Cancer Statistics by Type
U.S. Racial/Ethnic Cancer Patterns 1988-1992
National Cancer Institute website
Cancer Types covered: Urinary Bladder*/ Breast*/ Lifetime Probability of Breast Cancer in American Women / Cervix Uteri Cancer*/ Colon and Rectum*/ Endometrium*/ Esophagus*/ Kidney and Renal Pelvis*/ Leukemias*/ Liver and Intrahepatic Bile Duct*/ Lung and Bronchus*/ Nasopharynx*/ Non-Hodgkin's Lymphoma*/ Oral Cavity*/ Ovary*/ Pancreas*/ Prostate*/ Prostate Cancer Trends 1973-1995/ Stomach*/ Thyroid*
*U.S. Racial/Ethnic Cancer Patterns
Source: Miller BA, Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, West D, Key CR, Liff JM, Glover CS, Alexander GA, et al. (eds). Racial/Ethnic Patterns of Cancer in the United States 1988-1992, National Cancer Institute. NIH Pub. No. 96-4104. Bethesda, MD, 1996.
Graphs showing incidence and mortality for specific racial and ethnic groups including information that may not be discussed in the text above, is available at the NCI's Surveillance, Epidemiology, and End Results (SEER) website at: http://seer.cancer.gov/
The highest incidence rates for bladder cancer are found in industrialized countries such as the United States, Canada, France, Denmark, Italy, and Spain. Rates are lower in England, Scotland, and Eastern Europe. The lowest rates are in Asia and South America, where the incidence is only about 30% as high as in the United States. In all countries the rates are higher for men than women. In the SEER regions, for the period 1988 to 1992, the incidence rates are generally three to four times higher in men than in women. Among men, the highest rates are in white non-Hispanics (33.1 per 100,000). The rates for black men and Hispanic men are similar and are about one- half the white non-Hispanic rate. The lowest rates are in the Asian populations. For women, the highest rates are also in white non-Hispanics and are about twice the rate for Hispanics. Black women, however, have higher rates than Hispanic women. The incidence of bladder cancer increases dramatically with age among men and women in all populations. Rates in those aged 70 years and older are approximately two to three times higher than those aged 55-69 years, and about 15 to 20 times higher than those aged 30-54 years.
Mortality rates are two to three times higher for men than women. While incidence rates in the white population exceed those for the black population, such is not the case for mortality where the rates are much closer together. Black women who have a lower incidence of bladder cancer than white women actually die from the disease at a greater rate. This difference in survival between black and white populations reflects the fact that in whites a larger proportion of these cancers are diagnosed at an early more treatable stage. Mortality rates for Hispanic and Asian men and women are only about one-half those for whites and blacks.
Cigarette smoking is an established risk factor for urinary bladder cancer. It is estimated that about 50% of these cancers in men and 30% in women are due to smoking. Occupational exposures may account for up to 25% of all urinary bladder cancers. Most of the occupationally accrued risk is due to exposure to a group of chemicals known as arylamines. Occupations with high exposure to arylamines include dye workers, rubber workers, leather workers, truck drivers, painters, and aluminum workers. Because of this association with bladder cancer, some arylamines have been eliminated or greatly reduced in occupational settings. Coffee, alcohol, and artificial sweeteners have all been studied as risk factors for bladder cancer, but associations, if they exist, are weak. The greatest prevention strategy is reduction in the consumption of cigarettes. Cigarette use increases one's risk for bladder cancer by two to five times. When cigarette smokers quit, their risk declines in two to four years.
Breast cancer is the most common form of cancer among women in the United States. The incidence of breast cancer has been rising for the past two decades, while mortality has remained relatively stable since the 1950s. Much of the increase in incidence over the past 15 years is associated with increased screening by physical examination and mammography. However, screening alone does not seem to explain all of this increase. Breast cancer occurs among both women and men, but is quite rare among men. Since the incidence rates among men are so low, there are too few cases to explore ethnic diversity. This description is limited to breast cancer among women.
The age-adjusted incidence of invasive breast cancer reveals that white, Hawaiian, and black women have the highest rates in the SEER regions. The lowest rates occur among Korean, American Indian, and Vietnamese women. The incidence rate for white non-Hispanic women is four times as high as that for the lowest group (Korean women).
In situ breast cancer occurs at much lower rates than invasive breast cancer, but has a similar racial/ethnic pattern to that for the invasive cancers. White non-Hispanic women have the highest rates, over twice the rate for Hispanic women. Rates could not be calculated for Alaska Native, American Indian, Korean, and Vietnamese women due to the small numbers of cases.
Age-specific incidence rates for invasive breast cancer present similar ethnic patterns. Among women aged 30-54 years, however, the rates among Hawaiian women are comparable to those for the white non- Hispanic women. Among women aged 55- 69 years and 70 years and older, rates are highest for white, Hawaiian, and black women. In situ breast cancer incidence among women aged 30-54 years and 70 years and older is highest among white non- Hispanic women, followed by Japanese women, and white (total) women. At ages 55-69 years, in situ breast cancer is highest among white women, followed by Japanese women and black women.
Mortality rates are much lower than incidence rates for breast cancer, ranging from just 15% of the incidence rate for Japanese women to 33% of the incidence rate for black women. Racial/ethnic patterns of mortality differ slightly from those observed for incidence. The highest age- adjusted mortality occurs among black women, followed by white, and Hawaiian women. The higher breast cancer mortality among black women is related to the fact that, relative to white women, a larger percentage of their breast cancers are diagnosed at a later, less treatable stage. In the age groups 30-54 years and 55-69 years, black women have the highest rates, followed by Hawaiian, and white non- Hispanic women. In the 70 year and older age group, the mortality rate for white women exceeds that for black women.
Important risk factors for female breast cancer include early age at onset of menarche, late age at onset of menopause, first full-term pregnancy after age 30, a history of pre-menopausal breast cancer for mother and a sister, and a personal history of breast cancer or of benign proliferative breast disease. Obesity, nulliparity, and urban residence also have been shown to be associated with increased risk of breast cancer.
Although there are no proven methods of preventing breast cancer, randomized trials are currently underway to assess the effectiveness of tamoxifen in preventing breast cancer among high risk women and to determine whether reducing the percentage of dietary fat will reduce the incidence of breast cancer. Recent studies suggest that physical activity may have preventive potential, as well.
Lifetime Probability of Breast Cancer
in American Women
Date reviewed: 7/5/2001
This estimate is based on data from NCI's Surveillance, Epidemiology, and End Results Program (SEER) publication SEER Cancer Statistics Review 1973-1997 and is based on cancer rates from 1995 through 1997. This figure includes all age groups in 5-year intervals up to an open-ended interval of 85 years and over. Each age interval is assigned a weight in the calculations based on the proportion of the population living to that age.
The 1 in 8 figure means that, if current rates stay constant, a female born today has a 1 in 8 chance of developing breast cancer sometime during her life. On the other hand, she has a 7 in 8 chance of never developing breast cancer. Because the SEER calculations are weighted, they take into account that not all women live to older ages, when breast cancer risk becomes the greatest.
A woman's chance of being diagnosed with breast cancer is:*
from age 30 to age 40 . . . . . . .1 out of 257 from age 40 to age 50 . . . . . . .1 out of 67 from age 50 to age 60 . . . . . . .1 out of 36 from age 60 to age 70 . . . . . . .1 out of 28 from age 70 to age 80 . . . . . . .1 out of 24 Ever . . . . . . . . . . . . . . .1 out of 8
* Source: National Cancer Institute Surveillance, Epidemiology, and End Results Program, 1995-1997.
In evaluating cancer risk for a cancer-free individual at a specific point in time, age-specific (conditional) probabilities are more appropriate than lifetime probabilities. For example, at age 50, a cancer-free black woman has about a 2.5-percent chance of developing breast cancer by age 60, and a cancer-free white woman has about a 2.8-percent chance.
Among the racial/ethnic groups studied by SEER**, white, Hawaiian, and black women have the highest levels of breast cancer risk. Asian/Pacific Islander and Hispanic women have a lower level of risk; their chance of developing breast cancer is less than two-thirds of the risk of white women. The lowest levels of risk occur among Korean, Native American, and Vietnamese women.
** Source: National Cancer Institute Surveillance, Epidemiology, and End Results Program, Racial/Ethnic Patterns of Cancer in the United States 1988-1992.
These probabilities are based on population averages. An individual woman's breast cancer risk may be higher or lower, depending upon a variety of factors, including family history, reproductive history, and other factors that are not yet fully understood.
The NCI is directing special attention to women with disproportionately high rates of breast cancer and poor survival rates, including members of certain minority groups and the medically underserved. Efforts targeted at these groups are under way in all components of NCI's program: basic research, early detection, clinical trials, rehabilitation, education and information dissemination, and cancer centers.
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Cervix Uteri Cancer
Until the early 1970s, approximately 75% to 80% of cervical cancer in the United States was invasive at the time of diagnosis. Today, about 78% of cervical cancer cases are diagnosed at the in situ stage. Furthermore, both incidence and mortality for invasive cervical cancer have declined about 40% since the early 1970s. Mortality began declining just before the Papanicolaou screening test became widely utilized, however, leaving a dilemma as to the relationship between the Pap test and reductions in cervical cancer mortality. Around the world, cervical cancer is often the most common type of cancer among women.
The ethnic patterns of this disease are quite different from those of any of the other female reproductive system cancers. The highest age-adjusted incidence rate in the SEER areas occurs among Vietnamese women (43 per 100,000). Their rate is 7.4 times the lowest incidence rate, 5.8 per 100,000 in Japanese women. Incidence rates of 15 per 100,000 or higher also occur among Alaska Native, Korean, and Hispanic women.
The incidence of invasive cervical cancer exhibits different ethnic patterns by age group. Among women aged 30-54 years, Vietnamese women have the highest rate, followed by Hispanic women, and black women. The rate among Vietnamese women is nearly twice as high as that of Hispanic women, and five times as high as the rate for the group with the lowest rate, Chinese women. Vietnamese women continue to have the highest incidence of invasive cervical cancer in the age group 55-69 years, with a rate that is more than three times higher than the second ranked group, Korean women. Hispanic women have the third highest incidence in this age group, and are followed by black women.
There are too few cases in the 70 and older age group to assess many of the ethnic patterns.
United States mortality rates are about 50% to 80% lower than the incidence rates. The ethnic patterns in mortality differ somewhat from those seen in incidence. Black women have the highest age-adjusted mortality rate from cervical cancer, and are followed by Hispanic women. Mortality rates are not available for comparison, however, for Vietnamese, Korean, Alaska Native or American Indian (New Mexico) women. The lowest mortality from this disease occurs among Japanese women, whose rates are less than one-fourth as high as the rates among black women. Mortality patterns by age are similar, with black women having the highest mortality in each age group. Hispanic women have the second highest mortality in the two youngest age groups, while Chinese women aged 70 years and older rank second.
The major risk factors for cervical cancer include early age at initiation of sexual activity, multiple sexual partners, infection with human papilloma virus 16, and cigarette smoking. Therefore, primary prevention is focused mainly on modification of sexual behavior and eradication of cigarette smoking. Secondary prevention occurs through screening, using the Papanicolaou test.
Colon and Rectum
Cancers of the colon and rectum are the fourth most commonly diagnosed cancers and rank second among cancer deaths in the United States. The incidence rates show wide divergence by racial/ethnic group, with rates in the Alaska Native population that are over four times as high as rates in the American Indian population (New Mexico) for both men and women. There are only minor differences, between men and women, in the order of incidence rates by racial/ethnic group. After Alaska Natives, the next highest rates in men are among Japanese, black and non-Hispanic white populations. These are followed by Chinese, Hawaiians and white Hispanics; and then Filipinos, Koreans and Vietnamese. In women, Alaska Natives are followed by black, Japanese and white non- Hispanic Americans. Next are Chinese, Hawaiians, and Vietnamese; and finally white Hispanics, Koreans, and Filipinos. Incidence rates for both men and women are substantially lower among American Indians in New Mexico (18.6 per 100,000 in men, 15.3 per 100,000 in women).
In each racial/ethnic group, incidence rates for cancers of the colon and rectum among women are lower than those among men. Although the pattern of incidence rates by race/ethnicity is similar for each sex, the ratio of male-to-female rates varies. Among Filipinos and Japanese, men experience an excess of greater than 60%, while among American Indians, Alaska Natives and Vietnamese the male excess is much lower at only 13-22%. It is interesting that, although the Alaska Natives have the highest colorectal cancer incidence rates of all groups and the American Indians experience the lowest, the gender ratios of these two native American groups are similar.
Mortality patterns by race/ethnicity for cancers of the colon and rectum are similar to those for incidence, with several notable exceptions. Black, Alaska Native, and white non-Hispanic men and women, as well as Hawaiian and Japanese men, have comparatively high mortality rates. The high mortality rates among Alaska Natives and Japanese men are consistent with the high incidence rates in these groups. However, the mortality rates among white non-Hispanic and black men and women, and among Hawaiian men, appear disproportionately high.
Colon cancer accounts for 59% (Korean men) to 81% (Alaska Native men) of the combined colon and rectum cancer incidence rates. This is reflected in an racial/ethnic pattern for colon cancer incidence rates that is quite similar to the pattern for both sites combined. Incidence and mortality rates for cancers of the colon and rectum increase with age. Interestingly, the incidence rate for Hawaiian men is highest in the 55-69 year age group, and their mortality rate is second only to black men in this age group.
Migrant and other studies have provided very strong evidence that colorectal cancer risk is modifiable, and that differences in population rates may therefore be explained by lifestyle or environmental factors. Dietary factors and exercise appear to be very important. Migrants to the United States (from Japan and other countries where rates of colon and rectal cancer are lower than in the U.S.) have higher rates than do those who remain in their native country. Studies have shown that first and second generation American offspring from these migrant groups develop these cancers at rates reaching or exceeding those of the United States white population.
Cancer of the corpus uteri, or endometrium, is the fourth most common cancer among women in the United States. The racial and ethnic diversity of endometrial cancer follows a pattern similar to that of breast cancer. Women with the highest age-adjusted incidence of endometrial cancer in the SEER areas include Hawaiians, whites, Japanese and blacks. The lowest rates occur among Korean, Vietnamese, and American Indian women.
Endometrial cancer increases with advancing age in most, but not all, racial/ethnic groups. Exceptions to this general pattern are Chinese and Filipino women, among whom the highest rates occur at ages 55-69 years. In younger women, ages 30-54 at diagnosis, endometrial cancer is most common among Hawaiians, Japanese, and whites. At ages 55-69 years, endometrial cancer rates are highest for white, Hawaiian, and black women. At ages 70 years and older, rates are highest among white, black, and Japanese women. There were too few cases in Hawaiian women ages 70 years and older to calculate a rate.
Age-adjusted mortality rates in the United States are highest among Hawaiian women, followed by black women. Mortality among white, Hispanic, Chinese, Japanese and Filipino women is less than one-half the rate for Hawaiian women. Age- specific mortality is highest among black women in each of the three age groups (there were too few deaths among Hawaiian women to calculate rates by age). The ratio of incidence to mortality for black women is slightly over two and for Hawaiian women it is nearly three. Chinese women have incidence rates about five times higher than mortality, for white women the ratio is seven, for Japanese women it is nearly eight, and for Filipino women it is about nine. The smaller incidence-to-mortality ratios among black and Hawaiian women suggest that access to care may be a more acute problem for them.
Endometrial cancer is associated with obesity and, possibly, with abnormal glucose tolerance and diabetes. The predominant risk factor for this cancer is the use of exogenous menopausal estrogens. When menopausal estrogens are taken with progesterone, the elevation in risk is greatly reduced. Tamoxifen, a drug that is widely used to treat breast cancer, appears to have estrogen-like effects on the uterus, and may also be associated with increased risk of endometrial cancer. Excepting these risk factors, the epidemiology of endometrial cancer is not well defined.
Source: Miller BA, Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, West D, Key CR, Liff JM, Glover CS, Alexander GA, et al. (eds). Racial/Ethnic Patterns of Cancer in the United States 1988-1992, National Cancer Institute. NIH Pub. No. 96-4104. Bethesda, MD, 1996.
Cancer of the esophagus is a common cancer in developing areas of the world (Asia, Africa and Latin America), but is less common in the United States. Historically, most esophageal cancers were squamous cell tumors. Recently, however, there has been a marked increase in adenocarcinoma of the esophagus, primarily among white men, in developed countries of the world, including the United States. In fact, among white men, rates of adenocarcinoma of the esophagus nearly equal those of squamous cell tumors.
There is a five-fold range in the age-adjusted incidence rates for esophageal cancer among the racial/ethnic groups in the SEER regions. Men are three to five times more likely than women to be diagnosed with esophageal cancer. Among men, blacks have the highest rate (15.0 per 100,000) and Filipinos have the lowest (2.9 per 100,000). The incidence rate for black men is 60% higher than that for Hawaiians and more than 2.7 times greater than the rate for non-Hispanic white men. The rates for Chinese, Japanese and non-Hispanic white men are similar to each other (within the range of 5.3 to 5.6 per 100,000 men) and are modestly higher than the rate for white Hispanic men. Limited data are available for women. Hispanic and non-Hispanic white women have lower rates than black women. Incidence rates generally increase with age in all racial/ethnic groups. In black men, however, the incidence rate for the 55- 69 year age group is close to the rate for the 70 and over age group. In black women aged 55-69 years, the incidence rate is slightly higher than for the 70 years and older age group.
United States mortality rates for esophageal cancer are nearly as high as incidence rates in the SEER regions, reflecting the generally poor survival for patients with this cancer. Among black and Hawaiian populations, the incidence-to- mortality rate ratio is less than 1.1. It is 1.1 for non-Hispanic whites, Japanese and Filipinos and 1.3 for Chinese and white Hispanics. Mortality patterns by age are similar to those seen in the incidence rates.
Heavy alcohol consumption, cigarette smoking, and, possibly, other types of tobacco use each substantially increase the risk of esophageal cancer among persons in developed countries. The use of tobacco and alcohol, in combination, results in even larger elevations in risk. In developing countries, nutritional deficiencies related to lack of fresh fruit and vegetables, drinking hot beverages, and a range of chewing and smoking habits are also important risk factors.
Source: Miller BA, Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, West D, Key CR, Liff JM, Glover CS, Alexander GA, et al. (eds). Racial/Ethnic Patterns of Cancer in the United States 1988-1992, National Cancer Institute. NIH Pub. No. 96-4104. Bethesda, MD, 1996.
Kidney and Renal Pelvis
Historically, incidence rates for kidney cancer have included cancers of the renal cells (in the main part of the kidney) and the renal pelvis (the lower part of the kidney where urine collects before entering the ureter and continuing to the bladder), although there is evidence that these cancers have different characteristics. They are presented together here for continuity. About one of five kidney cancers occur in the renal pelvis. Internationally, the highest incidence rates occur in the United States, Canada, Northern Europe, Australia, and New Zealand. The lowest rates are in Thailand, China, and the Philippines. Rates in these countries are about one-third the rates in the high risk countries.
During the years 1988 to 1992, in the SEER regions, the incidence rates for kidney cancers are about twice as high in men as in women. The highest rates in the SEER regions are in American Indian men in New Mexico. Rates are somewhat lower in blacks, Hispanics and white non-Hispanics (ranging from 10 to 13 per 100,000 for men and about six per 100,000 for women). The lowest incidence rates occur in the Asian populations. There were too few cases among Alaska Native and Vietnamese populations to calculate rates. Age-specific incidence rates for kidney cancer demonstrate a small, temporary peak in early childhood due to Wilm's tumor, an uncommon tumor of the kidney with a good prognosis. Rates then decline with age and remain low until they finally surpass the early peak at around age 40. The racial/ethnic patterns for ages 55-69 years and 70 years and over are similar to those for all ages combined. In the 30-54 year old age group, racial/ethnic differences are slight.
Kidney cancer has a relatively high mortality rate in all racial/ethnic populations. Following the incidence pattern, mortality rates are about twice as high in men as in women, regardless of age. There are too few deaths among American Indian (New Mexico), Alaska Native and Hawaiian populations to calculate reliable rates. Mortality rates for blacks are comparable to those for white non- Hispanics. Rates for the other races are lower. In all racial/ethnic groups the mortality rates increase with age.
Cancers of the kidney and renal pelvis share many risk factors although the strengths of the associations differ. For both types of cancer the only well-established risk factor is cigarette smoking. Compared to nonsmokers, smokers have about twice the risk for renal cell cancer and about four times the risk for renal pelvis cancer than nonsmokers. Other probable risk factors include obesity and, especially for cancer of the renal pelvis, heavy long-term use of analgesics (medications used to relieve pain). Cessation of cigarette smoking is the best single step in preventing these cancers. It is estimated that this measure alone would reduce by one-half the number of renal pelvis cancers and by one-third the number of renal cell cancers.
Leukemias are cancers of the blood-forming tissues. They may be subdivided according to the particular cell type involved, the major types being lymphocytic and myelocytic (granulocytic) leukemias. Leukemias are also classified by their behavior, as either "acute" or "chronic." Childhood leukemias are mostly acute, with the lymphocytic form predominating. Both acute and chronic leukemias occur among adults; most lymphocytic leukemias among adults are chronic.
In both men and women, leukemia incidence is highest among whites and lowest among Chinese, Japanese, and Koreans. Incidence rates are shown for all leukemia types combined, but it can be noted that the ethnic patterns are generally similar to those seen when incidence is calculated separately for the lymphocytic and non-lymphocytic forms of the disease. The incidence in men is about 50% higher than in women for all racial/ethnic groups except Vietnamese, among whom the male rates are only slightly higher. Ethnic differences in the incidence rates are small in the youngest adult age group (30-54 years), but become more evident in each of the older age groups. Data for childhood leukemia (0-14 years) are not shown separately in the figures. However, we found that childhood leukemia rates are highest among Filipinos, followed by white Hispanics, non-Hispanic whites and blacks. Reliable rates could not be computed for children in the remaining racial/ethnic groups.
United States mortality rates are shown for all leukemia types combined. The mortality rates for men are generally 50% to 100% higher than those for women for all ages combined, ages 55-69 years and ages 70 years and older. Leukemia mortality rates are highest in white and black populations and in Hawaiian men. Rates among Asian populations are noticeably lower. The ratio of mortality-to-incidence rates is higher for adult leukemias than for childhood leukemias. Because treatment for childhood leukemias is quite successful, mortality from this cancer is comparatively low among children.
Established causes of leukemia include ionizing radiation (such as occurs from x-irradiation), certain drugs used in the treatment of cancer, and some chemicals (most notably benzene) used largely in industrial settings. Ionizing radiation has been associated with all forms of leukemia except the chronic lymphocytic form. It is suspected that many childhood leukemias may result from parental exposures before the time of conception or during early fetal development.
Liver and Intrahepatic Bile Duct
Primary cancers of the liver and intrahepatic bile ducts are far more common in regions of Africa and Asia than in the United States, where they only account for about 1.5% of all cancer cases. Five-year survival rates are very low in the United States, usually less than 10%. Reported statistics for these cancers often include mortality rates that equal or exceed the incidence rates. This discrepancy (more deaths than cases) occurs when the cause of death is misclassified as "liver cancer" for some patients whose cancer originated as a primary cancer in another organ and spread (metastasized) to become a "secondary" cancer in the liver.
Non-Hispanic white men and women have the lowest age-adjusted incidence rates (SEER areas) and mortality rates (United States) for primary liver cancer. Rates in the black populations and Hispanic populations are roughly twice as high as the rates in whites. The highest incidence rate is in Vietnamese men (41.8 per 100,000), probably reflecting risks associated with the high prevalence of viral hepatitis infections in their homeland. Other Asian-American groups also have liver cancer incidence and mortality rates several times higher than the white population. Age-adjusted mortality rates among Chinese populations are the highest of all groups for which there are sufficient numbers to calculate rates. There were too few cases among Alaska Native and American Indian populations to calculate incidence or mortality rates. Most cases of liver cancer occur in the two older age groups, but younger adults are often affected in the high risk racial/ethnic groups.
About two-thirds of liver cancers are hepatocellular carcinomas (HCC), which is the cancer type most clearly associated with hepatitis B and hepatitis C viral infections and cirrhosis. Certain molds that grow on stored foods are recognized risk factors in parts of Africa and Asia. HCC occurs more frequently in men than in women by a ratio of two-to-one. About one-in-five liver cancers are cholangiocarcinomas, arising from branches of the bile ducts that are located within the liver. Certain liver parasites are recognized risk factors for this type of liver cancer, especially in parts of southeast Asia. Angiosarcomas are rare cancers that can arise from blood vessels, including the blood vessels within the liver. They account for about 1% of primary liver cancers and some of them have been associated with industrial exposures to vinyl chloride.
Lung and Bronchus
Cancer of the lung and bronchus (hereafter, lung cancer) is the second most common cancer among both men and women and is the leading cause of cancer death in both sexes. Among men, age-adjusted lung cancer incidence rates (per 100,000) range from a low of about 14 among American Indians to a high of 117 among blacks, an eight- fold difference. Between these two extremes, rates fall into two groups ranging from 42 to 53 for Hispanics, Japanese, Chinese, Filipinos, and Koreans and from 71 to 89 for Vietnamese, whites, Alaska Natives and Hawaiians. The range among women is much narrower, from a rate of about 15 among Japanese to nearly 51 among Alaska Natives, only a three-fold difference. Rates for the remaining female populations fall roughly into two groups with low rates of 16 to 25 for Korean, Filipino, Hispanic and Chinese women, and rates of 31 to 44 among Vietnamese, white, Hawaiian and black women. The rates among men are about two to three times greater than the rates among women in each of the racial/ethnic groups.
In the 30-54 year age group, incidence rates among men are double those among women in most of the racial/ethnic groups. In white non-Hispanics and white Hispanics, however incidence rates for women are closer to those for men. This suggests that smoking cessation and prevention programs may have been especially successful among white men and/or that such programs have not been as effective among white women.
Age-adjusted mortality rates follow similar racial/ethnic patterns to those for the incidence rates. Among men, the incidence and mortality rates are very similar. Filipino men are an exception, with an incidence rate nearly twice as large as their mortality rate. Incidence rates are also similar to mortality rates among women, with the exception of Filipinos and Hispanics. In these two groups, incidence rates are nearly twice as large as mortality rates. Among Hawaiian women, the mortality rate actually exceeds the incidence rate. This may be due to differences in the accuracy of race classification on medical records versus death certificates.
Racial/ethnic patterns are generally consistent within each age group for both incidence and mortality. An exception is the high incidence and mortality rate in Chinese women aged 70 years and older. This group tends to have low incidence and mortality rates in the younger age groups.
Cigarette smoking accounts for nearly 90% of all lung cancers. Passive smoking also contributes to the development of lung cancer among nonsmokers. Certain occupational exposures such as asbestos exposure are also known to cause lung cancer. Air pollution is a probable cause, but makes a relatively small contribution to incidence and mortality rates. In certain geographic areas of the United States, indoor exposure to radon may also make a small contribution to the total incidence of lung cancer.
Cancer of the nasopharynx is a rare neoplasm in most countries. However, it occurs at high frequencies in China and Southeast Asia. The highest incidence rates in the SEER regions occur among the Chinese. Rates are also high in Vietnamese and Filipino men, two groups that include persons of Chinese heritage. Incidence rates of nasopharyngeal cancer are also available for black, Hispanic and white men and for white women in the SEER areas. There were too few nasopharyngeal cancers diagnosed between 1988 and 1992 in the other racial/ethnic groups to provide meaningful incidence rates.
The average annual age-adjusted incidence rate of nasopharyngeal cancer in Chinese men, 10.8 per 100,000, is 1.4 times greater than that of Vietnamese men and nearly 2.8 times greater than that of Filipino men. In fact, the rate among Filipino men, although relatively high, is the same as that for Chinese women. Rates of one per 100,000 and lower occur in black men, Hispanic and non-Hispanic white men and non-Hispanic white women.
The United States mortality rates for cancer of the nasopharynx reflect patterns similar to those for SEER incidence rates. Mortality is highest in Chinese, lower in Filipinos and lowest among blacks, Hispanics and non-Hispanic whites. No mortality rates are currently available for Vietnamese. Incidence-to-mortality rate ratios vary, with Chinese and Filipinos having higher incidence relative to mortality (2.3 for men in both groups and 3.2 for Chinese women) than other groups (ranging from about 1.7 for white Hispanic men to two for non-Hispanic white men). Incidence and mortality rates for nasopharyngeal cancer increase through the oldest age group, although the small number of cases precluded the calculation of reliable rates for many populations.
The major modifiable risk factor identified for cancer of the nasopharynx is the consumption of Cantonese salted fish, which is a common food item eaten from early infancy onward by groups with high risk of this disease. Other possible risk factors include extensive exposures to dusts and smoke and regular consumption of other fermented foods. The role of Epstein-Barr virus in the development of nasopharyngeal cancer continues to be explored.
Lymphomas, which include Hodgkin's disease and non-Hodgkin's lymphoma, are the fifth most common type of cancer diagnosed and the sixth most common death in the United States. Of the two basic lymphoma types, non-Hodgkin's lymphoma is the more common.
The age-adjusted incidence rates for non-Hodgkin's lymphoma are higher among men than women in every racial/ethnic group except Koreans, in which there is a slight preponderance among women. In both men and women, non-Hodgkin's lymphoma incidence rates are highest among non-Hispanic whites (19.1 and 12.0 per 100,000 men and women, respectively) and lowest among Koreans (5.8 and 6.0 per 100,000). This corresponds to a high to low ratio of the rates (white non-Hispanic to Korean) of 3.3 for men, and 2.0 for women. Vietnamese men have the second highest rates (after whites), followed by white Hispanic, black, Filipino, Hawaiian, Chinese and Japanese men. There were too few cases diagnosed in Alaska Native and American Indian (New Mexico) men to calculate reliable rates. Among women, white Hispanics accounted for the second highest rates, followed by Filipino, Japanese, black and Chinese women. There are insufficient numbers of lymphoma cases diagnosed in Alaska Native, American Indian (New Mexico), Hawaiian and Vietnamese women to estimate their rates reliably.
Age-adjusted mortality rates of non- Hodgkin's lymphoma are consistent with the incidence rates with one exception: the mortality rate for Hawaiian men (8.8 per 100,000) exceeds that of any other group, even though the corresponding incidence rate is considerably lower than that of white non-Hispanics. There are an insufficient number of deaths from non-Hodgkin's lymphoma among Hawaiian women to reliably assess the mortality rate for that group.
In every group, incidence rates increase with age, however the magnitude of this increase varies by racial/ethnic group. For example, from ages 30-54 years to ages 70 years and older, the incidence of non- Hodgkin's lymphoma increases about five- fold among white non-Hispanic men, but 11-fold among Filipino men. Among women, the comparable rates increase eight- fold among white non-Hispanics, but 16- fold among Filipinos. These differences reflect high incidence rates among older Filipinos, similar to those of white non- Hispanics. These high rates are not reflected, however, in the mortality data for Filipinos. Among those aged 30-54 years rates among black men and women are close to those among white non-Hispanics. Rates among black men and women aged 70 years and older, however, are only about one-half those of white non-Hispanics.
Cancer of the oral cavity includes the following subsites: lip (excluding skin of the lip), tongue, salivary glands, gum, mouth, pharynx, oropharynx, and hypopharynx. Cancer of the nasopharynx is treated separately in this publication, since its epidemiologic patterns are distinct from the others in this group.
For the SEER areas, incidence rates for oral cavity cancer are two to four times higher among men than women for all racial/ethnic groups except Filipinos, among whom the rates for the two sexes are similar. Too few cases occurred among Alaska Natives, American Indians, Koreans, and Vietnamese women for the calculation of reliable rates. Across racial/ethnic groups, the incidence rates vary by a factor of four in men and about three in women. Among men, the highest rates are in blacks, followed by whites (especially non-Hispanic whites), Vietnamese, and native Hawaiians. Less variation occurs in women, among whom high rates occur in non-Hispanic whites, blacks and Filipinos. Although reasons for these racial/ethnic and sex differences have not been established, differences in the extent of exposure to risk factors for oral cavity cancer (see below) are presumably largely responsible.
Incidence rates for oral cavity cancer increase with age in all groups except the oldest age group of black men and women. The greatest increase in rates occurs between the 30-54 year old group and the 55-69 year old group. For several racial/ethnic and sex groups, the numbers of cases were too few to compute reliable rates by age category.
Mortality rates for oral cavity cancer are substantially lower than incidence rates, reflecting the reasonably high survival rates for this cancer site. The mortality rates increase with age in all groups except black men and women aged 70 years and older.
Tobacco use, including pipes, cigars, cigarettes, and chewing tobacco are well- established causes of cancers of the oral cavity. Chewing of betel nut, not a common practice in the United States but a widespread habit in some parts of the world, is also a known cause. Alcohol consumption, especially when combined with cigarette smoking, is an established risk factor. Both factors together interact synergistically. Finally, some evidence suggests that diets high in fruits and vegetables reduce the risk of developing this cancer.
Among women in the United States, cancer of the ovary ranks fifth in incidence. There are no proven methods of prevention and it often is a rapidly fatal disease.
Age-adjusted incidence rates in the SEER areas are highest among American Indian women, followed by white, Vietnamese, white Hispanic, and Hawaiian women. Rates are lowest among Korean and Chinese women. There are too few cases among Alaska Native women to calculate an incidence rate. Among women for whom there are sufficient numbers of cases to calculate rates by age, incidence in the age group 30-54 years is highest in whites, followed by Japanese, Hispanics, and Filipinos. For ages 55-69 years, the highest rates occur in whites, then Hispanics, and Japanese. Among women 70 and older, the highest rate occurs among white women followed by black and Hispanic women.
The ovarian cancer mortality patterns by racial/ethnic group differ from the incidence patterns. The age-adjusted mortality rate is highest among white women, followed by Hawaiian women, and black women. White women have the highest age-specific ovarian cancer mortality rate in each of the three age groups. The ratio of incidence to mortality rates ranges from 1.5 among black women to 3.0 among Filipino women.
Although the epidemiology of ovarian cancer is not well understood, hormonal and reproductive risk factors are implicated in the etiology of this disease. There is an inverse relationship between parity and the occurrence of ovarian cancer, with parous women having the lowest risk of this disease. The risk of cancer of the ovary also decreases with increasing length of use of oral contraceptives and there is some suggestion of a protective effect of hysterectomy.
Cancer of the pancreas stands out as a highly lethal disease with the poorest likelihood of survival among all of the major malignancies. It accounts for only 2% of all newly diagnosed cancers in the United States each year, but 5% of all cancer deaths. Most pancreatic cancers are adenocarcinomas arising from the pancreatic ductal system. The disease is often far advanced by the time symptoms occur and the diagnosis is established. As indicated by five-year survival rates of less than 5%, successful treatment is rare. Islet cell carcinomas have a better prognosis, but account for less than 2% of all pancreatic cancers. Relatively few cancers arise from the enzyme-producing acinar (glandular) cells that form the bulk of the pancreas.
Men have higher incidence and mortality rates for pancreatic cancer than women in each racial/ethnic group. Black men and women have incidence and mortality rates that are about 50% higher than the rates for whites. Rates for native Hawaiians are somewhat higher than the rates for whites, whereas rates for Hispanics and the Asian-American groups are generally lower. There were too few cases among Alaska Native and American Indian populations to calculate rates.
Pancreatic cancer is rare in the 30-54 years age group. In the 55-69 years age group, incidence rates in the black populations exceed those for whites by about 60%. This difference diminishes somewhat among persons aged 70 years and older. Incidence rates for Japanese men and women exceed those for the white population in the oldest age group. Racial/ethnic patterns in mortality rates by age group closely follow those seen in the incidence rates.
Cigarette smoking has been identified consistently as an important risk factor for cancer of the pancreas. Other risk factors which have been suggested, but not confirmed include coffee drinking, high fat diets, diabetes mellitus and some occupations.
Prostate cancer is the leading cancer diagnosed among men in the United States. However, racial/ethnic variations in the SEER data are striking: the incidence rate among black men (180.6 per 100,000) is more than seven times that among Koreans (24.2). Indeed, blacks in the U.S. have the highest rates of this cancer in the world. Although the incidence among whites is quite high, it is distinctly lower than among blacks. Asian and native American men have the lowest rates. The very low rate in Korean men probably reflects the fact that most of the Koreans in the SEER areas are recent immigrants from Asia, where rates are lower than in the United States.
Age-specific incidence rates show dramatic increases between age categories. The remarkably sharp increase in incidence with age is a hallmark of this cancer. Sixty percent of all newly diagnosed prostate cancer cases and almost 80% of all deaths occur in men 70 years of age and older. Mortality rates for prostate cancer are much lower than the incidence rates, because survival for men with this cancer is generally quite high.
Prostate cancer incidence has been increasing rapidly in recent years. Most of this increase has been attributed to the greater use of screening modalities, and especially the widespread introduction of the prostate-specific antigen (PSA) test. The causes of prostate cancer are not known. Men with a family history of prostate cancer are at increased risk, but whether this is genetic or due to shared environmental influences, or both, is not known. It is thought that whatever the causal factors are, they act by altering the balance of male hormones in the body. Some research has suggested that diets high in fat and red meats increase risk, while a high intake of fruits and vegetables may offer some protection. There is current interest in the possibility that the low risk of prostate cancer in certain Asian populations may result from their high intake of soy products.
Prostate Cancer Trends 1973-1995
Last updated: September 07, 1999Monograph Data (PDF)
- Data are from the SEER program which has registries covering 14% of the U.S. population.
- 272,689 cases with histologically confirmed adenocarcinoma of the prostate newly diagnosed between 1973 and 1995 are included.
- Mortality data are both from the SEER areas and the entire U.S. population.
- Data for the 23-year period are presented for whites and blacks. Data for Asians, Native Americans, and Hispanics are only available for 1990-1995 and are presented in a separate section.
- Black men have about a 60% higher incidence rate than white men.
- Incidence rates modestly increased from 1973-1986, rapidly increased from 1987-1992, and declined from 1993-1995.
- Incidence rates increased 108% for white men from 1986-1992 and 102% for black men from 1986-1993; these increases in rates are believed to be related to use of the prostate-specific antigen (PSA) blood test as a new screening tool.
- The increase from 1986-1992 occurred in all age groups; the median age at diagnosis decreased by one year for whites and for blacks between 1980-1985 and 1990-1995.
- The increase from 1986-1992 occurred for both localized and regional stages of disease and mostly in moderately differentiated tumors.
- Incidence of distant stage prostate cancer peaked in 1985 and by 1995 declined by 56%.
- Black men have about a 2-fold higher mortality rate than white men.
- Death rates from prostate cancer have gradually increased over the last 20 years, but peaked in 1991 and 1993 for white and black men, respectively.
- The median age of death increased between 1980-1985 and 1990-1995 by one year in both whites and blacks.
- Though death rates have slightly decreased in recent years, a decline in the absolute number of deaths was first noted in 1995. In white men under age 75, the age-adjusted mortality rate declined by 15% between 1990 and 1995.
Grade and Stage (PDF)
- Between 1973-1995, about 60% of prostate cancers were diagnosed at a localized stage and about 40% were graded as moderately differentiated. The percent of moderately differentiated cancers differed little by race, but decreased slightly with advancing age.
Stage and grade are correlated; as the grade becomes less differentiated the stage is likely to be more advanced.
- The rapid increase in prostate cancer incidence from 1986-1992 was confined to moderately differentiated cancers for all ages and for whites and blacks.
- Only treatment data for 1983-1995 are included, as these are the only years with consistent coding. The monograph focuses on treatment patterns in localized and regional stage cancers.
- The increased incidence (1986-1992) was accompanied by increases in more aggressive therapy (radical prostatectomy or radiation therapy) for localized and regional cancers.
- Recent treatment patterns for local/regional cancers vary by age: radical prostatectomy is more frequent among men under age 70, radiation therapy in those age 70-79, and conservative therapy (no treatment or hormonal therapy) in those over age 79.
- Treatment for distant stage cancers has not changed over time with about 65% of patients receiving hormonal therapy.
- Based on cases diagnosed in 1990 and followed through 1995, 93% of all men diagnosed with prostate cancer will survive five years or longer.
- Relative survival rates have increased since 1973 for both black and white men, but the difference between blacks and whites has increased over time (survival has not improved as rapidly in black men).
- Consistent improvements in relative survival have occurred over time (1973 to 1993) for localized and regional stage cancers, with relative five-year survival now exceeding 99%.
- Relative survival has increased over time for all grades of cancer.
- Relative survival for younger men (age <50) is lower than for older men.
- Five-year relative survival for distant stage disease is 34% and has not improved over time.
- The lowest incidence rates are found in Native Americans and all other groups have lower rates than whites and blacks. The incidence rates peaked in 1992 for all groups except blacks, where it peaked in 1993.
- National mortality rates are not available for Asians and Native Americans; mortality rates are available for white-Hispanics, and their rates have not decreased as they have for blacks and white non-Hispanics.
- Stage distribution is similar across races, except the proportion with distant stage disease is higher for Hawaiians, Filipinos, and Native Americans.
- Filipino men have slightly more poorly differentiated cancers than the other groups. The proportion of tumors that are well or moderately differentiated is similar across all groups.
- Of patients with localized or regional stage prostate cancer, Native Americans have the poorest relative survival of all racial/ethnic groups. Blacks and white-Hispanics have the lowest five-year relative survival rates among patients with distant stage disease.
Stomach cancer was the most common form of cancer in the world in the 1970s and early 1980s, and is probably now only surpassed by lung cancer. Stomach cancer incidence rates show substantial variation internationally. Rates are highest in Japan and eastern Asia, but other areas of the world have high stomach cancer incidence rates including eastern Europe and parts of Latin America. Incidence rates are generally lower in western Europe and the United States. Stomach cancer incidence and mortality rates have been declining for several decades in most areas of the world. For one subsite of the stomach, the cardia, incidence rates appear to be increasing, particularly among white men.
Stomach cancer incidence rates for the racial/ethnic populations in the SEER regions can be grouped broadly into three levels. Those with high age-adjusted incidence rates are Koreans, Vietnamese, Japanese, Alaska Natives and Hawaiians. Those with intermediate incidence rates are white Hispanic, Chinese, and black populations. Filipinos and non-Hispanic whites have substantially lower incidence rates than the other groups. These patterns hold for both men and women when rates are available for both sexes.
The incidence rate for Korean men is 1.6 times the rate in Japanese men, the group with the second highest rate, and is 2.4 times the rate in Hawaiians. The range in incidence rates is narrower among the groups in the intermediate level. The incidence rate for Korean men is nearly 5.8 times greater than the rate in Filipino men, the group with the lowest incidence rate. Among women, the highest incidence rate is in the Vietnamese population and is nearly 6.6 times greater than the rate in non-Hispanic whites. The male-to-female ratio of age-adjusted incidence rates is highest for Koreans (2.6) and followed closely by non-Hispanic whites and blacks (2.5 and 2.4, respectively). The ratio is less than two for other racial-ethnic groups. Notably, the incidence rates for Vietnamese men and women are the same.
The racial/ethnic patterns of stomach cancer mortality in the United States are similar to those for incidence. These patterns remain when incidence and mortality rates are calculated for the three age groups. There are some differences in the ratios of incidence rates to mortality rates. Filipinos show relatively high ratios of incidence to mortality (greater than 2); Japanese, Alaska Natives, white Hispanics, Chinese, and non-Hispanic whites show intermediate ratios (1.5-1.9); blacks and Hawaiians show low ratios of incidence to mortality rates (1.0-1.4).
Better techniques for food preservation and storage are often cited as reasons for the decline in stomach cancer incidence worldwide. Refrigeration has resulted in lower intake of salted, smoked and pickled foods and greater availability of fresh fruits and vegetables. Evidence is strong that salt intake is a major determinant of stomach cancer risk. Cigarette smoking may also play a role. Infection with helicobacter pylori, the major cause of chronic active gastritis, also appears to be important in the development of stomach cancer.
Tiny and usually insignificant carcinomas can be found in five to 10% or more of all thyroid glands that are carefully examined under the microscope at autopsy, but relatively few of them grow or spread to produce symptoms that lead to their detection during a person's lifetime. The thyroid cancers that are diagnosed each year represent about 1% of all cancers in the U.S. population. Most types of thyroid cancer rank quite high in terms of successful treatment and long term survival. However, some rare subtypes may have a poor prognosis.
The highest incidence rates for thyroid cancer in the SEER regions occur in women, particularly in the Pacific Island and Southeast Asian populations living in California and Hawaii. The rates are highest among Filipino women (14.6 per 100,000), Vietnamese women (10.5) and Hawaiian women (9.1), and lowest among black women (3.3). Within each racial/ethnic group, incidence rates in women consistently exceed incidence rates in men by a factor of about three. Among men, highest rates occur in the Filipino population (4.1) and lowest in the black (1.4) and Japanese (1.6) populations.
Mortality rates are lower than incidence rates by a factor of about five to ten in men and eight to twenty in women. Although women have three-fold higher incidence rates than men, the gender difference for mortality is smaller, reflecting somewhat better survival rates for women than for men. Most deaths due to thyroid cancer occur in the older age groups and may occur more than ten years after diagnosis.
Thyroid cancers occur in all age groups. Whereas the incidence of most other cancers increases markedly with age, in most of the racial/ethnic groups, thyroid cancer reaches its highest incidence in young adults and remains fairly constant throughout the rest of life. Hispanic men are an exception, with incidence rates which rise from 2.3 in the 30-54 year age group to 4.5 in the 55-69 year age group and 9.2 in the 70 year and older age group.
Many studies report an association between thyroid cancer and radiation exposure. In the 1930s and 1940s, X-rays were often used in the treatment of skin diseases and other benign conditions such as enlarged thymus or tonsils. Increased risks have been described in Japanese atomic bomb survivors and in persons exposed to fallout from atomic testing in the Marshall Islands. Populations exposed to radioactive fallout from the nuclear processing facility in Hanford, Washington and from the vicinity of the Chernobyl nuclear plant disaster in the Ukraine are currently being studied. Goiter and other thyroid diseases, as well as diets high or low in iodine, have been suspected risk factors. Medullary carcinomas of the thyroid, which account for about 3% of cases, are often a part of an inherited disease complex called the Multiple Endocrine Neoplasia (MEN) Syndrome.
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