A progress report on cancer in the United States-incidence, stage and mortality (Proceedings)

Incidence

     • After decades of significant increase, delay adjusted rates stabilized in 1995 and fell since 1999.

     • Measuring New Cancer Cases: In 2010, more than half of all new cancers were cancers of the prostate, female breast, lung, and colon/rectum. According to the American Cancer Society, there were 1,529,560 new cases of cancer in 2010, including 217,730 cases of prostate cancer; 209,060 cases of female breast cancer; 222,520 cases of lung cancer; and 142,570 cases of colon/rectum cancer.

     • Measure: Incidence rate: The observed number of new cancer cases per 100,000 people per year is adjusted for cancer case reporting delays.

     • Period – 1975–2007 Trends: All sites combined: Incidence was on the rise from 1975 to 1989, with non-significant changes in rates from 1989 to 1999. From 1999 to 2007, incidence significantly declined. Among men, incidence rates rose from 1975 to 1992. From 1992 to 1995, cancer incidence among men significantly declined, with no significant change between 1995 and 2000. From 2000 to 2007, incidence trends among men resumed a decline.

     • Among women, from 1975 to 1979 incidence rates were stable, rose from 1979 to 1987 and stabilized through 1998. From 1998 to 2007 cancer incidence among women declined.

     • Groups at High Risk for New Cancer Diagnosis: Among racial/ethnic groups, blacks have the highest rate of new cancers, followed by whites. Comparatively, rates are lower among American Indians/Alaska Natives, Hispanics, and Asians and Pacific Islanders.

     • Prostate cancer: Incidence rose from 1975 to 1992 and fell until around 1995. After a period of non-significant change from 1995 to 2000, rates declined from 2000 to 2007.

     • Female breast cancer: After a period of no significant change, incidence rates rose between 1980 and 1987, before stabilizing from 1987 to 1998. Incidence rates fell from 1998 to 2007.

     • Colorectal cancer: Among males, incidence rose between 1975 and 1985; incidence rates were stable among women during these years. Among both men and women, incidence rates have fallen steadily since 1985, except for a period of non-significant change in rates among both men and women from 1995 to 1998.

     • Lung cancer: Incidence of lung cancer was consistently higher among males than females between 1975 and 2007. Incidence rates increased among men from 1975 until 1982, were stable from 1982 to 1991, and declined from 1991 to 2007. Lung cancer incidence rates steadily increased among women from 1975 to 2007.

     • Recent Estimates (Delay-adjusted): In 2007, all sites combined occurred at the following rate: 472.68 cases per 100,000 people per year

     • Prostate: 170.88 per 100,000 men per year

     • Female breast: 124.68 per 100,000 women per year

     • Colorectal: 51.60 per 100,000 men per year and 41.15 per 100,000 women per year

     • Lung: 71.82 per 100,000 men per year and 53.02 per 100,000 women per year

     • Healthy People 2010 Targets: None for cancer incidence.

     • Cancer Sites with Increasing Incidence Trends: The small subset of cancer sites with the fastest increasing incidence rates (annual percent changes of 2 percent or more per year) are melanoma of the skin; cancer of the kidney and renal pelvis; thyroid; and liver and intrahepatic bile duct. Rising cancer incidence trends must be interpreted with caution, because they can reflect real increases, temporary increases associated with early detection, or a permanent increase in cases associated with finding cases that are histologically malignant but biologically indolent.

     • Cancer Sites with Decreasing Incidence Trends: Incidence rates are decreasing for all cancer sites combined and for the four leading cancers (prostate, breast, lung, and colorectal cancer). Incidence rates are also decreasing for other sites with annual rate of 5+ cases per 100,000: corpus and uterus (not otherwise specified); ovary; oral cavity and pharynx; stomach; brain and other nervous system; and urinary bladder cancers.

     • Key Issues: The rate of increase in lung cancer incidence among women has slowed, however the trend remains statistically significant, and lung cancer is the leading cause of cancer deaths among women. There is a need to reduce smoking and environmental tobacco smoke exposure among women. Incidence rates of leading cancers are decreasing including female breast, prostate, colorectal and lung cancers. Nonetheless, some cancers are on the rise and require greater efforts at control. For instance, incidence rates of melanoma of the skin, cancer of the kidney, and renal pelvis, thyroid, and liver and intrahepatic bile duct cancers, are rising with annual percent changes of 2 percent.

Stage at Diagnosis

     • There are fewer late-stage diagnoses for four major cancers where early detection is either recommended and/or widely used.

     • Late-Stage Diagnosis of Cancer: Cancers can be diagnosed at different stages, for example, I, II, III, or IV or "localized," "regional," and "distant." The lower the number or the more localized the cancer, the better a person's chances of benefiting from treatment. Tracking the rates of late-stage (distant) cancers is a good way to monitor the impact of cancer screening. When more cancers are detected in early stages, fewer should be detected in late stages.

     • Measure - Late-stage diagnosis rate: The number of new cancer cases diagnosed at a late (distant) stage, per 100,000 people per year. This report shows the rates for cancers of the prostate, colon, rectum, and cervix uteri.

     • Period: 1980–2007 (Late-stage prostate data is presented for the years 1995 to 2007)

     • Trends - Prostate: Late-stage prostate cancer fell from 1995 to 2007, following the introduction of the prostate-specific antigen (PSA) test.

     • Colon: Late-stage colon cancer incidence fell for most of the time from 1980 to 2007.

     • Rectum: Incidence rates fell from 1980 to 2007.

     • Cervix: Incidence rates fell from 1980–2007.

Mortality

     • After several decades of steady increases, the U.S. cancer death rate stabilized from 1990 to 1992 and has significantly declined from 1992 to 2007.

     • Measuring Cancer Deaths: In 2007, cancers of the female breast, prostate, lung, and colon/rectum accounted for more than half of all cancer deaths in the United States. Lung cancer alone claimed one-fourth of the lives lost to cancer. According to the American Cancer Society, in 2010 there were 569,490 cancer deaths including 157,300 deaths from lung cancer; 51,370 from cancers of the colon/rectum; 39,840 from female breast cancer; 36,800 deaths from cancer of the pancreas and 32,050 from prostate cancer.

     • Measure: Cancer deaths per 100,000 person years age-adjusted to the U.S. 2000 population Period – 1975–2007 Trends, All sites combined: Death rates among both sexes combined increased through 1992 and then fell from 1992 through 2007. Among men, death rates increased through 1990, were stable from 1990 to 1993, and fell thereafter. Among women, rates increased through 1991 and fell thereafter.

     • Groups at High Risk for Cancer Deaths: Blacks experience the highest cancer death rates, followed by whites. Both groups exceed the Healthy People 2010 objective of 158.6 cancer deaths or less per 100,000 person years. In 2007, cancer death rates among Asian and Pacific Islanders, American Indians and Alaska Natives, and persons of Hispanic ethnicity were lower than the Healthy People 2010 objective. Death rates may be underestimated for these groups.

     • Lung cancer: Death rates among men rose from 1975 to 1991 and fell from 1991 to 2007. Death rates among women rose from 1975 to 2002 and fell from 2002 to 2007.

     • Colorectal cancer: Death rates among women fell from 1975 to 2007. Among men, rates fell from 1984 to 2007.

     • Female breast cancer: After rising from 1975 to 1990, death rates have steadily fallen.

     • Prostate cancer: After increasing from 1975-1991 prostate cancer death rates fell from 1994-2007

     • Recent Estimate: In 2007, the death rate for all cancers was 178.15 per 100,000 people.

     • Healthy People 2010 Target: Reduce overall cancer death rate to 158.6 cancer deaths per 100,000 people per by 2010.

     • Cancer Sites with Increasing Mortality Trends: Mortality rates are currently increasing for only a few cancer sites. These sites include liver and intrahepatic bile duct, pancreas—and recently—corpus and unspecified uterus.

     • Cancer Sites with Decreasing Mortality Trends: The mortality rates for less common cancer sites are also decreasing: leukemia; non-Hodgkin lymphoma; stomach cancer; ovarian cancer; urinary bladder cancer; and brain and other nervous system cancers.

     • Key Issues: Although overall death rates are on the decline, cancer deaths for some sites are increasing, such as liver and intrahepatic bile duct, pancreas, and corpus and unspecified uterus. A challenge is to find new and better ways to reduce and eliminate disparities in cancer deaths among different populations of Americans.

Person-Years of Life Lost

     • Cancer is responsible for more person years of life lost than all other causes combined.

     • Person-Years of Life Lost (PYLL): Death rates alone do not convey the burden of cancer. Another useful measure is person-years of life lost (PYLL)—the years of life lost because of early death from a particular cause or disease. On average, each person who died from cancer in 2007 lost an estimated 15.4 years of life.

     • Measure: PYLL from disease is the difference between actual and expected age of death. Most Recent Estimates: In 2007, cancer deaths were responsible for more than 8.6 million PYLL, which is more than all other causes combined. About 51 percent of the PYLL caused by cancer death occurred among women.