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Dr. Jemal is Program Director, Cancer Occurrence, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Ms. Siegel is Manager, Surveillance Information Services, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Ward is Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Mr. Murray is Manager, Surveillance Data Systems, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Mr. Xu is Epidemiologist, Mortality Statistics Branch, Division of Vital Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
Ms. Smigal is Epidemiologist, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Thun is Vice-President, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
| ABSTRACT |
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| INTRODUCTION |
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| MATERIALS AND METHODS |
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Estimated New Cancer Cases
The precise number of cancer cases diagnosed each year in the nation is unknown because complete cancer registration has not yet been achieved in many states. Consequently, for the national estimate we first estimated the number of new cancer cases occurring annually in the United States from 1979 through 2002, using age-specific cancer incidence rates collected by the SEER program2 and population data reported by the US Census Bureau.6 We then forecast the number of cancer cases expected to be diagnosed in the United States in the year 2006 using an autoregressive quadratic time-trend model fitted to the annual cancer case estimates.11 For estimates of new cancer cases in individual states, we projected the number of deaths from cancer in each state in 2006 and assumed that the ratio of estimated cancer deaths to cases in each state equaled that in the United States.
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 2006. Projections arebased on underlying cause-of-death from death certificates as reported to the NCHS.1 This model projects the number of cancer deaths expected to occur in 2006 based on the number that occurred each year from 1969 to 2003 in the United States and in each state separately.
Other Statistics
We provide mortality statistics for the leading causes of death as well as deaths from cancer in the year 2003. Causes of death for 2003 were coded and classified according to ICD-10.7 This report also provides updated statistics on trends in cancer incidence and mortality rates, the probability of developing cancer, and 5-year relative survival rates for selected cancer sites based on data from 1974 through 2002.3 All age-adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population.
The long-term incidence rates and trends (1975 to 2002) are adjusted for delays in reporting where possible. Delayed reporting affects the most recent 1 to 3 years of incidence data (in this case, 2000 to 2002), especially for cancers such as melanoma and prostate that are frequently diagnosed in outpatient settings. The NCI has developed a method to account for expected reporting delays in SEER registries for all cancer sites combined and several specific cancer sites when long-term incidence trends are analyzed.13 Delay-adjusted incidence provides a more accurate assessment of trends in the most recent years for which data are available.
| SELECTED FINDINGS |
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Figure 1 indicates the most common cancers expected to occur in men and women in 2006. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for over 56% of all newly diagnosed cancer. Prostate cancer alone accounts for about 33% (234,460) of incident cases in men. Based on cases diagnosed between 1995 and 2001, an estimated 91% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which 5-year relative survival approaches 100%.
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The three most commonly diagnosed cancers among women in 2006 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for about 54% of estimated cancer cases in women. Breast cancer alone is expected to account for 31% (212,920) of all new cancer cases among women.
Expected Number of New Cancer Deaths
Table 1 also shows the expected number of cancer deaths in 2006 for men, women, and both sexes combined. It is estimated that about 564,830 Americans will die from cancer, corresponding to over 1,500 deaths per day. Cancers of the lung and bronchus, colon and rectum, and prostate in men, and cancers of the lung and bronchus, breast, and colon and rectum in women continue to be the most common fatal cancers. These four cancers account for half of the total cancer deaths among men and women (Figure 1). Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. Lung cancer is expected to account for 26% of all cancer deaths among females in 2006. Table 3 provides the estimated number of cancer deaths in 2006 by state for selected cancer sites.
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Regional Variations in Cancer Rates
Table 4 depicts cancer incidence for select cancers by state. Rates vary widely across states. For example, among the cancers listed in Table 4, the largest variation in the incidence rates (in proportionate terms) occurred in lung cancer in which rates (cases per 100,000 population) ranged from 42.3 in men and 21.5 in women in Utah to 138.2 in men and 72.3 in women in Kentucky. In contrast, the variation in female breast cancer incidence rates was small, ranging from 116.6 cases per 100,000 populations in New Mexico to 149.5 cases in Washington. Factors that contribute to the state variations in the incidence rates include differences in the prevalence of risk factors, access to and utilization of early detection services, and completeness of reporting. For example, the state variation in lung cancer incidence rates reflects differences in smoking prevalence; Utah ranks lowest in adult smoking prevalence and Kentucky highest.
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Trends in Cancer Incidence and Mortality
Figures 2 to 5![]()
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depict long-term trends in cancer incidence and death rates for all cancers combined and for selected cancer sites by sex. Table 5 shows incidence and mortality patterns for all cancer sites and for the four most common cancer sites based on joinpoint analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates stabilized in men from 1995 to 2002 and increased in women by 0.3% per year from 1987 to 2002. Death rates for all cancer sites combined decreased by 1.5% per year from 1993 to 2002 in males and by 0.8% per year in females from 1992 to 2002.
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Mortality rates have continued to decrease across all four major cancer sites in men and in women, except for female lung cancer in which rates continued to increase by 0.3% per year from 1995 to 2002 (Table 5). The incidence trends are mixed, however. Lung cancer incidence rates are declining in men and have leveled off after increasing for many decades in women. The lag in the temporal trend of lung cancer incidence rates in women compared to men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked about 20 years later than in men. Colorectal cancer incidence rates have decreased from 1998 through 2002 in both males and in females. Prostate and female breast cancer incidence rates have continued to increase, although at a slower rate than in previous years. The continuing increase may be attributable to increased screening through prostate-specific antigen (PSA) testing for prostate cancer and mammography for breast cancer. Use of postmenopausal hormone therapy and increased prevalence of obesity may also be factors influencing the increase in female breast cancer incidence.14
Changes in the Recorded Number of Deaths from Cancer from 2002 to 2003
A total of 556,902 cancer deaths were recorded in the United States in 2003, the most recent year for which actual dates are available. About 369 fewer deaths were recorded in 2003 than in 2002, the first decrease since national mortality record keeping was instituted in 1930. Cancer accounted for about 23% of all deaths, ranking second only to heart disease (Table 6). When cause of death is ranked within each age group, categorized in 20-year age intervals, cancer is one of the five leading causes of death in each age group among both males and females (Table 7). Cancer is the leading cause of death among women ages 40 to 79 and among men ages 60 to 79. When age-adjusted death rates are considered (Figure 6), cancer is the leading cause of death among men and women under age 85. A total of 476,844 people under age 85 died from cancer in the US in 2003, compared with 436,258 deaths from heart disease.
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Table 8 presents the number of deaths from all cancers combined and the five most common cancer sites for males and females at various ages. Among males under age 40, leukemia is the most common cause of cancer death, whereas cancer of the lung and bronchus predominates in men age 40 years and older. Colon and rectum and prostate cancer are the second most common causes of cancer death among men 40 to 79 years old and age 80 years and older, respectively. Among females, leukemia is the leading cause of cancer death before age 20, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at age 60 years and older.
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From 2002 to 2003, the number of recorded cancer deaths decreased by 778 in men, but increased by 409 in women (Table 9). The largest change in the total number of deaths from the major cancers was for prostate cancer in men (decreased by 892) and for lung cancer in women (increased by 575).
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| CANCER OCCURRENCE BY RACE/ETHNICITY |
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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 are rates in Whites and African Americans. However, incidence and death rates for cancers of the uterine cervix, stomach, and liver are generally higher in minority population than in Whites. Stomach and liver cancer incidence and death rates are more than twice as high in Asian/Pacific Islanders as in Whites, reflecting increased exposure to infectious agents such as H. pylori and Hepatitis B virus.15
Trends in cancer incidence can only be adjusted for delayed reporting in Whites and African Americans, and not in other racial and ethnic subgroups because the long-term incidence data required for delay adjustment are available only for Whites and for African Americans. From 1992 to 2002, incidence rates for all cancer sites combined, not adjusted for delayed reporting, decreased by 2.7% per year among American Indians/Alaskan Natives, by 1.0% per year in African Americans, by 0.6% among Asian/Pacific Islanders, and by 0.4% among Hispanic-Latinos and Whites. Similarly, the death rate for all cancers combined decreased from 1992 through 2002 by 1.7% per year in Asian/Pacific Islanders, by 1.5% among African Americans, by 0.9% among Whites, and by 0.6% among 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 11). However, because of the relatively early age of onset of breast cancer, women have a slightly higher probability of developing cancer before the age of 60 years. It is noteworthy that these estimates are based on the average experience of the general population and may over or under estimate individual risk because of differences in exposure and/or genetic susceptibility.
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Cancer Survival by Race
Compared with Whites, African American men and women have poorer survival once a cancer diagnosis is made. As shown in Figure 7, African Americans are less likely than Whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated, and are more likely to be diagnosed with cancer at a regional or distant stage of disease. Five-year relative survival is lower in African Americans than Whites within each stratum of stage of diagnosis for nearly every cancer site (Figure 8). These disparities may result from inequalities in access to and receipt of quality health care and/or from 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 African Americans who receive similar cancer treatment and medical care as Whites experience similar outcomes.17
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There have been notable improvements over time in relative five-year survival rates for many cancer sites and for all cancers combined (Table 12). This is true for both Whites and African Americans. However, 5-year relative survival is still very poor (less than 25%) for many cancers, including pancreas, liver, esophagus, lung, and stomach.
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Relative survival rates cannot be calculated for other racial and ethnic populations because accurate life expectancies are not available. However, based on cause-specific survival rates of cancer patients diagnosed from 1992 to 2000 in SEER areas of the United States, all minority populations, except Asian/Pacific Islander women, have a greater probability of dying from cancer within 5 years of diagnosis than non-Hispanic Whites after accounting for 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 |
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| CANCER AROUND THE WORLD |
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| LIMITATIONS AND FUTURE CHALLENGES |
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| Footnotes |
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| References |
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