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US Cancer Burden

US Cancer Burden. Epi 242 Cancer Epidemiology Binh Goldstein, Ph.D. October 7, 2009. US Mortality, 2006. No. of deaths. % of all deaths. Rank. 1. Heart Diseases 631,636 26.0 2. Cancer 559,888 23.1 3. Cerebrovascular diseases 137,119 5.7

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US Cancer Burden

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  1. US Cancer Burden Epi 242 Cancer Epidemiology Binh Goldstein, Ph.D. October 7, 2009

  2. US Mortality, 2006 No. of deaths % of all deaths Rank • 1. Heart Diseases 631,636 26.0 • 2. Cancer559,888 23.1 • 3. Cerebrovascular diseases 137,119 5.7 • 4. Chronic lower respiratory diseases 124,583 5.1 • 5. Accidents (unintentional injuries) 121,599 5.0 • 6. Diabetes mellitus 72,449 3.0 • 7. Alzheimer disease 72,432 3.0 • 8. Influenza & pneumonia 56,326 2.3 • Nephritis* 45,344 1.9 • 10. Septicemia 34,234 1.4 Cause of Death *Includes nephrotic syndrome and nephrosis. Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

  3. Change in US Death Rates* from 1991 to 2006 Rate Per 100,000 1991 2006 * Age-adjusted to 2000 US standard population. Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

  4. Age Standardized Incidence Rates Source: GLOBOCAN 2002

  5. Ten Leading Cancer Types for New Cancer Cases2009 Estimates

  6. 2009 Estimated US Cancer Cases* Men766,130 Women713,220 27% Breast 14% Lung & bronchus 10% Colon & rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3% Kidney & renal pelvis 3% Ovary 3% Pancreas 22% All Other Sites Prostate 25% Lung & bronchus 15% Colon & rectum 10% Urinary bladder 7% Melanoma of skin 5% Non-Hodgkin 5% lymphoma Kidney & renal pelvis 5% Leukemia 3% Oral cavity 3% Pancreas 3% All Other Sites 19% *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2009.

  7. Cancer Incidence Rates* by Sex, US, 1975-2005 Rate Per 100,000 Men Both Sexes Women *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.

  8. Cancer Incidence Rates* Among Men, US, 1975-2005 Rate Per 100,000 Prostate Lung & bronchus Colon and rectum Urinary bladder Non-Hodgkin lymphoma Melanoma of the skin *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.

  9. Cancer Incidence Rates* Among Women, US, 1975-2005 Rate Per 100,000 Breast Colon and rectum Lung & bronchus Uterine Corpus Ovary Non-Hodgkin lymphoma *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.

  10. Cancer Incidence Rates* by Race and Ethnicity, 2001-2005 Rate Per 100,000 *Age-adjusted to the 2000 US standard population. †Person of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  11. Cancer Incidence Rates* by Sex and Race, US,1975-2005 Rate Per 100,000 African American men White men White women African American women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.

  12. Ten Leading Cancer Types for Cancer Deaths 2009 Estimates

  13. 2009 Estimated US Cancer Deaths* Men292,540 Women269,800 Lung & bronchus 30% Prostate 9% Colon & rectum 9% Pancreas 6% Leukemia 4% Liver & intrahepatic 4%bile duct Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 25% 26% Lung & bronchus 15% Breast 9% Colon & rectum 6% Pancreas 5% Ovary 4% Non-Hodgkin lymphoma 3% Leukemia 3% Uterine corpus 2% Liver & intrahepatic bile duct 2% Brain/ONS 25% All other sites ONS=Other nervous system. Source: American Cancer Society, 2009.

  14. Cancer Death Rates* by Sex, US, 1975-2005 Rate Per 100,000 Men Both Sexes Women *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

  15. Trends in the Number of Cancer Deaths Among Men and Women, US, 1930-2006 Men Men Women Women Number of Cancer Deaths Source: US Mortality Data, 1930-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

  16. Cancer Death Rates* Among Men, US,1930-2005 Rate Per 100,000 Lung & bronchus Stomach Prostate Colon & rectum Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

  17. Cancer Death Rates* Among Women, US,1930-2005 Rate Per 100,000 Lung & bronchus Uterus Breast Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

  18. Cancer Death Rates* by Race and Ethnicity, US, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. † Persons of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  19. Cancer Death Rates* by Sex and Race, US, 1975-2005 Rate Per 100,000 African American men White men African American women White women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  20. Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 Ratio of African American/White • All sites 313.0 230.7 1.4 • Prostate 59.4 24.6 2.4 • Larynx 4.8 2.1 2.3 • Stomach 11.5 5.0 2.3 • Myeloma 8.3 4.3 1.9 • Oral cavity and pharynx 6.7 3.8 1.8 • Small intestine 0.7 0.4 1.8 • Liver and intrahepatic bile duct 10.3 6.7 1.5 • Colon and rectum 31.8 22.1 1.4 • Esophagus 9.8 7.8 1.3 • Lung and bronchus 93.1 71.3 1.3 • Pancreas 15.4 12.1 1.3 Site African American White *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  21. Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 Ratio of African American/White Site • All sites 186.7 159.2 1.2 • Stomach 5.5 2.5 2.2 • Myeloma 6.0 2.8 2.1 • Uterine cervix 4.7 2.3 2.0 • Esophagus 2.8 1.6 1.8 • Uterine corpus 7.1 3.9 1.8 • Small intestine 0.5 0.3 1.7 • Larynx 0.8 0.5 1.6 • Colon and rectum 22.4 15.3 1.5 • Pancreas 12.4 9.0 1.4 • Breast 33.5 24.4 1.4 • Gallbladder 1.0 0.8 1.3 • Urinary bladder 2.8 2.2 1.3 • Liver and intrahepatic bile duct 3.9 2.9 1.3 African American White *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  22. Lifetime Probability of Developing Cancer, Men, 2003-2005* Site Risk All sites† 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 18 Urinary bladder‡ 1 in 27 Melanoma§ 1 in 39 Non-Hodgkin lymphoma 1 in 45 Kidney 1 in 57 Leukemia 1 in 67 Oral Cavity 1 in 72 Stomach 1 in 90 * For those free of cancer at beginning of age interval. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan

  23. Lifetime Probability of Developing Cancer, Women, US, 2003-2005* Site Risk All sites† 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 20 Uterine corpus 1 in 40 Non-Hodgkin lymphoma 1 in 53 Urinary bladder‡ 1 in 84 Melanoma§ 1 in 58 Ovary 1 in 72 Pancreas 1 in 75 Uterine cervix 1 in 145 * For those free of cancer at beginning of age interval. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan

  24. Cancer Survival*(%) by Race,1996-2004 Absolute Difference African Site White American All Sites 68 58 10 Breast (female) 91 78 13 Colon 66 55 11 Esophagus 18 11 7 Leukemia 52 42 10 Non-Hodgkin lymphoma 66 58 8 Oral cavity 62 42 20 Prostate 99 96 3 Rectum 67 59 8 Urinary bladder 82 66 16 Uterine cervix 74 65 9 Uterine corpus 86 61 25 *5-year relative survival rates based on cancer patients diagnosed from 1996 to 2004 and followed through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  25. Trends in Five-year Relative Survival (%)* Rates, US, 1975-2004 1984-1986 1996-2004 Site 1975-1977 • All sites 50 54 66 • Breast (female) 75 79 89 • Colon 52 59 65 • Leukemia 35 42 51 • Lung and bronchus 13 13 16 • Melanoma 82 87 92 • Non-Hodgkin lymphoma 48 53 65 • Ovary 37 40 46 • Pancreas 3 3 5 • Prostate 69 76 99 • Rectum 49 57 67 • Urinary bladder 74 78 81 *5-year relative survival rates based on follow up of patients through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

  26. Tobacco Use in the US, 1900-2005 Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Data, 1960-2005, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of Agriculture, 1900-2007.

  27. Trends in Cigarette Smoking Prevalence* (%), by Sex, Adults 18 and Older, US, 1965-2007 Men Women *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965-2007, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008.

  28. Trends in Obesity* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2006 *Body mass index (BMI) at or above the sex-and age-specific 95th percentile BMI cutoff points from the 2000 sex-specific BMI-for-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term “overweight” to describe youth in this BMI category. Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2006: Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, 2003-2006. JAMA 2008; 299 (20): 2401-05.

  29. Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006† *Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population.Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

  30. Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006† *Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard population.Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

  31. Less than 50% 50 to 55% More than 55% State did not participate in survey Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2007 1992 1995 1998 2007 *Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004-2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007, 2008.

  32. Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society • Yearly mammograms are recommended starting at age 40. • A clinical breast exam should be part of a periodic health examination, about every 3 years for women in their 20s and 30s. Asymptomatic women aged 40 and older should continue to undergo a clinical breast exam, preferably annually*. • Beginning in their early 20s, women should be told about the benefits and limitations of breast-self examination. Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. __________ * Beginning at age 40 years, annual CBE should be performed prior to mammography

  33. Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status, Women 40 and Older, US, 1991-2006 All women 40 and older Women with less than a high school education Women with no health insurance *A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007.

  34. Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society • Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age. • Screening should be done every year with regular Pap tests or every two years using liquid-based tests. • At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years with cervical cytology (either conventional or liquid-based Pap test) alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology. • Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening. • Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

  35. Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, 1992-2006 All women 18 and older Women with no health insurance Women with less than a high school education * A Pap test within the past three years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for women 25 and older. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007.

  36. Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas, American Cancer Society 2008 • Beginning at age 50, men and women should follow one of the following examination schedules: • A flexible sigmoidoscopy (FSIG) every five years • A colonoscopy every ten years • A double-contrast barium enema every five years • A Computerized Tomographic (CT) colonography every five years • A guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every year • A stool DNA test (interval uncertain) • Tests that detect adenomatous polyps and cancer • Tests that primarily detect cancer People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule

  37. Trends in Recent* Fecal Occult Blood Test Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006 *A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.

  38. Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006 *A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.

  39. Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society • Beginning at age 50, to men who have a life expectancy of at least 10 years, health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination.* ___________ * Information should be provided to men regarding the benefits and limitations of testing so that an informed decision concerning testing can be made with the clinician’s assistance.

  40. Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006 *A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007.

  41. Recent* Digital Rectal Examination (DRE) Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006 *A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007.

  42. Resources • American Cancer Society • Cancer Facts & Figures • www.cancer.org

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