Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics

Abstract

Background: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate to provide annual updates on cancer incidence and mortality and trends by cancer type, sex, age group, and racial/ethnic group in the United States. In this report, we also examine trends in stage-specific survival for melanoma of the skin (melanoma).

Methods: Incidence data for all cancers from 2001 through 2017 and survival data for melanoma cases diagnosed during 2001-2014 and followed-up through 2016 were obtained from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries. Data on cancer deaths from 2001 to 2018 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in age-standardized incidence and death rates and 2-year relative survival were estimated by joinpoint analysis, and trends in incidence and mortality were expressed as average annual percent change (AAPC) during the most recent 5 years (2013-2017 for incidence and 2014-2018 for mortality).

Results: Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval [CI] = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = -2.2%, 95% CI = -2.5% to -1.9%) and females (AAPC = -1.7%, 95% CI = -2.1% to -1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females.

Conclusions: Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations.

Figure 1.

Trends in age -standardized incidence (2001-2017) and mortality (2001-2018) rates, all cancer sites combined, all ages, all races and ethnicities combined, by sex. Trends were estimated using joinpoint regression and characterized by the annual percent change (APC), the slope of a single segment, and the average APC (AAPC), a summary measure of the APCs over a fixed 5-year interval. Joinpoint models with up to 3 joinpoints are based on rates per 100 000 population and are age standardized to the 2000 US standard population (19 age groups, Census P25–1130). Incidence rates were delay adjusted and covered 92% of the US population, and mortality covered the entire United States. Registries included for incidence (46 states): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. Scattered points were observed rates; lines were fitted rates according to joinpoint regression. ^aThe APC or AAPC is statistically significantly different from 0 (2-sided P < .05), using a t test for the APC and for the AAPC when it laid entirely within the last joinpoint segment and a z-test when the last joinpoint fell within the last 5 years of data. The 95% confidence limits are given in parentheses.

Figure 2.

Age-standardized, delay-adjusted overall cancer incidence rates (2013-2017) and age-standardized overall cancer death rates (2014-2018), all cancer sites combined, all ages, by sex and racial and ethnic group. Racial/ethnic groups are mutually exclusive. Data for non-Hispanic American Indian or Alaska Native (AI/AN) are restricted to counties with Indian Health Service Purchased/Referred Care Delivery Areas. API = Asian or Pacific Islander.

Figure 3.

Average annual percent change (AAPC) in age-standardized, delay-adjusted incidence rates for 2013-2017 for all sites and the 18 most common cancers in men and women and age-standardized death rates for 2014-2018 for the 19 most common cancer deaths in men and the 20 most common cancer deaths in women, all ages, all races or ethnicities combined, by sex. The AAPC was a weighted average of the annual percent change (APCs) over the fixed 5-year interval (incidence, 2013-2017; mortality, 2014-2018) using the underlying joinpoint regression model, which allowed up to 3 different APCs, for the 17-year period 2001-2017 for incidence and 18-year period 2001-2018 for mortality. ^aAAPCs were statistically significantly different from zero (2-sided P < .05), using a t test when the AAPC laid entirely within the last joinpoint segment and a z-test when the last joinpoint fell within the last 5 years of data, and are depicted as solid-colored bars; AAPCs with hash marks were not statistically significantly different from zero (stable). NOS = not otherwise specified.

Figure 4.

Trends in 2-year age-standardized relative survival for melanomas of the skin diagnosed during 2001-2014 and followed-up through 2016, both sexes and all races or ethnicities combined, by stage at diagnosis. Cases were censored at an achieved age of 100 years. Two-year relative survival estimates were age-standardized using the International Cancer Survival Standards, age standard 2, and age groups 15-44 years, 45-54 years, 55-64 years, 65-74 years, and 75 years and older. Trends were estimated using joinpoint regression (with up to 2 joinpoints) and characterized by the annual percent change (APC), the slope of a single segment. ^aAPCs were statistically significantly different from 0 based on proportional hazard joinpoint models fitted to survival data on the log hazard scale; 95% confidence limits are given in parentheses. Registries included for survival (28 states) covered 86% of the US population: Alabama, Arizona, California, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin.