|Annual Report to the Nation Finds Declines
in Cancer Incidence and Death Rates; Special Feature Reveals
Wide Variations in Lung Cancer Trends across States
A new report from the nation's leading cancer organizations shows
that, for the first time since the report was first issued in 1998,
both incidence and death rates for all cancers combined are decreasing
for both men and women, driven largely by declines in some of the
most common types of cancer. The report notes that, although the
decreases in overall cancer incidence and death rates are encouraging,
large state and regional differences in lung cancer trends among
women underscore the need to strengthen many state tobacco control
programs. The findings come from the "Annual Report to the
Nation on the Status of Cancer, 1975-2005, Featuring Trends in
Lung Cancer, Tobacco Use and Tobacco Control" online Nov.
25, 2008, and appearing in the Dec. 2, 2008, Journal of the National
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 drop in incidence seen in this year's Annual Report
is something we've been waiting to see for a long time," said
Otis W. Brawley, M.D., chief medical officer of the American Cancer
Society (ACS). "However, we have to be somewhat cautious about
how we interpret it, because changes in incidence can be caused
not only by reductions in risk factors for cancer, but also by
changes in screening practices. Regardless, the continuing drop
in mortality is evidence once again of real progress made against
cancer, reflecting real gains in prevention, early detection, and
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,
"While we have made progress in reducing the burden of cancer
in this country, we must accelerate our efforts, including making
a special effort to reach underserved cancer patients in the communities
where they live," said National Cancer Institute (NCI) Director
John Niederhuber, M.D. "This report gives us a better understanding
of where we may need to redouble our efforts and try to find new
ways of preventing or reducing the occurrence of kidney, liver,
and other cancers that continue to show increases in both mortality
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 explain 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
"It's very promising to see the progress we are making in
our fight against cancer," said Centers for Disease Control
and Prevention (CDC) Director Julie Gerberding, M.D. "Unfortunately,
tobacco use continues to plague our country, and it's the primary
reason why lung cancer continues to rob too many people of a long,
productive, and healthy life. We must recommit ourselves to implementing
tobacco control programs that we know work if we are truly going
to impact the staggering toll of tobacco on our society."
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.
"We can see that, in areas of the country where smoking and
tobacco use are entrenched in daily life, men and women continue
to pay a price with higher incidence and death rates from many
types of cancer. This type of geographic variation in smoking-related
cancers is due to smoking behaviors, not regional environmental
factors," said Betsy A. Kohler, M.P.H., executive director
of the North American Association of Central Cancer Registries
"The observed decrease in the incidence and death rates from
all cancers combined in men and women overall and in nearly all
racial and ethnic groups is highly encouraging," conclude
the authors. "However, this must be seen as a starting point
rather than a destination." They say a dual effort, combining
better application of existing knowledge with ongoing research
to improve prevention, early detection, and treatment will be needed
to sustain and extend this progress into the future.
The study was conducted by scientists at the ACS, CDC, NCI, which
is part of the National Institutes of Health, and the NAACCR.
To view the full report, go to: http://jnci.oxfordjournals.org.
For a Q&A on this Report, go to http://cancer.gov/newscenter/pressreleases/ReportNation2008QandA.
For Spanish translations of this press release and Q&A, go to http://cancer.gov/espanol/noticias/ReportNation2008SpanishRelease.
CDC's Division of Cancer Prevention and Control: http://www.cdc.gov/cancer.
NCI leads the National Cancer Program and the NIH effort to dramatically
reduce the burden of cancer and improve the lives of cancer patients
and their families, through research into prevention and cancer
biology, the development of new interventions, and the training
and mentoring of new researchers. For more information about cancer,
please visit the NCI Web site at http://www.cancer.gov or
call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates
the causes, treatments, and cures for both common and rare diseases.
For more information about NIH and its programs, visit www.nih.gov.
Jemal A, Thun MJ, Ries LAG, Howe HL, Weir HK, Center MM, Ward E,
Wu X, Eheman C, Anderson R, Ajani U, Kohler B, Edwards BK. Annual
Report to the Nation on the Status of Cancer, 1975-2005, Featuring
Trends in Lung Cancer, Tobacco Use and Tobacco Control. Journal
of the National Cancer Institute; Published online Nov. 25,
2008; Print issue Dec. 2, 2008. Vol. 100, No. 23.