NIH News Release
National Cancer Institute

Sunday, May 14 2000
4:00 p.m. EDT

National Cancer Institute
(301) 496-6641

American Cancer Society
(212) 382-2169

Centers for Disease Control and Prevention
(770) 488-5131

North American Association of Central Cancer Registries
(217) 698-0800

Questions and Answers: Annual Report to the Nation on the Status of Cancer, 1973-1997,
With a Special Section on Colorectal Cancer

1. What is the purpose of this report and who created it?

This report provides an update on the trends in cancer death rates in the United States and presents new information about trends in cancer incidence rates (new cases reported). It also contains a special section on colorectal cancer. The National Cancer Institute (NCI), the American Cancer Society (ACS), the North American Association of Central Cancer Registries (NAACCR), and the Centers for Disease Control and Prevention (CDC), including the National Center for Health Statistics (NCHS), collaborated to create this annual report.

2. What are the sources of the data?

Data on cancer incidence come from the NCI's Surveillance, Epidemiology, and End Results (SEER) Program and from NAACCR. The SEER program began in 1973 and currently collects cancer incidence data from 11 registries: five statewide registries (Connecticut, Hawaii, Iowa, New Mexico, and Utah) and six metropolitan area registries (Atlanta, Detroit, Los Angeles, San Francisco-Oakland, San Jose-Monterey, and Seattle-Puget Sound). These registries are population-based (collect information on every cancer among residents of a geographic area) and include approximately 14 percent of the U.S. population. SEER areas were selected to represent diverse populations. SEER data were used for the joinpoint analysis of trends by cancer site between 1973 and 1997 and more recent trends for a period from 1990 to 1997. Data on Alaska Natives still residing there were used together with data from the 11 SEER registries to calculate cancer incidence rates among American Indians/Alaska Natives. NAACCR data covering nearly 50 percent of the U.S. population were used for colorectal cancer incidence rates for 1993-1997.

Data on cancer mortality come from NCHS. The information on cause of death is provided by the certifying physician on death certificates filed in vital statistics offices in every state and the District of Columbia. NCHS consolidates the information into a national database, which covers 100 percent of the U.S. population. Information on population from the Census Bureau is combined with mortality information from NCHS to calculate the death rates shown in this report. Cancer deaths for this report occurred from 1950 to 1997.

3. What is happening with cancer rates overall?

After slightly increasing on average 0.9 percent per year from 1973 to 1983 and steadily increasing on average 1.8 percent per year from 1983 to 1992, incidence rates for all cancer sites combined decreased on average 1.3 percent per year from 1992 to 1997. This confirms the continued downward trend that has previously been reported to the nation.

Cancer death rates increased at a rate of 0.5 percent per year from 1973 to 1984, then slowed to a rate of 0.2 percent per year from 1984 to 1991, declined 0.6 percent per year from 1991 to 1995, with a more rapid decline of 1.7 percent per year occurring from 1995 to 1997.

4. How is the cancer burden monitored among ethnic and racial groups?

In this report, cancer incidence and death rates are analyzed for whites, blacks, Asian and Pacific Islanders, American Indians/Alaska Natives, and Hispanics. Hispanic is not mutually exclusive from whites, blacks, and Asian and Pacific Islanders. Cancer incidence rates for American Indians/Alaska Natives are based on data from Alaska plus all SEER registries.

5. What is happening with cancer among ethnic and racial groups?

Continued higher incidence and death rates among some racial and ethnic groups suggest that some populations may not have benefitted equally from cancer prevention and control efforts. Such disparities may be due to multiple factors, such as late stage of disease at diagnosis, barriers to health care access, history of other diseases, biologic and genetic differences in tumors, health behaviors, and the presence of risk factors. In April 2000, the NCI established Special Populations Networks which will distribute a total of $60 million in grants over five years to address some of these disparities. Additional efforts will be undertaken as part of the National Institutes of Health (NIH) Health Disparities Plan, with NCI responsible for the cancer-related issues.

The four leading cancer incidence sites for the five racial and ethnic populations were: lung and bronchus, prostate, female breast, and colon/rectum. Together these four sites account for 54 percent of all new diagnoses.

When these four sites of new cancer cases were examined by race and ethnicity, it was found that except for female breast cancer, blacks had higher incidence and death rates than the other racial and ethnic populations. Some cancer sites tended to be unique to a specific population. For example, melanoma and leukemia were the among the top 10 sites only in whites; liver cancer was among the top 10 sites only in Asian and Pacific Islanders; kidney and renal pelvis cancers were among the top 10 only in American Indian/Alaska Natives; and bladder cancer was among the top 10 only in whites and Hispanics.

With one exception, the four leading cancer death sites from 1990 to 1997 for the racial and ethnic groups were the same sites as for incidence: lung and bronchus, prostate, female breast, and colon/rectum. When these four mortality sites were examined by race and ethnicity, blacks had higher cancer death rates than whites, Asian and Pacific Islanders, American Indians/Alaska Natives, or Hispanics.

6. Why does the report emphasize colorectal cancer?

Colorectal cancer is the third highest cancer site (following prostate and lung cancers) for men of all races; second highest for Hispanic, American Indian/Alaska Native and Asian Pacific Islander women (after breast cancer); and third highest (after breast and lung cancer) in black and white women. For the first time since this annual report has been published, data from NAACCR was used to make comparisons about colorectal cancer incidence rates across states. The first Report to the Nation in 1998 had a special section which provided a comparison of recent cancer trends with earlier patterns and the 1999 Report to the Nation had a special section on lung cancer.

7. What do the data show about colorectal cancer incidence and mortality?

Colorectal cancer incidence increased until 1985 and has steadily decreased since then. Colorectal cancer mortality ranks third highest among all cancers regardless of race or gender. Colorectal cancer mortality rates have been declining in women since before 1950 and in men since the 1980s. Overall five-year survival rates are 61 percent but as high as 96 percent when detected in the earliest stage of the disease.

8. What do the data show about colorectal cancer screening?

In addition to incidence and mortality rates, the use of screening tests for colorectal cancer was analyzed with information from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS showed that 20 percent of people aged 50 and older had a fecal occult blood test in the year preceding the survey and 31 percent had a sigmoidoscopy or proctoscopy in the past five years. Despite the low use of screening tests, incidence rates have declined since 1985 and the results of the NHIS indicate gradual and modest increases in screening between 1987 and 1998. Reported use of procto-sigmoidoscopy for people over age 50 increased from 24 percent to 38 percent during this time period. New efforts are under way to increase awareness of screening benefits and treatment for colon cancer, including a CDC-led broad-based educational campaign called Screen for Life.

9. What is happening with breast cancer rates in women?

Breast cancer is the number one cancer incidence site in women regardless of race or ethnicity. Female breast cancer incidence rates have been approximately level since 1987, but rates for white women are more than double those for American Indians/Alaska Natives. Female breast cancer death rates for white women declined steadily after 1989 and dropped sharply after 1995. Death rates for black women climbed steadily between 1979 and 1991, but leveled off after 1991.

10. What is happening with prostate cancer rates?

Prostate cancer incidence rates fluctuated dramatically in the 1970s and 1980s. Incidence rates increased dramatically between 1988 and 1992 and then decreased after 1992. Prostate cancer is the number one cancer incidence site in men for all racial and ethnic groups. Incidence rates varied from 49.6 per 100,000 for American Indians/Alaska Natives to 225.0 per 100,000 for black men, a four-fold difference. Prostate cancer death rates have also varied considerably over time and death rates for blacks and whites have steadily declined since 1994. Death rates in black men are double those of other racial and ethnic groups.

11. What is happening with lung and bronchus cancer rates?

Lung cancer is the number one cause of cancer death among men and women in all racial and ethnic groups except for Hispanic women. Female lung cancer incidence rates have leveled off since 1991. Incidence rates in white men steadily increased between 1973 and 1980, leveled off around 1980, then declined steadily after 1991. Incidence rates in black men steadily rose until 1984 but have steadily declined since then. Death rates for men increased but the rates of increase began to slow for white men about 1980 and for black men after 1982. The rates began to decline for both around 1990. There has been a progressive slowing of the increase in death rates for white and black women.

12. What other key sites had significant incidence and mortality findings?

Non-Hodgkin's lymphoma incidence rates in white men and women have leveled off since about 1990. Incidence rates for black men and women have increased substantially since 1973. Death rates from non-Hodgkin's lymphoma have steadily increased since the middle to late 1970s.

Melanoma incidence rates steadily increased from 1973 to 1981 but slowed since about 1981 in whites. Incidence of melanoma in whites is very high compared to other racial and ethnic groups, especially blacks. Melanoma deaths rates have increased more slowly in whites since 1987 and have historically been quite low in blacks.

How to Read the Report

13. How are cancer incidence and death rates presented?

Cancer incidence rates and cancer death rates are measured as a number per 100,000 people and are age-adjusted to the 1970 U.S. standard million population. When a cancer affects only one gender, for example, prostate cancer, the number is per 100,000 persons of that gender.

14. How is progress against cancer being measured in this report?

This report primarily includes two measures of cancer -- the incidence rate and the death rate. In addition to the rates, the annual percent change in those rates has been calculated for 1990 to 1997 as well as other intervals. A secondary focus is measures of health behaviors, particularly screening.

15. What is an annual percent change or APC?

The annual percent change (APC) is the average rate of change in a cancer rate per year in a given time frame; i.e., how fast or slowly a cancer rate has increased or decreased each year over a period of years. Annual percent change, sometimes abbreviated as APC, was calculated for both incidence and death rates. The number is given as a percent -- such as the 1.3 percent per year decrease in incidence of all cancers diagnosed between 1990 to 1997. A negative APC describes a decreasing trend, and a positive APC describes an increasing trend.

16. What is joinpoint analysis?

Joinpoint analysis is a statistical method that describes changing trends over successive segments of time and the amount of increase or decrease within each segment. This statistical method chooses the best fitting point or points, which are called joinpoints, and these points are where the rate of increase or decrease changes significantly. Joinpoint analyses were performed for incidence and mortality trends for 1973 to 1997.

To simplify describing joinpoint analysis, various terms were derived that are comparable to statistical measurements. If a change over a particular period is under 1 percent, it is classified as slight; if it is between 1 percent and 4 percent, steady; and greater than 4 percent, sharp. If there is no statistically significant change, the trend is described as level.

17. Where is this report being published?

The report is published in the May 15, 2000 issue of Cancer. The authors are Lynn A.G. Ries, M.S. (NCI), Phyllis A. Wingo, Ph.D., M.S. (ACS), Daniel S. Miller, M.D., M.P.H. (CDC), Holly L. Howe, Ph.D. (NAACCR), Hannah K. Weir, Ph.D. (CDC), Harry M. Rosenberg, Ph.D. (NCHS), Sally W. Vernon, Ph.D. (University of Texas), Kathleen Cronin, Ph.D. (NCI), and Brenda K. Edwards, Ph.D. (NCI).

18. What Internet sites have more information on cancer?

NCI's SEER home page:
(This Web site contains all data points for graphs in the manuscript as well as supplementary data and charts.)

National Cancer Institute:

American Cancer Society:

CDC's Division of Cancer Prevention and Control:

CDC's National Center for Health Statistics:


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