Cancer statistics, 2019
Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006‐2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007‐2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2‐fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012‐2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.
Cancer is a major public health problem worldwide and is the second leading cause of death in the United States. In this article, we provide the estimated numbers of new cancer cases and deaths in 2019 in the United States nationally and for each state, as well as a comprehensive overview of cancer occurrence based on the most current population‐based data for cancer incidence through 2015 and for mortality through 2016. We also estimate the total number of deaths averted because of the continuous decline in cancer death rates since the early 1990s and analyze cancer mortality rates by county‐level poverty. Mortality data from 1930 to 2016 were provided by the National Center for Health Statistics (NCHS).1-3 Forty‐seven states and the District of Columbia met data quality requirements for reporting to the national vital statistics system in 1930, and Texas, Alaska, and Hawaii began reporting in 1933, 1959, and 1960, respectively. The methods for abstraction and age adjustment of historic mortality data are described elsewhere.3, 4 Five‐year mortality rates (2011‐2015) for Puerto Rico were previously published in volume 3 of the North American Association of Central Cancer Registries’ (NAACCR’s) Cancer in North America: 2011‐2015.5 Population‐based cancer incidence data in the United States have been collected by the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) Program since 1973 and by the Centers for Disease Control and Prevention's (CDC’s) National Program of Cancer Registries (NPCR) since 1995. The SEER program is the only source for historic population‐based incidence data. Long‐term (1975–2015) incidence and survival trends were based on data from the 9 oldest SEER areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound), representing approximately 9% of the US population.6, 7 The lifetime probability of developing cancer and contemporary stage distribution and survival statistics were based on data from all 18 SEER registries (the SEER 9 registries plus Alaska Natives, California, Georgia, Kentucky, Louisiana, and New Jersey), covering 28% of the US population.8 The probability of developing cancer was calculated using NCI’s DevCan software (version 6.7.6).9 Some of the statistical information presented herein was adapted from data previously published in the SEER Cancer Statistics Review 1975‐2015.10 The NAACCR compiles and reports incidence data from 1995 onward for registries that participate in the SEER program and/or the NPCR. These data approach 100% coverage of the US population for the most recent years and were the source for the projected new cancer cases in 2019 and cross‐sectional incidence rates by state and race/ethnicity.11, 12Some of the incidence data presented herein were previously published in volumes 1 and 2 of Cancer in North America: 2011‐2015.13, 14 All cancer cases were classified according to the International Classification of Diseases for Oncology except childhood and adolescent cancers, which were classified according to the International Classification of Childhood Cancer (ICCC).15, 16 Causes of death were classified according to the International Classification of Diseases.17 All incidence and death rates were age standardized to the 2000 US standard population and expressed per 100,000 population, as calculated by NCI’s SEER*Stat software (version 8.3.5).18 The annual percent change in rates was quantified using NCI’s Joinpoint Regression Program (version 4.6.0).19 Whenever possible, cancer incidence rates were adjusted for delays in reporting, which occur because of a lag in case capture or data corrections. Delay‐adjustment has the largest effect on the most recent data years for cancers that are frequently diagnosed in outpatient settings (eg, melanoma, leukemia, and prostate cancer) and provides the most accurate portrayal of cancer occurrence in the most recent time period.20 For example, the leukemia incidence rate for 2015 in the 9 oldest SEER registries was 12% higher after adjusting for reporting delays (15.2 vs 13.6 per 100,000 population).10 The most recent year for which reported incidence and mortality data are available lags 2 to 4 years behind the current year due to the time required for data collection, compilation, quality control, and dissemination. Therefore, we projected the numbers of new cancer cases and deaths in the United States in 2019 to provide an estimate of the contemporary cancer burden. To calculate the number of invasive cancer cases, a generalized linear mixed model was used to estimate complete counts for each county (or health service area for rare cancers) from 2001 through 2015 using delay‐adjusted, high‐quality incidence data from 48 states and the District of Columbia (96% population coverage) and geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors.21 (Data were unavailable for all years for Kansas and Minnesota, as well as for a few sporadic years for a handful of states.) Modeled counts were aggregated to the national and state level for each year, and a time series projection method (vector autoregression) was applied to all 15 years to estimate cases for 2019. Basal cell and squamous cell skin cancers cannot be estimated because incidence data are not collected by most cancer registries. For complete details of the case projection methodology, please refer to Zhu et al.22 New cases of in situ female breast carcinoma and melanoma of the skin diagnosed in 2019 were estimated by first approximating the number of cases occurring annually from 2006 through 2015 based on age‐specific NAACCR incidence rates (data from 46 states with high‐quality data for all 10 years) and US Census Bureau population estimates obtained via SEER*Stat. Counts were then adjusted for delays in reporting using SEER delay factors for invasive disease (delay factors are unavailable for in situ cases) and projected to 2019 based on the average annual percent change generated by the joinpoint regression model. The number of cancer deaths expected to occur in 2019 was estimated based on the most recent joinpoint‐generated annual percent change in reported cancer deaths from 2002 through 2016 at the state and national levels as reported to the NCHS. For the complete details of this methodology, please refer to Chen et al.23 The number of cancer deaths averted in men and women due to the reduction in cancer death rates since the early 1990s was estimated by summing the difference between the annual number of recorded cancer deaths from the number that would have been expected if cancer death rates had remained at their peak. The expected number of deaths was estimated by applying the 5‐year age‐ and sex‐specific cancer death rates in the peak year for age‐standardized cancer death rates (1990 in men and 1991 in women) to the corresponding age‐ and sex‐specific populations in subsequent years through 2016. Temporal trends in socioeconomic disparities in cancer mortality were examined using county‐level poverty as a proxy for socioeconomic status. Cancer death rates by county‐level poverty quintile were calculated using linked attributes from the US Census Bureau American Community Survey 2012–2016 available through SEER*Stat. The total resident population in each quintile was 73,559,180 persons (1.81%‐10.84% poverty); 62,695,449 persons (10.85%‐14.10% poverty); 74,157,401 persons (14.11%‐17.16% poverty); 76,945,467 persons (17.17%‐21.17% poverty); and 35,770,016 persons (21.18%‐53.95% poverty), respectively. County‐level poverty in the United States has shifted slightly from the South to the West since 1970, although the highest concentration remains in the South.24Introduction
Materials and Methods
Incidence and Mortality Data
Projected Cancer Cases and Deaths in 2019
Other Statistics
https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551