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Siegel 2013

Created By: Kaylin Braden
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http://onlinelibrary.wiley.com/doi/10.3322/caac.21166/full

Introduction
[1] Cancer is a major public health problem in the United States and many other parts of the world. One in 4 deaths in the United States is due to cancer. In this article, we provide the expected numbers of new cancer cases and deaths in 2013 nationally and by state, as well as an overview of current cancer statistics using data through 2009, including incidence, mortality, and survival rates and trends. We also estimate the total number of deaths averted as a result of the decline in cancer death rates since the early 1990s, and provide the actual reported numbers of deaths in 2009 by age for the 10 leading causes of death and the 5 leading cancer types.

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 2013. The overall estimate of more than 1.6 million new cases does not include carcinoma in situ of any site except urinary bladder, nor does it include basal cell or squamous cell cancers of the skin. About 64,640 cases of breast carcinoma in situ and 61,300 cases of melanoma in situ are expected to be newly diagnosed in 2013. The estimated numbers of new cancer cases by state for selected cancer sites are shown in Table 2.

Table 1. Estimated New Cancer Cases and Deaths by Sex, United States, 2013*
  ESTIMATED NEW CASES ESTIMATED DEATHS
  BOTH SEXES MALE FEMALE BOTH SEXES MALE FEMALE
  • *

    Rounded to the nearest 10; estimated new cases exclude basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. About 64,640 carcinoma in situ of the female breast and 61,300 melanoma in situ will be newly diagnosed in 2013.

  • Estimated deaths for colon and rectum cancers are combined.

  • More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates and/or an undercount in the case estimate.

[2] All sites 1,660,290 854,790 805,500 580,350 306,920 273,430
Oral cavity & pharynx 41,380 29,620 11,760 7,890 5,500 2,390
 Tongue 13,590 9,900 3,690 2,070 1,380 690
 Mouth 11,400 6,730 4,670 1,800 1,080 720
 Pharynx 13,930 11,200 2,730 2,400 1,790 610
 Other oral cavity 2,460 1,790 670 1,640 1,260 380
Digestive system 290,200 160,750 129,450 144,570 82,700 61,870
 Esophagus 17,990 14,440 3,550 15,210 12,220 2,990
 Stomach 21,600 13,230 8,370 10,990 6,740 4,250
 Small intestine 8,810 4,670 4,140 1,170 610 560
 Colon 102,480 50,090 52,390 50,830 26,300 24,530
 Rectum 40,340 23,590 16,750      
 Anus, anal canal, & anorectum 7,060 2,630 4,430 880 330 550
 Liver & intrahepatic bile duct 30,640 22,720 7,920 21,670 14,890 6,780
 Gallbladder & other biliary 10,310 4,740 5,570 3,230 1,260 1,970
 Pancreas 45,220 22,740 22,480 38,460 19,480 18,980
 Other digestive organs 5,750 1,900 3,850 2,130 870 1,260
Respiratory system 246,210 131,760 114,450 163,890 90,600 73,290
 Larynx 12,260 9,680 2,580 3,630 2,860 770
 Lung & bronchus 228,190 118,080 110,110 159,480 87,260 72,220
 Other respiratory organs 5,760 4,000 1,760 780 480 300
Bones & joints 3,010 1,680 1,330 1,440 810 630
Soft tissue (including heart) 11,410 6,290 5,120 4,390 2,500 1,890
Skin (excluding basal & squamous) 82,770 48,660 34,110 12,650 8,560 4,090
 Melanoma-skin 76,690 45,060 31,630 9,480 6,280 3,200
 Other nonepithelial skin 6,080 3,600 2,480 3,170 2,280 890
Breast 234,580 2,240 232,340 40,030 410 39,620
Genital system 339,810 248,080 91,730 58,480 30,400 28,080
 Uterine cervix 12,340   12,340 4,030   4,030
 Uterine corpus 49,560   49,560 8,190   8,190
 Ovary 22,240   22,240 14,030   14,030
 Vulva 4,700   4,700 990   990
 Vagina & other genital, female 2,890   2,890 840   840
 Prostate 238,590 238,590   29,720 29,720  
 Testis 7,920 7,920   370 370  
 Penis & other genital, male 1,570 1,570   310 310  
Urinary system 140,430 96,800 43,630 29,790 20,120 9,670
 Urinary bladder 72,570 54,610 17,960 15,210 10,820 4,390
 Kidney & renal pelvis 65,150 40,430 24,720 13,680 8,780 4,900
 Ureter & other urinary organs 2,710 1,760 950 900 520 380
Eye & orbit 2,800 1,490 1,310 320 120 200
Brain & other nervous system 23,130 12,770 10,360 14,080 7,930 6,150
Endocrine system 62,710 16,210 46,500 2,770 1,270 1,500
 Thyroid 60,220 14,910 45,310 1,850 810 1,040
 Other endocrine 2,490 1,300 1,190 920 460 460
Lymphoma 79,030 42,670 36,360 20,200 11,250 8,950
 Hodgkin lymphoma 9,290 5,070 4,220 1,180 660 520
 Non-Hodgkin lymphoma 69,740 37,600 32,140 19,020 10,590 8,430
Myeloma 22,350 12,440 9,910 10,710 6,070 4,640
Leukemia 48,610 27,880 20,730 23,720 13,660 10,060
 Acute lymphocytic leukemia 6,070 3,350 2,720 1,430 820 610
 Chronic lymphocytic leukemia 15,680 9,720 5,960 4,580 2,750 1,830
 Acute myeloid leukemia 14,590 7,820 6,770 10,370 5,930 4,440
 Chronic myeloid leukemia 5,920 3,420 2,500 610 340 270
 Other leukemia 6,350 3,570 2,780 6,730 3,820 2,910
Other & unspecified primary sites 31,860 15,450 16,410 45,420 25,020 20,400


Incidence and Mortality Data
Mortality data from 1930 to 2009 in the United States were obtained from the National Center for Health Statistics (NCHS).1, 2 There are several sources for cancer incidence data. The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute reports long-term (beginning in 1973), high-quality, population-based incidence data covering up to 26% of the US population. Cancer incidence rates for long-term trends (1975-2009), 5-year relative and cause-specific survival rates (2002-2008), and estimations of the lifetime probability of developing cancer (2007-2009) were obtained from SEER registries.3-6 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 Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). Incidence data for state-level rates (2005-2009), trends by race/ethnicity (2000-2009), and estimated new cancer cases in 2013 were obtained from NAACCR.7 Cancer cases were classified according to the International Classification of Diseases for Oncology.8 All incidence and death rates are age-standardized to the 2000 US standard population and expressed per 100,000 persons.
Cancer incidence rates in this report are delay-adjusted whenever possible in order to account for anticipated future corrections to registry data due to inherent delays and errors in case reporting. Delay-adjusted rates primarily affect the most recent years of data for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate) and provide a more accurate portrayal of the cancer burden in the most recent time period.9 For example, melanoma incidence rates adjusted for delays in reporting are 14% higher than unadjusted rates in the most recent reporting year. Delay-adjusted rates are available for SEER registry data and were obtained from the National Cancer Institute. Incidence trends presented for the most recent 5 years (2005-2009) are based on delay-adjusted rates from SEER 13 cancer registries.4

Projected Cancer Cases and Deaths in 2013
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 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 2013 in order to provide an estimate of the contemporary cancer burden. The methods for projecting both new cases and deaths in the current year were recently modified so estimates should not be compared from year to year.
We projected the number of new invasive cancer cases that will be diagnosed in 2013 (with the exception of urinary bladder, for which in situ cases are included) using a 2-step process that first estimates complete incidence counts by state during years for which observed data are available, and then projects these counts 4 years ahead for the United States overall and each state individually.10 To estimate counts for each state through 2009, we used a spatiotemporal model based on incidence data for 1995 through 2009 from 49 states and the District of Columbia that met NAACCR's high-quality data standard for incidence, covering about 98% of the US population.11 (Minnesota cancer registry data could not be included in the model because county-level data were unavailable.) 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. A temporal projection method (the vector autoregressive model) was then applied to the estimated counts to obtain projections for 2013. For the complete details of this methodology, please refer to Zhu et al.10
To estimate the numbers of new breast carcinoma in situ (female) and melanoma in situ cases in 2013, we first estimated the number of in situ cases occurring annually from 2000 through 2009 in the United States by applying the age-specific incidence rates in the 18 SEER areas to the corresponding US population estimates provided in SEER*Stat.12 We then projected the total number of cases in 2013 based on the annual percent change from 2000 through 2009 generated by the joinpoint regression model.13
We estimated the number of cancer deaths expected to occur in 2013 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 2009 at the state and national levels as reported to the NCHS.1 For the complete details of this methodology, please refer to Chen et al.14

Other Statistics
The estimated numbers of cancer deaths averted in men and women due to the reduction in overall cancer death rates were calculated 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 2009 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.

Trends in Cancer Mortality
Cancer death rates decreased by 1.8% per year in males and by 1.5% per year in females during the most recent 5 years of data (2005-2009). These declines have been consistent since 2001 and 2002 in men and women, respectively, and are larger in magnitude than those occurring in the previous decade (Table 5). Death rates peaked in men in 1990 (279.8 per 100,000), in women in 1991 (175.3 per 100,000), and overall in 1991 (215.1 per 100,000). Between 1990/1991 and 2009, cancer death rates decreased 24% in men, 16% in women, and 20% overall. Figure 6 shows that as a result of almost two decades of consistent declines in cancer death rates, about 1,177,300 cancer deaths were averted, 152,900 of these in 2009 alone.
Death rates continue to decrease for the 4 major cancer sites (Figs. 4 and 5). Over the past two decades of data, death rates have decreased from their peak by more than 30% for cancers of the colorectum, female breast, and male lung, and by more than 40% for prostate cancer. The decrease in lung cancer death rates—among men since 1990 and among women since 2002—is due to the reduction in tobacco use,20 while the decrease in death rates for female breast, colorectal, and prostate cancers largely reflects improvements in early detection and/or treatment.17, 21, 22 Over the past 10 years of data (2000-2009), the largest annual declines in death rates were for chronic myeloid leukemia (8.4%), cancers of the stomach (3.1%) and colorectum (3.0%), and non-Hodgkin lymphoma (3.0%).

Cancer Survival
African Americans are less likely to survive cancer than whites. The 5-year relative survival is lower among African Americans for every stage of diagnosis for nearly every type of cancer (Fig. 7). 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 8, African Americans are less likely than whites to be diagnosed with cancer at a localized stage, when treatment is usually less extensive and more successful. The extent to which factors other than stage at diagnosis contribute to the overall survival differential is unclear.28 A study of Medicare-insured patients showed that African Americans remain less likely than whites to receive standard cancer therapies for lung, breast, colorectal, and prostate cancers.29 Some studies suggest that African Americans who receive cancer treatment and medical care similar to that of whites experience similar outcomes.30

Conclusions
In 2009, Americans had a 20% lower risk of death from cancer than in 1991, when cancer death rates peaked. Despite this substantial progress, all demographic groups have not benefitted equally, particularly for cancers such as colorectal and breast, for which mortality declines have been attributed to earlier detection and improvements in treatment. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those groups in the lowest socioeconomic bracket as well as other disadvantaged populations.
 

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