S. Bolden

The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its annual compilation of estimated cancer incidence, mortality, and survival data for the United States in the year 2000. After 70 years of increases, the recorded number of total cancer deaths among men in the US declined for the first time from 1996 to 1997. This decrease in overall male mortality is the result of recent down-turns in lung and bronchus cancer deaths, prostate cancer deaths, and colon and rectum cancer deaths. Despite decreasing numbers of deaths from female breast cancer and colon and rectum cancer, mortality associated with lung and bronchus cancer among women continues to increase. Lung cancer is expected to account for 25% of all female cancer deaths in 2000. This report also includes a summary of global cancer mortality rates using data from the World Health Organization.

Cancer is an important public health concern in the United States and around the world. To provide an up-to-date perspective on the occurrence of cancer, the American Cancer Society presents an overview of cancer frequency, incidence, mortality, and survival statistics for 1999. Because the United States does not have a nationwide cancer registry, exactly how many new cases of cancer are diagnosed in the total United States and individual states each year is not known. Consequently, we estimated the number of new cancer cases occurring annually in the United States from 1979 through 1995 using population data reported by the US Bureau of the Census and age-specific cancer incidence rates collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.1 We fitted these annual cancer case estimates to an autoregressive quadratic model to forecast the number of cancer cases expected to be diagnosed in the total United States in 1999. This method has been described in detail elsewhere.2 Between 1987 and 1992, the incidence rate of prostate cancer increased 85%, followed by a decline of 28% between 1992 and 1995.3 The sharp increase in incidence followed by the decline in recent years probably reflects extensive use of prostate-specific antigen (PSA) screening in a previously unscreened population and the subsequent increase in diagnoses at an early stage.4 We assumed that the number of prostate cancer cases would approach the pattern of rates in effect before widespread use of PSA screening, and we estimated new cases of prostate cancer for 1999 using a linear projection based on data from 1979 to 1989. Because cancer incidence rates and case counts for 1979 through 1995 were not available for many states, we could not use the methods mentioned earlier to estimate new cases for individual states. To derive these estimates, we assumed that the ratio of cancer deaths to cancer cases for each state was the same as the ratio for the United States. This method has been described in detail elsewhere.2 We estimated the number of cancer deaths expected to occur in the United States in 1999 using underlying cause of death data from death certificates as reported to the National Center for Health Statistics.5 The numbers of cancer deaths occurring annually from 1979 to 1995 were fitted to an autoregressive quadratic model to forecast the number of cancer deaths expected to occur in the total United States in 1999. The estimated number of cancer deaths for each state was calculated with the same modeling procedure used for the total United States. These methods have been described in detail elsewhere.2 Mortality statistics for the leading causes of death and the leading causes of cancer death and cancer mortality rates for 1930 to 1995 were obtained from the National Center for Health Statistics.5 Incidence rates, the probability of developing cancer, and 5-year relative survival rates were obtained from SEER.3, 6 In 1999, we estimate that about 1,221,800 new cases of invasive cancer will be diagnosed in the United States (Table 1). This estimate does not include carcinoma in situ of any site except the urinary bladder, and it does not include basal and squamous cell cancers of the skin. Approximately 1 million cases of basal and squamous cell skin cancers, 39,900 cases of breast carcinoma in situ, and 23,200 cases of melanoma carcinoma in situ are expected to be newly diagnosed in 1999. Among men, the most common cancers in 1999 are expected to be cancers of the prostate, lung and bronchus, and colon and rectum (Fig. 1). Prostate is the leading site for cancer incidence, accounting for 29% of new cancer cases in men. This year, 179,300 new cases of prostate cancer are expected to be diagnosed. Among women, the three most commonly diagnosed cancers are expected to be cancers of the breast, lung and bronchus, and colon and rectum (Fig. 1). Cancers occurring at these sites are expected to account for more than 50% of new cancer cases in women. Breast cancer alone is expected to account for 175,000 new cancer cases (29%) in 1999. For all sites combined, cancer incidence rates declined an average of −0.7% per year from 1990 to 1995, in contrast to increasing trends in earlier years.7 Similar recent declines are seen among many leading cancer sites (Figs. 3 and 4). Breast cancer incidence rates have been approximately level during the 1990s; however, they appear to be decreasing in younger women. Decreases in colon and rectum cancer incidence began in the mid-1980s, and today these rates continue to decline significantly, on averase −2.3% per year.7 A downturn in the incidence of lung and bronchus cancer in males began in the late 1980s, and during 1990 to 1995, incidence rates decreased significantly, −2.3% per year. Rates of incidence of lung and bronchus cancer among females are stabilizing. During 1990 to 1995, prostate cancer incidence rates declined significantly, on average-1.0% per year. In 1999, an estimated 563,100 Americans are expected to die of cancer—more than 1,500 people a day (Table 2). Although most 1999 cancer deaths in men (54%) are expected to be from cancers of the lung and bronchus, prostate, and colon and rectum (Fig. 2), the number of deaths from these three sites appears to be leveling off and may be beginning to decline. Among women, cancers of the lung and bronchus, breast, and colon and rectum are expected to account for more than half of all cancer deaths in 1999 (Fig. 2). In 1987, lung cancer surpassed breast cancer as the leading cause of cancer death in women and is expected to account for 25% of all cancer deaths in females in 1999. Breast and colon and rectum cancers will account for 16% and 11% of cancer deaths in females, respectively. After significant increases over the past 70 years, cancer mortality rates for all cancers combined began to decline in the 1990s (Figs. 5 and 6-8).7 Significant decreases have been seen among males and females, persons younger than 65 years of age, and among whites, African Americans, and Hispanics. Breast cancer mortality rates in females decreased an average of −1.7% per year during 1990 to 1995; decreases were more pronounced among white women and among younger women. During 1990 to 1995, mortality from cancers of the colon and rectum decreased significantly, on average −1.5% per year.7 Similar to what was seen with trends in incidence, significant decreases in mortality from lung and bronchus cancer have occurred only among males (on average −1.6% per year during 1990 to 1995); rates among females recently have begun to slow and appear to be stabilizing. Prostate cancer mortality decreased an average of −1.1% per year during 1990 to 1995.7 Overall rates of cancer incidence vary considerably among racial and ethnic groups (Table 10). African Americans have the highest incidence rates of cancer; they are 60% more likely to develop cancer than are Hispanics and Asian/Pacific Islanders and more than two times more likely to develop cancer than are American Indians. During 1990 to 1995, incidence rates decreased about −1.0% per year among whites and Hispanics, remained relatively stable among African Americans and Asian/Pacific Islanders, and appear to be increasing slightly among American Indians.3 White women are more likely to develop breast cancer than are women of other racial and ethnic groups, and African-American women are more likely to develop cancers of the colon and rectum.3 African-American men have the highest incidence rates of colon and rectum, lung and bronchus, and prostate cancers; they are at least 50% more likely to develop prostate cancer than are men of other racial and ethnic groups. African Americans are about 34% more likely to die of cancer than are whites and more than two times more likely to die of cancer than are Asian/Pacific Islanders, American Indians, and Hispanics. During 1990 to 1995, mortality rates decreased significantly among African Americans (-0.8% per year), Hispanics (-0.6% per year), and whites (-0.4% per year); remained stable among Asian/Pacific Islanders; and appear to be increasing slightly among American Indians.3 African-American women are more likely to die of breast and colon and rectum cancers than are women of any other racial and ethnic group, and they have approximately the same lung and bronchus cancer mortality rate as white women. Similar to the pattern seen with incidence rates, African-American men have the highest mortality rates of colon and rectum, lung and bronchus, and prostate cancer.3 Cancer is the second leading cause of death among children aged 1 to 14 years in the United States. Accidents are the most frequent cause of death (Table 12). The most common cancers found in children are leukemias (in particular, acute lymphocytic leukemia), brain and other nervous system cancers, non-Hodgkin's lymphoma, and soft tissue cancers.3 Over the past 20 years, significant improvements have occurred in the 5-year relative survival rate for many childhood cancers. Between 1974–1976 and 1989–1994, survival rates improved by at least 20% for acute lymphocytic and myeloid leukemias, neuroblastoma, non-Hodgkin's lymphoma, soft tissue cancer, and Wilms' tumor (Table 13). Our estimated numbers of new cancer cases and cancer deaths should be interpreted with caution when used to study trends in cancer incidence and mortality. These estimates may vary considerably from year to year, particularly for rare cancers and for states with smaller populations. We therefore discourage the use of these estimates to track year-to-year changes in cancer occurrence and death. National Center for Health Statistics mortality rates and SEER cancer incidence rates are generally more informative statistics to use for tracking cancer trends. For example, breast cancer incidence rates increased about 1% per year between 1979 and 1982, increased 4% per year between 1982 and 1987, and were approximately constant between 1987 and 1995. Despite the stabilization of rates during the latter period, the estimates of new breast cancer cases increased between 1988 and 1996. Our estimates are based on the most currently available cancer incidence and mortality data; however, these data are 4 years old at the time that the estimates are calculated. As such, the effects of large changes occurring in the 4-year interval between 1995 and 1999 cannot be captured by our modeling efforts. Finally, our estimates of new cancer cases are based on incidence rates for the geographic locations that participate in the SEER program and, therefore, may not be representative of the total United States. Despite these limitations, our estimates do provide an indication of current patterns of cancer in the United States. Such estimates will assist our continuing efforts to reduce the burden of cancer in the United States as the 21st century approaches. Estimated New Cancer Cases* 10 Leading Sites by Sex, United States, 1999 Estimated Cancer Deaths* 10 Leading Sites by Sex, United States, 1999 Age-Adjusted Cancer Incidence Rates* for Females by Site, United States, 1973-1995 Age-Adjusted Cancer Incidence Rates for Males by Site, United States, 1973–1995 Age-Adjusted Cancer Death Rates* for Females by Site, United States, 1930-1995 Age-Adjusted Cancer Death Rates* for Males by Site, United States, 1930–1995 Percent Distribution of Cancer Cases by Race and Stage at Diagnosis, United States, 1989–1994 Five-Year Relative Survival Rates by Race and Stage at Diagnosis, United States, 1989–1994

Cancer is an important public health concern in the United States and around the world. To provide an up-to-date perspective on the occurrence of cancer, the American Cancer Society presents an overview of cancer burden, incidence, mortality, and survival statistics for 1998. Because the United States does not have a nationwide cancer registry and because the quality of case reporting varies among state cancer registries, investigators have no way of knowing exactly how many new cases of cancer are diagnosed in the United States as a whole and in selected states each year. Consequently, we estimated the number of new cancer cases expected to be diagnosed in 1998 using population data collected by the US Bureau of the Census and cancer incidence rates collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.1-3 Estimates were calculated using a three-step procedure. First, we multiplied annual age-specific cancer incidence rates for 1979 through 1994 by the age-appropriate US Census Bureau population projections for the same years to estimate the number of cancer cases diagnosed annually from 1979 to 1994. Second, we fitted these annual cancer case estimates to an autoregressive quadratic model using the SAS procedure PROC FORECAST.4, 5 Finally, we used the model to forecast the number of cancer cases expected to be diagnosed in 1998. Some additional adjustments were made for sites (or types of cancer) with recently changing incidence rates or with widely varying year-to-year estimates. These sites (or types) included rectum, pancreas, chronic lymphocytic leukemia, acute lymphocytic leukemia, and lung and bronchus in men and women; other respiratory tract, bones and joints, other leukemia, and prostate in men; and colon, gallbladder and other biliary passages, other digestive tract, endometrium (uterus), and brain and other nervous system in women. Between 1987 and 1992, the incidence rate of prostate cancer increased 84%, followed by a decline of 46% between 1992 and 1994.3 Preliminary data for 1995 show a continued decline (personal communication with Lynn A.G. Ries of the National Cancer Institute's Cancer Control Research Program). The sharp increase in incidence followed by the decline in recent years probably reflects extensive use of prostate-specific antigen (PSA) screening in the late 1980s and the subsequent increase in earlier diagnoses.6 Assuming that the number of prostate cancer cases will continue to decline until it approaches rates in effect before widespread use of PSA screening, we estimated new cases of prostate cancer for 1998 using a linear projection based on data from 1979 to 1989. Because cancer incidence rates and case counts for 1979 through 1994 were not available for many states, we used state-specific data on cancer deaths to calculate new cases in individual states. We calculated the proportion of cancer deaths forecasted for each state in 1998 among cancer deaths forecasted for the United States in 1998; we then multiplied this proportion by the 1998 forecast of new cancer cases for the United States. This method assumes that the ratio of cancer deaths to cancer cases for each state is the same as the ratio for the United States as a whole. We estimated the number of cancer deaths expected to occur in the United States in 1998 using data on underlying cause of death from death certificates reported to the National Center for Health Statistics (NCHS).7 The numbers of cancer deaths occurring annually from 1979 to 1994 were fitted to an autoregressive quadratic model using PROC FORECAST.4, 5 This model was used to forecast the number of cancer deaths expected to occur in the United States in 1998. Some estimates were adjusted slightly to compensate for the effects of recently changing mortality rates or large year-to-year variations in estimates. These sites included colon and prostate in men and colon, stomach, and cervix (uterus) in women. The estimated number of cancer deaths for each state was calculated with the same modeling procedure used to estimate cancer deaths for the United States as a whole. Mortality statistics for the leading causes of death, the probability of developing cancer, and cancer survival are also presented in this report (Figs. Figure 3-Figure 6, Tables 5–13). These statistics have been assembled from a variety of sources, and the methods used to calculate them were described previously.8 We computed mortality rates for cancer around the world (Table 14) using data compiled by the World Health Organization; we included countries that had populations of 500,000 or more, death registration of at least 82%, and a proportion of deaths with a medically certified cause of death of at least 95%.9 We estimate that about 1,228,600 new cases of invasive cancer are expected to be diagnosed in the United States in 1998 (Table 1). This estimate does not include carcinoma in situ of any site except urinary bladder, and it does not include basal and squamous cell cancers of the skin. Approximately 1 million cases of basal and squamous cell skin cancers, 36,900 cases of breast carcinoma in situ, and 21,100 cases of melanoma carcinoma in situ are expected to be diagnosed in 1998. Among men, the most common cancers in 1998 are expected to continue to be cancers of the prostate, lung and bronchus, and colon and rectum (Fig. 1). Prostate is the leading cancer site, accounting for 29% of new cancer cases in men. This year 184,500 new diagnoses of prostate cancer are expected (Table 1). Among women, the three mostly commonly diagnosed cancers are expected to be cancers of the breast, lung and bronchus, and colon and rectum (Fig. 1). Approximately 325,800 new cancers are expected to occur at these sites (Table 1), accounting for more than 50% of new cancer cases in women. Breast cancer alone is expected to account for about 30% of new cancer cases, with approximately 178,700 cases in 1998 (Table 1). In 1998, we estimate that about 564,800 Americans can be expected to die of cancer—more than 1,500 people a day (Table 2). Although most 1998 cancer deaths in men (54%) are expected to be from cancers of the lung and bronchus, prostate, and colon and rectum (Fig. 2), the number of deaths from these three sites appears to be leveling off and may be beginning to decline. This change is consistent with the continuing declines in overall cancer mortality rates.3, 10 Between 1990 and 1994, mortality rates for men decreased about 1.4% per year for lung cancer, 0.5% per year for prostate cancer, and 1.9% per year for colorectal cancers.3 Among women, cancers of the lung and bronchus, breast, and colon and rectum are expected to account for more than half of all cancer deaths in 1998 (Fig. 2). In 1987, lung cancer surpassed breast cancer as the leading cause of cancer death in women, and it is expected to account for 25% of all cancer deaths in women in 1998. Although lung cancer mortality in men is leveling off, the mortality rate and the number of deaths from lung cancer in women are steadily increasing. Between 1990 and 1994, the lung cancer mortality rate in women increased about 1.7% per year.3 Conversely, the numbers of deaths of women from breast and colorectal cancers appear to be leveling off and may be beginning to decline. These sites account for 16% and 11%, respectively, of cancer deaths in women (Fig. 2). Between 1990 and 1994, mortality rates in women decreased about 1.8% per year for breast cancer and 1.5% per year for colorectal cancers.3 Our estimated numbers of new cancer cases and cancer deaths should be interpreted with caution when used to study trends in cancer incidence and mortality. These are estimates that can vary considerably from year to year, particularly for less common cancers and for smaller states. For this reason, we discourage the use of our estimates to track year-to-year changes in cancer occurrence and cancer deaths. NCHS mortality rates and SEER cancer incidence rates are generally more informative statistics to use for tracking cancer trends. For example, breast cancer incidence rates increased about 1% per year between 1979 and 1982, increased 4% per year between 1982 and 1987, and were approximately constant between 1987 and 1994. Despite the stabilization of rates during the latter period, our estimates for new breast cancer cases increased between 1988 and 1996. Our estimates are based on the most currently available cancer incidence and mortality data; however, these data are 4 years old at the time that the estimates are calculated. As such, the effects of large changes occurring in the 4-year interval between 1994 and 1998 cannot be captured by our modeling efforts. Reports of the direction of such changes in different geographic locations during the 4-year interval may help in determining appropriate interpretations. Finally, our estimates of new cancer cases are based on incidence rates for the geographic locations that participate in the SEER program and therefore may not be representative of the United States as a whole. Despite these limitations, our estimates do provide an indication of current patterns of cancer in the United States. Such estimates will assist our continuing efforts to reduce the burden of cancer in the US and world populations as the 21st century approaches. Estimated New Cancer Cases* 10 Leading Sites by Sex, United States, 1998 Estimated Cancer Deaths* 10 Leading Sites by Sex, United States, 1998 Age-Adjusted Cancer Death Rates* for Females by Site, United States, 1930–1994 Age-Adjusted Cancer Death Rates* for Males by Site, United States, 1930–1994 Percent Distribution of Cancer Cases by Race and Stage at Diagnosis, United States, 1986–1993 Five-Year Relative Survival Rates by Race and Stage at Diagnosis, United States, 1986–1993 The American Cancer Society is earmarking $1.5 million for this grant cycle for each of two areas of research in prostate cancer (1) health policy and outcomes research and (2) behavioral, psychosocial, and quality-of-life research. Application is open to independent investigators at any stage of their careers. The next deadline for applications for both grants is April 1, 1998. Subsequent deadlines will be October 15,1998, April 1, 1999, and October 1, 1999. The grants will be for 3 years, up to $250,000 per year, including 25% indirect costs, and will be renewable as long as this remains a targeted priority area. At least two grants will be awarded in each research area during each grant cycle, contingent on the quality of the applications. Please contact the grants administration or development office at your institution for a special application form, or download it from http://www.cancer.org. Questions concerning this request for applications should be directed to Dr. Ralph Vogler at 404–329–7542 or to Dr. Frank Baker at 404–329–7795.

Cancer is an important public health concern in the United States and around the world. In order to provide an up-to-date perspective on the occurrence of cancer, we present an overview of cancer incidence, mortality, and survival statistics for 1997. Estimated New Cancer Cases: We estimated the number of new cancer cases that we expect to be diagnosed in the coming year using population data collected by the US Bureau of the Census and cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program.1-3 Estimates were calculated using a two-step procedure. First, we multiplied cancer incidence rates for 1979 through 1993 by US Census Bureau population projections for the same years to estimate the number of cancer cases diagnosed annually from 1979 to 1993.1-3 Next, we fitted these annual case estimates to a quadratic function using the SAS procedure PROC FORECAST to project the number of cancer cases expected to be diagnosed in 1997.4, 5 Some additional adjustments were made for sites with recently changing incidence rates or with widely varying year-to-year estimates. These sites included rectum, pancreas, and other leukemia in males and females; larynx, prostate, chronic lymphocytic leukemia, and anus, anal canal, and anorectum in males; and lung and bronchus, corpus and other uterus, eye and orbit, and Hodgkin's disease in females. Because cancer incidence rates for 1979 through 1993 were not available for many states, we used state-specific data on cancer deaths to estimate the number of new cancer cases occurring in each state. First, using methods described in the section below, we estimated the number of 1997 cancer deaths expected to occur in each state and in the United States as a whole. Next, we used these US and state estimates to calculate the proportion of cancer deaths expected to occur in each state. Finally, we estimated the number of cancer cases for each state by multiplying the proportion of cancer deaths expected to occur in each state in 1997 by the estimated number of new cancer cases for the United States for the same year. Estimated Cancer Deaths: We estimated the number of US cancer deaths expected to occur in 1997 using data on underlying cause of death gathered from death certificates by the National Center for Health Statistics (NCHS).6 Data on the number of cancer deaths occurring annually from 1979 to 1993 were fitted to a quadratic model using the SAS procedure PROC FORECAST. This model was used to forecast the number of cancer deaths expected to occur in 1997.4, 5 Some estimates were adjusted slightly to compensate for the effect of recently changing mortality rates or large year-to-year variations in estimates. These sites included rectum, pancreas, larynx, bones and joints, other nonepithelial skin, breast, testis, urinary bladder, other endocrine, and acute myelocytic leukemia in men; and stomach, cervix uteri, corpus and other uterus, and thyroid in women. The estimated number of cancer deaths for each state was calculated with the same modeling procedure that was used to estimate cancer deaths for the United States as a whole. Other Statistics: Statistics on cancer and noncancer mortality, the probability of developing cancer, and relative survival are also presented in this report (Figs. Figure 3-Figure 6, Tables 5–14). These statistics have been assembled from several sources, and methods used to calculate them have been previously described.7 Expected Numbers of New Cancer Cases: In 1997, we estimate that about 1,382,400 new cases of invasive cancer are expected to be diagnosed in the United States (Table 1). This estimate does not include carcinoma in situ of any site but bladder, nor does it include basal and squamous cell cancers of the skin. Over 900,000 cases of basal and squamous cell skin cancers, 36,400 cases of breast carcinoma in situ, and 20,100 cases of melanoma carcinoma in situ are expected to be diagnosed in 1997. Among women, we estimate that in 1997 the three most commonly diagnosed cancers will be cancers of the breast, lung and bronchus, and colon and rectum (Fig. 1). There will be about 324,800 new cancers occurring at these sites, accounting for over 50 percent of new cancer cases. Breast cancer alone will account for 30 percent of new cancer cases with about 180,200 new cases to be diagnosed in 1997. Among men, the most common cancers in 1997 will be cancers of the prostate, lung and bronchus, and colon and rectum (Fig. 1). Prostate is the leading cancer site, accounting for 43 percent of new cancer cases. Between 1990 and 1997, our estimates for prostate cancer cases increased sharply; this increase reflects the dramatic increase in prostate cancer incidence rates between 1988 and 1993. Expected Numbers of Cancer Deaths: In 1997, we estimate that about 560,000 Americans will die of cancer — more than 1,500 people a day (Table 2). Preliminary data for 1995 suggest that overall cancer mortality rates have recently begun to decline.9 Numbers of deaths, however, have continued to increase due to the aging population. Among women, we estimate that cancers of the lung and bronchus, breast, and colon and rectum will account for over half of all cancer deaths in 1997 (Fig. 2). Lung is the leading cancer site, accounting for 25 percent of all cancer deaths. Since 1987, lung cancer has been the leading cause of cancer death in women. Prior to that time, more deaths were caused by breast cancer, which for over 40 years was the major cause of cancer death in women.1, 6 In 1997, breast cancer is expected to be responsible for 17 percent of female cancer deaths. The overall breast cancer mortality rate has been declining since 1989. Between 1989 and 1993, breast cancer mortality declined among white women aged 80 years and younger and among African-American women aged 70 years and younger.1, 6 Among men, most 1997 cancer deaths are expected to be caused by cancers of the lung and bronchus, prostate, and colon and rectum (Fig. 2). Like women, men are more likely to die of lung cancer than cancer of any other site. In 1997 alone, lung cancer is expected to be responsible for 98,300 deaths in men (32 percent). Responsible for about half as many deaths as lung cancer, prostate cancer is expected to cause about 14 percent of cancer deaths in 1997. Recent increases in prostate cancer mortality rates have been much less dramatic than increases in prostate cancer incidence rates. Consequently, our estimated number of prostate cancer deaths increased only 39 percent between 1990 and 1997 compared to over 200 percent for our estimated number of prostate cancer cases. Our estimated numbers of new cancer cases and cancer deaths should be interpreted with caution when used to study trends in cancer incidence and mortality. Numbers can vary considerably from year to year, particularly for less common cancers and for states with small populations. NCHS mortality rates and SEER and state cancer incidence rates are generally more informative statistics to use when tracking cancer trends. Changes in incidence or mortality trends that have occurred since 1993 are not reflected in this year's estimates. For example, regional reports suggest that the rapid increase in prostate cancer incidence rates observed between 1988 and 1992 may have begun to slow or change in 1993.1, 8 If this is correct, the estimates of new prostate cases that we have published in recent years will be higher than the actual number of new cases. In addition, our estimates may not reflect fluctuations in trends occurring between 1979 and 1993. For example, although breast cancer incidence rates increased about one percent per year between 1979 and 1982 and four percent per year between 1982 and 1987, rates were about constant between 1987 and 1993. Despite the stabilization of rates during the latter time period, our estimates for new breast cancer cases continued increasing between 1988 and 1986. Despite these limitations, our estimates do provide an indication of current patterns of cancer in the United States. Continuing efforts in the areas of prevention, screening, and treatment are necessary to reduce the burden of cancer in the US and world populations as we approach the 21st century. Estimated New Cancer Cases* 10 Leading Sites by Sex, United States, 1997 Estimated Cancer Deaths* 10 Leading Sites by Sex, United States, 1997 Age-Adjusted Cancer Death Rates* Females by Site, United States, 1930–1993 Age-Adjusted Cancer Death Rates* Males by Site, United States, 1930–1993 Percent Distribution of Cancer Cases By Race and Stage at Diagnosis, United States, 1986–1992 Five-Year Relative Survival Rates By Race and Stage at Diagnosis, United States, 1986–1992

We present incidence, mortality, and survival statistics to provide a perspective on the patterns of cancer occurrence in the United States population. Estimates of the numbers of new cancer cases and deaths for 1996 are presented according to sex, site, and state. We also present information on cancer and noncancer mortality, the probability of developing cancer at certain ages, and cancer survival in adults and children. Because no nationwide cancer registry exists, there is no way of knowing exactly how many new cases of cancer are diagnosed annually in the United States. We use cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and US population data collected by the Bureau of the Census to estimate the number of new cancer cases that are expected to be diagnosed in the coming year (Table 1).1–3 The SEER program currently tabulates cancer data from nine population-based cancer registries in the following states and metropolitan areas: Connecticut, Hawaii, Iowa, New Mexico, Utah, San Francisco-Oakland, Detroit, Seattle, and Atlanta. These registries, which cover about 10 percent of the US population, are useful for monitoring the occurrence of cancer for the nation.1 We calculated the 1996 estimates of new cancer cases using a two-step procedure. First, we applied incidence rates from the SEER program for 1979–1992 to the US Census Bureau's population projections for the same years to estimate the number of cancer cases diagnosed yearly from 1979 through 1992.1–3 We fitted these annual estimates to a quadratic function that is used to project an estimate of the number of new cancer cases expected to be diagnosed in 1996.4,5 Some additional adjustments were made for selected sites with recent variations in the estimated number of cases diagnosed. Cancer sites that were adjusted include the mouth, prostate, and thyroid in males and the eye, corpus and unspecified uterus, and selected other and unspecified sites in females. The estimated number of new cancer cases for each state was calculated using 1996 estimates of new cancer cases for the United States and 1996 estimates of cancer deaths for each state (Table 3). For each cancer site, state estimates of new cancer cases were calculated by apportioning the number of new cases for the United States as a whole according to the distribution of estimated state cancer deaths in 1996 (see mortality section for additional information on the estimation process). Mortality data on the number of cancer deaths that occur in the United States each year are collected and compiled by the National Center for Health Statistics (NCHS).6 We calculated the US estimates of cancer mortality for 1996 by fitting the number of cancer deaths reported for 1979–1992 to a quadratic function that is used to project an estimate of the number of cancer deaths expected to occur in 1996 (Table 2).4,5 Estimates of state-specific cancer deaths were calculated using the same model fitted with the actual number of reported deaths occurring in each state from 1979 through 1992 (Table 4). Some additional adjustments were made for selected sites with recent variations in the estimated number of deaths. Cancer sites with such adjustments include other and unspecified sites in males and stomach, cervix uteri, and other and unspecified sites in females. The reported number of deaths in 1992 that we present in this report were compiled using the most recent data available from NCHS (Tables 6–9 and 12). Mortality rates were calculated using number of deaths reported to NCHS and US population data from the Bureau of the Census (Tables 7 and 12, Figs. 3 and 4). All rates are standardized to the age distribution of the 1970 Census population. Age standardization is a statistical method used to remove the effects of age differences between populations for comparison purposes.7 We present US mortality data on the 10 leading sites of cancer death for minority populations (Table 10). Reported cancer deaths are based on the underlying cause of death as coded on death certificates for whites, African Americans, Native Americans, Asians and Pacific Islanders, and Hispanics in 1992.6 Cancer deaths among Hispanic persons are presented only for the 48 states that record Hispanic origin on death certificates. In 1990 these states accounted for about 99.6 percent of the Hispanic population in the United States.8 Estimated probabilities of developing invasive cancers at certain ages were calculated by applying age-specific incidence and mortality rates from the SEER program for the years 1990–1992 to a hypothetical group of 10 million persons (Table 5).1,9 For each five-year age interval from ages 0–4 through ages 95 and older, the number of persons developing a specific cancer and the number of persons dying from other causes were calculated. The probability of being diagnosed with a specific cancer during a given age interval was estimated by dividing the number of persons developing cancer in that interval by the number of persons alive and free of that cancer at the beginning of the interval. The lifetime probability of developing a specific cancer was estimated by summing all cancer cases that occurred in the hypothetical group from ages 0 through 95 and older and dividing by 10 million. This procedure for estimating interval and lifetime cancer risk does not assume that all persons live to the end of an age interval or to any fixed age. It also does not take into account individual behaviors and risk factors. For example, the estimated 5.38 percent of females likely to develop lung cancer is a low estimate for smokers and a high estimate for persons who do not smoke. Five-year relative survival rates are commonly used to monitor progress in the early detection and treatment of cancer. The rates are calculated by dividing the survival rate observed among a group of cancer patients by the rate for persons in the general population who are similar with respect to age, sex, race, and calendar year of observation. Five-year relative survival rates are reasonable indicators of the average survival experience of cancer patients in a given population, but they are less informative when used to predict individual prognosis. The interpretation of five-year relative survival rates is difficult because the rates are based on patients whose treatment reflected methods of medical practice at least eight years ago and also because an increase or decrease in survival may be caused by several factors, including changes in early detection techniques and in treatment strategies. We present five-year relative survival rates by site, race, and stage at diagnosis for cases diagnosed during the years 1986–1991 (Fig. 6), as well as trend data from 1960 through 1991 for adults and children (Tables 11 and 13).1,10 The relative survival rates are based on the follow-up of patients through 1993 as reported to the SEER program. International mortality rates were calculated from data made available by the World Health Organization (WHO) (Table 14), age-adjusted to the WHO standard world population.11 Mortality data from China were reported for certain urban and rural areas in the eastern half of the country and included about 10 percent of the total Chinese population. Our estimates of new cases and deaths have limitations and should be interpreted with caution when used to study patterns in the occurrence of cancer. Although the estimates are based on the most recent data, they are computed before the year begins and based on data that are at least three years old. Other sources of cancer data may be helpful for interpreting these data. Incidence and survival statistics are based only on invasive cancers, except for cancer of the urinary bladder, which includes carcinoma in situ.1 The number of deaths for minorities is likely to be underestimated due to underreporting of Asian, Pacific Islander, and Native American race and Hispanic ethnicity on death certificates.8 Figure 1 1996 Estimated New Cancer Cases, United States Percent Distribution of Sites by Sex* Figure 2 1996 Estimated Cancer Deaths, United States Percent Distribution of Sites by Sex* Age-Adjusted Cancer Death Rates* Females by Site, United States, 1930–1992 Age-Adjusted Cancer Death Rates* Males by Site, United States, 1930–1992 Figure 5 Percent of Cancer Cases by Stage at Diagnosis United States, 1986–1991 Five-Year Relative Survival Rates (Percent) by Race and Stage at Diagnosis, United States, 1986–1991