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Cancer Statistics, 2008

Dr. Jemal is Strategic Director, Cancer Surveillance, 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 Managing Director, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Hao is Senior Epidemiologist, Surveillance Research, Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA.
Dr. Xu is Epidemiologist, Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
Mr. Murray is Manager, Surveillance Data Systems, 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

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 age-standardized to the 2000 US standard million population. A total of 1,437,180 new cancer cases and 565,650 deaths from cancer are projected to occur in the United States in 2008. Notable trends in cancer incidence and mortality include stabilization of incidence rates for all cancer sites combined in men from 1995 through 2004 and in women from 1999 through 2004 and a continued decrease in the cancer death rate since 1990 in men and since 1991 in women. Overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% and 10.5%, respectively, resulting in the avoidance of over a half million deaths from cancer during this time interval. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year, as well as the proportionate contribution of selected sites to the overall trends. Although much progress has been made in reducing mortality rates, stabilizing incidence rates, and improving survival, cancer still accounts for more deaths than heart disease in persons under age 85 years. Further progress can be accelerated by supporting new discoveries and 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 many other parts of the world. Currently, one in 4 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 2008.

    MATERIALS AND METHODS

    Data Sources
Mortality data from 1930 to 2005 in the United States were obtained from the National Center for Health Statistics (NCHS).¹ Incidence data for long-term trends (1975 to 2004), 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, currently covering about 26% of the US population.^2–5 Incidence data (1995 to 2004) for projecting new cancer cases were obtained from cancer registries that participate in the SEER program or the Centers for Disease Control and Prevention (CDC)’s National Program of Cancer Registries (NPCR) through the North American Association of Central Cancer Registries (NAACCR). State-specific incidence rates were abstracted from Cancer in North America (2000–2004) Volume One,⁶ 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).^8–10 Cancer cases were classified 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 complete cancer registration has not yet been achieved in some states. Furthermore, the most recent year for which incidence and mortality data are available lags 3 to 4 years behind the current year due to the time required for data collection and compilation. Estimated new cancer cases in the current year (2008) were projected using a spatio-temporal model¹² based on incidence data from 1995 through 2004 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 socio-demographic 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 2008. 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 2008 based on the number that occurred each year from 1969 to 2005 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 2005. Causes of death for 2005 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 2004.³ 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 2004) are adjusted for delays in reporting where possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 2002 to 2004), especially for cancers such as melanoma, leukemia, and prostate that are frequently diagnosed in outpatient settings. The National Cancer Institute 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.

We also provide estimates of the total number of cancer deaths avoided due to the reduction in age-standardized cancer death rates since 1991 in men and 1992 in women. We applied 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 2004 to obtain the number of expected deaths in each calendar year if the death rates had 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 13- or 14-year interval.

    SELECTED FINDINGS

    Expected Numbers of New Cancer Cases
Table 1 presents estimates of the numbers of new cases of invasive cancer expected among men and women in the United States in 2008. The overall estimate of about 1.44 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 cases of basal cell and squamous cell skin cancer, about 67,770 cases of breast carcinoma in situ, and 54,020 cases of in situ melanoma are expected to be newly diagnosed in 2008. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2.

View larger version (105K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 1 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths, by Sex, United States, 2008. *Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Estimates are rounded to the nearest 10.

    Expected Number of New Cancer Deaths
Table 1 also shows the expected number of deaths from cancer projected for 2008 for men, women, and both sexes combined. It is estimated that about 565,650 Americans will die from cancer, corresponding to over 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 4 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 female cancer deaths in 2008. Table 3 provides the estimated number of cancer deaths in 2008 by state for selected cancer sites.

View larger version (55K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 2 Annual Age-adjusted Cancer Incidence and Death Rates* for All Sites by Sex, United States, 1975 to 2004. *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, 9 Registries, 1975–2004." National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2007, based on the November 2006 SEER data submission. Mortality—US Mortality Data, 1960 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

View larger version (78K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 3 Annual Age-adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2004. *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, 9 Registries, 1975–2004." National Cancer Institute, DCCPS, Surveillance Research Program, Statistical Research and Applications Branch, released April 2007, based on the November 2006 SEER data submission.

View larger version (64K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 4 Annual Age-adjusted Cancer Death Rates* Among Males for Selected Cancers, United States, 1930 to 2004. *Rates are age-adjusted to the 2000 US standard population. Note: 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 2004, US Mortality Volumes, 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

View larger version (56K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 5 Annual Age-adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2004. *Rates are age-adjusted to the 2000 US standard population. Uterus includes uterine cervix and uterine corpus. Note: 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 2004, US Mortality Volumes 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

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 2004, death rates from cancer decreased by 18.4% among men and by 10.5% among women. Among men, reductions in death rates from lung, prostate, and colorectal cancers account for nearly 80% of the total decrease in cancer death rates, while reductions in death rates from breast and colorectal cancers account for 60% of the decrease among women. Lung cancer in men and breast cancer in women alone account for nearly 40% of the sex-specific decreases in cancer death rates. The decrease in lung cancer death rates among men is due to reduction in tobacco use over the past 40 years, while the decrease in death rates for colorectal, female breast, and prostate cancer largely reflects improvements in early detection and treatment.¹⁸ Between 1990/1991 and 2004, death rates increased substantially for lung cancer in women and for liver and intrahepatic bile duct cancer in men.

View larger version (52K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 6 Death Rates* for Cancer and Heart Disease for Ages Younger than 85 and 85 and Older, 1975 to 2004. *Rates are age-adjusted to the 2000 US standard population. Source: US Mortality Data, 1960 to 2004, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.

View larger version (47K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 7 Total Number of Cancer Deaths Avoided from 1991 to 2004 in Men and 1992 to 2004 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 1990/1991.

Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11). For all cancer sites combined, African American men have a 19% higher incidence rate and a 37% 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 Whites are thought to reflect a combination of factors that affect both diagnosis (such as more frequent mammography in White women) and the underlying factors that affect disease occurrence (such as later age at first birth and greater use of hormone replacement therapy among White compared with African American women).¹⁹

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 1995 to 2004, incidence rates in males for all cancer sites combined (unadjusted for delayed reporting) decreased among all racial and ethnic groups except American Indian/Alaska Native men; among women, rates stabilized in all racial and ethnic groups during the same time period. In contrast, death rates from cancer significantly decreased in each racial and ethnic group, with larger decreases in men than in women.³

    Death Rates by Educational Attainment, Race, and Sex
Table 12 shows death rates for all cancers combined and the 4 major cancers by educational attainment among White and African American men and women aged 25 to 64 years in 2001.²¹ The death rate for all cancers combined among less-educated (12 years of education) compared with more-educated (>12 years of education) people was more than twice as high in men and about 40% higher in women. For specific cancer sites, the ratio of death rates in the less-educated compared with the more-educated group ranged from 1.16 for breast cancer among African American women to 3.36 for lung cancer among White men. For lung cancer in men and women and for colorectal cancer in men, the absolute difference in death rates between the less educated and more educated was larger than the difference between Whites and African Americans by sex at each level of educational attainment. Factors that contribute to higher death rates from cancer in less-educated men and women include higher prevalence of risk factors such as smoking and obesity and limited access to medical services.

View larger version (156K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 8 Five-year Relative Survival Rates Among Patients Diagnosed with Selected Cancers by Race and Stage at Diagnosis, United States, 1996 to 2003. * The rate for localized stage represents localized and regional stages combined. The standard error of the survival rate is between 5 and 10 percentage points. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Melbert D, Krapcho M, et al.3

View larger version (127K): [in this window] [in a new window] [PowerPoint slide for Educational Purposes]   FIGURE 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1996 to 2003. *The rate for localized stage represents localized and regional stages combined. Note: Staging according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. For each cancer type, stage categories do not total 100% because sufficient information is not available to assign a stage to all cancer cases. Comparison of this data to that of previous years is discouraged due to the use of an expanded data set. Source: Ries LAG, Melbert D, Krapcho M, et al.3

    CANCER IN CHILDREN

Cancer is the second most common cause of death among children between the age of 1 and 14 years in the United States, surpassed only by accidents (Table 15). Leukemia (particularly acute lymphocytic leukemia) is the most common cancer in children (aged 0 to 14 years), followed by cancer of the brain and other nervous system, neuroblastoma, renal (Wilms) tumors, and non-Hodgkin lymphoma.³ Over 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 to 1977 to 80% for those diagnosed in 1996 to 2003.³

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 a number of cancers, particularly leukemia and female breast (see Pickle et al¹² for more detailed discussion). Not all changes in cancer trends are 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 NCHS and cancer incidence rates from SEER or NPCR, even though 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

Published online through CA First Look at http://CAonline.AmCancerSoc.org.

^* Disclaimer: The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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