Declines In U.S. Cancer Incidence And Death Rates According to Annual Report

Although cancer death rates have been dropping since the publication of the first Annual Report to the Nation 10 years ago, the latest edition marks the first time the report has documented a simultaneous decline in cancer incidence, the rate at which new cancers are diagnosed, for both men and women. Based on the long-term incidence trend, rates for all cancers combined decreased 0.8 percent per year from 1999 through 2005 for both sexes combined; rates decreased 1.8 percent per year from 2001 through 2005 for men and 0.6 percent per year from 1998 through 2005 for women. The decline in both incidence and death rates for all cancers combined is due in large part to declines in the three most common cancers among men (lung, colon/rectum, and prostate) and the two most common cancers among women (breast and colon/rectum), combined with a leveling off of lung cancer death rates among women.

The new report shows that, from 1996 through 2005, death rates for all cancers combined decreased for all racial and ethnic populations and for both men and women, except for American Indian/Alaska Native men and women, for whom rates were stable. The drop in death rates has been steeper for men, who have higher rates, than for women. Death rates declined for 10 of the top 15 causes of cancer death among both men and women. However, death rates for certain individual cancers are increasing, including esophageal cancer for men, pancreatic cancer for women, and liver cancer for both men and women. Overall cancer death rates were highest for African-Americans and lowest for Asian American/Pacific Islanders.

Among men, incidence rates dropped for cancers of the lung, colon/rectum, oral cavity, and stomach. Prostate cancer incidence rates decreased by 4.4 percent per year from 2001 through 2005 after increasing by 2.1 percent per year from 1995 to 2001. In contrast, incidence rates increased for cancers of the liver, kidney, and esophagus, as well as for melanoma (2003-2005), non-Hodgkin lymphoma, and myeloma. Incidence rates were stable for cancers of the bladder, pancreas, and brain/nervous system, and for leukemia.

For women, incidence rates dropped for cancers of the breast, colon/rectum, uterus, ovary, cervix, and oral cavity but increased for cancers of the lung, thyroid, pancreas, brain/nervous system, bladder, and kidney, as well as for leukemia, non-Hodgkin lymphoma, and melanoma.

Summary of findings

• Overall incidence rates for all racial and ethnic populations combined decreased by 0.8% per year from 1999 through 2005 in both sexes combined, 1.8% per year from 2001 through 2005 in men, and 0.6% per year from 1998 through 2005 in women.
• Black men had the highest cancer incidence rate for 2001-2005 among all men and white women had the highest rate among all women.
• Among men, rates continued to decrease for lung and bronchus(lung), colon and rectal (colorectal), oral cavity and pharynx (oral cavity), and stomach cancers. For prostate cancer, rates decreased by 4.4% per year in the period 2001 through 2005 after increasing by 2.1% annually from 1995 through 2001. In contrast, rates increased for cancers of the kidney and renal pelvis (kidney), liver and intrahepatic bile duct (liver), and esophagus and for myeloma, non-Hodgkin lymphoma (NHL), and melanoma of the skin (melanoma). Incidence rates were stable for cancers of urinary bladder (bladder), pancreas, and brain and other nervous system (brain) and for leukemia.
• Among women, incidence rates decreased during the most recent joinpoint segments for six of the top 15 cancers [breast, colorectum, uterine corpus and uterus NOS (uterus), ovary, cervix uteri (cervix) and oral cavity]. Rates increased for the remaining 9 of the top 15 cancers (lung, thyroid, pancreas, bladder, kidney, brain, NHL, melanoma, and leukemia).
• Overall cancer death rates continued to decrease since the early 1990s in both men and women. Death rates decreased by 1.5% per year from 1993 through 2001 and 2.0% per year from 2001 through 2005 in men and by 0.8% per year from 1994 through 2002 and 1.6% per year from 2002 through 2005 in women.
• Death rates for all cancers combined (2001-2005) were highest for blacks and lowest for Asian American/Pacific Islander(API) men and women. Cancers of the lung, prostate and colorectum were the three leading causes of cancer death in rank order among men for each major racial and ethnic population, except API men in whom cancer of the liver ranked second. The corresponding leading causes of cancer death in rank order among women were lung, breast and colorectum, except among Hispanic women in whom breast cancer ranked first.
• Among men, the lung cancer death rate decreased during the years 1996 to 2005 in 44 of the 50 states and in the District of Colombia, whereas in women, the death rate decreased in only three states (California, New Jersey, and Texas), and increased in 13 states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Kansas, South Dakota, Indiana, Michigan, and Iowa.
• Trends in initiation of smoking among 12-17 year-old adolescents in the United States, 1940 through 2000, show that initiation rates increased sharply in girls from 1965 through 1975. Subsequently, rates decreased through mid the 1980s in both girls and boys, but rose again from 1990 through the mid-1990s, especially in boys. Initiation rates were similar for boys and girls during the most recent data years (1996 through 2000).

The Special Feature section of the Report highlights wide variations in tobacco smoking patterns across the United States, which, coupled with differences in smoking behaviors in younger versus older populations, helps explains the delay in an expected decrease in lung cancer deaths among women and a slowing of the decrease in lung cancer deaths among men.

The report finds substantial differences in lung cancer death rate trends by state and geographic region. For example, lung cancer death rates dropped an average of 2.8 percent per year among men in California from 1996 through 2005, more than twice the drop seen in many states in the Midwest and the South. The geographic variation is even more extreme among women, for whom lung cancer death rates increased from 1996 through 2005 in 13 states and decreased only in three. The report also notes that, in five states (Pennsylvania, Illinois, Minnesota, Nebraska, and Idaho), lung cancer incidence among women showed an increasing trend, whereas the mortality trend was level.

Variation in smoking prevalence among the states is influenced by several factors, including public awareness of the harms of tobacco use, social acceptance of tobacco use, local tobacco control activities, and tobacco industry promotional activities targeted in a geographic area. The 13 states where lung cancer death rates for women are on the rise have higher percentages of adult female smokers, low excise taxes, and local economies that are traditionally dependent on tobacco farming and production. In contrast, California, which was the first state to implement a comprehensive, statewide tobacco control program, was the only state in the country to show declines in both lung cancer incidence and deaths in women.

According to a U.S. Surgeon General's report, cigarette smoking accounts for approximately 30 percent of all cancer deaths, with lung cancer accounting for 80 percent of the smoking-attributable cancer deaths. Other cancers caused by smoking include cancers of the oral cavity, pharynx, larynx, esophagus, stomach, bladder, pancreas, liver, kidney, and uterine cervix and myeloid leukemia.

The study was conducted by scientists at the ACS, CDC, NCI, which is part of the National Institutes of Health, and the NAACCR.