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Dr. Jemal is Program Director for Cancer Occurrence, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Ms. Thomas is Manager, Surveillance Information Services, 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. Thun is Vice President for Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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MATERIALS AND METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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Estimated New Cancer Cases
Because the United States has no nationwide cancer registry, precisely how many new cases of cancer are diagnosed each year in the United States and in all individual states is unknown. Consequently, we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 1998 by using age-specific cancer incidence rates collected by NCI's SEER program2 coupled with population data reported by the US Census Bureau.3 We then forecasted the number of cancer cases expected to be diagnosed in the United States in the year 2002 using an autoregressive quadratic model fitted to the annual cancer case estimates.7
The observed trend in prostate cancer incidence was not compatible with the selected forecasting model, as rates increased greatly between 1988 and 1992, declined sharply between 1992 and 1995, and leveled off from 1995 to 1998.8,9 This trend likely reflects extensive use of prostate-specific antigen (PSA) screening in a previously unscreened population and the subsequent increase in cancer diagnoses at an early stage.10,11 We therefore assumed that the number of prostate cancer cases is approaching the pattern in effect prior to widespread use of PSA screening; and then estimated the number of new cases of prostate cancer for 2002 using a linear projection based on data from 1979 to 1989 and 1995 to 1998 only.
We could not use the methods mentioned above to estimate new cancer cases for individual states because complete cancer incidence and case counts are not available for many states. To derive these estimates, we relied on state cancer death statistical data and assumed that the ratio of cancer deaths to cancer cases was the same in each state as in the United States on the whole.
Estimated Cancer Deaths
We estimated the number of cancer deaths expected to occur in the United States and in each state in the year 2002 using underlying cause-of-death data from death certificates as reported to the National Center for Health Statistics.1 The recorded numbers of cancer deaths occurring annually from 1979 to 1999 in the United States and in each state were fitted with autoregressive quadratic models7 in order to forecast the number of cancer deaths expected to occur in 2002.
Other Statistics
We provide mortality statistics for the leading causes of deaths and deaths from cancer for 1999. Causes of death for 1999 mortality data were coded and classified according to ICD-10 rulings, replacing ICD-9 coding used for deaths that occurred from 1979 through 1998. Comparisons between the recorded number of deaths between 1998 and 1999 were adjusted for the change in ICD coding rules using a comparability ratio.12
This report also provides updated statistics on the probability of developing cancer,13 trends in cancer mortality and incidence, and five-year relative survival rates for selected cancer sites based on data from 1973 through 1998.2 Cancer incidence and death rates are standardized to the 1970 US standard population and expressed per 100,000 person-years. Death rates for 1999 are presented using both 1970 and 2000 US standard population for age standardization to illustrate the impact of the 2000 standard population on death rates.
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SELECTED FINDINGS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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. The estimate of about 1,284,900 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 one million cases of basal and squamous cell skin cancers, 54,300 cases of breast carcinoma in situ, and 34,300 cases of in situ melanoma are expected to be newly diagnosed in 2002. The estimated number of new cancer cases by state and cancer site are shown in Table 2.
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lists the most common cancers expected to occur in men and women in 2002. Among men, cancers of the prostate, lung and bronchus, and colon and rectum comprise 55 percent of all new cancer cases. Prostate cancer accounts for 30 percent (189,000) of new cancer cases in men. Based on the most current data on stage distributions of prostate cancer cases, however, over 80 percent of these estimated new cases are expected to be diagnosed at local and regional stages with nearly 100 percent five-year relative survival rates.
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Expected Number of Cancer Deaths
Table 1 also shows the expected number of cancer deaths in 2002 for men, women, and both sexes combined. It is estimated that about 555,500 Americans will die from cancer, corresponding to 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 causes of cancer deaths. These four cancers account for more than half of the total cancer deaths among men and women (Figure 1
). Lung cancer has surpassed breast cancer as the leading cause of cancer death in women since 1987 and is expected to account for about 25 percent of all female cancer deaths in 2002. The estimated number of cancer deaths in 2002 by state appears in Table 3.
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). Mortality declined among both males and females, while incidence declined only in males and increased slightly in females. Most notably, African-American men showed the largest decline for both incidence and mortality (data not shown). Recent declines or stabilizations in incidence (Figure 3) and mortality (Figures 4 and 5) have occurred for several leading cancer sites.
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). A significant downturn in the incidence of lung and bronchus cancer in males began in the early 1980s; between 1992 and 1998, incidence rates decreased 2.4 percent per year. Overall incidence rates of female lung and bronchus cancer have been stable since 1991, but rates have begun to decline in women under 65 years of age from 28.3 percent per 100,000 women in 1991 to 22.7 percent per 100,000 women in 1998. In both men and women, colon and rectum cancer incidence declined between the mid-1980s and the mid-1990s and stabilized thereafter. Prostate cancer incidence rates have generally leveled off during the years 1995 to 1998, following large annual increases of 17.5 percent from 1988 to 1992 and a sharp decline of 10.0 percent per year from 1992 to 1995.8,9
Similar to trends in incidence, significant decreases in death rates for lung and bronchus cancer have occurred only among males (on average 1.8 percent per year during 1990 to 1998) (Figure 4); the increase in lung cancer death rates among females has begun to slow recently (Figure 5).
Breast cancer death rates among females declined annually by 1.6 percent from 1989 to 1995, and by 3.4 percent since then. Age-specific analysis revealed that breast cancer mortality declined in every age group except in African-American women, age 75 and older; the decline was more pronounced in females younger than 50 years old in both whites and African Americans.9 Colon and rectum cancer death rates have been decreasing by about 2 percent per year since 1984 in females and 1987 in males.8,9 Prostate cancer deaths peaked in 1991, and have decreased an average of 4.5 percent per year from 1994 through 1998.8,9
The Recorded Number of Deaths from Cancer and Other Causes in 1999
A total of 549,838 cancer deaths were recorded in 1999 in the United States, up by 8,306 deaths compared with 1998. Adjusting for changes in rules for selecting underlying cause of death reduced the increase in the number of cancer deaths to 4,624. Cancer deaths accounted for 23 percent of all deaths, ranking second only to death from heart disease (Table 4). When deaths are categorized by age and sex, cancer is by far the leading cause of death among women aged 40 to 79 and among men aged 60 to 79 (Table 5). In contrast, cancer ranks fifth as a cause of death among men aged 20 to 39.
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describes the leading site-specific causes of cancer death by age for males and females. Among men under age 40, leukemia is the most common fatal cancer, while lung and bronchus cancer ranks first for men aged 40 years and older. Colorectal cancer is the second most common site causing death among men 40 to 79 years old. Among women under age 20, leukemia is the leading cause of cancer death; breast cancer ranks first as the cause of cancer death for women between age 20 to 59 years, and lung cancer is the leading cause of cancer death for women aged 60 years and above.
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). Accounting for the change in ICD coding rules diminished the increase to 1,849. The recorded number of deaths from lung cancer continued to decrease among men. The decrease in lung cancer death was accentuated by the change in ICD code from ICD-9 to ICD-10. The new ICD code more rigorously excluded cancers metastatic to the lung, causing a decline of 1.6 percent of total lung cancer deaths.12 Accounting for this change substantially reduced the decline in the number of lung cancer deaths (from 1,998 deaths to 508 deaths). The number of prostate cancer deaths has continued to decline since 1995. From 1998 to 1999, the recorded number of prostate cancer deaths decreased by 474 and 906 with and without adjustment for the change in ICD codes and coding rules, respectively. Colon and rectum cancer deaths among men increased by about 300 from 1998 to 1999, and were affected very little by the new ICD version.
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). Adjusting for changes in ICD coding rules reduced the increase from 4,539 to 2,775 cancer deaths. There were 413 fewer female lung cancer deaths in 1999, compared with the year before, due to a decrease of 1.6 percent of lung cancer deaths resulting from the implementation of ICD-10. Accounting for this change resulted in 615 more lung cancer deaths in 1999 compared with 1998, consistent with the long-term increasing trend. Female breast cancer deaths decreased by 593, and decreased even more (827 deaths) when accounting for changes in ICD coding rules. The number of colorectal cancer deaths among females has remained fairly constant in recent years.
Lifetime Probability of Developing Cancer
The lifetime probability of developing cancer is higher for men (43.39 percent) than for women (38.25 percent) (Table 9). However, because of breast cancer, women have a slightly higher probability of developing cancer before the age of 60.
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CANCER OCCURRENCE BY RACE/ETHNICITY |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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). Overall, African Americans have the highest incidence and mortality rates for cancer. Incidence rate is 60 percent higher in African Americans than in Hispanics and Asian/Pacific Islanders and is more than twice as high as the rate for American Indians. Similarly, the mortality rate from cancer is about 33 percent higher in African Americans than among whites, and more than twice as high as cancer death rates in Asian/Pacific Islanders, American Indians, and Hispanics. Except for female breast cancer incidence and female lung cancer death rates, where rates are highest in whites, race- and sex-specific incidence and death rates for the most common cancer sites are higher for African Americans than for any of the other racial and ethnic groups. From 1992 through 1998, cancer incidence rates decreased by 2 percent per year among Hispanics, by 1.7 percent for African Americans, and by 1.2 percent for whites, while rates remained relatively stable among American Indians/Alaska Natives and Asian/Pacific Islanders (data not shown). Similarly, the annual mortality rate for all cancer sites combined decreased 1.3 percent in African Americans, 1.2 percent in Asian/Pacific Islanders, 1.1 percent among whites, and 0.9 percent among Hispanics; and it leveled off in American Indians/Alaska Natives. For race- and sex-specific trends, African-American men showed the largest decrease in both incidence and mortality during the same calendar years.
Cancer Survival By Race
A poorer probability of survival once a cancer diagnosis is made contributes to the higher death rates among African-American men and women. 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. This is true for most of the common cancer sites (Figure 6). Furthermore, for nearly every cancer site, African Americans have lower five-year relative survival rates than whites at each stage of diagnosis (Figure 7), suggesting the possible influences of differences in treatment, tumor pathology, and comorbid conditions.
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). This is true for both whites and African Americans. Cancer sites without significant improvements in survival in the past 25 years include uterine cervix, larynx, and oral cavity.
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CANCER IN CHILDREN |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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). The most commonly occurring cancers found in children are leukemias (in particular, acute lymphocytic leukemia), tumors of the central and sympathetic nervous systems, lymphomas, soft-tissue sarcomas, and renal tumors.9 Over the past 25 years, there have been significant improvements in the five-year relative survival rate for many childhood cancers, especially acute lymphocytic and acute myeloid leukemia, non-Hodgkin's lymphoma, and Wilms' Tumor (Table 12). Between the years 1974 to 1976 and 1992 to 1997, the five-year relative survival rate among children for all cancer sites combined improved from 55.7 to 77.1 percent.9
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LIMITATIONS AND FUTURE CHALLENGES |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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Our estimates are based on the most currently available cancer mortality and incidence data; however, these data are three and four years old, respectively, at the time that the estimates are calculated. Unanticipated changes that may have occurred in the three-or four-year interval between 1998 or 1999 and 2002 are not captured by our modeling efforts. Finally, our 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 the 1999 mortality data, the underlying causes of deaths were coded and classified using ICD-10 coding rules, replacing ICD-9 coding designations used for deaths occurring between 1979 and 1998. Several important changes have taken place in selection and coding of primary sites of malignant neoplasm in ICD-10 codes, including the following two changes:
These coding changes will undoubtedly affect the temporal trends of various cancer mortalities. For the changes in the number of deaths from the most common cancer sites between 1998 and 1999, we have accounted for the change in ICD coding rules using a comparability ratio conversion method, and assumed that they are not influenced by sex.12
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 us in our continuing effort to reduce the public health burden of cancer.
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Acknowledgments |
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Footnotes |
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REFERENCES |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSSELECTED FINDINGSCANCER OCCURRENCE BY...CANCER IN CHILDRENLIMITATIONS AND FUTURE...REFERENCES |
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Uterus cancer death rates are for uterine cervix and uterine corpus combined.
The rate for local stage represents local and regional stages combined.