Annual Report to the Nation on the Status of Cancer, featuring state-level statistics after the onset of the COVID-19 pandemic

Abstract

Background: This report represents a collaborative effort by the major cancer surveillance organizations to present the definitive US statistics for cancer incidence and mortality.

Methods: Cancer incidence data were obtained from population-based cancer registries funded by the Centers for Disease Control and Prevention and the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Cancer death data were obtained from the National Center for Health Statistics' National Vital Statistics System. Statistics are reported by cancer type, sex, race and ethnicity, and age. The potential impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence was assessed by using state-level changes compared with previous years, the stringency of COVID-19 policy restrictions, the magnitude of COVID-19 death rates, and changes in the use of mammography.

Results: Overall cancer incidence rates per 100,000 were 500 among males and 437 among females. Excluding 2020, cancer incidence rates remained stable (2013-2021) among males and increased 0.3% per year on average (2003-2021) among females. The overall cancer death rate per 100,000 was 173 among males and 126 among females. Cancer death rates decreased by 1.5% per year (2018-2022), slowing from a previous 2.1% decline. Cancer incidence in 2020 declined from prepandemic levels for all demographic groups examined. However, the magnitude of decline was not strongly associated with the study's proxies for health care capacity, health care access, or COVID-19 policies.

Conclusions: Overall cancer mortality declined over 20 years, even during the COVID-19 pandemic. Disruptions in health care use early in the pandemic resulted in incidence declines in 2020, but 2021 incidence returned to prepandemic levels.

Keywords: National Program of Cancer Registries; National Vital Statistics System; North American Association of Central Cancer Registries (NAACCR); Surveillance, Epidemiology, and End Results (SEER) Program; annual report to the nation; cancer; coronavirus disease 2019 (COVID‐19); epidemiology.

FIGURE 1

Trends in age‐standardized incidence (2001−2021) and mortality (2001−2022) rates are illustrated for all cancer sites combined, all ages, and all racial/ethnic groups combined, by sex. Trends were estimated using joinpoint regression and were characterized using 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. Scattered points are observed rates; lines are fitted rates according to joinpoint regression. An asterisk (*) indicates that the APC or AAPC is statistically significantly different from zero (p < .05); 95% confidence limits are given in parentheses.

FIGURE 2

Average annual percent changes (AAPCs) in age‐standardized, delay‐adjusted incidence rates for 2017–2021 are illustrated for all sites and for the 18 most common cancers in males and females, all ages, and all racial/ethnic groups combined, by sex. The AAPC was a weighted average of the annual percent changes over the fixed 5‐year interval using the underlying joinpoint regression model. AAPCs with an asterisk (*) were statistically significantly different from zero (p < .05) and are depicted as solid‐colored bars; AAPCs with hash marks were not statistically significantly different from zero (stable). NOS indicates not otherwise specified.

FIGURE 3

Average annual percent changes (AAPCs) in age‐standardized, delay‐adjusted death rates for 2018–2022 are illustrated for all sites and for the 18 most common cancers in males and females, all ages, and all racial/ethnic groups combined, by sex. The AAPC was a weighted average of the annual percent changes over the fixed 5‐year interval using the underlying joinpoint regression model. AAPCs with an asterisk (*) were statistically significantly different from zero (p < .05) and are depicted as solid‐colored bars; AAPCs with hash marks were not statistically significantly different from zero (stable). NOS indicates not otherwise specified.

FIGURE 4

Overall, observed, age‐adjusted rates for all cancer sites combined by month for 2016 through 2021. Max indicates maximum; min, minimum.

FIGURE 5

Four choropleth US maps illustrate the potential impact of the COVID‐19 pandemic. (A) Map A illustrates the relative decline in cancer incidence rates from 2019 to 2020, with the darkest colors representing greater declines in rates. (B) To approximate curtailed general life activities, map B illustrates the stringency of COVID‐19 policy restrictions from March 1 to November 1, 2020, with the darkest colors representing the most restrictive policies. (C) To approximates limits on health care access because of health system capacity, map C illustrates the magnitude of COVID‐19 death rates during 2020, with the darkest colors representing the highest death rates. (D) To approximate health care access because of facility closure and related policies, map D illustrates the change in mammography use reported in 2018 and 2020, with the darkest colors representing the greatest declines in screening and hashing representing an increase. COVID‐19 indicates coronavirus disease 2019.

FIGURE 6

The percentage of cases diagnosed at late stage (regional or distant) for all sites and for five sites with screenable cancers by year (2017–2021) with confidence intervals. Late stage is defined as the percentage of total staged cancers that are diagnosed as regional or distant based on the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) summary stage.