Cancer statistics, 2014

Incidence and Mortality Data

Mortality data from 1930 to 2010 were obtained from the National Center for Health Statistics (NCHS).1 Population-based cancer incidence data in the United States are collected both by the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program and the Centers for Disease Control and Prevention's (CDC's) National Program of Cancer Registries (NPCR). The SEER program reports long-term (beginning in 1973), high-quality incidence, prevalence, and survival data. Long-term incidence and survival trends (1975-2010) were based on data from the 9 oldest SEER areas (Connecticut, Iowa, Hawaii, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound), representing approximately 10% of the US population.2 As of 1992, SEER data have been available for 4 additional populations (Alaska Natives, Los Angeles County, San Jose-Monterey, and rural Georgia) that increase the coverage of minority groups and allow for stratification by race and ethnicity.3 Data from these SEER 13 registries were the source for the annual percent change in incidence from 1992 to 2010. The SEER program added 5 additional catchment areas beginning with cases diagnosed in 2000 (greater California, greater Georgia, Kentucky, Louisiana, and New Jersey), achieving 28% population coverage.4 Data from all 18 SEER areas were the source for cancer stage distribution, stage-specific survival, and the lifetime probability of developing cancer. Much of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review, 1975-2010.5

The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data from 1995 onward for cancer registries that participate in the SEER program or the NPCR. These data approach 100% coverage of the US population and were the source for incidence rates by state and race/ethnicity, as well as the projection of new cancer cases in 2014.6 Some of the data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2006-2010.7, 8

All cancer cases were classified according to the International Classification of Diseases for Oncology.9 The lifetime probability of cancer was calculated using the NCI's DevCan software (version 6.7.0).10 All incidence and death rates were age-standardized to the 2000 US standard population and expressed per 100,000 population, as calculated by NCI's SEER*Stat software (version 8.1.2).11

Cancer incidence rates in this report were adjusted for delays in reporting whenever possible. This adjustment, which is available only for SEER data, is based on historic patterns of case ascertainment and accounts for anticipated future corrections to registry data primarily due to a lag in case reporting. Delay adjustment has the largest effect on the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate cancer) and provides a more accurate portrayal of the cancer burden in the most recent time period.12 For example, melanoma incidence rates adjusted for reporting delays are 14% higher than unadjusted rates in the most recent data year. Delay-adjusted rates were obtained from the SEER Canques database (surveillance.cancer.gov/delay/canques.html [accessed August 6, 2013]).

Projected Cancer Cases and Deaths in 2014

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, compilation, quality control, and dissemination. Therefore, we project the numbers of new cancer cases and deaths in the United States in the current year in order to provide an estimate of the contemporary cancer burden. These estimates are not useful for tracking cancer occurrence over time because they are model-based and because the calculation methodology changes every few years in order to take advantage of improvements in modeling techniques, increased cancer registration coverage, and updated risk factor surveillance.

A 3-step spatio-temporal model was used to project the number of new invasive cancer cases that will be diagnosed in 2014 based on 1995 through 2010 high-quality incidence data from 49 states and the District of Columbia, representing 89% population coverage. (All states did not meet high quality data standards for all years and Minnesota did not submit incidence data to NAACCR during the 2012 call for data.) This method accounts for expected delays in case reporting and considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence.13 First, complete incidence counts were estimated for each county from 1995 through 2010. Then these counts were adjusted to account for delays in cancer reporting. Finally, a temporal projection method (the vector autoregressive model) was applied to the last 15 years of data (1996-2010) to estimate counts for 2014, which were then aggregated to obtain state-level estimates. This method cannot estimate numbers of basal cell or squamous cell skin cancers because data on the occurrence of these cancers are not reported to cancer registries. For the complete details of the case projection methodology, please refer to Zhu et al.14

To estimate the number of in situ female breast and melanoma cases diagnosed in 2014, we first estimated the number of cases occurring annually from 2001 through 2010 by applying age-specific SEER 13 incidence rates to the corresponding US population estimates provided in SEER*Stat.11 (Delay-adjusted rates were available for in situ breast cancer but not for in situ melanoma.) We then projected the total number of cases in 2014 based on the average annual percent change in case counts from 2001 through 2010 generated by the joinpoint regression model.15

We estimated the number of cancer deaths expected to occur in 2014 in the United States overall and in each state using the joinpoint regression model based on the actual numbers of cancer deaths from 1995 through 2010 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.16

Other Statistics

The estimated number of cancer deaths averted in men and women due to the reduction in overall cancer death rates was calculated by first estimating the number of cancer deaths that would have occurred if death rates had remained at their peak. The expected number of deaths was estimated by applying the 5-year age-specific cancer death rates in the peak year for age-standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age-specific populations in the subsequent years through 2010. Then the difference between the number of expected and recorded cancer deaths in each age group and calendar year was summed for men and women separately.

Expected Numbers of New Cancer Cases

Table 1 presents the estimated numbers of new cases of invasive cancer expected among men and women in the United States in 2014. The overall estimate of 1,665,540 new cases is the equivalent of more than 4,500 new cancer diagnoses each day. About 62,570 cases of breast carcinoma in situ and 63,770 cases of melanoma in situ are expected to be newly diagnosed in 2014. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2.

Figure 1 indicates the most common cancers expected to occur in men and women in 2014. Among men, cancers of the prostate, lung and bronchus, and colorectum will account for about 50% of all newly diagnosed cancers. Prostate cancer alone will account for 27% (233,000) of incident cases in men. The 3 most commonly diagnosed types of cancer among women in 2014 will be breast, lung and bronchus, and colorectum, accounting for one-half of all cases in women. Breast cancer alone is expected to account for 29% (232,670) of all new cancers among women.

Expected Numbers of Cancer Deaths

Table 1 also shows the expected numbers of deaths from cancer projected for 2014. It is estimated that about 585,720 Americans will die from cancer this year, corresponding to about 1,600 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 causes of cancer death. These 4 cancers account for almost half of the total cancer deaths among men and women (Fig. 1), with more than one-quarter of all cancer deaths due to lung cancer. Table 3 provides the estimated numbers of cancer deaths in 2014 by state for selected cancer sites.

Lifetime Probability of Developing Cancer

The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (38%) (Table 4). However, because of the earlier median age at diagnosis for breast cancer (61 years) compared with prostate (66 years) and other major cancers, women have a slightly higher probability of developing cancer than men before age 65 years. These estimates are based on the average experience of the general population and may over- or underestimate individual risk because of differences in exposure (eg, smoking history), medical history, and/or genetic susceptibility.

Trends in Cancer Incidence

Figures 2 and 3 illustrate long-term trends in cancer incidence rates for all cancers combined and for selected cancer sites by sex. Trends since 1992 are presented in Table 5 in terms of the annual percent change in rates using joinpoint regression analysis. Joinpoint is a tool used to describe and quantify trends by fitting observed rates to lines connected at “joinpoints” where trends change in direction or magnitude.15, 17

The overall cancer incidence rate is 23% lower among women compared with men. However, during the past 5 years for which there are data (2006-2010), the incidence rate decreased by 0.6% per year among males but remained stable in females (Table 5). The decrease in men is driven by the rapid declines in colorectal (3.3% per year), prostate (2.0% per year), and lung (1.9% per year) cancers. Among women, although colorectal cancer declines are similar to those in men, the lung cancer rate has been slow to decline and breast cancer incidence rates have remained relatively flat since 2003 (Fig. 3).

Declines in incidence rates for the major cancers reflect improvements in cancer control and prevention. The long-term declines in colorectal cancer incidence rates since the mid-1980s have been attributed to both changes in risk factors and the introduction of screening.18 However, the rapid declines in recent years (eg, greater than 4.0% per year from 2008-2010) have been attributed to the increased uptake of colonoscopy, which prevents cancer by allowing for the removal of precancerous lesions.19, 20 Prostate cancer incidence rates have been generally declining since around 2000, although rates have fluctuated widely from year to year (Fig. 3), likely reflecting variation in the prevalence of prostate-specific antigen testing for the detection of prostate cancer. Lung cancer incidence rates began declining in the mid-1980s in men and in the late 1990s in women as a result of reduced smoking prevalence.5 Differences in lung cancer incidence patterns between men and women (Fig. 3) reflect historical differences in tobacco use; cigarette smoking prevalence peaked about 20 years later in women than in men.21

In contrast to the stable or declining trends for most cancer types, incidence rates are increasing for melanoma of the skin; esophageal adenocarcinoma; cancers of the thyroid, liver, kidney, anus, and pancreas; and human papillomavirus-positive oropharyngeal cancers.5, 22 Among both men and women, the largest annual increases from 2006 to 2010 were for cancers of the thyroid (5.4% and 6.5% in men and women, respectively) and liver (3.7% and 2.9% in men and women, respectively) (Table 5).

Trends in Cancer Mortality

The overall cancer death rate rose for most of the 20th century, peaking at 215.1 deaths per 100,000 population in 1991. This increase was largely driven by rapid increases in lung cancer deaths among men as a consequence of the tobacco epidemic. Over the past 2 decades, however, there has been a steady decline in the cancer death rate (to 171.8 in 2010) as a result of advances in prevention, early detection, and treatment, including the implementation of comprehensive tobacco control. As a result of this 20% decline, an estimated 1,340,400 cancer deaths (952,700 in men and 387,700 in women) that would have occurred had peak rates persisted have been averted (Fig. 4).

Overall declines in the cancer death rate from 1991 to 2010 occurred among white women (16%), black women (20%), white men (24%), and black men (33%). Figure 5 illustrates the variation in the magnitude of the declines by race, sex, and 10-year age group. Downturns occurred for black and white men and women of all ages with the exception of white women aged 80 years and older. Notably, black males experienced the largest drop in death rates in every age group. The sharpest decrease (44%–55%) occurred among black men aged 30 years to 59 years. In general, middle-aged men and women experienced the largest declines, particularly compared with adults aged 70 years and older. The smaller declines among seniors reflect the lingering effects of the tobacco epidemic on older birth cohorts. Progress is more stunted among women than men in this generation because of the later onset and more protracted decline in smoking prevalence among women.

Figure 6 depicts long-term trends in cancer death rates among men and women overall and for selected cancer sites. In contrast to male cancer death rates, which rose continuously prior to 1990, female cancer death rates fell from the late 1940s to the mid-1970s (Fig. 6a). It is also interesting to note that prior to 1941, men had a lower risk of dying from cancer than women due to the high death rate for uterine cancer (uterine corpus and uterine cervix combined), which was the leading cause of cancer death among women in the early 20th century. Uterine cancer death rates declined by more than 80% between 1930 and 2010, largely due to the widespread uptake of screening for the prevention and early detection of cervical cancer. A similar dramatic decline occurred for stomach cancer, which accounted for 30% and 20% of male and female cancer deaths, respectively, in the 1930s. By 2010, stomach cancer accounted for just 2% of cancer deaths. Rates of stomach cancer have declined worldwide due to improved hygiene, resulting in a lower prevalence of Helicobacter pylori, and advances in food preservation techniques (eg, refrigeration), which have led to lower salt intake and higher consumption of fresh fruits and vegetables.

During the most recent 5 years for which data are available, the average annual decline in cancer death rates was slightly larger among men (1.8%) than women (1.4%) (Fig. 6) (Table 5). These declines are driven by continued decreases in death rates for the 4 major cancer sites (Fig. 6). Due to the reduction in tobacco use over the past 50 years, the lung cancer death rate declined 34% between 1991 and 2010 among males and 9% between 2002 and 2010 among females.5, 23 Death rates for breast, prostate, and colorectal cancers are down from peak rates by 34%, 45%, and 46%, respectively, as a result of improvements in early detection and treatment.5, 18, 24, 25

In contrast, joinpoint trend analysis for 2001 to 2010 indicates that death rates are rising for cancers of the oropharynx, anus, liver, pancreas, and soft tissue (including the heart), and for melanoma in men.5 The rate of death from thyroid cancer is also increasing according to joinpoint analysis (Table 5), although the observed rates increased only slightly from 0.47 (per 100,000 population) to 0.50 among men and from 0.48 to 0.51 among women.

Recorded Number of Deaths in 2010

A total of 2,468,435 deaths were recorded in the United States in 2010, of which 574,743 (23%) were from cancer. Overall, cancer is the second leading cause of death following heart disease. However, within 20-year age groups, cancer is the leading cause of death among adults aged 40 years to 79 years (Table 6). Among females, cancer is the first or second leading cause of death in every age group.

Table 7 presents the number of deaths from all cancers combined and from the 5 most common sites for each 20-year age group by sex. For all ages combined, men have a higher number of deaths for shared sites with the exception of pancreatic cancer, for which the burden is similar. Among males, leukemia is the leading cause of cancer death in those aged younger than 40 years, while lung cancer ranks first in men aged 40 years and older. Among females, leukemia is the leading cause of cancer death in children and adolescents (aged younger than 20 years), breast cancer ranks first in women aged 20 years to 59 years, and lung cancer causes the most cancer deaths in those aged 60 years and older.

Regional Variations in Cancer Rates

Tables 8 and 9 depict cancer incidence and death rates for selected cancers by state. Lung cancer shows the largest geographic variation in cancer occurrence by far, reflecting the large historical and continuing differences in smoking prevalence among states.23 For example, lung cancer incidence rates in Kentucky, which has historically had the highest smoking prevalence, are almost 4-fold higher than those in Utah, which has the lowest smoking prevalence (126 vs 34 cases per 100,000 men). There is also a large range for prostate cancer incidence rates, from 112.7 in Arizona to 194.4 in the District of Columbia, which likely reflects state differences in PSA testing prevalence and racial distribution.27 In contrast, state variations for other cancer sites are smaller in both absolute and relative terms. For example, the breast cancer incidence rate ranges from 140 (per 100,000 population) in the District of Columbia to 109 in New Mexico, a difference of 28%. State variation in incidence rates reflects differences in the use of screening tests or detection practices in addition to differences in disease occurrence.

Cancer Survival

The stage-specific 5-year relative survival rate is lower for blacks than for whites for nearly every cancer type (Fig. 7). Studies suggest that racial disparities in survival are primarily due to differences in treatment, stage at diagnosis, and comorbidities, as opposed to differences in cancer biology.35 As shown in Figure 8, blacks are less likely than whites to be diagnosed with cancer at a localized stage, when treatment is more successful. This disparity is particularly striking for cancers of the breast, cervix, uterine corpus, and oral cavity and pharynx. Lower socioeconomic status among blacks likely explains much of the stage disparity and is also associated with receipt of less aggressive treatment.36, 37 Even among Medicare-insured patients, blacks are less likely than whites to receive standard cancer therapies for lung, breast, colorectal, and prostate cancers.26

There have been notable improvements in survival over the past 3 decades for most cancers among both whites and blacks (Table 12). Between 1975 and 1977 and 2003 and 2009, overall 5-year relative survival rates increased 19 percentage points among whites and 22 percentage points among blacks. The largest improvements in survival have been for leukemia and non-Hodgkin lymphoma, while lung and pancreatic cancers have shown the least improvement.

Relative survival rates cannot be calculated for some minority populations because accurate life tables are not available. Comparison of cause-specific survival rates for patients diagnosed from 2003 to 2009 indicates that Asian American/Pacific Islander women have the highest probability of surviving 5 years after a cancer diagnosis (69.5%), while American Indian/Alaska Native men have the lowest probability of surviving (56.8%).5 For both sexes combined, whites and Hispanics have the highest 5-year cause-specific survival (66.7%), while American Indians/Alaska Natives have the lowest (59.0%).