Published online before print July 7, 2010
CA Cancer J Clin 2010
doi: 10.3322/caac.20073
© 2010 American Cancer Society
Cancer Statistics, 2010
Ahmedin Jemal, DVM, PhD1,
Rebecca Siegel, MPH2,
Jiaquan Xu, MD3 and
Elizabeth Ward, PhD4
1Cancer Surveillance, Surveillance and Health Policy Research, American Cancer Society, Atlanta, GA
2Surveillance Information Services, Surveillance and Health Policy Research, American Cancer Society, Atlanta, GA
3Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
4Surveillance and Health Policy Research, American Cancer Society, Atlanta, GA
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.
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Abstract
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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 regarding cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, the 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 1,529,560 new cancer cases and 569,490 deaths from cancer are projected to occur in the United States in 2010. Overall cancer incidence rates decreased in the most recent time period in both men (1.3% per year from 2000 to 2006) and women (0.5% per year from 1998 to 2006), largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and 2 major cancer sites in women (breast and colorectum). This decrease occurred in all racial/ethnic groups in both men and women with the exception of American Indian/Alaska Native women, in whom rates were stable. Among men, death rates for all races combined decreased by 21.0% between 1990 and 2006, with decreases in lung, prostate, and colorectal cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2006 decreased by 12.3%, with decreases in breast and colorectal cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, 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. 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 2010. © 2010 American Cancer Society, Inc.
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Introduction
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Cancer is a major public health problem in the United States and many other parts of the world. Currently, 1 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 2010.
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Materials and Methods
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Data Sources
Mortality data from 1930 to 2007 in the United States were obtained from the National Center for Health Statistics (NCHS).1 Incidence data for long-term trends (1975–2006), 5-year relative survival rates, and lifetime probability of developing cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), covering approximately 26% of the US population.2–5 Incidence data (1995–2006) 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) covering approximately 89% of the US population. State-specific incidence rates were obtained from NAACCR based on data collected by cancer registries participating in the SEER program and the NPCR.6 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 and Deaths
The precise number of cancer cases diagnosed each year in the nation and in every state is unknown because cancer case reporting is incomplete 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. Therefore, we project the expected number of new cancer cases and deaths in the United States in 2010 to provide an estimate of the current cancer burden. Estimated new cancer cases in the current year (2010) were projected using a spatiotemporal model based on incidence data from 1995 through 2006 from 44 states and the District of Columbia that met the NAACCR's high-quality data standard for incidence, covering approximately 89% of the US population.12 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.
We used the state-space prediction method to estimate the number of cancer deaths expected to occur in the United States and in each state in the year 2010.13 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 2010 based on the number that occurred each year from 1969 to 2007 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 2007. Causes of death for 2007 were coded and classified according to ICD-10.10 This report also provides updated statistics regarding 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 2006.2,6 All age-adjusted incidence and death rates are standardized to the 2000 US standard population and expressed per 100,000 population.
The incidence rates (2002–2006) and long-term trends (1975–2006) are adjusted for delays in reporting when possible. Delayed reporting primarily affects the most recent 1 to 3 years of incidence data (in this case, 2004–2006), 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 for selected cancer sites were previously published in the 2010 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 1991 in women and estimates of the total number of cancer deaths avoided because of the reduction in overall age-standardized cancer death rates through 2006. 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 2006 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 15-year (women) or 16-year (men) interval.
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Selected Findings
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Expected Numbers of New Cancer Cases in 2010
Table 1 presents estimates of the number of new cases of invasive cancer expected among men and women in the US in 2010. The overall estimate of approximately 1.53 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. Greater than 2 million unreported cases of basal cell and squamous cell skin cancer, approximately 54,010 cases of breast carcinoma in situ, and 46,770 cases of melanoma in situ are expected to be newly diagnosed in 2010. The estimated numbers of new cancer cases for each state and selected cancer sites are shown in Table 2.
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TABLE 2 Age-standardized Incidence Rates for All Cancers Combined, 2002–2006, and Estimated New Cases* for Selected Cancers by State, United States, 2010
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Figure 1 indicates the most common cancers expected to occur in men and women in 2010. Among men, cancers of the prostate, lung and bronchus, and colorectum account for 52% of all newly diagnosed cancers. Prostate cancer alone accounts for 28% (217,730) of incident cases in men. Based on cases diagnosed between 1999 and 2005, an estimated 92% of these new cases of prostate cancer are expected to be diagnosed at local or regional stages, for which the 5-year relative survival approaches 100%.
The 3 most commonly diagnosed types of cancer among women in 2010 will be cancers of the breast, lung and bronchus, and colorectum, accounting for 52% of estimated cancer cases in women. Breast cancer alone is expected to account for 28% (207,090) of all new cancer cases among women.
Expected Number of Cancer Deaths in 2010
Table 1 also shows the expected number of deaths from cancer projected for 2010 for men, women, and both sexes combined. It is estimated that approximately 569,490 Americans will die from cancer, corresponding to greater than 1500 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 4 cancers account for approximately 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 and is expected to account for 26% of all female cancer deaths in 2010. Table 3 provides the estimated number of cancer deaths in 2010 by state for selected cancer sites.
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TABLE 3 Age-standardized Death Rates for All Cancers Combined, 2002–2006, and Estimated Deaths* for Selected Cancers by State, United States, 2010
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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 for lung cancer, for which rates (cases per 100,000 population) range from 37.8 in men and 23.0 in women in Utah to 133.1 in men and 76.9 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 is smaller in both absolute and proportionate terms. For screenable cancers, such as those of the prostate and female breast, variation in incidence rates reflects differences in the use of screening tests in addition to differences in disease occurrence.
Trends in Cancer Incidence and Mortality
Figures 2 to 5
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 4 most common cancer sites based on join point analysis. Trends in incidence were adjusted for delayed reporting. Delay-adjusted cancer incidence rates decreased by 1.3% per year from 2000 through 2006 in males and by 0.5% per year from 1998 through 2006 in females.15 Incidence trends decreased for all 4 major cancer sites except for lung cancer in women, in whom rates are still increasing, though at a much slower rate than in 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 approximately 20 years later than in men. The accelerated decrease in colorectal cancer incidence rates from 1998 to 2006 largely reflects increases in screening that can detect and remove precancerous polyps.15 The decrease in prostate cancer incidence rates (by 2.4% per year from 2000–2006) may reflect recent stabilization of prostate-specific antigen testing, resulting in decreased detection or a reduced number of undiagnosed cases.16–18 The decrease in the breast cancer incidence rate since 1999 likely reflects the large discontinuity in the use of menopausal hormone therapy among postmenopausal women beginning in 2001, and it may also reflect delayed diagnosis due to decreased mammography use.19–20 However, close inspection of incidence data by individual year (Fig. 3) shows that after a 6% decrease from 2002 to 2003, incidence rates from 2003 to 2006 remained relatively unchanged. This may support the hypothesis that postmenopausal hormones may be acting as promoters rather than initiators of breast cancer.20
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FIGURE 2 Annual Age-Adjusted Cancer Incidence and Death Rates* by Sex, United States, 1975 to 2006.
*Rates are age adjusted to the 2000 US standard population. Incidences rates are adjusted for delays in reporting. Sources: Incidence: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov). Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission. Mortality: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention.
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FIGURE 3 Annual Age-Adjusted Cancer Incidence Rates* for Selected Cancers by Sex, United States, 1975 to 2006.
*Rates are age adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results (SEER) program (available at: www.seer.cancer.gov). Delay-adjusted incidence database: SEER Incidence Delay-Adjusted Rates, 9 Registries, 1975–2006. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Statistical Research and Applications Branch; 2009. Released April 2009, based on the November 2008 SEER data submission.
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FIGURE 4 Annual Age-Adjusted Cancer Death Rates*Among Males for Selected Cancers, United States, 1930 to 2006.
*Rates are age adjusted to the 2000 US standard population. Due to changes in International Classification of Diseases (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 2006, US Mortality Vol. 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention.
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FIGURE 5 Annual Age-Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2006.
*Rates are age adjusted to the 2000 US standard population.  Uterus includes uterine cervix and uterine corpus. Due to changes in International Classification of Diseases (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 2006, US Mortality Volumes 1930 to 1959. National Center for Health Statistics, Centers for Disease Control and Prevention.
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Death rates for all cancer sites combined decreased by 2.0% per year in men from 2001 through 2006 and by 1.5% per year in women from 2002 to 2006, compared with declines of 1.5% per year in men from 1993 to 2001 and 0.8% per year in women from 1994 through 2002 (Table 5). Mortality rates have continued to decrease across all 4 major cancer sites in both men and women, except for female lung cancer, for which rates stabilized from 2003 to 2006 after increasing for many decades. Table 6 shows the contribution of individual cancer sites to the decreasing portion of the total cancer death rate for each sex. Death rates from all cancers combined peaked in 1990 for men and in 1991 for women. Between 1990–1991 and 2006, death rates for cancer decreased by 21.0% among men and by 12.3% among women. Among men, reduction in death rates from lung, prostate, and colorectal cancers accounted for nearly 80% of the total decrease in the cancer death rate, whereas reduction in death rates from breast and colorectal cancers accounted for 60% of the decrease noted among women. Lung cancer in men and breast cancer in women each 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 a reduction in tobacco use over the past 50 years, whereas 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 2006, death rates increased for liver cancer in both men and women, esophageal cancer and melanoma in men, and lung and pancreatic cancer in women. 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. Approximately 767,000 cancer deaths (561,400 in men and 205,700 in women) were averted between 1991–1992 and 2006.
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FIGURE 7 Total Number of Cancer Deaths Avoided From 1991 to 2006 in Males and From 1992 to 2006 in Females.
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.
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Recorded Number of Deaths from Cancer in 2007
A total of 562,875 cancer deaths were recorded in the United States in 2007, the most recent year for which actual data are available, accounting for approximately 23% of all deaths (Table 7). Despite a decrease in age-standardized death rates, from 180.7 in 2006 to 178.4 in 2007, there were 2987 more cancer deaths reported in 2007 than in 2006 due to the influence of the aging and growth of the population (Table 8). When causes of death are ranked within 20-year age groups, cancer is one of the 5 leading causes of death in all age groups among both males and females; it is the leading cause of death among men and women ages 40 to 79 years (Table 9). Cancer is the leading cause of death among men and women aged younger than 85 years (Fig. 6). A total of 475,211 persons aged younger than 85 years died from cancer in the United States in 2007, compared with 380,791 deaths from heart disease, which is the leading cause of death overall in the United States.1
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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 to 2006.
*Rates are age adjusted to the 2000 US standard population. Source: US Mortality Data, 1975 to 2006. National Center for Health Statistics, Centers for Disease Control and Prevention.
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Table 10 presents the number of deaths from all cancers combined and from the 5 most common cancer sites for each 20-year age group. Among males aged younger than 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 ages 40 to 79 years, and prostate cancer among men aged 80 years and older. Among females, leukemia is the leading cause of cancer death before age 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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Cancer Occurrence by Race/Ethnicity
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Cancer incidence and death rates vary considerably among racial and ethnic groups (Table 11), although the extent of variation may be affected by misclassification of race and ethnicity on medical records, including death certificates.26 For all cancer sites combined, African American men have a 14% higher incidence rate and a 34% higher death rate than white men, whereas African American women have a 7% 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 compared with 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 screening (breast, cervical, and colorectal cancers), and timely diagnosis and treatment. The higher breast cancer incidence rates observed among white women are believed to reflect a combination of factors that affect both diagnosis (eg, more frequent mammography in white women) and underlying disease occurrence (eg, later age at first birth and greater use of menopausal hormone therapy among white compared with black women).21
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 4 most common cancer sites. However, incidence and death rates for cancer sites related to infectious agents, such as those of the uterine cervix, stomach, and liver, are generally higher in minority populations than in whites. Stomach and liver cancer incidence and death rates are twice as high in Asian American/Pacific Islanders compared with whites, reflecting an increased prevalence of chronic infection with Helicobacter pylori and hepatitis B and C viruses, respectively, in this population.22 Kidney cancer death rates are the highest among American Indians/Alaskan Natives; the higher prevalence of obesity and smoking in this population may contribute to this disparity.16
Trends in cancer incidence can be adjusted for delayed reporting only in whites and African Americans because the long-term incidence data required for delay adjustment are not available for other racial and ethnic subgroups. From 1997 through 2006, 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 males and females. Among American Indians/Alska Natives residing in Indian Health Service Contract Health Service Delivery Areas, incidence and mortality rates decreased in men but remained stable in women during this time period.15
Lifetime Probability of Developing Cancer
The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (38%) (Table 12). 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. 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 12 Probability of Developing Invasive Cancers Within Selected Age Intervals by Sex, United States, 2004–2006*
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Cancer Survival By Race
Compared with whites, African American men and women have poorer survival once cancer is diagnosed. The 5-year relative survival is lower in African Americans than in whites for every 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 are less likely than whites to be diagnosed with cancer at a localized stage, when the disease may be more easily and successfully treated. The extent to which factors other than stage at diagnosis contribute to the overall differential survival is unclear.23 However, some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.24
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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, 1999 to 2005.
*The standard error of the survival rate is between 5 and 10 percentage points. The survival rate for in situ urinary bladder cancer is 97% for all races combined, whites, and African Americans. Staging was performed according to Surveillance, Epidemiology, and End Results (SEER) historic stage categories rather than the American Joint Committee on Cancer (AJCC) staging system. Source: Horner MJ, Ries LAG, Krapcho M, et al.2
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FIGURE 9 Distribution of Selected Cancers by Race and Stage at Diagnosis, United States, 1999 to 2005.
*The proportion of in situ urinary bladder cancer cases is 50%, 51%, and 36% in all races combined, whites, and African Americans, respectively. Staging was performed 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. Source: Horner MJ, Ries LAG, Krapcho M, et al.2
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There have been notable improvements since 1975 in the relative 5-year survival rates for many cancer sites for both whites and African Americans (Table 13). Cancers for which survival has not improved substantially over the past 30 years include those of the lung and pancreas. The improvement in survival reflects a combination of earlier diagnosis and improved treatments.
Relative survival rates cannot be calculated for racial and ethnic populations other than 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 between 1999 and 2005 in SEER areas of the United States, all minority male populations have a greater probability of dying from cancer within 5 years of diagnosis than whites. Among women, African Americans have the lowest 5-year, cancer-specific survival (55.8%), followed by American Indians/Alaska Natives (60.0%), whites (65.5%), Hispanics (66.4%), and Asians/Pacific Islanders (68.0%).2 For all 4 major cancer sites (prostate, female breast, lung and bronchus, and colorectum), minority populations are generally more likely to be diagnosed at distant stage, compared with whites (Fig. 9).25
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Cancer in Children
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Cancer is the second most common cause of death among children between the ages of 1 and 14 years in the United States, surpassed only by accidents (Table 14). Nearly one-third of the cancers diagnosed in children ages birth to 14 years are leukemias (particularly acute lymphocytic leukemia), followed by cancer of the brain and other nervous system (21%), soft tissue sarcomas (including neuroblastoma [7%] and rhabdomyosarcoma [3%]), renal (Wilms) tumors (5%), and non-Hodgkin lymphoma (4%). 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 15). The 5-year relative survival rate among children for all cancer sites combined improved from 58% for patients diagnosed between 1975 and 1977 to 81% for those diagnosed between 1999 and 2005.2
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Limitations
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Estimates of the expected numbers of new cancer cases and cancer deaths should be interpreted cautiously because these estimates are based on models and may vary considerably from year to year. 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.12 Not all changes in cancer trends are captured by modeling techniques and sometimes the model may be too sensitive to recent trends, resulting in over- or underestimates. 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 age-standardized or age-specific cancer incidence rates from SEER or NPCR and cancer death rates from the NCHS. 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.
Errors in reporting race/ethnicity in medical records and death certificates may result in underestimates of cancer incidence and mortality rates in nonwhite and nonblack populations. It is also important to note that cancer data in the United States are primarily reported for broad racial and ethnic minority groups that are not homogenous, and thus significant differences in the cancer burden within racial/ethnic subgroups may be masked.26
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Footnotes
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Available online at: http://cajournal.org and http://cacancerjournal.org 
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References
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- National Center for Health Statistics, Division of Vital Statistics, Center for Disease Control 1930–2004, public-use data file; 2005–2007, special-use data file.
- Horner M, Ries L, Krapcho M, et al, eds. SEER Cancer Statistics Review, 1975–2006. Bethesda, MD: National Cancer Institute; 2009.
- Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 17 Regs Public Use, Nov. 2008 Sub (2000–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
- Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 13 Regs Public Use, Nov. 2008 Sub (1992–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
- Surveillance, Epidemiology, and End Results Program. SEER*Stat Database: Incidence-SEER 9 Regs Public Use, Nov. 2008 Sub (1973–2006)-Linked to County Attributes-Total US, 1969–2006 Counties. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009. Released April 2009 based on the November 2008 submission. Available at: www.seer.cancer.gov.
- Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: NAACCR Incidence-CiNA Analytic File, 1995–2006, for Expanded Races, Custom File with County, ACS Facts & Figures Projection Project, North American Association of Central Cancer Registries. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2009.
- US Census Bureau. Available at: http://www.census.gov. Accessed 2010.
- World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol1. 8th rev. Geneva: World Health Organization; 1967.
- World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol1. 9th rev. Geneva: World Health Organization; 1975.
- World Health Organization. Manual of International Statistical Classification of Diseases, Injuries, and Causes of Death. Vol1. 10th rev. Geneva: World Health Organization; 1992.
- Fritz A, Percy C, Jack A, et al, eds. International Classification of Diseases for Oncology. 3rd ed. Geneva: World Health Organization; 2000.
- Pickle LW, Hao Y, Jemal A, et al. A new method of estimating United States and state-level cancer incidence counts for the current calendar year. CA Cancer J Clin. 2007;57:30–42.[Abstract/Free Full Text]
- 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.[Abstract/Free Full Text]
- Clegg LX, Feuer EJ, Midthune DN, Fay MP, Hankey BF. Impact of reporting delay and reporting error on cancer incidence rates and trends. J Natl Cancer Inst. 2002;94:1537–1545.[Abstract/Free Full Text]
- Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.[CrossRef][Medline]
- Espey DK, Wu XC, Swan J, et al. Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives. Cancer. 2007;110:2119–2152.[CrossRef][Medline]
- Farwell WR, Linder JA, Jha AK. Trends in prostate-specific antigen testing from 1995 through 2004. Arch Intern Med. 2007;167:2497–2502.[Abstract/Free Full Text]
- 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.[CrossRef][Medline]
- Jemal A, Ward E, Thun MJ. Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women. Breast Cancer Res. 2007;9:R28.[CrossRef][Medline]
- Ravdin PM, Cronin KA, Howlader N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007;356:1670–1674.[Abstract/Free Full Text]
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Abstract
Introduction
