The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes incidence trends for human papillomavirus (HPV)–associated cancers and HPV vaccination (recommended for adolescents aged 11–12 years).
Data on cancer incidence were obtained from the CDC, NCI, and NAACCR, and data on mortality were obtained from the CDC. Long- (1975/1992–2009) and short-term (2000–2009) trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and among women were examined by joinpoint analysis. Prevalence of HPV vaccination coverage during 2008 and 2010 and of Papanicolaou (Pap) testing during 2010 were obtained from national surveys.
Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2000 to 2009. Overall incidence rates decreased in men but stabilized in women. Incidence rates increased for two HPV-associated cancers (oropharynx, anus) and some cancers not associated with HPV (eg, liver, kidney, thyroid). Nationally, 32.0% (95% confidence interval [CI] = 30.3% to 33.6%) of girls aged 13 to 17 years in 2010 had received three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states (eg, 20.0% in Alabama [95% CI = 13.9% to 27.9%] and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest.
The overall trends in declining cancer death rates continue. However, increases in incidence rates for some HPV-associated cancers and low vaccination coverage among adolescents underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage.
The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated cancer incidence and mortality data for the United States. The initial report documented the first steady decline in cancer death rates, beginning in the early 1990s, since national record keeping on vital statistics began in 1930 (
Exposure to HPV is common through sexual contact, and most infections resolve over time. However, persistent infection with oncogenic HPV types is etiologically linked to cervical cancer (
Population-based data on cancer incidence were based on the CDC’s National Program of Cancer Registries (NPCR) and/or the NCI’s Surveillance, Epidemiology, and End Results (SEER) program that met NAACCR’s data quality criteria (
Incidence data were not available uniformly for every calendar year, geographic area, and racial and ethnic group in the United States. Therefore, long-term (1992–2009) incidence trends for all racial and ethnic groups combined were estimated using data from the 13 SEER registries covering approximately 14% of the US population (
Cause of death was based on death certificate information reported to state vital statistics offices and compiled into a national file through the CDC National Center for Health Statistics’ National Vital Statistics System (
For classifying HPV-associated cancers, we used the same framework as in a prior study (
Data on HPV vaccination coverage for receipt of one or more and three (some received more than three) doses of HPV vaccine among girls aged 13 to 17 years for 2008 and 2010 were obtained from the National Immunization Survey-Teen (NIS-Teen), a random-digit-dialed landline telephone survey of US households (
Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state-based, random-digit-dialed telephone survey, were used to estimate the state-level (and national average) prevalence of recent Pap testing (during the previous 3 years) for women aged 21 to 65 years with an intact uterus, overall, and by usual source of medical care (
Population estimates from the Census Bureau’s Vintage 2009 National Tables were used in the SEER*Stat software (
Average annual cancer incidence and death rates per 100 000 persons were age standardized to the 2000 US standard population by the direct method (
Trends in age-standardized cancer incidence and death rates were analyzed using joinpoint regression, which involves fitting a series of joined straight lines on a logarithmic scale to the trends in the annual age-standardized rates (
Sample-weighted national vaccination coverage estimates, as well as the percentage point changes in estimates from 2008 to 2010, for selected sociodemographic characteristics and by state were calculated using Statistical Analysis Software (SAS, version 9.3, SAS Institute, Cary, NC)–callable- SUDAAN (release 10.0, Research Triangle Institute, Research Triangle Park, NC) (
SAS-callable-SUDAAN (
Trend analysis based on SEER 13 data showed that overall delay-adjusted cancer incidence rates in all racial and ethnic groups and sexes combined were stable from 2000 to 2009 (
Surveillance, Epidemiology, and End Results (SEER) cancer incidence rate trends with joinpoint analyses from 1992 to 2009 for the most common cancers, by sex, for all racial and ethnic groups combined*
Joinpoint analyses (1992–2009)† | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Trend 1 | Trend 2 | Trend 3 | Trend 4 | AAPC‡ | ||||||
Cancer site or type by sex | Years | APC§ | Years | APC§ | Years | APC§ | Years | APC§ | 2000–2009 | 2005–2009 |
All sites|| | ||||||||||
Both sexes | 1992–1994 | −3.1¶ | 1994–1999 | 0.3 | 1999–2009 | −0.6¶ | −0.6# | −0.6# | ||
Delay adjusted | 1992–1994 | −3.1¶ | 1994–1999 | 0.4 | 1999–2005 | −0.7¶ | 2005–2009 | 0.1 | −0.4 | 0.1 |
Men | 1992–1995 | −4.5¶ | 1995–2000 | 0.2 | 2000–2009 | −1.0¶ | −1.0# | −1.0# | ||
Delay adjusted | 1992–1994 | −5.6¶ | 1994–2009 | −0.6¶ | −0.6# | −0.6# | ||||
Women | 1992–1994 | −0.4 | 1994–1998 | 1.2 | 1998–2004 | −0.8¶ | 2004–2009 | 0.2 | −0.2 | 0.2 |
Delay adjusted | 1992–1998 | 0.8¶ | 1998–2006 | −0.5¶ | 2006–2009 | 1.0 | 0.0 | 0.6 | ||
Children (ages 0–14) | 1992–2009 | 0.5¶ | 0.5# | 0.5# | ||||||
Delay adjusted | 1992–2009 | 0.6¶ | 0.6# | 0.6# | ||||||
Children (ages 0–19) | 1992–2009 | 0.6¶ | 0.6# | 0.6# | ||||||
Delay adjusted | 1992–2009 | 0.7¶ | 0.7# | 0.7# | ||||||
17 most common cancers for men** | ||||||||||
Prostate | 1992–1995 | −11.2¶ | 1995–2000 | 2.1 | 2000–2009 | −2.1¶ | −2.1# | −2.1# | ||
Delay adjusted | 1992–1995 | −11.1¶ | 1995–2000 | 2.0 | 2000–2009 | −1.9¶ | −1.9# | −1.9# | ||
Lung and bronchus | 1992–2009 | −2.0¶ | −2.0# | −2.0# | ||||||
Delay adjusted | 1992–2009 | −1.9¶ | −1.9# | −1.9# | ||||||
Colon and rectum | 1992–1995 | −2.6¶ | 1995–1998 | 1.6 | 1998–2009 | −2.7¶ | −2.7# | −2.7# | ||
Delay adjusted | 1992–1995 | −2.6¶ | 1995–1998 | 1.5 | 1998–2009 | −2.6¶ | −2.6# | −2.6# | ||
Urinary bladder | 1992–2007 | 0.1 | 2007–2009 | −3.3 | −0.7 | −1.6 | ||||
Delay adjusted | 1992–2007 | 0.1 | 2007–2009 | −2.5 | −0.5 | −1.2 | ||||
Melanoma of the skin | 1992–2009 | 2.4¶ | 2.4# | 2.4# | ||||||
Delay adjusted | 1992–2009 | 2.5¶ | 2.5# | 2.5# | ||||||
Non-Hodgkin lymphoma | 1992–2009 | 0.1 | 0.1 | 0.1 | ||||||
Delay adjusted | 1992–2009 | 0.2 | 0.2 | 0.2 | ||||||
Kidney and renal pelvis | 1992–2009 | 2.3¶ | 2.3# | 2.3# | ||||||
Delay adjusted | 1992–1999 | 1.3¶ | 1999–2009 | 2.9¶ | 2.9# | 2.9# | ||||
Oral cavity and pharynx | 1992–2005 | −1.4¶ | 2005–2009 | 1.5 | −0.1 | 1.5 | ||||
Delay adjusted | 1992–2005 | −1.4¶ | 2005–2009 | 1.8 | 0.0 | 1.8 | ||||
Leukemia | 1992–2009 | −0.3¶ | −0.3# | −0.3# | ||||||
Delay adjusted | 1992–2009 | 0.2 | 0.2 | 0.2 | ||||||
Pancreas | 1992–2002 | 0.0 | 2002–2009 | 1.4¶ | 1.1# | 1.4# | ||||
Delay adjusted | 1992–2002 | 0.0 | 2002–2009 | 1.7¶ | 1.3# | 1.7# | ||||
Liver and intrahepatic bile duct | 1992–2009 | 3.5¶ | 3.5# | 3.5# | ||||||
Delay adjusted | 1992–2009 | 3.7¶ | 3.7# | 3.7# | ||||||
Stomach | 1992–2009 | −1.7¶ | −1.7# | −1.7# | ||||||
Delay adjusted | 1992–2009 | −1.7¶ | −1.7# | −1.7# | ||||||
Esophagus | 1992–2009 | 0.0 | 0.0 | 0.0 | ||||||
Delay adjusted | 1992–2009 | 0.0 | 0.0 | 0.0 | ||||||
Brain and other nervous system | 1992–2009 | −0.3¶ | −0.3# | −0.3# | ||||||
Delay adjusted | 1992–2009 | −0.2 | −0.2 | −0.2 | ||||||
Myeloma | 1992–2009 | 0.2 | 0.2 | 0.2 | ||||||
Delay adjusted | 1992–2009 | 0.5¶ | 0.5# | 0.5# | ||||||
Larynx | 1992–2009 | −2.8¶ | −2.8# | −2.8# | ||||||
Delay adjusted | 1992–2009 | −2.8¶ | −2.8# | −2.8# | ||||||
Thyroid | 1992–1996 | −1.4 | 1996–2009 | 5.5¶ | 5.5# | 5.5# | ||||
Delay adjusted | 1992–1996 | −1.4 | 1996–2009 | 5.6¶ | 5.6# | 5.6# | ||||
18 most common cancers for women** | ||||||||||
Breast | 1992–1999 | 1.3¶ | 1999–2005 | −2.0¶ | 2005–2009 | 0.9 | −0.7 | 0.9 | ||
Delay adjusted | 1992–1999 | 1.3¶ | 1999–2005 | −2.0¶ | 2005–2009 | 1.1 | −0.6 | 1.1 | ||
Lung and bronchus | 1992–1998 | 0.8¶ | 1998–2001 | −1.3 | 2001–2005 | 0.5 | 2005–2009 | −1.2¶ | −0.5 | −1.2# |
Delay adjusted | 1992–1997 | 0.7 | 1997–2009 | −0.3¶ | −0.3# | −0.3# | ||||
Colon and rectum | 1992–1995 | −1.9¶ | 1995–1998 | 1.9 | 1998–2009 | −2.1¶ | −2.1# | −2.1# | ||
Delay adjusted | 1992–1995 | −1.8¶ | 1995–1998 | 1.9 | 1998–2009 | −2.1¶ | −2.1# | −2.1# | ||
Corpus and uterus, NOS | 1992–2006 | −0.2 | 2006–2009 | 3.1¶ | 0.9# | 2.3# | ||||
Delay adjusted | 1992–2007 | −0.1 | 2007–2009 | 5.2¶ | 1.0# | 2.5# | ||||
Thyroid | 1992–1999 | 4.1¶ | 1999–2009 | 6.9¶ | 6.9# | 6.9# | ||||
Delay adjusted | 1992–1999 | 4.1¶ | 1999–2009 | 7.0¶ | 7.0# | 7.0# | ||||
Non-Hodgkin lymphoma | 1992–2003 | 1.3¶ | 2003–2009 | −0.5 | 0.1 | −0.5 | ||||
Delay adjusted | 1992–2003 | 1.4¶ | 2003–2009 | −0.1 | 0.4 | −0.1 | ||||
Melanoma of the skin | 1992–1997 | 4.0¶ | 1997–2009 | 1.6¶ | 1.6# | 1.6# | ||||
Delay adjusted | 1992–1997 | 3.9¶ | 1997–2009 | 1.7¶ | 1.7# | 1.7# | ||||
Ovary|| | 1992–2001 | −0.6¶ | 2001–2009 | −1.4¶ | −1.3# | −1.4# | ||||
Delay adjusted|| | 1992–2009 | −0.9¶ | −0.9# | −0.9# | ||||||
Kidney and renal pelvis | 1992–2009 | 2.5¶ | 2.5# | 2.5# | ||||||
Delay adjusted | 1992–1998 | 1.3 | 1998–2009 | 3.1¶ | 3.1# | 3.1# | ||||
Pancreas | 1992–2009 | 0.6¶ | 0.6# | 0.6# | ||||||
Delay adjusted | 1992–2000 | −0.1 | 2000–2009 | 1.4¶ | 1.4# | 1.4# | ||||
Leukemia | 1992–2009 | 0.0 | 0.0 | 0.0 | ||||||
Delay adjusted | 1992–2009 | 0.5¶ | 0.5# | 0.5# | ||||||
Urinary bladder | 1992–2004 | −0.2 | 2004–2009 | −1.7¶ | −1.0# | −1.7# | ||||
Delay adjusted | 1992–2004 | −0.1 | 2004–2009 | −1.3¶ | −0.8# | −1.3# | ||||
Cervix uteri | 1992–2009 | −2.6¶ | −2.6# | −2.6# | ||||||
Delay adjusted | 1992–2009 | −2.5¶ | −2.5# | −2.5# | ||||||
Oral cavity and pharynx | 1992–2009 | −1.0¶ | −1.0# | −1.0# | ||||||
Delay adjusted | 1992–2009 | −0.9¶ | −0.9# | −0.9# | ||||||
Brain and other nervous system | 1992–2009 | −0.2 | −0.2 | −0.2 | ||||||
Delay adjusted | 1992–2009 | 0.0 | 0.0 | 0.0 | ||||||
Myeloma | 1992–2009 | −0.1 | −0.1 | −0.1 | ||||||
Delay adjusted | 1992–2009 | 0.3 | 0.3 | 0.3 | ||||||
Stomach | 1992–2009 | −0.8¶ | −0.8# | −0.8# | ||||||
Delay adjusted | 1992–2009 | −0.8¶ | −0.8# | −0.8# | ||||||
Liver and intrahepatic bile duct | 1992–2009 | 2.8¶ | 2.8# | 2.8# | ||||||
Delay adjusted | 1992–2009 | 3.0¶ | 3.0# | 3.0# |
* Source: Surveillance, Epidemiology, and End Results (SEER) 13 areas covering about 14% of the US population (Connecticut, Hawaii, Iowa, Utah, and New Mexico, the Alaska Native Tumor Registry, rural Georgia, and the metropolitan areas of San Francisco, Los Angeles, San Jose-Monterey, Detroit, Atlanta, and Seattle-Puget Sound). AAPC = average annual percent change; APC = annual percent change; NOS = not otherwise specified.
† Joinpoint analyses with up to three joinpoints yielding up to four trend segments (Trends 1–4) were based on rates per 100 000 persons and were age adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, … , 80–84 years, ≥85 years; Census publication p25-1130; US Bureau of the Census, Current Population Reports. Washington, DC: US Government Printing Office, 2000). For joinpoint analysis, the Joinpoint Regression Program was used (version 3.5.1, July 2011; Surveillance Research Program, National Cancer Institute, Bethesda, MD).
‡ The AAPC is a weighted average of the APCs that is calculated by joinpoint regression.
§ The APC is based on age-adjusted rates (see above).
|| All sites excludes myelodysplastic syndromes and borderline tumors; ovary excludes borderline tumors.
¶ The APC is statistically significantly different from zero (2-sided t test;
# The AAPC is statistically significantly different from zero (2-sided Z test;
** Cancers are listed in descending rank order of sex-specific, age-adjusted incidence rates for 2005 through 2009 for all racial and ethnic groups combined (using data from the National Program of Cancer Registries [NPCR] and SEER Program areas reported by the North American Association of Central Cancer Registries [NAACCR] as meeting high-quality incidence data standards for 2005–2009). To include the 15 most common cancers in each racial and ethnic group, more than 15 cancers are given for men and women in total.
Among men, incidence rates from 2000 to 2009 decreased for five of the 17 most common cancers: prostate, lung and bronchus (lung), colon and rectum (colorectal), stomach, and larynx. In contrast, rates among men during the same time interval increased for six cancers: kidney and renal pelvis (kidney), pancreas, liver and intrahepatic bile duct (liver), thyroid, melanoma of the skin (melanoma), and myeloma. Among women, incidence rates decreased from 2000 to 2009 for seven of the 18 most common cancers: lung, colorectal, urinary bladder (bladder), cervix uteri (cervix), oral cavity and pharynx (all tumors regardless of their potential association with HPV infection), ovary, and stomach. Incidence rates among women increased from 2000 to 2009 for seven cancers: thyroid, melanoma, kidney, pancreas, leukemia, liver, and corpus and uterus (uterus). Incidence rates were stable for all other cancers during the period from 2000 to 2009, including female breast cancer and non-Hodgkin lymphoma in men and women.
Overall cancer death rates have been declining since the early 1990s, with rates decreasing by about 1.8% per year in men and by 1.4% per year in women from 2000 to 2009 (
US cancer death rate trends with joinpoint analyses from 1975 to 2009 for the most common cancers, by sex, for all racial and ethnic groups combined*
Joinpoint analyses (1975–2009)† | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Trend 1 | Trend 2 | Trend 3 | Trend 4 | Trend 5 | Trend 6 | AAPC‡ | ||||||||
Cancer site or type by sex | Years | APC§ | Years | APC§ | Years | APC§ | Years | APC§ | Years | APC§ | Years | APC§ | 2000–2009 | 2005–2009 |
All sites | ||||||||||||||
Both sexes | 1975–1984 | 0.5|| | 1984–1991 | 0.3|| | 1991–1994 | −0.5 | 1994–1998 | −1.3|| | 1998–2001 | −0.8 | 2001–2009 | −1.6|| | −1.5¶ | −1.6¶ |
Men | 1975–1979 | 1.0|| | 1979–1990 | 0.3|| | 1990–1993 | −0.5 | 1993–2001 | −1.5|| | 2001–2009 | −1.8|| | −1.8¶ | −1.8¶ | ||
Women | 1975–1990 | 0.6|| | 1990–1994 | −0.2 | 1994–2002 | −0.8|| | 2002–2009 | −1.5|| | −1.4¶ | −1.5¶ | ||||
Children (aged 0–14 y) | 1975–1998 | −2.9|| | 1998–2003 | 0.2 | 2003–2009 | −2.8|| | −1.8¶ | −2.8¶ | ||||||
Children (aged 0–19 y) | 1975–1998 | −2.7|| | 1998–2003 | 0.0 | 2003–2009 | −2.7|| | −1.8¶ | −2.7¶ | ||||||
17 most common cancers for men# | ||||||||||||||
Lung and bronchus | 1975–1978 | 2.5|| | 1978–1984 | 1.2|| | 1984–1990 | 0.4|| | 1990–1993 | −1.1 | 1993–2005 | −1.9|| | 2005–2009 | −2.8|| | −2.3¶ | −2.8¶ |
Prostate | 1975–1987 | 0.9|| | 1987–1991 | 3.1|| | 1991–1994 | −0.7 | 1994–2004 | −3.9|| | 2004–2009 | −3.2|| | −3.5¶ | −3.2¶ | ||
Colon and rectum | 1975–1978 | 0.8 | 1978–1984 | −0.4 | 1984–1990 | −1.3|| | 1990–2002 | −2.0|| | 2002–2005 | −3.9|| | 2005–2009 | −2.5|| | −2.9¶ | −2.5¶ |
Pancreas | 1975–1986 | −0.8|| | 1986–2001 | −0.3|| | 2001–2009 | 0.5|| | 0.4¶ | 0.5¶ | ||||||
Leukemia | 1975–1995 | −0.2|| | 1995–2009 | −0.8|| | −0.8¶ | −0.8¶ | ||||||||
Non-Hodgkin lymphoma | 1975–1991 | 2.7|| | 1991–1997 | 1.5|| | 1997–2009 | −2.7|| | −2.7¶ | −2.7¶ | ||||||
Liver and intrahepatic bile duct | 1975–1985 | 1.5|| | 1985–1996 | 3.8|| | 1996–1999 | 0.5 | 1999–2009 | 2.6|| | 2.6¶ | 2.6¶ | ||||
Esophagus | 1975–1985 | 0.7|| | 1985–1994 | 1.2|| | 1994–2005 | 0.5|| | 2005–2009 | −1.2|| | −0.3 | −1.2¶ | ||||
Urinary bladder | 1975–1983 | −1.4|| | 1983–1987 | −2.8|| | 1987–1993 | 0.2 | 1993–1997 | −1.1 | 1997–2009 | 0.0 | 0.0 | 0.0 | ||
Kidney and renal pelvis | 1975–1992 | 1.1|| | 1992–2009 | −0.4|| | −0.4¶ | −0.4¶ | ||||||||
Brain and other nervous system | 1975–1977 | 4.4 | 1977–1982 | −0.4 | 1982–1991 | 1.3|| | 1991–2007 | −1.0|| | 2007–2009 | 1.5 | −0.4 | 0.3 | ||
Stomach | 1975–1987 | −2.3|| | 1987–1991 | −1.0 | 1991–2009 | −3.4|| | −3.4¶ | −3.4¶ | ||||||
Myeloma | 1975–1994 | 1.5|| | 1994–2009 | −1.1|| | −1.1¶ | −1.1¶ | ||||||||
Melanoma of the skin | 1975–1990 | 2.2|| | 1990–2002 | 0.0 | 2002–2009 | 1.0|| | 0.8¶ | 1.0¶ | ||||||
Oral cavity and pharynx | 1975–1993 | −1.9|| | 1993–1999 | −3.1|| | 1999–2009 | −1.3|| | −1.3¶ | −1.3¶ | ||||||
Larynx | 1975–1994 | −0.8|| | 1994–2009 | −2.5|| | −2.5¶ | −2.5¶ | ||||||||
Soft tissue including heart | 1975–1980 | 7.6|| | 1980–1997 | 1.2|| | 1997–2002 | −3.5|| | 2002–2009 | 1.2|| | 0.2 | 1.2¶ | ||||
18 most common cancers for women# | ||||||||||||||
Lung and bronchus | 1975–1982 | 6.0|| | 1982–1990 | 4.2|| | 1990–1995 | 1.7|| | 1995–2003 | 0.3|| | 2003–2009 | −1.1|| | −0.6¶ | −1.1¶ | ||
Breast | 1975–1990 | 0.4|| | 1990–1995 | −1.8|| | 1995–1998 | −3.2|| | 1998–2009 | −1.9|| | −1.9¶ | −1.9¶ | ||||
Colon and rectum | 1975–1984 | −1.0|| | 1984–2001 | −1.8|| | 2001–2009 | −3.1|| | −2.9¶ | −3.1¶ | ||||||
Pancreas | 1975–1984 | 0.8|| | 1984–2002 | 0.1 | 2002–2009 | 0.4|| | 0.4¶ | 0.4¶ | ||||||
Ovary | 1975–1982 | −1.2|| | 1982–1992 | 0.3|| | 1992–1998 | −1.2|| | 1998–2002 | 1.0 | 2002–2009 | −2.0|| | −1.3¶ | −2.0¶ | ||
Leukemia | 1975–1980 | 0.8 | 1980–2000 | −0.4|| | 2000–2009 | −1.5|| | −1.5¶ | −1.5¶ | ||||||
Non-Hodgkin lymphoma | 1975–1994 | 2.2|| | 1994–1997 | 1.0 | 1997–2009 | −3.4|| | −3.4¶ | −3.4¶ | ||||||
Corpus and uterus, NOS | 1975–1989 | −1.6|| | 1989–1997 | −0.7|| | 1997–2009 | 0.3|| | 0.3¶ | 0.3¶ | ||||||
Brain and other nervous system | 1975–1992 | 0.9|| | 1992–2009 | −0.9|| | −0.9¶ | −0.9¶ | ||||||||
Liver and intrahepatic bile duct | 1975–1987 | 0.8|| | 1987–1995 | 3.8|| | 1995–2000 | 0.4 | 2000–2009 | 1.5|| | 1.5¶ | 1.5¶ | ||||
Myeloma | 1975–1993 | 1.5|| | 1993–2002 | −0.5|| | 2002–2009 | −2.9|| | −2.3¶ | −2.9¶ | ||||||
Kidney and renal pelvis | 1975–1994 | 1.1|| | 1994–2009 | −0.9|| | −0.9¶ | −0.9¶ | ||||||||
Stomach | 1975–1987 | −2.8|| | 1987–1990 | −0.2 | 1990–2009 | −2.7|| | −2.7¶ | −2.7¶ | ||||||
Cervix uteri | 1975–1982 | −4.3|| | 1982–1996 | −1.6|| | 1996–2003 | −3.8|| | 2003–2009 | −0.9|| | −1.9¶ | −0.9¶ | ||||
Urinary bladder | 1975–1986 | −1.6|| | 1986–2009 | −0.4|| | −0.4¶ | −0.4¶ | ||||||||
Esophagus | 1975–2001 | 0.0 | 2001–2009 | −2.0|| | −1.7¶ | −2.0¶ | ||||||||
Oral cavity and pharynx | 1975–1990 | −1.0|| | 1990–2009 | −2.3|| | −2.3¶ | −2.3¶ | ||||||||
Gallbladder | 1975–1990 | −3.0|| | 1990–2009 | −2.3|| | −2.3¶ | −2.3¶ |
* Source: National Center for Health Statistics public-use data file for the total US, 1975 through 2009. AAPC = average annual percent change; APC = annual percent change; NOS = not otherwise specified.
† Joinpoint analyses with up to five joinpoints yielding up to six trend segments (Trends 1–6) were based on rates per 100 000 persons and were age adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, … , 80–84 years, ≥85 years; Census publication p25-1130; US Bureau of the Census, Current Population Reports. Washington, DC: US Government Printing Office, 2000). For joinpoint analysis, the Joinpoint Regression Program was used (version 3.5.1, July 2011; Surveillance Research Program, National Cancer Institute, Bethesda, MD).
‡ The AAPC is a weighted average of the APCs calculated by joinpoint regression.
§ The APC is based on age-adjusted rates (see above).
|| The APC is statistically significantly different from zero (two-sided t test;
¶ The AAPC is statistically significantly different from zero (two-sided Z test;
# Cancers are listed in descending rank order of sex-specific, age-adjusted incidence rates for 2005 through 2009 for all racial and ethnic groups combined. To include the 15 most common cancers in each racial and ethnic group, more than 15 cancers are given for men and women in total.
Five-year incidence rates (2005–2009) and short-term trends (2000–2009), which were not delay adjusted, are presented for men and women by race and ethnicity in
Incidence rates for the period from 2005 to 2009 and fixed-interval trends for the period from 2000 to 2009 for the most common cancers by sex, race, and ethnicity, for areas in the United States with high-quality incidence data*
All races/ethnicities | White‡ | Black‡ | API‡ | AI/AN (CHSDA)‡ | Hispanic‡ | Non-Hispanic‡ | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cancer site or type by sex† | Rank | Rate§ | 2000–2009 AAPC|| | 2005–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| | Rank | Rate§ | 2000–2009 AAPC|| |
All sites¶ | ||||||||||||||||||||||
Both sexes | 473.4 | −0.6# | −0.6# | 472.8 | −0.7# | 484.7 | −0.7# | 301.2 | −0.7# | 385.4 | −0.3 | 366.1 | −0.9# | 483.7 | −0.5# | |||||||
Men | 550.7 | −1.1# | −1.1# | 543.1 | −1.2# | 619.7 | −1.4# | 327.5 | −1.8# | 423.2 | −0.7 | 418.7 | −1.7# | 563.0 | −1.0# | |||||||
Women | 419.3 | −0.3# | −0.3# | 424.0 | −0.3# | 396.8 | 0.0 | 286.2 | 0.2 | 360.3 | 0.0 | 333.2 | −0.3# | 427.6 | −0.2# | |||||||
Children (aged 0–14 y) | 15.6 | 0.3 | 0.3 | 16.0 | −0.1 | 12.3 | 1.4# | 12.7 | 0.5 | 12.1 | −0.6 | 15.5 | 0.2 | 15.6 | 0.3 | |||||||
Children (aged 0–19 y) | 17.2 | 0.4 | 0.4 | 17.8 | 0.1 | 13.1 | 1.4# | 14.0 | 1.4 | 13.8 | −0.2 | 17.1 | 0.6# | 17.3 | 0.4 | |||||||
17 most common cancers for men | ||||||||||||||||||||||
Prostate | 1 | 151.4 | −1.9# | −1.9# | 1 | 141.0 | −2.3# | 1 | 228.7 | −2.0# | 1 | 77.2 | −3.1# | 1 | 98.8 | −2.1# | 1 | 124.9 | −2.4# | 1 | 153.8 | −1.9# |
Lung and bronchus | 2 | 82.7 | −2.0# | −2.6# | 2 | 82.3 | −1.9# | 2 | 99.3 | −2.4# | 2 | 49.4 | −1.6# | 2 | 67.4 | −2.1# | 3 | 45.4 | −2.9# | 2 | 85.9 | −1.8# |
Colon and rectum | 3 | 54.0 | −3.2# | −3.2# | 3 | 52.8 | −3.5# | 3 | 65.1 | −1.9# | 3 | 41.4 | −2.9# | 3 | 50.7 | −0.8 | 2 | 46.9 | −2.3# | 3 | 54.6 | −3.2# |
Urinary bladder | 4 | 37.5 | −0.8# | −1.8# | 4 | 39.5 | −0.9# | 5 | 19.5 | 0.4 | 6 | 15.3 | −1.1 | 5 | 18.0 | 0.1 | 4 | 20.1 | −2.0# | 4 | 38.9 | −0.7# |
Melanoma of the skin | 5 | 24.6 | 1.9# | 1.9# | 5 | 27.2 | 1.9# | 25 | 1.1 | −0.1 | 20 | 1.6 | −0.8 | 13 | 6.4 | −1.6 | 16 | 4.6 | −0.9 | 5 | 26.7 | 2.2# |
Non-Hodgkin lymphoma | 6 | 23.3 | 0.1 | −0.7# | 6 | 23.9 | 0.0 | 6 | 17.0 | 0.0 | 7 | 14.8 | −0.5 | 7 | 16.0 | −1.2 | 6 | 19.3 | −0.7 | 6 | 23.7 | 0.2 |
Kidney and renal pelvis | 7 | 21.2 | 2.0# | 0.9 | 7 | 21.2 | 2.0# | 4 | 23.3 | 2.9# | 9 | 10.1 | 2.7# | 4 | 29.0 | 3.6# | 5 | 19.8 | 1.6# | 7 | 21.4 | 2.1# |
Oral cavity and pharynx | 8 | 16.4 | 0.2 | 0.2 | 8 | 16.5 | 0.5# | 9 | 15.7 | −2.7# | 8 | 10.7 | −0.6 | 9 | 12.7 | 0.2 | 11 | 10.4 | −1.4# | 8 | 17.1 | 0.5# |
Leukemia | 9 | 16.1 | −1.1# | −1.1# | 9 | 16.5 | −1.3# | 12 | 12.3 | −1.0# | 11 | 8.5 | −1.6# | 10 | 11.8 | 1.0 | 9 | 12.0 | −1.3# | 9 | 16.3 | −1.0# |
Pancreas | 10 | 13.6 | 0.8# | 0.8# | 10 | 13.4 | 0.9# | 7 | 16.9 | 0.9# | 10 | 9.6 | 0.1 | 11 | 10.8 | 1.7 | 10 | 11.5 | −0.4 | 10 | 13.8 | 1.0# |
Liver and intrahepatic bile duct | 11 | 10.3 | 4.0# | 4.0# | 11 | 9.1 | 4.0# | 10 | 15.0 | 5.2# | 4 | 21.6 | −0.1 | 6 | 16.4 | 4.4# | 7 | 17.5 | 2.6# | 11 | 9.7 | 4.0# |
Stomach | 12 | 9.4 | −1.8# | −1.8# | 13 | 8.4 | −2.0# | 8 | 16.3 | −1.4# | 5 | 16.1 | −3.2# | 8 | 13.0 | −3.8 | 8 | 13.5 | −2.5# | 12 | 9.0 | −1.9# |
Esophagus | 13 | 8.7 | 0.0 | 0.0 | 12 | 8.8 | 0.6# | 14 | 9.2 | −4.7# | 15 | 3.8 | −1.1 | 12 | 7.3 | −2.4 | 15 | 5.5 | −1.1 | 13 | 9.0 | 0.2 |
Brain and other nervous system | 14 | 7.9 | −0.4# | −0.4# | 14 | 8.4 | −0.4# | 15 | 4.7 | −0.4 | 13 | 4.3 | 0.4 | 16 | 5.3 | −0.1 | 13 | 5.9 | −1.3# | 14 | 8.1 | −0.3 |
Myeloma | 15 | 7.2 | 0.1 | −0.7# | 15 | 6.6 | −0.2 | 11 | 13.6 | 0.4 | 14 | 4.1 | 1.2# | 15 | 6.0 | −4.5# | 12 | 6.6 | −0.8 | 15 | 7.2 | 0.1 |
Larynx | 16 | 6.8 | −2.4# | −2.4# | 16 | 6.6 | −2.5# | 13 | 10.3 | −3.1# | 18 | 2.2 | −4.8# | 14 | 6.2 | −0.4 | 14 | 5.5 | −3.3# | 16 | 6.9 | −2.2# |
Thyroid | 17 | 6.0 | 6.5# | 6.5# | 17 | 6.3 | 6.6# | 18 | 3.2 | 5.6# | 12 | 5.3 | 6.0# | 19 | 3.3 | — | 17 | 4.6 | 4.4# | 17 | 6.3 | 6.8# |
18 most common cancers for women | ||||||||||||||||||||||
Breast | 1 | 122.3 | −0.9# | 0.5 | 1 | 123.3 | −1.0# | 1 | 118.0 | 0.7# | 1 | 85.9 | 0.7# | 1 | 89.1 | −0.4 | 1 | 93.0 | −0.2 | 1 | 125.1 | −0.8# |
Lung and bronchus | 2 | 55.9 | −0.2 | −1.1# | 2 | 57.5 | −0.1 | 2 | 51.3 | 0.2 | 3 | 28.1 | 0.1 | 2 | 49.5 | −0.7 | 3 | 26.6 | −0.6 | 2 | 58.4 | 0.0 |
Colon and rectum | 3 | 40.3 | −2.8# | −3.4# | 3 | 39.2 | −3.0# | 3 | 48.0 | −2.1# | 2 | 32.1 | −1.6# | 3 | 41.1 | −0.3 | 2 | 33.3 | −2.4# | 3 | 40.9 | −2.8# |
Corpus and uterus, NOS | 4 | 24.5 | 0.6# | 0.6# | 4 | 24.9 | 0.4 | 4 | 22.5 | 2.2# | 5 | 16.9 | 2.7# | 4 | 22.1 | 2.3 | 4 | 20.1 | 1.2# | 4 | 24.8 | 0.6# |
Thyroid | 5 | 17.7 | 7.0# | 7.0# | 5 | 18.5 | 7.0# | 8 | 10.8 | 6.1# | 4 | 18.4 | 6.5# | 8 | 11.6 | 5.4# | 5 | 17.2 | 6.7# | 5 | 17.9 | 7.0# |
Non-Hodgkin lymphoma | 6 | 16.2 | −0.2 | −1.0# | 7 | 16.7 | −0.3 | 7 | 11.6 | 0.1 | 6 | 10.5 | −0.6 | 6 | 13.5 | −0.7 | 6 | 15.3 | 0.5 | 7 | 16.3 | −0.3 |
Melanoma of the skin | 7 | 15.8 | 1.9# | 1.9# | 6 | 17.9 | 2.0# | 29 | 1.0 | −0.1 | 21 | 1.2 | −0.8 | 14 | 5.5 | 1.9 | 18 | 4.1 | −0.7 | 6 | 17.2 | 2.3# |
Ovary | 8 | 12.5 | −1.9# | −1.9# | 8 | 12.9 | −2.0# | 11 | 9.5 | −1.0# | 8 | 9.2 | −1.3# | 7 | 11.8 | −2.2 | 9 | 11.1 | −1.5# | 8 | 12.6 | −1.9# |
Kidney and renal pelvis | 9 | 11.1 | 2.5# | 1.2# | 9 | 11.2 | 2.5# | 6 | 12.1 | 3.6# | 13 | 5.1 | 3.0# | 5 | 16.6 | 2.9# | 8 | 11.4 | 2.6# | 9 | 11.1 | 2.5# |
Pancreas | 10 | 10.5 | 0.9# | 0.9# | 10 | 10.2 | 0.9# | 5 | 13.9 | 0.4 | 9 | 8.1 | 0.1 | 10 | 9.1 | −1.6 | 10 | 9.9 | 0.1 | 10 | 10.6 | 0.9# |
Leukemia | 11 | 9.7 | −0.8# | −0.8# | 11 | 10.0 | −0.9# | 13 | 7.7 | −1.3# | 12 | 5.9 | 0.4 | 12 | 7.5 | −0.7 | 11 | 8.5 | −0.5 | 11 | 9.7 | −0.8# |
Urinary bladder | 12 | 9.3 | −1.0# | −1.0# | 12 | 9.7 | −1.1# | 14 | 6.6 | −0.7 | 15 | 3.8 | −1.6 | 18 | 4.3 | −2.8 | 14 | 5.3 | −2.3# | 12 | 9.6 | −0.9# |
Cervix uteri | 13 | 8.1 | −2.0# | −0.6 | 13 | 7.8 | −1.9# | 9 | 10.4 | −3.0# | 11 | 7.2 | −3.0# | 9 | 10.1 | 0.4 | 7 | 11.8 | −3.6# | 13 | 7.7 | −1.8# |
Oral cavity and pharynx | 14 | 6.2 | 0.0 | 0.0 | 14 | 6.2 | 0.1 | 15 | 5.3 | −0.7 | 14 | 5.0 | −2.5# | 15 | 5.0 | −2.1 | 17 | 4.2 | −1.4 | 14 | 6.4 | 0.1 |
Brain and other nervous system | 15 | 5.7 | −0.2 | −0.2 | 15 | 6.1 | −0.3 | 17 | 3.7 | 0.5 | 16 | 3.0 | −0.2 | 17 | 4.5 | −3.9 | 16 | 4.7 | −0.9 | 15 | 5.9 | −0.1 |
Myeloma | 16 | 4.7 | −0.5# | −0.5# | 16 | 4.1 | −0.7# | 10 | 9.8 | −0.2 | 17 | 2.8 | −1.8# | 16 | 4.5 | −3.9 | 15 | 4.8 | −1.3# | 16 | 4.7 | −0.4# |
Stomach | 17 | 4.7 | −1.2# | −1.9# | 17 | 4.0 | −1.5# | 12 | 8.2 | −1.8# | 7 | 9.3 | −2.9# | 13 | 6.4 | −4.4# | 12 | 8.1 | −2.2# | 17 | 4.3 | −1.5# |
Liver and intrahepatic bile duct | 18 | 3.4 | 2.9# | 2.9# | 18 | 3.1 | 2.8# | 16 | 4.2 | 3.5# | 10 | 8.1 | −0.5 | 11 | 7.6 | 4.1 | 13 | 6.6 | 2.0# | 18 | 3.2 | 2.8# |
* Source: National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) areas reported by the North American Association of Central Cancer Registries (NAACCR) as meeting high-quality incidence data standards for the specified time periods. The rates for all races/ethnicities for the period from 2005 to 2009 are from 47 states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wyoming. The AAPCs for all races/ethnicities for the period from 2000 to 2009 are from 42 states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, Wyoming. AAPC = average annual percent change; APC = annual percent change; API = Asian/Pacific Islander; AI/AN = American Indian/Alaska Native; CHSDA = Indian Health Services Contract Health Services Delivery Area; NOS = not otherwise specified; — = statistic could not be calculated because the AAPC is based on less than 10 cases for at least 1 year within the time interval.
† Cancers are sorted in descending order according to sex-specific rates for all races/ethnicities. To include the 15 most common cancers in each racial and ethnic group, more than 15 cancers are given for men and women in total.
‡ White, black, API, and AI/AN (CHSDA counties) include Hispanic and non-Hispanic; the race and ethnicity categories are not mutually exclusive. AI/AN (CHSDA) statistics exclude data from Kansas and Minnesota.
§ Rates are per 100 000 persons and were age adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, … , 80–84 years, and ≥85 years; Census publication p25-1130; US Bureau of the Census, Current Population Reports. Washington, DC: US Government Printing Office, 2000).
|| AAPC is the average annual percent change and is a weighted average of the APCs calculated by Joinpoint over the time period from 2000 to 2009 unless otherwise noted. Joinpoint analyses with up to two joinpoints are based on age-adjusted rates (see above). Joinpoint Regression Program, Version 3.5.1 July 2011, Surveillance Research Program, National Cancer Institute.
¶ For all sites, myelodysplastic syndromes are included for the rate calculations but not for the APC calculations; they are excluded from cancer-specific analysis. Ovary excludes borderline tumors.
# AAPC is statistically significantly different from zero (two-sided Z test;
During the period from 2000 to 2009, incidence rates for all cancers combined declined among men of each racial and ethnic group, although the decrease was not statistically significant for AI/AN men. In contrast, rates of all cancers combined among women decreased only in whites and Hispanics. Childhood cancer incidence rates among those aged 0 to 19 years increased for black and Hispanic children but were stable for children of all other racial and ethnic groups; however, blacks had the lowest rates of any racial and ethnic group. Prostate cancer incidence rates declined among men of all racial and ethnic groups. Breast cancer incidence rates declined during the period from 2000 to 2009 among white women but increased among black and API women and were stable among AI/AN and among Hispanic women; however, in the most recent 5-year period (2005–2009), rates were stable among women of all racial and ethnic groups. Lung cancer incidence rates from 2000 to 2009 declined in men and were stable among women of all racial and ethnic groups, although rates decreased among all women from 2005 to 2009. Colorectal cancer incidence rates from 2000 to 2009 decreased among both men and women of every racial and ethnic group, although this decrease was not statistically significant for AI/AN men or women. Liver cancer incidence rates increased among white, black, AI/AN, and Hispanic men and among white, black, and Hispanic women. Pancreas cancer incidence rates increased only among white men and women and black men. Kidney and thyroid cancer incidence rates increased among men and women of every racial and ethnic group, except the thyroid cancer incidence rate did not increase among AI/AN men. Uterine cancer incidence rates increased among women of all racial and ethnic groups, although increases were not statistically significant among white and AI/AN women.
For individuals of all racial and ethnic groups, overall cancer death rates declined during the most recent 10-year time period (2000–2009) among both sexes combined (1.5% per year) and among children aged 0 to 19 years (2.0% per year), although the decreases were not statistically significant among AI/AN persons (
US cancer death rates for the period from 2005 to 2009 and fixed-interval trends from 2000 to 2009 for the most common cancers by sex, race, and ethnicity*
All racial and ethnic groups combined | White† | Black† | API† | AI/AN (CHSDA)† | Hispanic†,‡ | Non-Hispanic†,‡ | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cancer Site or Type by sex§ | Rank | Rate|| | 2000– 2009 AAPC¶ | 2005– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ | Rank | Rate|| | 2000– 2009 AAPC¶ |
All sites | ||||||||||||||||||||||
Both sexes | 178.7 | −1.5# | −1.5# | 177.6 | −1.5# | 216.4 | −2.0# | 109.5 | −1.3# | 156.2 | −0.7 | 119.4 | −1.8# | 183.2 | −1.4# | |||||||
Men | 219.4 | −1.8# | −1.8# | 216.7 | −1.7# | 288.3 | −2.4# | 132.6 | −1.5# | 184.9 | −0.8 | 146.4 | −2.3# | 224.8 | −1.7# | |||||||
Women | 151.1 | −1.4# | −1.4# | 150.8 | −1.4# | 174.6 | −1.5# | 93.2 | −1.1# | 135.9 | −0.8 | 100.6 | −1.4# | 155.1 | −1.4# | |||||||
Children (aged 0–14 y) | 2.2 | −2.0# | −2.0# | 2.3 | −2.0# | 2.2 | −1.5 | 1.8 | −3.8# | 1.5 | ** | 2.3 | −2.2# | 2.2 | −1.8# | |||||||
Children (aged 0–19 y) | 2.5 | −2.0# | −2.0# | 2.5 | −2.0# | 2.5 | −1.9# | 2.1 | −2.2# | 2.0 | −1.8 | 2.7 | −1.9# | 2.4 | −2.1# | |||||||
17 most common cancers for men§ | ||||||||||||||||||||||
Lung and bronchus | 1 | 65.7 | −2.3# | −2.8# | 1 | 65.3 | −2.2# | 1 | 82.6 | −3.0# | 1 | 35.9 | −1.5# | 1 | 48.3 | −0.4 | 1 | 30.8 | −3.3# | 1 | 68.4 | −2.1# |
Prostate | 2 | 23.6 | −3.5# | −3.5# | 2 | 21.7 | −3.4# | 2 | 53.1 | −3.7# | 4 | 10.0 | −2.8# | 2 | 19.7 | −2.9# | 2 | 17.8 | −3.8# | 2 | 23.8 | −3.4# |
Colon and rectum | 3 | 20.2 | −3.1# | −3.1# | 3 | 19.5 | −3.0# | 3 | 29.8 | −2.3# | 3 | 13.1 | −2.8# | 3 | 18.8 | −2.3 | 3 | 15.3 | −1.9# | 3 | 20.5 | −3.0# |
Pancreas | 4 | 12.5 | 0.4# | 0.4# | 4 | 12.4 | 0.5# | 4 | 15.5 | −0.1 | 6 | 8.4 | 1.0# | 5 | 10.1 | 2.2 | 5 | 9.2 | 0.2 | 4 | 12.8 | 0.5# |
Leukemia | 5 | 9.6 | −0.9# | −0.9# | 5 | 9.9 | −0.9# | 7 | 8.5 | −0.8 | 8 | 4.9 | −0.9 | 9 | 6.3 | 1.9 | 8 | 5.9 | −2.0# | 5 | 9.8 | −0.8# |
Non-Hodgkin lymphoma | 6 | 8.4 | −2.6# | −1.9# | 6 | 8.7 | −2.7# | 10 | 6.1 | −1.8# | 7 | 5.2 | −2.2# | 10 | 5.0 | −4.0 | 7 | 6.3 | −2.6# | 6 | 8.5 | −2.6# |
Liver and intrahepatic bile duct | 7 | 8.1 | 2.6# | 2.6# | 9 | 7.4 | 2.6# | 5 | 11.9 | 3.4# | 2 | 14.5 | −1.2# | 4 | 11.9 | 1.6 | 4 | 11.8 | 1.5# | 9 | 7.8 | 2.6# |
Esophagus | 8 | 7.7 | −0.4 | −1.2# | 8 | 7.9 | 0.3 | 8 | 8.2 | −4.5# | 9 | 3.0 | −0.2 | 8 | 6.4 | −1.0 | 10 | 4.2 | −0.7 | 7 | 8.0 | −0.2 |
Urinary bladder | 9 | 7.7 | 0.1 | 0.1 | 7 | 8.0 | 0.2 | 13 | 5.6 | −0.1 | 12 | 2.7 | −0.7 | 12 | 3.6 | — | 11 | 3.8 | −1.5 | 8 | 7.9 | 0.4# |
Kidney and renal pelvis | 10 | 5.8 | −0.9# | −0.9# | 10 | 5.9 | −0.9# | 11 | 6.0 | −0.7 | 11 | 2.9 | 2.7 | 6 | 8.8 | −1.1 | 9 | 5.0 | −1.5 | 10 | 5.9 | −0.8# |
Brain and other nervous system | 11 | 5.2 | −0.5 | 0.4 | 11 | 5.6 | −0.4 | 15 | 3.1 | −0.8 | 13 | 2.3 | −1.4 | 14 | 2.9 | 2.7 | 13 | 3.3 | −1.0 | 11 | 5.4 | −0.3 |
Stomach | 12 | 5.0 | −3.3# | −3.3# | 13 | 4.3 | −3.5# | 6 | 10.3 | −2.9# | 5 | 9.0 | −3.6# | 7 | 8.3 | −3.7 | 6 | 7.4 | −4.0# | 12 | 4.8 | −3.4# |
Myeloma | 13 | 4.4 | −1.2# | −1.2# | 14 | 4.1 | −1.2# | 9 | 8.0 | −1.2# | 14 | 2.1 | 2.5# | 11 | 3.8 | −1.7 | 12 | 3.3 | −2.5# | 13 | 4.4 | −1.0# |
Melanoma of the skin | 14 | 4.1 | 1.0# | 1.0# | 12 | 4.6 | 1.1# | 21 | 0.5 | 1.0 | 20 | 0.5 | — | 16 | 1.7 | — | 17 | 1.0 | 0.5 | 14 | 4.4 | 1.2# |
Oral cavity and pharynx | 15 | 3.8 | −1.3# | −1.3# | 15 | 3.6 | −0.8# | 12 | 5.7 | −3.6# | 10 | 3.0 | −2.8# | 13 | 3.5 | −3.1 | 14 | 2.4 | −2.9# | 15 | 3.9 | −1.0# |
Larynx | 16 | 2.1 | −2.7# | −2.7# | 16 | 2.0 | −2.5# | 14 | 4.2 | −3.4# | 16 | 0.8 | −2.2 | 15 | 2.0 | — | 15 | 1.6 | −3.2# | 16 | 2.1 | −2.6# |
Soft tissue including heart | 17 | 1.5 | 0.1 | 1.2# | 18 | 1.5 | 0.0 | 16 | 1.4 | 0.1 | 15 | 1.0 | 1.5 | 17 | 1.2 | — | 16 | 1.0 | −0.3 | 18 | 1.5 | 0.1 |
18 most common cancers for women§ | ||||||||||||||||||||||
Lung and bronchus | 1 | 39.6 | −0.7# | −1.3# | 1 | 40.8 | −0.6# | 1 | 38.0 | −1.0# | 1 | 18.5 | −0.3 | 1 | 33.2 | 0.0 | 2 | 14.1 | −1.0# | 1 | 41.8 | −0.6# |
Breast | 2 | 23.0 | −2.1# | −2.1# | 2 | 22.4 | −2.1# | 2 | 31.6 | −1.4# | 2 | 11.9 | −1.3# | 2 | 16.6 | 0.4 | 1 | 14.9 | −1.6# | 2 | 23.7 | −2.0# |
Colon and rectum | 3 | 14.1 | −3.1# | −3.1# | 3 | 13.6 | −3.1# | 3 | 19.8 | −3.0# | 3 | 9.6 | −1.6# | 3 | 14.6 | 1.1 | 3 | 10.2 | −2.0# | 3 | 14.4 | −3.0# |
Pancreas | 4 | 9.5 | 0.4# | 0.4# | 4 | 9.3 | 0.5# | 4 | 12.6 | −0.3 | 4 | 6.9 | −0.2 | 4 | 7.9 | 0.1 | 4 | 7.5 | −0.3 | 4 | 9.6 | 0.5# |
Ovary | 5 | 8.2 | −1.5# | −2.5# | 5 | 8.6 | −1.5# | 6 | 6.8 | −0.8 | 7 | 5.0 | −0.1 | 5 | 6.8 | −1.5 | 5 | 5.9 | −1.1# | 5 | 8.4 | −1.5# |
Leukemia | 6 | 5.3 | −1.4# | −1.4# | 6 | 5.5 | −1.4# | 8 | 4.8 | −1.6# | 9 | 3.1 | 0.5 | 11 | 3.3 | −3.8 | 9 | 3.9 | −0.8 | 6 | 5.4 | −1.5# |
Non-Hodgkin lymphoma | 7 | 5.2 | −3.5# | −3.1# | 7 | 5.4 | −3.5# | 12 | 3.6 | −2.9# | 8 | 3.4 | −2.7# | 7 | 4.5 | −3.3 | 7 | 4.3 | −2.3# | 7 | 5.3 | −3.4# |
Corpus and uterus, NOS | 8 | 4.2 | 0.2 | 0.2 | 8 | 3.9 | 0.1 | 5 | 7.3 | 0.5 | 10 | 2.6 | 1.5# | 12 | 3.0 | — | 10 | 3.3 | 0.6 | 8 | 4.2 | 0.2 |
Brain and other nervous system | 9 | 3.5 | −0.5# | −0.5# | 9 | 3.8 | −0.4 | 16 | 2.1 | −0.5 | 12 | 1.5 | −0.2 | 15 | 2.0 | — | 12 | 2.4 | −0.1 | 9 | 3.6 | −0.5# |
Liver and intrahepatic bile duct | 10 | 3.3 | 1.5# | 1.5# | 10 | 3.1 | 1.7# | 11 | 4.0 | 1.0 | 5 | 6.1 | −2.1# | 6 | 5.9 | −0.5 | 6 | 5.3 | 1.0# | 10 | 3.1 | 1.3# |
Myeloma | 11 | 2.7 | −2.6# | −2.6# | 12 | 2.5 | −2.5# | 7 | 5.4 | −2.9# | 13 | 1.4 | −2.3 | 13 | 2.5 | −5.1 | 13 | 2.3 | −2.9# | 11 | 2.8 | −2.5# |
Kidney and renal pelvis | 12 | 2.6 | −1.3# | −2.1# | 11 | 2.7 | −1.3# | 13 | 2.6 | −0.8 | 14 | 1.3 | 0.4 | 8 | 4.1 | 0.1 | 14 | 2.3 | −0.7 | 12 | 2.6 | −1.2# |
Stomach | 13 | 2.6 | −3.1# | −3.1# | 13 | 2.2 | −3.2# | 9 | 4.8 | −3.8# | 6 | 5.3 | −3.9# | 9 | 3.8 | −6.4# | 8 | 4.3 | −3.0# | 13 | 2.4 | −3.3# |
Cervix uteri | 14 | 2.4 | −2.0# | −1.2 | 15 | 2.2 | −1.9# | 10 | 4.3 | −2.6# | 11 | 2.0 | −4.4# | 10 | 3.5 | −0.6 | 11 | 3.0 | −3.2# | 14 | 2.3 | −2.0# |
Urinary bladder | 15 | 2.2 | −0.7# | −0.7# | 14 | 2.2 | −0.5 | 14 | 2.6 | −1.4 | 16 | 0.9 | −1.7 | 18 | 1.0 | — | 16 | 1.2 | −1.7 | 15 | 2.3 | −0.5 |
Esophagus | 17 | 1.6 | −1.9# | −1.9# | 17 | 1.6 | −1.2# | 15 | 2.2 | −5.3# | 17 | 0.9 | 0.3 | 16 | 1.5 | — | 18 | 0.8 | −3.8# | 17 | 1.7 | −1.7# |
Oral cavity and pharynx | 18 | 1.4 | −1.9# | −1.9# | 18 | 1.4 | −1.7# | 17 | 1.4 | −3.2# | 15 | 1.3 | −2.8 | 17 | 1.3 | — | 19 | 0.7 | −1.6 | 18 | 1.4 | −1.8# |
Gallbladder | 20 | 0.8 | −1.7# | −1.7# | 20 | 0.7 | −1.9# | 19 | 1.0 | −1.1 | 20 | 0.8 | −0.7 | 14 | 2.1 | −3.1 | 15 | 1.3 | −2.1 | 20 | 0.7 | −1.9# |
* Source: National Center for Health Statistics public-use data file for the total US, 1975−2009. AAPC = average annual percent change; API = Asian/Pacific Islander; AI/AN = American Indian/Alaska Native; CHSDA = Indian Health Services Contract Health Services Delivery Area; NOS = not otherwise specified; — = statistic could not be calculated because the AAPC is based on less than 10 cases for at least 1 year within the time interval.
† White, black, API, and AI/AN (CHSDA counties) populations include Hispanic and non-Hispanic; the race and ethnicity categories are not mutually exclusive.
‡ Data for Hispanic and non-Hispanic exclude the District of Columbia, Minnesota, New Hampshire, North Dakota, and South Carolina.
§ Cancers are listed in descending rank order of sex-specific, age-adjusted incidence rates for the period from 2005 to 2009 for all racial and ethnic groups combined. To include the 15 most common cancers in each racial and ethnic group, more than 15 cancers are given for men and women in total.
|| Rates are per 100 000 persons and are age adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, . . . , 80–84 years, >85 years; Census publication; US Bureau of the Census, Current Population Reports, p25-1130. Washington, DC: US Government Printing Office, 2000).
¶ The AAPC is a weighted average of the annual percent change and is calculated by joinpoint analyses with up to two joinpoints yielding up to three trend segments based on age adjusted rates (see above). For joinpoint analysis, the Joinpoint Regression Program was used (version 3.5.1, July 2011; Surveillance Research Program, National Cancer Institute, Bethesda, MD).
# The AAPC is statistically significantly different from zero (two-sided Z test;
HPV-associated cancers accounted for 3.3% (21 342 of 646 684) of all cancer cases among women and 2.0% (13 446 of 676 672) of the total cancer cases among men diagnosed in 2009 in the combined SEER and NPCR databases (
Number of new human papillomavirus (HPV)–associated cancers overall, and by sex, in the United States, 2009. Source: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results areas reported by the North American Association of Central Cancer Registries as meeting high-quality incidence data standards for the specified time period. Note that the number of cancer cases underestimates the actual number of cases occurring because of incomplete coverage of population-based registries in 2009 (93%). HPV-associated cancers are defined as cancers at specific anatomic sites and with specific cellular types in which HPV DNA frequently is found. Some of these cancers may not necessarily be HPV-positive because no testing was conducted. Virtually all cervical cancers are due to HPV infection, along with 90% of anal cancers, more than 60% of certain subsites of oropharyngeal cancers, and approximately 40% of vagina, vulva, and penile cancers.
Incidence rates for HPV-associated oropharyngeal cancers (2005–2009) were highest among white and black men (
Age-adjusted incidence rates for human papillomavirus (HPV)–associated cancers in the United States by sex and race and ethnicity, 2005 to 2009. The scale of the
Incidence of human papillomavirus (HPV)–associated cancers in the United States, by sex, race and ethnicity, and area-level socioeconomic status (SES) during the period from 2005 to 2009, for areas with high-quality incidence data*
All racial and ethnic groups combined | White‡ | Black‡ | API‡ | AI/AN (CHSDA)‡ | Hispanic | |
---|---|---|---|---|---|---|
Cancer site by sex and area-level SES† | Rate (95% CI) | Rate (95% CI) | Rate (95% CI) | Rate (95% CI) | Rate (95% CI) | Rate (95% CI) |
Men | ||||||
Oropharynx | ||||||
<10% | 8.0 (7.8 to 8.1) | 8.3 (8.2 to 8.4) | 6.5 (6.0 to 7.1) | 2.3 (2.0 to 2.06) | 3.5 (1.9 to 6.3) | 5.0 (4.5 to 5.5) |
10.0%–19.9% | 8.5 (8.4 to 8.6) | 8.8 (8.7 to 8.9) | 8.2 (7.9 to 8.5) | 2.2 (1.9 to 2.5) | 6.5 (5.2 to 8.0) | 4.5 (4.3 to 4.8) |
>20% | 7.8 (7.6 to 8.1) | 7.9 (7.6 to 8.2) | 8.7 (8.1 to 9.3) | 2.0 (1.3 to 2.9) | 4.9 (3.4 to 6.9) | 5.4 (4.8 to 5.9) |
Anus | ||||||
<10% | 1.3 (1.2 to 1.3) | 1.3 (1.2 to 1.3) | 1.6 (1.4 to 1.9) | 0.2 (0.1 to 0.4) | — | 0.8 (0.6 to 1.0) |
10.0%–19.9% | 1.7 (1.7 to 1.8) | 1.7 (1.6 to 1.8) | 2.1 (2.0 to 2.3) | 0.3 (0.2 to 0.4) | 1.3 (0.8 to 2.0) | 1.1 (1.0 to 1.2) |
>20% | 2.0 (1.9 to 2.1) | 1.8 (1.7 to 2.0) | 2.7 (2.3 to 3.0) | 0.5 (0.2 to 1.1) | — | 1.3 (1.0 to 1.6) |
Penis | ||||||
<10% | 0.9 (0.8 to 0.9) | 0.9 (0.8 to 0.9) | 1.2 (0.9 to 1.5) | 0.4 (0.3 to 0.6) | — | 1.7 (1.4 to 2.0) |
10.0%–19.9% | 1.0 (1.0 to 1.0) | 1.0 (1.0 to 1.0) | 1.1 (1.0 to 1.3) | 0.5 (0.4 to 0.7) | 1.6 (0.9 to 2.6) | 1.4 (1.3 to 1.6) |
>20% | 1.5 (1.3 to 1.6) | 1.4 (1.3 to 1.6) | 1.4 (1.2 to 1.7) | 0.9 (0.5 to 1.7) | 2.8 (1.5 to 4.7) | 2.4 (2.1 to 2.8) |
Women | ||||||
Oropharynx | ||||||
<10% | 1.8 (1.7 to 1.8) | 1.8 (1.8 to 1.9) | 1.3 (1.2 to 1.6) | 0.7 (0.5 to 0.9) | — | 1.0 (0.8 to 1.3) |
10.0%–19.9% | 1.9 (1.9 to 1.9) | 2.0 (1.9 to 2.0) | 1.9 (1.8 to 2.0) | 0.6 (0.5 to 0.7) | 1.2 (0.7 to 1.9) | 0.9 (0.8 to 1.0) |
>20% | 1.7 (1.6 to 1.9) | 1.7 (1.6 to 1.9) | 2.0 (1.7 to 2.2) | 0.6 (0.3 to 1.1) | — | 1.0 (0.8 to 1.3) |
Anus | ||||||
<10% | 2.4 (2.3 to 2.4) | 2.5 (2.4 to 2.6) | 1.6 (1.4 to 1.8) | 0.5 (0.4 to 0.7) | — | 2.0 (1.7 to 2.3) |
10.0%–19.9% | 2.5 (2.5 to 2.6) | 2.7 (2.7 to 2.8) | 1.9 (1.7 to 2.0) | 0.5 (0.4 to 0.7) | 1.9 (1.3 to 2.8) | 2.0 (1.8 to 2.1) |
>20% | 2.4 (2.3 to 2.5) | 2.6 (2.4 to 2.8) | 2.0 (1.8 to 2.3) | 0.5 (0.2 to 1.1) | 1.4 (0.7 to 2.4) | 2.0 (1.7 to 2.3) |
Cervix | ||||||
<10% | 8.4 (8.3 to 8.6) | 8.2 (8.1 to 8.4) | 10.4 (9.9 to 11.0) | 7.5 (7.0 to 8.0) | 16.0 (12.2 to 20.8) | 13.5 (12.8 to 14.2) |
10.0%–19.9% | 10.5 (10.4 to 10.6) | 10.2 (10.0 to 10.3) | 12.7 (12.4 to 13.1) | 9.4 (8.9 to 9.9) | 11.6 (10.1 to 13.4) | 14.6 (14.2 to 15.0) |
>20% | 12.4 (12.1 to 12.8) | 11.4 (11.0 to 11.8) | 14.9 (14.2 to 15.6) | 12.0 (10.3 to 13.9) | 11.7 (9.4 to 14.3) | 14.4 (13.6 to 15.2) |
Vagina | ||||||
<10% | 0.5 (0.4 to 0.5) | 0.4 (0.4 to 0.5) | 0.8 (0.6 to 0.9) | 0.4 (0.3 to 0.6) | — | 0.5 (0.3 to 0.7) |
10.0%–19.9% | 0.6 (0.5 to 0.6) | 0.5 (0.5 to 0.6) | 0.8 (0.8 to 0.9) | 0.3 (0.2 to 0.4) | — | 0.6 (0.5 to 0.7) |
>20% | 0.7 (0.6 to 0.7) | 0.6 (0.5 to 0.7) | 0.8 (0.6 to 1.0) | 0.4 (0.2 to 0.8) | — | 0.6 (0.5 to 0.8) |
Vulva | ||||||
<10% | 2.4 (2.3 to 2.4) | 2.5 (2.4 to 2.5) | 1.6 (1.4 to 1.8) | 0.6 (0.4 to 0.8) | 2.3 (1.0 to 4.7) | 1.7 (1.4 to 2.0) |
10.0%–19.9% | 2.4 (2.4 to 2.5) | 2.5 (2.5 to 2.6) | 1.9 (1.7 to 2.0) | 0.4 (0.3 to 0.5) | 1.8 (1.2 to 2.6) | 1.5 (1.3 to 1.6) |
>20% | 2.3 (2.2 to 2.5) | 2.5 (2.3 to 2.7) | 1.9 (1.7 to 2.2) | — | 1.8 (0.9 to 3.0) | 1.7 (1.4 to 2.0) |
* Source: National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) areas reported by the North American Association of Central Cancer Registries (NAACCR) as meeting high-quality incidence data standards for the specified time periods. HPV-associated cancers are defined as cancers at specific anatomic sites and with specific cellular types in which HPV DNA frequently is found. Some of these cancers may not necessarily be HPV positive because no testing was conducted. The rates for all races and ethnicities for the period from 2005 to 2009 are from 47 states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wyoming. AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander; CHSDA = Indian Health Service Contract Health Services Delivery Area; CI = confidence interval; — = statistic not given because of less than six cases.
† Area-level SES was defined using criteria discussed in the Methods section and presented as the percent of the population in the county of the cancer case’s diagnosis living beneath the poverty threshold. Areas with 20% or more of the population beneath the poverty threshold represent severely disadvantaged areas. Rates are per 100 000 persons and were age adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, . . . , 80–84 years, and >85 years; Census publication p25-1130, US Bureau of the Census, Current Population Reports, Washington, DC: US Government Printing Office, 2000). Analyses restricted to persons aged 15 years or older.
‡ White, black, API, and AI/AN (CHSDA counties) include Hispanic and non-Hispanic; the race and ethnicity categories are not mutually exclusive.
From 2000 to 2009, incidence rates increased for HPV-associated cancer of the oropharynx among white men and women, for anal cancer among white and black men and women, and for cancer of the vulva among white and black women (
Trends in age-adjusted human papillomavirus (HPV)–associated cancer incidence rates by sex and race and ethnicity in the United States, 2000 to 2009. An asterisk indicates average annual percentage change was statistically significantly different from zero at
Nationally, less than half (48.7%, 95% CI = 46.9% to 50.5%) of adolescent girls aged 13 to 17 years in 2010 had received or more doses, and 32.0% (95% CI = 30.3% to 33.6%) had received three doses of the HPV vaccine (
Human papillomavirus (HPV) vaccination coverage among adolescent girls, aged 13 to 17 years, by select sociodemographic characteristics, National Immunization Survey-Teen, United States, 2008 and 2010*
≥1 dose† | 3 dose | 3-dose series completion‡ | |||||||
---|---|---|---|---|---|---|---|---|---|
2008 | 2010 | Difference | 2008 | 2010 | Difference | 2008 | 2010 | Difference | |
% (95% CI)§ | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |
Overall | 37.2 (35.1 to 39.3) | 48.7 (46.9 to 50.5) | 11.5 (8.7 to 14.3)|| | 17.9 (16.3 to 19.6) | 32.0 (30.3 to 33.6) | 14.1 (11.8 to 16.4)|| | 59.6 (55.5 to 63.5) | 69.6 (66.8 to 72.2) | 10.0 (5.2 to 14.8)|| |
Age at interview, y | |||||||||
13 | 35.2 (31.1 to 39.6) | 38.9 (34.9 to 43.1) | 3.7 ( to 2.2 to 9.6) | 14.5 (11.9 to 17.5) | 23.2 (20.1 to 26.6) | 8.7 (4.4 to 13.0)|| | 53.1 (44.3 to 61.7) | 64.1 (55.9 to 71.5) | 11.0 (−0.8 to 22.8) |
14 | 33.8 (29.5 to 38.3) | 48.5 (44.5 to 52.6) | 14.7 (8.7 to 20.7)|| | 16.6 (13.5 to 20.2) | 30.5 (26.9 to 34.3) | 13.9 (8.9 to 18.9)|| | 62.9 (53.9 to 71.2) | 68.2 (61.7 to 74.0) | 5.3 (−5.4 to 16.0) |
15 | 42.2 (37.5 to 47.2) | 51.1 (47.0 to 55.3) | 8.9 (2.5 to 15.3)|| | 18.5 (15.5 to 21.8) | 31.9 (28.3 to 35.6) | 13.4 (8.6 to 18.2)|| | 54.1 (45.7 to 62.3) | 65.6 (59.4 to 71.3) | 11.5 (1.2 to 21.8)|| |
16 | 35.7 (31.7 to 39.9) | 51.7 (47.8 to 55.7) | 16.0 (10.3 to 21.7)|| | 18.8 (15.6 to 22.4) | 36.9 (33.2 to 40.8) | 18.1 (13.0 to 23.2)|| | 65.2 (57.8 to 71.9) | 74.3 (69.4 to 78.7) | 9.1 (0.6 to 17.6)|| |
17 | 38.5 (33.3 to 43.9) | 53.1 (49.1 to 57.1) | 14.6 (8.0 to 21.2)|| | 20.9 (16.3 to 26.3) | 37.5 (33.7 to 41.5) | 16.6 (10.3 to 22.9)|| | 63.1 (52.9 to 72.3) | 74.6 (68.8 to 79.6) | 11.5 (0.3 to 22.7)|| |
Race/ethnicity¶ | |||||||||
White, non-Hispanic | 35.0 (32.9 to 37.2) | 45.8 (43.8 to 47.9) | 10.8 (7.9 to 13.7)|| | 19.5 (17.8 to 21.4) | 32.4 (30.6 to 34.2) | 12.9 (10.3 to 15.5)|| | 67.9 (63.9 to 71.6) | 74.7 (71.6 to 77.5) | 6.8 (1.9 to 11.7)|| |
Black, non-Hispanic | 35.7 (29.6 to 42.4) | 48.9 (43.8 to 54.1) | 13.2 (4.9 to 21.5)|| | 14.9 (9.7 to 22.3) | 30.2 (25.5 to 35.4) | 15.3 (7.3 to 23.3)|| | 48.5 (34.9 to 62.3) | 65.4 (57.5 to 72.5) | 16.9 (1.0 to 32.8)|| |
Hispanic | 44.4 (38.0 to 50.9) | 56.2 (50.6 to 61.6) | 11.8 (3.3 to 20.3)|| | 14.7 (11.4 to 18.8) | 29.5 (25.0 to 34.4) | 14.8 (8.8 to 20.8)|| | 45.5 (34.9 to 56.4) | 56.1 (48.5 to 63.5) | 10.6 (−2.6 to 23.8) |
American Indian/Alaska Native, non-Hispanic | 52.8 (35.4 to 69.6) | 64.8 (46.6 to 79.5) | 12.0 (−12.6 to 36.6) | — | 40.5 (26.7 to 56.0) | — | — | 64.0 (45.6 to 79.1) | — |
Asian, non-Hispanic | 40.6 (27.6 to 55.2) | 50.1 (38.2 to 61.9) | 9.5 (−9.1 to 28.1) | — | 39.8 (28.3 to 52.5) | — | — | 86.0 (75.4 to 92.5) | — |
Other | 40.1 (28.2 to 53.2) | 52.3 (44.0 to 60.5) | 12.2 (−3.0 to 27.4) | 20.2 (12.2 to 31.6) | 37.3 (29.9 to 45.3) | 17.1 (4.7 to 29.5)|| | 64.4 (46.1 to 79.4) | 75.4 (62.7 to 84.8) | 11.0 (−9.5 to 31.5) |
Household poverty level# | |||||||||
Above the poverty level | 35.8 (33.7 to 37.9) | 47.7 (45.7 to 49.6) | 11.9 (9.0 to 14.8)|| | 18.6 (17.0 to 20.3) | 32.9 (31.1 to 34.7) | 14.3 (11.9 to 16.7)|| | 63.7 (59.7 to 67.5) | 73.2 (70.3 to 76.0) | 9.5 (4.7 to 14.3)|| |
Below the poverty level | 46.4 (39.8 to 53.1) | 51.8 (46.8 to 56.8) | 5.4 (−3.0 to 13.8) | 14.8 (9.6 to 22.2) | 28.2 (24.2 to 32.4) | 13.4 (6.0 to 20.8)|| | 41.1 (28.3 to 55.3) | 57.3 (50.1 to 64.2) | 16.2 (0.6 to 31.8)|| |
Unknown | 31.1 (23.5 to 39.9) | 52.1 (44.2 to 59.8) | 21.0 (9.6 to 32.4)|| | 16.3 (11.4 to 22.8) | 33.0 (25.8 to 41.0) | 16.7 (7.2 to 26.2)|| | 66.9 (51.5 to 79.3) | 68.1 (56.2 to 78.1) | 1.2 (−16.8 to 19.2) |
Maternal education level | |||||||||
Less than 12 years | 39.4 (32.6 to 46.5) | 56.6 (50.3 to 62.7) | 17.2 (7.9 to 26.5)|| | 11.5 (8.1 to 16.1) | 28.0 (23.2 to 33.2) | 16.5 (10.1 to 22.9)|| | 38.1 (26.6 to 51.1) | 51.0 (42.8 to 59.1) | 12.9 (−2.0 to 27.8) |
12 years | 35.4 (30.9 to 40.0) | 47.4 (43.7 to 51.1) | 12.0 (6.1 to 17.9)|| | 16.2 (12.7 to 20.5) | 28.7 (25.4 to 32.2) | 12.5 (7.4 to 17.6)|| | 57.9 (48.8 to 66.4) | 65.8 (60.0 to 71.2) | 7.9 (−2.6 to 18.4) |
More than 12 years, non-college graduate | 36.1 (32.6 to 39.6) | 46.7 (43.5 to 50.0) | 10.6 (5.8 to 15.4)|| | 17.6 (15.0 to 20.6) | 32.4 (29.3 to 35.6) | 14.8 (10.6 to 19.0)|| | 61.2 (54.1 to 67.8) | 73.7 (69.0 to 77.9) | 12.5 (4.3 to 20.7)|| |
College graduate | 38.8 (35.8 to 41.9) | 48.0 (45.2 to 50.8) | 9.2 (5.1 to 13.3)|| | 22.3 (19.9 to 24.9) | 35.8 (33.2 to 38.4) | 13.5 (9.9 to 17.1)|| | 68.1 (62.7 to 73.1) | 78.4 (74.4 to 82.0) | 10.3 (3.9 to 16.7)|| |
Health insurance | |||||||||
VFC eligible, uninsured only | 19.1 (13.4 to 26.6) | 34.9 (26.7 to 44.2) | 15.8 (4.8 to 26.8)|| | — | 14.1 (9.4 to 20.6) | — | 54.8 (35.4 to 72.8) | 41.5 (27.9 to 56.6) | −13.3 (−37.9 to 11.3) |
VFC eligible, all others | 42.7 (37.0 to 48.6) | 55.7 (51.6 to 59.8) | 13.0 (5.8 to 20.2)|| | 15.9 (11.4 to 21.7) | 31.6 (28.0 to 35.4) | 15.7 (9.4 to 22.0)|| | 46.8 (35.6 to 58.2) | 60.2 (54.1 to 66.1) | 13.4 (0.4 to 26.4)|| |
Private/other insurance | 37.3 (35.1 to 39.5) | 47.7 (45.7 to 49.8) | 10.4 (7.4 to 13.4)|| | 19.2 (17.6 to 20.9) | 33.8 (32.0 to 35.7) | 14.6 (12.1 to 17.1)|| | 63.6 (59.3 to 67.7) | 75.2 (72.4 to 77.9) | 11.6 (6.6 to 16.6)|| |
*Adolescent girls (N = 17 827) in the 2008 and 2010 National Immunization Survey-Teen were born during the period from January 1990 to February 1996 and the period from January 1992 to February 1998, respectively. Source: National Immunization Survey-Teen 2008, 2010; National Center for Health Statistics, Centers for Disease Control and Prevention, 2010, 2011. CI = confidence interval; VFC = Vaccines for Children program; — = estimate not reported because unweighted sample size for the denominator was less than 30 or the confidence interval half-width/estimate was greater than 0.588.
† Either quadrivalent or bivalent human papillomavirus vaccine.
‡ Percentage of girls who received three doses among those who had at least one HPV dose and had at least 24 weeks between the first dose and the interview date.
§ Estimates with confidence interval widths greater than 20 might not be reliable.
|| The percentage point difference in vaccination coverage levels from 2008 to 2010 is statistically significantly different from zero (two-sided t test,
¶ Sample adolescents who were reported by the adult respondent as Hispanic were of any race. Sample respondents who were reported as white, black, Asian, or American Indian/Alaska Native were all considered
non-Hispanic. Native Hawaiian, other Pacific Islanders, and persons of multiple races were categorized as other.
# Adolescents were classified as below poverty level if their total family income was less than the federal poverty level specified for the applicable family size and number of children aged less than 18 years. All others were classified
as at or above the poverty level. Additional information available at
Three-dose human pappilomavirus (HPV) vaccination coverage among girls (aged 13 to 17 years), by state, in the United States, 2010. Source: National Immunization Survey-Teen (NIS-Teen) 2010, National Center for Health Statistics, Centers for Disease Control and Prevention, 2011. Girls in the 2010 NIS-Teen were born during the period from January 1992 to February 1998 and received either quadrivalent or bivalent human papillomavirus vaccine (some girls received more than three doses).
Virtually all sociodemographic groups showed statistically significant increases in one or more–dose and three-dose coverage and series completion rates for HPV vaccination from 2008 to 2010 (
Nationally, 86.7% (95% CI = 86.3% to 87.0%) of women aged 21 to 65 years had a recent Pap test (during the previous 3 years) in 2010 (
Scatter plots of human pappilomavirus (HPV) vaccination coverage levels (
Overall cancer death rates continue to decrease in the United States, and this favorable trend involved men and women, all major racial and ethnic groups, and all four major sites, including lung, colorectal, female breast, and prostate cancers. However, death rates continued to increase for cancers of the liver, pancreas, melanoma (men only), and uterus. Similarly, incidence rates continued to increase for these cancers and other cancers, including some associated with HPV infection (ie, oropharynx and anus). Notably, HPV vaccination coverage among girls in 2010 remained low, underscoring the need for broader interventions to increase vaccination uptake.
Factors that contribute to the favorable trends for lung, colorectal, female breast, and prostate cancer death rates have been discussed in previous annual reports and include reductions in important risk factors (eg, smoking for lung cancer) and improved early detection and treatment (eg, screening as well as adjuvant chemotherapy for breast and colorectal cancers) (
Although overall breast cancer incidence rates stabilized during the most recent time period (2005–2009) after sharply decreasing between 2002 and 2003 because of reductions in the use of postmenopausal hormone replacement therapy (
With respect to HPV-associated cancers, rates increased for cancer of the oropharynx in white men and women, for vulvar cancer in white and black women, and for anal cancer in white and black men and women. Based on data from three SEER registries, the presence of HPV DNA detected in oropharyngeal tumors increased from 16.3% during the period from 1984 to 1989 to 71.7% during the period from 2000 to 2004 (
Anal cancer incidence rates in the United States increased by more than twofold from 1975 to 2009 in both men and women (
In contrast to HPV-associated oropharyngeal and anal cancers, cervical cancer incidence rates declined substantially for women of most racial and ethnic groups because of wider dissemination and utilization of Pap testing and successful treatment of screen-detected precancerous lesions (
In 2006, the ACIP recommended routine vaccination of girls aged 11 to 12 years with the quadrivalent HPV vaccine and vaccination for unvaccinated girls and women aged 13 to 26 years (
Previous studies have found that health-care provider recommendation is the most important predictor of vaccine acceptance (
Although the vaccine is available free of cost through the VFC program for eligible children and adolescents (
Patient reminder systems in primary care setting, such as telephone calls, postcards, and letters, have been shown to improve immunization rates (
Mandates that require immunization for school entry increase vaccination coverage levels for a number of childhood vaccines (
Routine HPV vaccination of boys was recommended by the ACIP in December 2011 (
Although HPV vaccination coverage among girls increased between 2008 and 2010 in most states, some Southern states continue to have lower HPV vaccination coverage. Pap testing prevalence is also low in these states, which show the highest cervical cancer burden in the United States. These unfavorable patterns may, at least in part, be because these areas are disproportionately represented by economically disadvantaged groups, including uninsured residents, blacks, and Hispanics (
High-quality cancer surveillance data in the United States are available for the entire population for mortality and for 93% of the population for incidence (2005–2009); however, certain limitations in data sources, data collection, and analyses may have influenced the findings of this report. First, differences between the numerator (incidence data) and denominator (Census population data) can occur in the designation of characteristics such as age, race, ethnicity, and place of residency. Postcensal population estimates based on numbers updated by birth and death data, administrative information, and emigration/immigration information are more subject to error than estimates based on actual Census counts; errors in these estimates may increase as time passes from the original recording of Census data. Additionally, the NCI modified these Census estimates to account for changes in 2005 county-level populations due to displacement of people after Hurricanes Katrina and Rita in the most-affected counties of Louisiana, Mississippi, Alabama, and Texas.
Second, as noted in previous Annual Reports to the Nation (
Third, analyses of trends should be carefully interpreted for several reasons. Changes in incidence may result from changes in the prevalence of risk factors, the introduction or increased use of screening or diagnostic techniques, or a combination of these. The AAPC was used as a summary measure to average trends over a 5- or 10-year period using joinpoint regression; joinpoint models identify recent changes in the magnitude and direction of trends but may give an impression of a continuous increase or decrease over time when this is not the case. Furthermore, delayed case reporting may affect incidence trends if the most recent joinpoint segments overestimate recent declines or underestimate recent increases; methods to adjust for delayed reporting (
Fourth, US Department of Veterans Affairs (VA) hospitals traditionally are a critical source of data for cancers diagnosed among veterans, representing approximately 3% to 8% of cancer diagnoses among men (
Fifth, we considered the cancers included in the special section to be HPV-associated based on numerous rigorous etiologic studies and previously established methods (proportions of cancers generally found to be associated with HPV are listed in the Introduction) (
Finally, both the BRFSS and NIS-Teen are landline telephone surveys and exclude households without landlines. The estimates from these surveys may be under- or overestimated, although they were adjusted for noncoverage of households with no landline telephones and for nonresponse (
Although substantial progress in cancer prevention and control has been made for many cancers, including lung, colorectal, female breast, and prostate cancers (
A greater understanding of the increasing incidence rates for HPV-associated cancers requires continued monitoring of changes in sexual practices that increase HPV exposure as well as of trends in the population-based prevalence of HPV infections at anatomic sites where these cancers arise. Notably, HPV-associated cancers occur in excess among people with HIV and AIDS relative to the general population, warranting additional monitoring and prevention activities in this high-risk population (
Primary prevention of HPV-associated cervical, vaginal, vulvar, and anal cancers is achieved through childhood vaccination of girls and boys, although vaccine coverage remains low compared with the Healthy People 2020 target of 80% (
Research on HPV vaccines is ongoing in several areas. There is interest in evaluating the efficacy of less than three doses (
Early detection of cervical and noncervical cancers associated with HPV infection also deserves brief comment. For cervical cancers, the ACS and multiple clinical organizations, as well as the US Preventive Services Task Force, have recently issued updated age-specific guidelines for cytologic and HPV testing for the early detection of cervical cancer (
As incidence rates for some HPV-associated cancers continue to rise, these cases will contribute to the overall growing number of cancers associated with population aging and expansion, requiring additional resources for medical research and treatment. Continued monitoring of incidence and mortality trends for all cancers is warranted to inform cancer prevention and control policies and programs.
This work was supported by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, the National Institutes of Health, and the North American Association of Central Cancer Registries.
The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
We gratefully acknowledge the contributions of the state and regional cancer registry staffs for their work in collecting the data used in this study. In addition we thank Lynn A. G. Ries, a contractor with the National Cancer Institute, and Andrew Lake, Martin Krapcho, and Rick Firth, of Information Management Services, Inc, for assistance in compiling the data used in this report.