Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics

Abstract

Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States.

Methods: Incidence data were obtained from the CDC-funded and NCI-funded population-based cancer registry programs and compiled by NAACCR. Data on cancer deaths were obtained from the National Center for Health Statistics National Vital Statistics System. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex, race, and ethnicity were estimated by joinpoint analysis and expressed as the annual percent change. Stage distribution and 5-year survival by stage at diagnosis were calculated for breast cancer, colon and rectum (colorectal) cancer, lung and bronchus cancer, and melanoma of the skin.

Results: Overall cancer incidence rates from 2008 to 2014 decreased by 2.2% per year among men but were stable among women. Overall cancer death rates from 1999 to 2015 decreased by 1.8% per year among men and by 1.4% per year among women. Among men, incidence rates during the most recent 5-year period (2010-2014) decreased for 7 of the 17 most common cancer types, and death rates (2011-2015) decreased for 11 of the 18 most common types. Among women, incidence rates declined for 7 of the 18 most common cancers, and death rates declined for 14 of the 20 most common cancers. Death rates decreased for cancer sites, including lung and bronchus (men and women), colorectal (men and women), female breast, and prostate. Death rates increased for cancers of the liver (men and women); pancreas (men and women); brain and other nervous system (men and women); oral cavity and pharynx (men only); soft tissue, including heart (men only); nonmelanoma skin (men only); and uterus. Incidence and death rates were higher among men than among women for all racial and ethnic groups. For all cancer sites combined, black men and white women had the highest incidence rates compared with other racial groups, and black men and black women had the highest death rates compared with other racial groups. Non-Hispanic men and women had higher incidence and mortality rates than those of Hispanic ethnicity. Five-year survival for cases diagnosed from 2007 through 2013 ranged from 100% (stage I) to 26.5% (stage IV) for female breast cancer, from 88.1% (stage I) to 12.6% (stage IV) for colorectal cancer, from 55.1% (stage I) to 4.2% (stage IV) for lung and bronchus cancer, and from 99.5% (stage I) to 16% (stage IV) for melanoma of the skin. Among children, overall cancer incidence rates increased by 0.8% per year from 2010 to 2014, and overall cancer death rates decreased by 1.5% per year from 2011 to 2015.

Conclusions: For all cancer sites combined, cancer incidence rates decreased among men but were stable among women. Overall, there continue to be significant declines in cancer death rates among both men and women. Differences in rates and trends by race and ethnic group remain. Progress in reducing cancer mortality has not occurred for all sites. Examining stage distribution and 5-year survival by stage highlights the potential benefits associated with early detection and treatment. Cancer 2018;124:2785-2800. © 2018 American Cancer Society.

Keywords: Annual Report to the Nation; Epidemiology; National Program of Cancer Registries (NPCR); National Vital Statistics System (NVSS); North American Association of Central Cancer Registries (NAACCR); Surveillance; and End Results (SEER); cancer; incidence; mortality; survival; trends.

Figure 1

Trends in age‐standardized incidence (1999‐2014) and mortality rates (1999‐2015) are illustrated for all cancer sites combined, all races/ethnicities combined, and by sex. An asterisk indicates that the annual percent change (APC) or the average APC (AAPC) is statistically significantly different from zero (2‐sided t test; P < .05). UNK indicates unknown. Rates were age‐standardized to the 2000 US standard population (19 age groups; Bureau of the Census. Current Population Reports, Publication 25‐1130. Washington, DC: US Government Printing Office; 2000 [Census 25‐1130]). Scattered points indicate observed rates, and lines are fitted rates according to joinpoint regression. Incidence rates were delay‐adjusted and covered 89% of the US population, and mortality covered the entire United States. The following registries were included for incidence: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. The AAPC is a weighted average of the APCs over the fixed interval (2010‐2014 for incidence; 2011‐2015 for mortality) using the underlying Joinpoint model for the period from 1999 to 2014 for incidence and the period from 1999 to 2015 for mortality. Joinpoint models with up to 2 joinpoints for incidence and up to 3 joinpoints for mortality are based on rates per 100,000 persons age standardized to the 2000 US standard population (19 age groups; Census P25‐1130). For joinpoint analysis, the Joinpoint Regression Program was used (version 4.5.01; Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; June 2017).

Figure 2

Age‐standardized, delay‐adjusted incidence rates and recent trends (2010‐2014) are illustrated for the 17 most common cancers in men and the 18 most common cancers in women for all races/ethnicities combined and by sex. The 5‐year average annual percent change (AAPC) is based on the joinpoint trend from 1999 to 2014. An asterisk indicates that the AAPC is statistically significantly different from zero (2‐sided t test or Z test; P < .05). Rates were age‐standardized to the 2000 US standard population (19 age groups; Census P25‐1130), were delay‐adjusted, and covered 89% of the US population. The following registries were included in the analyses: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. The AAPC is a weighted average of the annual percent changes (APCs) over the fixed interval (2010‐2014) using the underlying joinpoint model for the period from 1999 to 2014. Joinpoint models with up to 2 joinpoints are based on rates per 100,000 persons age standardized to the 2000 US standard population (19 age groups; Census P25‐1130). For joinpoint analysis, the Joinpoint Regression Program was used (version 4.5.0.1; Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; June 2017).

Figure 3

Age‐standardized death rates and recent fixed‐interval trends (2011‐2015) are illustrated for the 18 most common cancers in men and the 20 most common cancers in women, for all races/ethnicities combined, and by sex. The 5‐year average annual percent change (AAPC) is based on the joinpoint trend from 1999 to 2015. An asterisk indicates that the AAPC is statistically significantly different from zero (2‐sided t test or Z test; P < .05). Rates were age‐standardized to the 2000 US standard population (19 age groups; Bureau of the Census. Current Population Reports, Publication 25‐1130. Washington, DC: US Government Printing Office; 2000 [Census P25‐1130]). The AAPC is a weighted average of the annual percent changes over the fixed interval (2011‐2015) using the underlying joinpoint model for the period from 1999 to 2015. Joinpoint models with up to 3 joinpoints are based on rates per 100,000 persons age standardized to the 2000 US standard population (19 age groups; Census P25‐1130). For joinpoint analysis, the Joinpoint Regression Program was used (version 4.5.0.1; Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; June 2017).

Figure 4

Delay‐adjusted incidence (1999‐2014) and mortality (1999‐2015) trends, 5‐year survival estimates by stage (2007‐2013), and stage distribution at diagnosis are illustrated for (A) female breast cancer, (B) colon and rectum cancer, (C) lung and bronchus cancer, and (D) melanoma of the skin. Rates were age‐standardized to the 2000 US standard population (19 age groups; Bureau of the Census. Current Population Reports, Publication 25‐1130. Washington, DC: US Government Printing Office; 2000 [Census P25‐1130]). Scattered points indicate observed rates, and lines are fitted rates according to joinpoint regression. Incidence rates were delay‐adjusted and covered 89% of the US population, and mortality covered the entire United States. The following registries were included for incidence: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. Joinpoint models with up to 2 joinpoints for incidence and up to 3 joinpoints for mortality are based on rates per 100,000 persons age standardized to the 2000 US standard population (19 age groups; Census P25‐1130). For joinpoint analysis, the Joinpoint Regression Program was used (version 4.5.0.1; Bethesda, MD: Statistical Research and Applications Branch, National Cancer Institute; June 2017). Five‐year relative survival rates covered 69.5% of the US population. The following registries were included for survival: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Michigan, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Seattle, West Virginia, Wisconsin, and Wyoming.