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Published online before print May 27, 2009
CA Cancer J Clin 2009; 59:225-249
doi: 10.3322/caac.20006
© 2009 American Cancer Society
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Cancer Statistics, 2009

Ahmedin Jemal, DVM, PhD1, Rebecca Siegel, MPH2, Elizabeth Ward, PhD3, Yongping Hao, PhD4, Jiaquan Xu, MD5 and Michael J. Thun, MD, MS6

1Strategic Director, Cancer Surveillance, Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
2Manager, Surveillance Information Services, Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
3Vice President, Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
4Senior Epidemiologist, Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
5Epidemiologist, Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
6Vice President Emeritus, Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia

Corresponding author: Ahmedin Jemal, DVM, PhD, Surveillance and Health Policy Research, American Cancer Society, 250 Williams Street, NW, Atlanta, GA 30303-1002; ahmedin.jemal{at}cancer.org

DISCLOSURES: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors report no conflicts of interest.


   Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Selected Findings
 Cancer Occurrence by...
 Cancer in Children
 Limitations
 References
 
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, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are standardized by age to the 2000 United States standard million population. A total of 1,479,350 new cancer cases and 562,340 deaths from cancer are projected to occur in the United States in 2009. Overall cancer incidence rates decreased in the most recent time period in both men (1.8% per year from 2001 to 2005) and women (0.6% per year from 1998 to 2005), largely because of decreases in the three major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and in two major cancer sites in women (breast and colorectum). Overall cancer death rates decreased in men by 19.2% between 1990 and 2005, with decreases in lung (37%), prostate (24%), and colorectal (17%) cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2005 decreased by 11.4%, with decreases in breast (37%) and colorectal (24%) cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates has resulted in the avoidance of about 650,000 deaths from cancer over the 15-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years of age. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. CA Cancer J Clin 2009;59:225-249. � 2009 American Cancer Society, Inc.


   Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Selected Findings
 Cancer Occurrence by...
 Cancer in Children
 Limitations
 References
 
Cancer is a major public health problem in the United States and many other parts of the world. 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 numbers of new cancer cases and deaths in 2009.


   Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Selected Findings
 Cancer Occurrence by...
 Cancer in Children
 Limitations
 References
 
    Data Sources
Mortality data from 1930 to 2006 in the United States were obtained from the National Center for Health Statistics (NCHS).1 Incidence data for long-term trends (1975–2005), 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, covering about 26% of the US population.2,3,4,5 Incidence data (1995–2005) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Center for Disease Control (CDC)'s National Program of Cancer Registries (NPCR), through the North American Association of Central Cancer Registries (NAACCR). State-specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and NPCR. Population data were obtained from the US Census Bureau.7 Causes of death were coded and classified according to the International Classification of Diseases (ICD-8, ICD-9, and ICD-10).8,9,10 Cancer cases were classi fied according to the International Classification of Diseases for Oncology.11

    Estimated New Cancer Cases
The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer registration is incomplete in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3–4 years behind the current year because of the time required for data collection and compilation. Estimated new cancer cases in the current year (2009) were projected by using a spatiotemporal model12 on the basis of incidence data from 1995 through 2005 from 41 states and the District of Columbia that met NAACCR's high-quality data standard for incidence, covering about 85% of the US population. The method also considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer-screening behaviors as predictors of incidence, and accounts for expected delays in case reporting.

    Estimated Cancer Deaths
We used the state-space prediction method13 to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2009. 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 2009 on the basis of the number that occurred each year from 1969 to 2006 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 2006. Causes of death for 2006 were coded and classified according to ICD-10.8 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 1975 through 2005.3 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 2005) are adjusted for delays in reporting where possible. Delayed reporting primarily affects the most recent 1–3 years of incidence data (in this case, 2003–2005), especially for cancers such as melanoma, leukemia, 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 many specific cancer sites.14 Delay-adjusted rates provide a more accurate assessment of trends in the most recent years for which data are available. Long-term incidence and mortality trends (1975–2005) for selected cancer sites were previously published in the 2008 Annual Report to the Nation on the Status of Cancer.15

We also provide the contribution of individual cancer sites to the total decrease in overall cancer death rates since 1990 in men and since 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age-standardized cancer death rates over these time intervals. The total number of cancer deaths avoided was calculated by applying the age-specific cancer death rates in the peak year for the age-standardized cancer death rates (1990 for males and 1991 for females) to the corresponding age-specific populations in the subsequent years through 2005 to obtain the number of expected deaths in each calendar year had the death rates not decreased. We then summed the difference between the number of expected and observed deaths in each age group and calendar year for men and women separately to obtain the total number of cancer deaths avoided over the 14-year (women) or 15-year (men) interval.


   Selected Findings
Top
 Abstract
 Introduction
 Materials and Methods
 Selected Findings
Cancer Occurrence by...
 Cancer in Children
 Limitations
 References
 
    Expected Numbers of New Cancer Cases
Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the United States in 2009. The overall estimate of about 1.5 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal-cell and squamous-cell cancers of the skin. More than 1 million additional cases of basal-cell and squamous-cell skin cancers, about 62,280 cases of breast carcinoma in situ, and 53,120 cases of melanoma in situ are expected to be newly diagnosed in 2009. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2.


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  		TABLE 1 Estimated New Cancer Cases and Deaths by Sex, United States, 2009*
 

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  		TABLE 2 Age-standardized Incidence Rates for All Cancers Combined, 2001–2005, and Estimated New Cases* for Selected Cancers by State, United States, 2009
 
Figure 1 indicates the most common cancers expected to occur in men and women in 2009. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for about 50% of all newly diagnosed cancers. Prostate cancer alone accounts for 25% (192,280) of incident cases in men. On the basis of cases diagnosed between 1996 and 2004, 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%.


Figure 1
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  		FIGURE 1 Ten Leading Cancer Types for Estimated New Cancer Cases and Deaths, by Sex, United States, 2009.

*Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10.

 
The three most commonly diagnosed types of cancer among women in 2009 will be cancers of the breast, lung and bronchus, and colon and rectum, accounting for 51% of estimated cancer cases in women. Breast cancer alone is expected to account for 27% (192,370) of all new cancer cases among women.

    Expected Number of Cancer Deaths
Table 1 also shows the expected number of deaths from cancer projected for 2009 for men, women, and both sexes combined. It is estimated that about 562,340 Americans will die from cancer, corresponding to more than 1,500 deaths per day. Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common fatal cancers. These four cancers account for almost half of the total cancer deaths among men and women (Fig. 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 female cancer deaths in 2009. Table 3 provides the estimated number of cancer deaths in 2009 by state for selected cancer sites.


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  		TABLE 3 Age-standardized Death Rates for All Cancers Combined, 2001–2005, and Estimated Deaths* for Selected Cancers by State, United States, 2009
 
    Regional Variations in Cancer Rates
Table 4 depicts cancer incidence rates for selected cancer sites by state. By far, the largest variation in incidence among the cancer sites listed in Table 4 is seen for lung cancer, where rates (cases per 100,000 population) range from 39.6 in men and 22.4 in women in Utah to 136.2 in men and 76.2 in women in Kentucky. This variation reflects the large and continuing differences in smoking prevalence among states. Utah ranks lowest in adult-smoking prevalence and Kentucky highest. In contrast, state variation in the incidence rates of other cancer sites shown in Table 4 was smaller in both absolute and proportionate terms. For prostate and female breast cancers in particular, variation in incidence reflects differences in the use of screening tests in addition to differences in disease occurrence.


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  		TABLE 4 Cancer Incidence Rates* by Site and State, United States, 2001–2005
 
    Trends in Cancer Incidence and Mortality
Figures 2 to 5GoGoGo 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 join point analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates decreased by 1.8% per year from 2001–2005 in males and by 0.6% per year from 1998–2005 in females. Death rates for all cancer sites combined decreased by 2.0% per year from 2001–2005 in males and by 1.6% per year in females from 2002–2005, compared with declines of 1.5% per year in males from 1993–2001 and 0.8% per year in females from 1994–2002.


Figure 2
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  		FIGURE 2 Annual Age-adjusted Cancer Incidence and Death Rates for All Sites by Sex, United States, 1975–2005.

Rates are age adjusted to the 2000 US standard population. Incidence rates are adjusted for delays in reporting. Source: Incidence, Surveillance, Epidemiology, and End Results (SEER) program (www.seer.cancer.gov). Delay-adjusted incidence database, SEER incidence delay-adjusted rates from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released in April 2008, based on the November 2007 SEER data submission. Mortality, US mortality data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

 

Figure 3
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  		FIGURE 3 Annual Age-adjusted Cancer Incidence Rates among Males and Females for Selected Cancers, United States, 1975– 2005.

Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (www.seer.cancer.gov). Delay-adjusted incidence database, SEER Incidence Delay-Adjusted Rates, from nine registries, 1975 to 2005. National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2008, based on the November 2007 SEER data submission.

 

Figure 4
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  		FIGURE 4 Annual Age-adjusted Cancer Death Rates among Males for Selected Cancers, United States, 1930–2005.

Rates are age adjusted to the 2000 US population. Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the lung and bronchus, colon and rectum, and liver are affected by these changes. Source: US mortality data, 1960 to 2005, US Mortality Vol. 1930–1959, National Cancer Institute, Centers for Disease Control and Prevention, 2008.

 

Figure 5
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  		FIGURE 5 Annual Age-adjusted Cancer Death Rates* among Females for Selected Cancers, United States, 1930–2005.

*Rates are age adjusted to the 2000 US standard population. {dagger}Uterus includes uterine cervix and uterine corpus. Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the uterus, ovary, lung and bronchus, and colon and rectum are affected by these changes. Source: US mortality data, 1960 to 2005, US Mortality Vol. 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

 

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  		TABLE 5 Trends in Cancer Incidence and Death Rates for Selected Cancers by Sex, United States, 1975–2005
 
Mortality rates have continued to decrease across all four major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2005 after increasing for many decades (Table 5). Similarly, incidence trends decreased for all four major cancer sites except for lung cancer in women, in whom rates are still increasing although at a much slower rate than in the previous years. The lag in the temporal trend of lung cancer rates in women compared with men reflects historical differences in cigarette smoking between men and women; cigarette smoking in women peaked about 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2005 largely reflects increases in screening that can detect and remove precancerous polyps. The decrease in the breast cancer incidence rate since 1999 likely reflects a combination of two factors: the decrease in use of menopausal hormone therapy among postmenopausal women and delayed diagnosis because of decreased mammography utilization.16–17 The sharp decrease in prostate cancer incidence rates (by 4.4% per year from 2001–2005) may reflect recent stabilization of prostate-specific antigen (PSA) testing, which has resulted in decreased detection, or reduced number of undiagnosed cases.18–20

Table 6 shows the contribution of individual cancer sites to the total decrease in overall cancer death rates. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2005, death rates from cancer decreased by 19.2% among men and by 11.4% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in cancer death rates, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use during the past 50 years, while the decrease in death rates for female breast, colorectal, and prostate cancer largely reflects improvements in early detection and/or treatment. Between 1990–1991 and 2005, death rates increased for liver cancer in both men and women, for esophageal cancer and melanoma in men, and for lung and pancreatic cancer in women.


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  		TABLE 6 Contribution of Indvidual Cancer Sites to Decreases in Cancer Death Rates, 1990–2005 for Males and 1991–2005 for Females
 
    Recorded Number of Deaths from Cancer in 2006
A total of 559,888 cancer deaths were recorded in the United States in 2006, the most recent year for which actual data are available, accounting for about 23% of all deaths (Table 7). Despite a decrease in age-standardized death rates, there were 568 more cancer deaths reported in 2006 than in 2005 due to the growth and aging of the population (Table 8). This is because the decrease in the age-standardized death rates did not offset the influence of the aging and growth of the population on the total number of cancer deaths. When causes of death are ranked within age groups separated into 20-year intervals, cancer is one of the five leading causes of death in all age groups among both males and females (Table 9). Cancer is the leading cause of death among women ages 40 to 79 years and among men ages 60 to 79 years. It is also the leading cause of death among men and women younger than age 85 years (Fig. 6). A total of 474,808 persons younger than age 85 years died from cancer in the United States in 2006, compared with 394,257 deaths from heart disease.


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  		TABLE 7 Fifteen Leading Causes of Death, United States, 2006
 

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  		TABLE 8 Trends in the Recorded Number of Deaths from Selected Cancers by Sex, United States, 1990–2006
 

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  		TABLE 9 Ten Leading Causes of Death by Age and Sex, United States, 2006
 

Figure 6
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  		FIGURE 6 Death Rates for Cancer and Heart Disease for Ages Younger than 85 Years and 85 Years and Older, 1975–2005.

Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1960 to 2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

 
Table 10 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 younger than age 40 years, leukemia is the most common fatal cancer, whereas 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 aged 40 to 79 years, and prostate cancer among those aged 80 years and older. Among females, leukemia is the leading cause of cancer death before the age of 20 years, breast cancer ranks first at ages 20 to 59 years, and lung cancer ranks first at ages 60 years and older.


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  		TABLE 10 Reported Deaths for the Five Leading Cancer Sites by Age and Sex, United States, 2006
 
Figure 7 shows the total number of cancer deaths avoided since death rates began to decrease in 1991 in men and in 1992 in women. About 650,000 cancer deaths (481,300 in men and 169,100 in women) were averted during the 1991–1992 through 2005 time interval.


Figure 7
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  		FIGURE 7 Total Number of Cancer Deaths Avoided from 1991–2005 in Men and from 1992–2005 in Women.

The blue line represents the actual number of cancer deaths recorded in each year, and the bold red line represents the expected number of cancer deaths if cancer mortality rates had remained the same since 1990 and 1991.

 

   Cancer Occurrence by Race/Ethnicity
Top
 Abstract
 Introduction
 Materials and Methods
 Selected Findings
 Cancer Occurrence by...
Cancer in Children
 Limitations
 References
 
Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11). For all cancer sites combined, African American men have an 18% higher incidence rate and a 36% higher death rate than white men, whereas African American women have a 6% lower incidence rate but a 17% higher death rate than white women. For the specific cancer sites listed in Table 11, incidence and death rates are consistently higher in African Americans than in whites except for cancers of the breast (incidence) and lung (incidence and mortality) among women, and kidney (mortality) among both men and women. Factors known to contribute to racial disparities in mortality vary by cancer site and include differences in exposure to underlying risk factors (eg, historical smoking prevalence for lung cancer among men), access to high-quality regular screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment (for many cancers). The higher breast cancer incidence rates among white women is thought to reflect a combination of factors that affect both diagnosis (more frequent mammography in white women) and underlying disease occurrence (such as later age at first birth and greater use of menopausal hormone therapy among white than black women).21


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  		TABLE 11 Incidence and Mortality Rates* by Site, Race, and Ethnicity, United States, 2001–2005
 
Cancer incidence and death rates are lower in other racial and ethnic groups than in whites and African Americans for all cancer sites combined and for the four most common cancer sites. However, incidence and death rates are generally higher in minority populations than in whites for cancers of the uterine cervix, stomach, and liver. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders as they are in whites, reflecting increased prevalence of chronic infection with H pylori and hepatitis B and C viruses.22 Kidney cancer incidence and death rates are highest among American Indians/Alaskan Natives, although obesity is the only factor known to contribute to this disparity.

Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because long-term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1996 to 2005, incidence (unadjusted for delayed reporting) and death rates for all cancer sites combined decreased among whites, African Americans, Asian Americans/Pacific Islanders, and Hispanics in both men and women.15 Among American Indians/Alaska Natives residing in Indian Health Service (IHS) Contract Health Service Delivery Areas, mortality rates during this time period remained stable; trends in incidence rates could not be examined because the linkage of incident cancer cases with IHS was not complete at the time of this report.15

    Death Rates by Educational Attainment, Race, and Sex
Table 12 shows trends in death rates from 1993 to 2001 for the four major cancers by educational attainment among white and African American men and women aged 25 to 64 years.23 In general, death rates decreased significantly from 1993 through 2001 for those with 13 or more years of education but increased or remained constant in those with 12 or fewer years of education. For example, lung cancer death rates in white women decreased for those with 13 or more years of education, leveled in those with 12 years of education, and increased in those with fewer than 12 years of education. Similarly, colorectal cancer death rates among black men decreased for those with 16 or more years of education, leveled in those with 12–15 years of education, and increased in those with fewer than 12 years of education. Notably, the rate of decreases in death rates for each race-, sex-, and cancer-specific category followed an educational gradient in that each group of increasing educational level experienced a progressively steeper decrease. As a result, educational disparity in cancer mortality increased from 1993 to 2001 for lung and colorectal cancers (except among black women) and prostate cancer. Factors that may have contributed to this disparity include higher prevalence of risk factors, such as smoking and obesity, and limited access to medical services among less educated individuals. If everyone ages 25 to 64 years experienced the same cancer death rates as the most educated, 17,650 cancer deaths in women and 30,940 cancer deaths in men could have been averted or postponed in 2001, accounting for over 30% of the total number of cancer deaths in this age group.


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  		TABLE 12 Trends in Cancer Death Rates* by Education, Race, and Sex, United States, 1993–2001
 
    Lifetime Probability of Developing Cancer
The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (37%) (Table 13). However, because of the earlier median age of diagnosis for breast cancer compared with other major cancers, women have a slightly higher probability of developing cancer before age 60 years. 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.


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  		TABLE 13 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2003–2005*
 
    Cancer Survival by Race
Compared with whites, African American men and women have poorer survival once cancer is diagnosed. Five-year relative survival is lower in African Americans than in whites within every stratum of stage of diagnosis for nearly every cancer site (Fig. 8). These disparities may result from inequalities in access to and receipt of quality health care and/or from differences in comorbidities. As shown in Figure 9, African Americans areless 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. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear.24 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.25


Figure 8
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  		FIGURE 8 Five-year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004.

*The rate for localized stage represents localized and regional stages combined. {dagger}The standard error of the mean for the survival rate is between 5 and 10 percentage points. Staging is according to Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. Source: Ries LAG, Melbert D, and Krapcho M, et al.3

 

Figure 9
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  		FIGURE 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1996–2004.

*The rate for localized stage represents localized and regional stages combined. {dagger}Staging was performed according to the Surveillance, Epidemiology, and End Results historic stage categories rather than according to the American Joint Committee on Cancer staging system. For each cancer type, stage categories do not total 100% because sufficient information was not available to assign a stage to all cancer cases. Source: Ries LAG, Melbert D, Krapcho M, et al.3

 
There have been notable improvements since 1975 in relative 5-year survival rates for many cancer sites and for all cancers combined (Table 14). This is true for both whites and African Americans. Cancers for which survival has not improved substantially during the past 30 years include lung and pancreas. The improvement in survival reflects a combination of earlier diagnoses and improved treatments.


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  		TABLE 14 Trends in 5-Year Relative Survival Rates* (%) by Race and Year of Diagnosis, United States, 1975–2004
 
Relative survival rates cannot be calculated for racial and ethnic populations other than for whites and African Americans because accurate life expectancies (the average number of years of life remaining for persons who have attained a given age) 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, compared to non-Hispanic whites, all minority populations except Asian American/Pacific Islander women have a greater probability of dying from cancer within five years of diagnosis after accounting for differences in stage at diagnosis.20,26 For the four major cancer sites (prostate, female breast, lung and bronchus, and colon and rectum), minority populations are more likely than non-Hispanic whites to be diagnosed at a distant stage.26


   Cancer in Children
Top
 Abstract
 Introduction
 Materials and Methods
 Selected Findings
 Cancer Occurrence by...
 Cancer in Children
Limitations
 References
 
In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, surpassed only by accidents (Table 15). Leukemia (particularly acute lymphocytic leukemia) is the most common cancer in children (aged 0–14 years), followed by cancer of the brain and other nervous system, soft tissue sarcomas, renal (Wilms) tumors, and non-Hodgkin lymphoma.3 During the past 25 years, there have been significant improvements in the 5-year relative survival rate for all of the major childhood cancers (Table 16). The 5-year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed in 1975–1977 to 80% for those diagnosed in 1996–2004.3


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  		TABLE 15 Ten Leading Causes of Death Among Children Aged 1 to 14 Years, United States, 2006
 

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  		TABLE 16 Trends in 5-Year Relative Survival Rates* (%) for Children Younger than Age 15 Years, US, 1975–2004
 

   Limitations
Top
 Abstract
 Introduction
 Materials and Methods
 Selected Findings
 Cancer Occurrence by...
 Cancer in Children
 Limitations
References
 
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. Estimates are also affected by changes in method. The introduction of a new method for projecting incident cancer cases beginning with the 2007 estimates substantially affected the estimates for several cancers, particularly leukemia and female breast. (See Pickle et al for more detailed discussion.) Not all changes in cancer trendsare captured by modeling techniques. For these reasons, we discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. The preferred data sources for tracking cancer trends are the age-standardized or age-specific cancer death rates from the National Center for Health Statistics and cancer incidence rates from SEER or NPCR, although these data are 3 and 4 years old, respectively, by the time that they become available. Nevertheless, the American Cancer Society estimates of the number of new cancer cases and deaths in the current year provide reasonably accurate estimates of the burden of new cancer cases and deaths in the United States.


   Footnotes
 
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   References
Top
 Abstract
 Introduction
 Materials and Methods
 Selected Findings
 Cancer Occurrence by...
 Cancer in Children
 Limitations
 References
 

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P. N. Munster and J. T. Carpenter
Estradiol in Breast Cancer Treatment: Reviving the Past
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