.1 0.2 1.9 1.7

19982001 19952001 19952001

1.3 1.0 0.2 2.4 2.9 2.3

19751985 19751986 19751985 19751984 19751984 19751984 19751980 19751990 19751988 19751987

0.8 1.1 0.3 0.5 0.1 1.0 0.4 0.4 2.6 0.9

19851995 19861995 19851995 19842001 19841990 19842001 19801987 19902001 19881992 19871991

19951998 19951998 19951998

1.3 1.1 1.8 2.0 0.5 11.5 0.6

19982001 19982001 19982001

19902001

19872001

19921995 19911994

19952001 19942001

2.0 4.1

*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 2.7, 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

bronchus, prostate, and colon and rectum 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 one-half of the total cancer deaths among men and women (Figure 1). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 27% of all female cancer deaths in 2005. Table 3 provides the estimated number of cancer deaths in 2005 by state for selected cancer sites.

Trends in Cancer Incidence and Mortality

Figures 2 through 5 depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 4 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 in the table (joinpoint analysis) but not in the figures (Figures 2 and 3). Death rates from all cancers combined decreased by 1.5% per year from 1993 to 2001 in
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TABLE 5
Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Fifteen Leading Causes of Death, United States, 2002


Causes of Death All causes Heart diseases Cancer Cerebrovascular diseases Chronic lower respiratory diseases Accidents (unintentional injuries) Diabetes mellitus Influenza & pneumonia Alzheimer disease Nephritis, nephrotic syndrome, & nephrosis Septicemia Intentional self-harm (suicide) Chronic liver disease & cirrhosis Hypertension and hypertensive renal disease Assault (homicide) Parkinson disease All other & ill-defined causes Number of Deaths 2,443,387 696,947 557,271 162,672 124,816 106,742 73,249 65,681 58,866 40,974 33,865 31,655 27,257 20,261 17,638 16,959 408,534 Percent (%) of Total Deaths 28.5 22.8 6.7 5.1 4.4 3.0 2.7 2.4 1.7 1.4 1.3 1.1 0.8 0.7 0.7 Death Rate* 843.6 240.1 193.4 56.0 43.4 36.8 25.4 22.5 20.1 14.2 11.7 10.9 9.4 7.0 6.1 5.9

*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 and pneumonitis due to solids and liquids were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tape, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

males and by 0.8% per year in females from1992 to 2001 (Table 4). Delay-adjusted cancer incidence rates stabilized in men from 1995 to 2001 and increased by 0.3% per year from 1987 to 2001 in women (Table 4). 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 have leveled off for the first time after increasing for many decades (Table 4). The incidence trends are mixed, however. Lung cancer incidence rates are declining in men and leveled off for the first time in women after increasing for many decades. Colorectal cancer incidence rates have decreased from 1998 through 2001 both in males and in females. The incidence rates of prostate cancer and female breast cancer 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 testing (for prostate cancer) and mammography (for breast cancer). The increase in female breast cancer incidence may also reflect increased use of hormone replacement therapy and/or increased prevalence of obesity.14
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Changes in the Recorded Number of Deaths From Cancer From 2001 to 2002

A total of 557,271 cancer deaths were recorded in the United States in 2002, the most recent year for which actual data are available. More than 3,500 additional cancer deaths were recorded in 2002 than in 2001, predominantly because of growth and aging of the population. Cancer accounted for approximately 23% of all deaths, ranking second only to heart disease (Table 5). 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 476,009 people under age 85 died from cancer in the United States in 2002 compared with 450,637 deaths from heart disease. When cause of death is ranked within each age group, categorized in 20year age intervals, cancer is one of the five leading causes of death in each age group among both males and females. Cancer is the leading cause of death among women aged 40 to 79 and among men aged 60 to 79 (Table 6).

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TABLE 6

Ten Leading Causes of Death, by Age and Sex, United States, 2002
All Ages Ages 1 to 19 Male
All Causes 16,848

Ages 20 to 39 Male
All Causes 65,934

Ages 40 to 59 Male
All Causes 212,519 Heart diseases 54,028

Ages 60 to 79 Male
All Causes 488,179 Cancer 156,527

Ages 80 Male
All Causes 399,785

Male
All Causes 1,199,264

Female
All Causes 1,244,123

Female
All Causes 8,972

Female
All Causes 30,002

Female
All Causes 131,100 Cancer 49,570

Female
All Causes 402,852 Cancer 129,699

Female
All Causes 658,805

1 Heart diseases Heart diseases 340,933 356,014

Accidents Accidents Accidents Accidents (unintentional (unintentional (unintentional (unintentional injuries) injuries) injuries) injuries) 6,859 21,627 3,778 7,718 Assault (homicide) 2,035 Cancer 957 Intentional self-harm (suicide) 8,771 Assault (homicide) 7,827 Cancer 5,403

Heart diseases Heart diseases 136,941 231,969

Cancer 288,768

Cancer 268,503

Cancer 52,489

Heart diseases 21,677

Heart diseases Heart diseases 143,570 99,160

Cancer 73,839

Cancer 82,840

Accidents (unintentional injuries) 69,257 Cerebrovascular disease 62,622 Chronic lower respiratory diseases 60,713 Diabetes mellitus 34,301

Cerebrovascular disease 100,050 Chronic lower respiratory diseases 64,103 Alzheimer disease 41,877

Intentional self-harm (suicide) 1,479 Cancer 1,240

Assault (homicide) 636

Heart diseases 2,640

Accidents (unintentional injuries) 20,224 Intentional self-harm (suicide) 9,325 Chronic liver disease & cirrhosis 9,082 Diabetes mellitus 6,719

Accidents (unintentional injuries) 8,076 Cerebrovascular diseases 5,536 Diabetes mellitus 4,675

Chronic lower respiratory diseases 31,438 Cerebrovascular disease 24,573 Diabetes mellitus 16,886

Chronic lower respiratory diseases 29,905 Cerebrovascular diseases 25,934 Diabetes mellitus 17,038

Cerebrovascular diseases 30,688 Chronic lower respiratory diseases 24,411 Influenza & pneumonia 16,980

Cerebrovascular diseases 67,702 Alzheimer disease 35,225

Congenital anomalies 552

Heart diseases 5,590

Intentional self-harm (suicide) 1,913 Assault (homicide) 1,723

Congenital anomalies 643

Heart diseases 322

Cancer 4,626

Chronic lower respiratory diseases 29,619 Influenza & pneumonia 27,094

Diabetes mellitus 38,948

Heart disease 503

Intentional self-harm (suicide) 298 Influenza & pneumonia 134

HIV disease 3,206

HIV disease 1,391

Chronic lower respiratory diseases 4,089 Chronic liver disease & cirrhosis 3,617

Accidents (unintentional injuries) 10,825 Influenza & pneumonia 8,960

Influenza & pneumonia 7,508

Alzheimer disease 12,384

Influenza & pneumonia 28,918

Accidents (unintentional injuries) 37,485

Chronic lower respiratory diseases 186

Diabetes mellitus 905

Cerebrovascular disease 740

HIV disease 6,450

Nephritis, nephrotic syndrome & nephrosis 7,375

Diabetes mellitus 9,737

Diabetes mellitus 16,566

Intentional self-harm (suicide) 25,409

Influenza & pneumonia 36,763

Influenza & pneumonia 142

Chronic lower Chronic liver Diabetes mellitus 629 disease & respiratory cirrhosis diseases 852 108

Cerebrovascular diseases 6,440

Intentional self-harm (suicide) 2,879

Nephritis, nephrotic syndrome & nephrosis 8,077

Accidents (unintentional injuries) 6,987

Nephritis, nephrotic syndrome & nephrosis 9,030

Nephritis, nephrotic syndrome & nephrosis 11,784

Nephritis, nephrotic syndrome & nephrosis 19,695

Nephritis, nephrotic syndrome & nephrosis 21,279 Septicemia 18,918

Septecemia 115

Septicemia 108

Cerebrovascular disease 742

Chronic liver disease & cirrhosis 475

Chronic lower respiratory diseases 4,274

HIV disease 1,998

Septicemia 6,611

Septicemia 6,781

Accidents (unintentional injuries) 8,236

Accidents (unintentional injuries) 11,381

10 Chronic liver disease & cirrhosis 17,401

Cerebrovascular disease 111

In Situ/Benign unknown neoplasms 90

Congenital anomalies 552

Congenital anomalies 431

Assault (homicide) 2,875

Septicemia 1,938

Chronic Liver disease & cirrhosis 6,313

Alzheimer disease 6,542

Parkinson disease 5,805

Septicemia 9,614

Note: Symptoms, signs, and abnormalities and events of undetermined intent were excluded from the cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

Table 7 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among men under age 40, leukemia is the most common fatal cancer, while cancer of the lung and bronchus predominates in men

aged 40 years and older. Colorectal cancer is the second most common cause of cancer death among men 40 to 79 years old, and prostate cancer is the second most common among men aged 80 and older. Among women, leukemia is the leading cause of cancer death before age 20,
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Cancer Statistics, 2005

breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at age 60 years and older. From 2001 to 2002, the number of recorded cancer deaths increased by 1,693 in men and by 1,810 in women (Table 8). The total number of deaths for the major cancers in men and women did not change substantially except for lung cancer (increased by 1,903) and colorectal cancer (decreased by 447) among women.
CANCER OCCURRENCE BY RACE AND ETHNICITY

Cancer incidence and death rates vary considerably among racial and ethnic groups (Ta22

ble 9). For all cancer sites combined, African American men have a 24% higher incidence rate and 40% higher death rate than Whites. African American women have a lower incidence rate but nearly 20% higher death rate than Whites for all cancer sites combined. For the specific cancer sites listed in Table 9, 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 the rates in Whites. Factors that contribute to these mortality differences include differences in exposure (eg, Helicobacter pylori for stomach

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TABLE 7

Reported Deaths for the Five Leading Cancer Sites, by Age and Sex, United States, 2002
<20
All Sites 1,282 Leukemia 382 Brain & ONS* 327 Other endocrine system 104 Bones & joints 96 Soft tissue 82

All Ages
All Sites 288,768 Lung & bronchus 90,121 Prostate 30,446 Colon & rectum 28,472 Pancreas 14,877 Leukemia 12,058

20 to 39
Male All Sites 4,626 Leukemia 599 Brain & ONS* 516 Colon & rectum 413 Non-Hodgkin lymphoma 401 Lung & bronchus 394 Female

40 to 59
All Sites 52,489 Lung & bronchus 16,044 Colon & rectum 5,257 Pancreas 3,195 Liver & bile duct 2,733 Esophagus 2,470

60 to 79
All Sites 156,527 Lung & bronchus 55,996 Colon & rectum 14,973 Prostate 13,539 Pancreas 8,312 Leukemia 5,919

>80
All Sites 73,839 Lung & bronchus 17,681 Prostate 15,795 Colon & rectum 7,820 Leukemia 3,409 Urinary bladder 3,331

All Sites 268,503 Lung & bronchus 67,509 Breast 41,514 Colon & rectum 28,132 Pancreas 15,387 Ovary 14,682

All Sites 989 Leukemia 296 Brain & ONS* 244 Other endocrine system 88 Bones & joints 83 Soft tissue 71

All Sites 5,403 Breast 1,331 Uterine cervix 499 Leukemia 433 Lung & bronchus 370 Brain & ONS* 349

All Sites 49,570 Breast 12,115 Lung & bronchus 11,129 Colon & rectum 3,857 Ovary 3,285 Pancreas 1,999

All Sites 129,699 Lung & bronchus 39,943 Breast 17,218 Colon & rectum 11,904 Pancreas 7,869 Ovary 7,349

All Sites 82,840 Lung & bronchus 16,064 Colon & rectum 12,030 Breast 10,849 Pancreas 5,436 Non-Hodgkin lymphoma 4,029

*ONS, other nervous system. Note: Others and Unspecified Primary are excluded from cause of death ranking order. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

cancer), access to regular screening (breast, cervical, and colorectal cancers), and timely, high quality treatments (many cancers). The higher breast cancer incidence rates among Whites are thought to reflect a combination of more frequent mammography, which makes diagnosis more likely, delayed age at first birth, and historically greater use of hormone replacement therapy.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 cancer sites than those for 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 than in Whites, reflecting increased exposure to infectious agents such as H pylori and hepatitis C virus.15 Historical information to adjust for delays in reporting is not available for all racial and ethnic groups. From 1992 to 2001, incidence rates for all cancer sites combined, not adjusted for
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TABLE 8 Trends in the Recorded Number of Cancer Deaths for Selected Cancers, by Sex, United States, 1989 to 2002
All Sites Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Male 263,309 268,283 272,380 274,838 279,375 280,465 281,611 281,898 281,110 282,065 285,832 286,082 287,075 288,768 Female 232,843 237,039 242,277 245,740 250,529 253,845 256,844 257,635 258,467 259,467 264,006 267,009 266,693 268,503 Lung and Bronchus Male 88,975 91,014 91,603 91,322 92,493 91,825 91,800 91,559 91,278 91,399 89,401 90,415 90,367 90,121 Female 48,042 50,136 52,022 54,485 56,234 57,535 59,304 60,351 61,922 63,075 62,662 65,016 65,606 67,509 Colon and Rectum Male 28,123 28,484 28,026 28,280 28,199 28,471 28,409 27,989 28,075 28,024 28,313 28,484 28,229 28,472 Female 28,903 28,674 28,753 28,714 29,206 28,936 29,237 28,766 28,621 28,950 28,909 28,950 28,579 28,132 Prostate Male 30,520 32,378 33,564 34,240 34,865 34,902 34,475 34,123 32,891 32,203 31,729 31,078 30,719 30,446 Breast Female 42,837 43,391 43,583 43,068 43,555 43,644 43,844 43,091 41,943 41,737 41,144 41,872 41,394 41,514

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 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

delayed reporting, decreased by 2.8% per year among American Indians/Alaskan Natives, by 1.2% per year in African Americans, by 0.7% among Asian/Pacific Islanders, by 0.6% among Hispanic-Latinos, and by 0.5% among Whites (data not shown). Similarly, the death rate from all cancers combined decreased from 1992 through 2001 by 1.6% per year in Asian/Pacific Islanders, by 1.4% among African Americans, by 0.9% among Whites, and by 0.5% among Hispanic-Latinos. The death rate from all cancers combined stabilized during this time period among American Indians/Alaskan Natives.3

Cancer Survival by Race

Lifetime Probability of Developing Cancer

The lifetime probability of developing cancer is higher for men (46%) than for women (38%) (Table 10). 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. It is noteworthy that these estimates are based on the average experience of the general population and may overestimate or underestimate individual risk because of differences in exposure and/or genetic susceptibility.
24

African American men and women have poorer probability of 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 in Whites at each 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 differences 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 when African Americans receive similar cancer treatment and medical care as Whites they tend to have similar disease outcomes.17 There have been notable improvements over time in the relative 5-year survival rates for the common cancer sites and all cancers combined (Table 11).3 This is true for both Whites and African Americans. Cancer sites for which survival has not improved substan-

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TABLE 9 Age-standardized Incidence and Death Rates* for Selected Cancer Sites by Race and Ethnicity, United States, 1997 to 2001
Asian American/ Pacific Islander American Indian/Alaskan Native

All Races 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

White

African American Incidence Rates

HispanicLatino

554.3 414.4 135.2 63.4 46.4 79.1 49.1 172.3 12.6 6.1 9.1 3.5 9.3

556.5 429.8 141.7 63.1 45.9 77.9 51.3 167.4 10.8 5.0 7.2 2.9 8.9

689.2 400.1 119.9 72.9 56.5 117.2 54.5 271.3 18.8 9.9 11.8 3.9 11.8 Death Rates

385.9 302.8 96.8 56.3 38.6 60.5 28.5 100.7 21.9 12.4 21.1 7.7 9.5

263.2 222.5 54.2 38.3 32.7 46.0 23.4 51.2 15.7 8.9 8.3 4.8 6.0

419.8 309.9 89.6 49.6 32.5 45.2 23.9 140.0 17.8 10.0 13.5 5.8 16.2

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

251.1 166.7 27.0 25.3 17.7 77.9 40.8 31.5 6.6 3.3 6.7 2.9 2.9

245.5 165.5 26.4 24.8 17.1 76.6 41.6 28.8 5.8 2.8 6.1 2.7 2.6

347.3 196.5 35.4 34.3 24.5 104.1 39.9 70.4 13.3 6.3 9.3 3.8 5.6

151.2 100.5 12.6 15.8 10.8 40.2 19.2 13.0 11.9 7.0 15.6 6.6 2.8

167.0 113.4 13.6 17.1 11.7 49.8 26.6 20.2 7.3 4.1 8.3 4.3 2.8

174.0 111.6 17.3 18.0 11.6 39.6 14.9 23.5 9.7 5.3 10.6 5.1 3.6

*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

tially over the past 25 years include uterine corpus, uterine cervix, larynx, liver, lung, pancreas, stomach, and esophagus. Relative survival rate cannot be calculated for other racial and ethnic groups 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 an elevated probability of dying from all cancers combined within 5 years of diagnosis compared with nonHispanic Whites after accounting for differences 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
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TABLE 10 Probability of Developing Invasive Cancers Within Selected Age Intervals, by Sex, United States, 1999 to 2001*
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 1.41 (1 in 71) 1.97 (1 in 51) 0.02 (1 in 4264) 0.01 (1 in 8876) 0.48 (1 in 207) 0.07 (1 in 1484) 0.06 (1 in 1586) 0.15 (1 in 659) 0.13 (1 in 799) 0.03 (1 in 3164) 0.03 (1 in 2977) 0.13 (1 in 795) 0.21 (1 in 484) 0.14 (1 in 724) 0.09 (1 in 1147) 0.01 (1 in 9879) 0.16 (1 in 636) 0.06 (1 in 1632) 40 to 59 (%) 8.52 (1 in 12) 9.10 (1 in 11) 0.41 (1 in 243) 0.12 (1 in 804) 4.18 (1 in 24) 0.90 (1 in 111) 0.69 (1 in 145) 0.22 (1 in 461) 0.14 (1 in 697) 1.06 (1 in 95) 0.81 (1 in 123) 0.51 (1 in 195) 0.40 (1 in 248) 0.46 (1 in 217) 0.31 (1 in 328) 2.58 (1 in 39) 0.29 (1 in 340) 0.72 (1 in 139) 60 to 79 (%) 34.63 (1 in 3) 22.51 (1 in 4) 2.42 (1 in 41) 0.65 (1 in 153) 7.49 (1 in 13) 3.96 (1 in 25) 3.04 (1 in 33) 0.85 (1 in 118) 0.48 (1 in 206) 5.75 (1 in 17) 3.91 (1 in 26) 1.08 (1 in 93) 0.53 (1 in 190) 1.32 (1 in 76) 1.00 (1 in 100) 14.76 (1 in 7) 0.27 (1 in 368) 1.57 (1 in 64) Birth to Death (%) 45.59 (1 in 2) 38.18 (1 in 3) 3.56 (1 in 28) 1.13 (1 in 88) 13.39 (1 in 7) 5.90 (1 in 17) 5.54 (1 in 18) 1.47 (1 in 68) 1.04 (1 in 96) 7.63 (1 in 13) 5.71 (1 in 18) 1.89 (1 in 53) 1.28 (1 in 78) 2.18 (1 in 46) 1.80 (1 in 56) 17.81 (1 in 6) 0.77 (1 in 130) 2.62 (1 in 38)

*For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 1999 to 2001. The 1 in statistic and the inverse of the percentage may not be equivalent due to rounding. All sites exclude 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 5.2. Statistical Research and Applications Branch, National Cancer Institute, 2005. http://srab.cancer.gov/devcan.

CANCER IN CHILDREN

Cancer is the second leading cause of death among children between the ages of 1 and 14 in the United States; accidents are the most frequent cause of death in this age group (Table 12). The most commonly occurring cancers in children (0 to 14 years) are leukemia (particularly acute lymphocytic leukemia), brain and other nervous system cancers, soft tissue sarcomas, non-Hodgkin lymphoma, and renal (Wilms) tumor.3 Over the past 25 years, there have been significant improvements in the 5-year relative survival rate for many childhood cancers, including non-Hodgkin lymphoma, acute lymphocytic leukemia, acute myeloid leukemia, and Wilms tumor (Table 13).3 The 5-year relative survival rate among children for all cancer sites combined improved from 56% for patients diagnosed in 1974 to 1976 to 79% for those diagnosed in 1995 to 2000.3
LIMITATIONS AND FUTURE CHALLENGES

Estimates of the expected numbers of new cancer cases and cancer deaths should be inter26

preted cautiously. These estimates may vary 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 mortality. The recorded number of cancer deaths and cancer death rates from the NCHS and cancer incidence rates from SEER are generally the preferred data sources for tracking cancer trends, even though these data are 3 and 4 years old, respectively, at the time that the estimates are calculated. Despite these limitations, the American Cancer Society estimates do provide evidence of current patterns of cancer incidence and mortality in the United States. Such estimates will assist in continuing efforts to reduce the public health burden of cancer.

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TABLE 11 Trends in Five-year Relative Survival Rates* (%) for Selected Cancer Sites, by Race and Year of Diagnosis, United States, 1974 to 2000
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 2000


66 32 89 64 16 86 64 67 48 8 15 91 32 60 61 44 4 100 65 22 96 97 83 74 86

All Races 1974 to 1976


50 22 75 50 5 71 52 66 34 4 13 80 25 47 54 37 3 67 49 15 79 92 73 69 88

Site All Cancers Brain & ONS Breast (female) Colon Esophagus Hodgkin disease Kidney & renal pelvis Larynx Leukemia Liver & bile duct Lung & bronchus Melanoma of the skin Myeloma Non-Hodgkin lymphoma Oral cavity & pharynx Ovary** Pancreas Prostate Rectum Stomach Testis Thyroid Urinary bladder Uterine cervix Uterine corpus

1983 to 1985
54 26 79 59 9 79 56 69 42 6 14 85 27 55 55 40 3 76 56 16 91 93 78 71 85

1974 to 1976
39 27 63 46 4 69 49 60 31 1 12 67 28 49 36 41 3 58 42 16 76 88 48 64 62

1983 to 1985
40 32 64 50 6 77 55 55 34 4 11 75 31 45 35 42 5 64 44 19 88 92 60 61 54

1995 to 2000
55 38 75 54 9 80 64 51 39 5 13 74 32 51 39 38 4 96 55 24 87 95 62 66 63

1983 to 1985
53 27 78 58 8 79 56 67 41 6 14 85 28 54 53 41 3 75 55 17 91 94 78 69 83

1995 to 2000
64 33 88 63 14 85 64 65 46 8 15 91 32 59 59 44 4 99 64 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 2000, and followed through 2001. The difference in rates between 1974 to 1976 and 1995 to 2000 is statistically significant (P 0.05). ONS, other nervous system. 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 ovarian tumors, have affected 1995-2000 survival rates. Source: Ries LAG, Eisner MP, Kosary CL, et al.3

TABLE 12

Fifteen Leading Causes of Death Among Children Aged 1 to 14, United States, 2002
Number of Deaths 12,008 4,359 1,474 947 779 420 264 201 201 174 149 144 74 50 37 35 2,700

Rank

Cause of Death All Causes Accidents (unintentional injuries) Cancer Congenital anomalies Assault (homicide) Heart diseases Intentional self-harm (suicide) Chronic lower respiratory disease Influenza & pneumonia Septicemia In situ & benign neoplasms Cerebrovascular disease Anemias Meningitis Diabetes mellitus Nephritis, nephrotic syndrome, & nephrosis All other causes

Percent (%) of Total Deaths* 100.0 36.3 12.3 7.9 6.5 3.5 2.2 1.7 1.7 1.4 1.2 1.2 0.6 0.4 0.3 0.3 22.5

Death Rate 21.2 7.7 2.6 1.7 1.4 0.7 0.5 0.4 0.4 0.3 0.3 0.3 0.1 0.1 0.1 0.1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

*Percentages may not total 100 due to rounding. Symptoms, signs, and abnormalities, events of undetermined intent, certain perinatal conditions, and complications from treatment were excluded from ranking order. Rates are per 100,000 population and age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes, 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

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TABLE 13 Trends in Five-year Relative Cancer Survival Rates* (%) for Children Under Age 15, United States, 1974 to 2000
Five-year Relative Survival Rates (%) Year of Diagnosis Site All sites Acute lymphocytic leukemia Acute myeloidleukemia Bones & joints Brain & other nervous system Hodgkin disease Neuroblastoma Non-Hodgkin lymphoma Soft tissue Wilms tumor 1974 to 1976 56 53 14 55 55 78 53 45 60 74 1977 to 1979 62 67 26 52 56 84 53 50 68 78 1980 to 1982 65 71 25 54 56 91 53 61 65 86 1983 to 1985 68 69 30 57 62 90 55 71 70 87 1986 to 1988 71 78 33 63 63 90 60 70 67 91 1989 to 1991 73 80 36 62 62 94 68 75 78 93 1995 to 2000 79 85 53 73 73 96 66 85 75 92

*Survival rates are adjusted for normal life expectancy and are based on follow-up of patients through 2001. The difference in rates between 1974 to 1976 and 1995 to 2000 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

REFERENCES 1. National Center for Health Statistics, Division of Vital Statistics. Centers for Disease Control Web site. Available at: http://www.cdc.gov/ nchs/nvss.htm. Accessed September 2004. 2. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat database. Incidence - SEER 9 Regs Public-Use, Nov 2003 Sub (19732001). Available at: www. seer.cancer.gov. Released April 2004, based on the November 2002 submission. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Accessed October 15, 2004. 3. Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 19752001. Bethesda, MD: National Cancer Institute. Available at: http://seer.cancer.gov/csr/1975_2001/ Accessed October 15, 2004. 4. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat database. Incidence - SEER 12 Regs Public-Use, Nov 2002 Sub for Expanded Races (19922001). Available at: www.seer.cancer.gov. Released April 2004, based on the November 2003 submission. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Accessed October 15, 2004. 5. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat database. Incidence

- SEER 11 Regs Public-Use, Nov 2003 Sub for Hispanics (19922001). Released April 2004, based on the November 2003 submission. Available at: www.seer.cancer.gov. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Accessed October 15, 2004. 6. US Census Bureau. Available at: http://www. census.gov. Accessed September 2004. 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. Manual of the 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: WHO; 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 mortality counts for the current calendar year. CA Cancer J Clin 2004;54:30 40. 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 2004;54:78 93. 16. Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin 2002;52:326 341. 17. Bach PB, Schrag D, Brawley OW, et al. Survival of blacks and whites after a cancer diagnosis. JAMA 2002;287:2106 2112. 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.

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