Cancer Statistics, 2005
http://www.100md.com
《临床癌症学报》
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.
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.
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 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.2–5 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).7–9 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 age-specific cancer incidence rates collected by the SEER program2 and population data reported by 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 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 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.
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 formore 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 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 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 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
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 20-year 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).
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, 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 (Table 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 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 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
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.
Cancer Survival by Race
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 substantially 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 non-Hispanic 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
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 interpreted 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.
REFERENCES
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.
Surveillance, Epidemiology, and End Results (SEER) Program. SEERStat database. Incidence - SEER 9 Regs Public-Use, Nov 2003 Sub (1973–2001). 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.
Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975–2001. Bethesda, MD: National Cancer Institute. Available at: http://seer.cancer.gov/csr/1975_2001/ Accessed October 15, 2004.
Surveillance, Epidemiology, and End Results (SEER) Program. SEERStat database. Incidence - SEER 12 Regs Public-Use, Nov 2002 Sub for Expanded Races (1992–2001). 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.
Surveillance, Epidemiology, and End Results (SEER) Program. SEERStat database. Incidence - SEER 11 Regs Public-Use, Nov 2003 Sub for Hispanics (1992–2001). 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.
US Census Bureau. Available at: http://www.census.gov. Accessed September 2004.
World Health Organization. International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol. 1, 10th Rev. Geneva: WHO; 1992.
World Health Organization. International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol. 1, 9th Rev. Geneva: WHO; 1975.
World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol 1, 8th Rev. Geneva: WHO; 1967.
Fritz A, Percy C, Jack A, et al. (eds). International Classification of Diseases for Oncology. 3rd Ed. Geneva: WHO; 2000.
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: 43–51.
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.
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.
Ghafoor A, Jemal A, Ward E, et al. Trends in breast cancer by race and ethnicity. CA Cancer J Clin 2003; 53: 342–355.
Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004; 54: 78–93.
Ghafoor A, Jemal A, Cokkinides V, et al. Cancer statistics for African Americans. CA Cancer J Clin 2002; 52: 326–341.
Bach PB, Schrag D, Brawley OW, et al. Survival of blacks and whites after a cancer diagnosis. JAMA 2002; 287: 2106–2112.
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: 3–27.
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: 1985–1993.(Ahmedin Jemal, DVM, PhD, )
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.
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.
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 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.2–5 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).7–9 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 age-specific cancer incidence rates collected by the SEER program2 and population data reported by 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 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 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.
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 formore 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 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 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 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
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 20-year 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).
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, 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 (Table 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 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 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
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.
Cancer Survival by Race
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 substantially 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 non-Hispanic 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
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 interpreted 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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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: 1985–1993.(Ahmedin Jemal, DVM, PhD, )