1197

COMMUNICATION
American Cancer Society,
National Cancer Institute,
and Centers for Disease
Control and Prevention

Cancer Incidence and Mortality,

19731995
A Report Card for the U. S.
Phyllis A. Wingo, Ph.D., M.S.1
Lynn A. G. Ries, M.S.2
Harry M. Rosenberg, Ph.D.3
Daniel S. Miller, M.D., M.P.H.4
Brenda K. Edwards, Ph.D.2
1

Epidemiology and Surveillance Research Department, American Cancer Society, Atlanta,

Georgia.
2

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda,
Maryland.
3

Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control
and Prevention, Hyattsville, Maryland.
4

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

BACKGROUND. The American Cancer Society, the National Cancer Institute (NCI),
and the Centers for Disease Control and Prevention including the National Center
for Health Statistics (NCHS) agreed to produce together an annual Report Card
to the nation on progress related to cancer prevention and control in the U.S.
METHODS. This report provides average annual percent changes in incidence and
mortality during 19731990 and 19901995, plus age-adjusted cancer incidence
and death rates for whites, blacks, Asians and Pacific Islanders, and Hispanics.
Information on newly diagnosed cancer cases is based on data collected by NCI,
and information on cancer deaths is based on underlying causes of death as reported to NCHS.
RESULTS. For all sites combined, cancer incidence rates decreased on average 0.7%
per year during 19901995 (P 0.05), in contrast to an increasing trend in earlier
years. Among the ten leading cancer incidence sites, a similar reversal in trends
was apparent for the cancers of the lung, prostate, colon/rectum, urinary bladder,
and leukemia; female breast cancer incidence rates increased significantly during
19731990 but were level during 19901995. Cancer death rates for all sites combined decreased on average 0.5% per year during 19901995 (P 0.05) after
significantly increasing 0.4% per year during 19731990. Death rates for the four
major cancers (lung, female breast, prostate, and colon/rectum) decreased significantly during 19901995.
CONCLUSIONS. These apparent successes are encouraging and signal the need to
maximize cancer control efforts in the future so that even greater in-roads in
Address for reprints: Phyllis A. Wingo, Ph.D.,
American Cancer Society, 1599 Clifton Road,
N.E., Atlanta, GA 30329-4251.

reducing the cancer burden in the population are achieved. Cancer 1998;82:1197
207. q 1998 American Cancer Society.

Received December 24, 1997; accepted December 30, 1997.

KEYWORDS: neoplasms; incidence; mortality; race; gender; Surveillance, Epidemiology, and End Results program.

q 1998 American Cancer Society

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t a press conference on the 25th anniversary of the

National Cancer Act, the American Cancer Society
(ACS), the National Cancer Institute (NCI), and the
Centers for Disease Control and Prevention (CDC) including the National Center for Health Statistics
(NCHS) reported the first sustained decline in cancer
mortality since national recordkeeping was instituted
in the 1930s.1 5 These organizations agreed to continue to collaborate, monitor cancer statistics, and
produce an annual Report Card to the nation on
progress related to cancer prevention and control in
the U. S. The purpose of the current report is to provide an update on the continuing decline in cancer
mortality in the U. S. and to present information regarding cancer incidence not reported previously. In
addition, the report includes cancer incidence and
mortality rates and short term trends in four populations: whites, blacks, Asians and Pacific Islanders, and
Hispanics.

MATERIALS AND METHODS

Cancer Cases
Information on newly diagnosed cancer cases occurring in the U. S. is based on data collected by the
NCIs Surveillance, Epidemiology, and End Results
(SEER) program.5 Briefly, the SEER program collects
cancer incidence data from nine population-based
registries, including five states (Connecticut, Hawaii,
Iowa, New Mexico, and Utah) and four standard metropolitan statistical areas (Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound), representing an estimated 9.5% of the U.S. population. Estimates of cancer rates and trends for the total U. S.
frequently are based on SEER data. For this analysis,
we use cancer cases diagnosed during 1973 19955; the
second edition of the International Classification for
Diseases for Oncology (ICD-02) groupings for the specific cancer sites included in this report have been
published previously.5,6

Cancer Deaths
Information on cancer deaths in the U. S. is based on
causes of death reported by certifying physicians on
death certificates filed in the states. The mortality information is processed and consolidated into a national data base by the NCHS (reference 7 and unpublished data). The underlying cause of death is selected
for tabulation following the procedures specified by
the World Health Organization in the relevant Manual
of the International Classification of Diseases, Injuries,
and Causes of Death. For the period 1973 1978, the
eighth revision (ICDA-8) was used, and for 1979 1995
the ninth revision (ICD-9) was used.9 For this analysis,
ICDA-8 codes on individual records were converted to

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ICD-9 codes by applying a conversion algorithm used

by the NCI. To ensure comparability between the
ICDA-8 and ICD-9 codes, the ICD-9 codes in this report are categorized according to SEER site groupings.5

Cancer Incidence and Death Rates

We use resident population estimates for each year
from the U.S. Bureau of the Census to compute ageadjusted cancer incidence and death rates; population
data for whites were adjusted slightly for an overcount
of whites in Hawaii (reference 10 and unpublished
data). Rates are expressed as per 100,000 population,
and age-adjustment involves the direct method and
the 1970 U.S. standard million population. For cancer
sites that pertain only to males or females, rates are
based on gender specific data. For cancer incidence
rates, the denominators are county level population
data for the geographic areas that participate in the
SEER program, and for cancer death rates, the denominators are population data for the total U. S., except
for Hispanic data. All rates in this report are based on
at least 25 cases or deaths. The term all sites refers
to all cancer sites combined, not just to the aggregate
of sites included in each figure; specific site abbreviations include other areas of the nervous system (ONS)
and intrahepatic bile duct (IBD).
Average Annual Percent Change
The average annual percent change (APC) is estimated
by fitting a regression line to the natural logarithm of
the rates using calendar year as a regressor variable,
i.e., y m x / b in which y ln (rate) and x calendar
year. Then the estimated APC 100(e m 0 1). Testing
the hypothesis that the APC is equal to zero is equivalent to testing the hypothesis that the slope of the line
in the above equation is equal to zero (i.e., that the
rate is not increasing or decreasing). The hypothesis
test statistic uses the t distribution of m/SE m in which
SE is the standard error of m and the number of degrees of freedom is equal to the number of calendar
years minus two.11 The calculation assumes that rates
increase or decrease at a constant rate over time although the validity of this assumption has not been
assessed. Differences between incidence and mortality
trends for the time period 1973 1990 versus those for
1990 1995 have been tested for statistical significance
using a t statistic with 20 degrees of freedom defined
as the difference in the regression coefficients divided
by the standard error of the difference.11 Statistical significance for all hypothesis tests was assessed using
P 0.05, and no adjustment was made for multiple
hypothesis testing.

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FIGURE 1. ** Incidence rates are age-adjusted to the 1970 U.S. standard

million population. # Annual Percent Change (APC) is based on gender
specific rates. * The APC is significantly different from zero (P 0.05).
NOS: not otherwise specified.

FIGURE 2. ** Incidence rates are age-adjusted by 5-year age groups

to the 1970 U.S. standard million population. * The Annual Percent Change
is significantly different from zero (P0.05).

Race and Ethnicity

Because information regarding Hispanic origin is collected separately from race, persons categorized as
Hispanic are not mutually exclusive from whites,
blacks, and Asians and Pacific Islanders. Cancer incidence rates for Hispanics are based on data from all
the areas that have participated in the SEER program
since the mid-1970s. Cancer death rates for Hispanics
include cancer deaths that occurred in all states except
Connecticut, Louisiana, New Hampshire, and Oklahoma, which were omitted due to the absence of comparable data on Hispanic origin. Data for Native
Americans are not shown separately in this analysis
but currently are being evaluated for future reports;
they are included in the statistics for all races combined.

trends) between the two time periods was statistically

significant. Among the ten leading cancer incidence
sites (Fig. 1), a similar reversal in trends was apparent
for cancer of the lung, prostate, colon/rectum, urinary
bladder, and leukemia. However, the differences in the
average annual percent change between the two time
periods were significant only for cancers of the lung,
colon/rectum, and urinary bladder. Although incidence rates for female breast cancer were not decreasing in 1990 1995, they were no longer significantly
increasing as in 1973 1990 (1.8% per year). Incidence
rates for non-Hodgkins lymphoma and melanomas
increased during both time periods; it is interesting to
note that the annual percent increase for non-Hodgkins lymphoma for 1990 1995 was significantly lower
than for the earlier time period, suggesting a slowing
in the annual increase in incidence for this disease.
Trends in the incidence of cancer of the corpus uteri
and uterus, not otherwise specified (NOS) were in the
opposite directions of the overall trends; they decreased significantly during 1973 1990 primarily due
to changes in prescribing practices for unopposed
noncontraceptive estrogens and increased during
1990 1995. The change in direction in trends for the

RESULTS
Incidence
For all sites combined, SEER incidence rates increased
(1.2% per year) during 1973 1990 and decreased
(00.7% per year) during 1990 1995 (Fig. 1), although
the trend for the latter time period was not statistically
significant. The change in direction (the difference in

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FIGURE 3.

** Rates are per

100,000 and age-adjusted to the 1970

U.S. standard million population, #

Rates are based on gender specific
data. NOS: not otherwise specified;
ONS: other nervous system; IBD: intrahepatic bile duct.

FIGURE 4.

** Rates are per

100,000 and age-adjusted to the 1970
U.S. standard million population. #
Rates are based on gender specific
data. NOS: not otherwise specified;

IBD: intrahepatic bile duct; ONS: other

nervous system.

two time periods was statistically significant. During

1990 1995, the largest annual decreases in incidence
occurred in persons who were ages 35 44 years and
persons who were age 75 years at diagnosis (Fig. 2).
Although most age groups demonstrated significant
annual increases during 1973 1990, all ages showed
declines or nonsignificant increases during the later
time period.

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During 1990 1995, the four leading cancer sites

for all racial and ethnic populations in the U. S. were
cancers of the lung and bronchus, prostate, female
breast, and colon/rectum (Figs. 3 6), which together
account for approximately 54% of all newly diagnosed
cancers.12 Examination of incidence rates for each of
these sites by race and ethnicity revealed that, except
for female breast cancer, blacks had higher incidence

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FIGURE 5.

** Rates are per

100,000 and age-adjusted to the 1970
U.S. standard million population. #
Rates are based on gender specific
data. NOS: not otherwise specified;
IBD: intrahepatic bile duct; ONS: other
nervous system.

FIGURE 6.

** Rates are per

100,000 and age-adjusted to the 1970
U.S. standard million population.
Hispanic is not mutually exclusive
from whites, blacks, and Asians and
Pacific Islanders; death rates exclude
deaths that occurred in Connecticut,
Louisiana, New Hampshire, and Oklahoma. # Rates are based on gender
specific data. NOS: not otherwise
specified; IBD: intrahepatic bile duct;
ONS: other nervous system.

rates than whites, Asians and Pacific Islanders, or Hispanics. Although all four racial and ethnic groups had
cancer of the corpus uteri and uterus, NOS and nonHodgkins lymphoma in common among the top ten
sites, some sites were unique to a specific population.
Melanoma and leukemia were among the top ten incidence sites only in whites, cancers of the pancreas and
oral cavity/pharynx were among the top ten sites only

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in blacks, and liver cancer was among the top ten

sites only in Asians and Pacific Islanders. Cancer of
the uterine cervix and stomach were among the top
ten sites for all racial and ethnic groups except whites.
Incidence trends during 1990 1995 also varied by
gender, race, and ethnicity. Between 1990 and 1995,
SEER incidence rates for all cancer sites combined decreased for all racial and ethnic groups, except for

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FIGURE 7. ** Incidence and death rates are age-adjusted to the 1970 U.S. standard million population; Annual Percent Change (APC) is based on
gender specific rates. # Asians and Pacific Islanders. @ Hispanic is not mutually exclusive from whites, blacks, and Asians and Pacific Islanders; death
rates exclude deaths that occurred in Connecticut, Louisiana, New Hampshire, and Oklahoma. * The APC is significantly different from zero (P0.05).

black males and Asian and Pacific Islander females;

the declines were not statistically significant (Figs. 7
and 8). Black males did not experience this overall
decline, primarily due to the average annual increase
of 3.9% per year in prostate cancer incidence. However, after increases during 1989 1993, prostate cancer incidence rates in black males declined sharply in
1994 and 1995.5 Cancer incidence rates for Asian and
Pacific Islander females did not increase or decrease
consistently during this time period.
The pattern of decreasing incidence for the four
major cancers varied by gender, race, and ethnicity
(Figs. 7 and 8). The incidence of cancers of the colon/
rectum decreased in males and females in all racial
and ethnic groups; the declines were statistically significant in white males, white females, and Asian and
Pacific Islander males. Lung cancer incidence in males
also declined in all racial and ethnic groups, whereas
lung cancer incidence in females declined only among
black (01.5% per year) and Hispanic females (03.4%
per year). Other exceptions to the overall declining
incidence patterns for the major cancers included an
increasing prostate cancer incidence in black, Asian
and Pacific Islander, and Hispanic males, increasing

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lung cancer in white and Asian and Pacific Islander

females, and increasing breast cancer in black females.

Mortality
After significantly increasing on average 0.4% per year
during 1973 1990, cancer death rates for all sites combined decreased significantly an average of 0.5% per
year during 1990 1995 (Fig. 9); the change in direction
and the difference in trends between the two time
periods was statistically significant. Among the ten
leading cancer mortality sites, a pattern of significantly
increasing cancer death rates during 1973 1990, followed by significantly decreasing cancer death rates
during 1990 1995, was observed for lung cancer, female breast cancer, and prostate cancer. The mortality
pattern for melanoma was similar, except that the
trend for 1990 1995 did not achieve statistical significance. Death rates for cancers of the colon/rectum
were decreasing significantly in both time periods.
Among the other top ten cancer mortality sites, nonHodgkins lymphoma death rates were increasing significantly in both time periods, whereas death rates
for cancer of the corpus uteri and uterus, NOS, urinary
bladder, ovary, and leukemia decreased over both time

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FIGURE 8. ** Incidence and death rates are age-adjusted to the 1970 U.S. standard million population; Annual Percent Change (APC) is based on
gender specific rates. # Asians and Pacific Islanders. @ Hispanic is not mutually exclusive from whites, blacks, and Asians and Pacific Islanders. Death
rates exclude deaths that occurred in Connecticut, Louisiana, New Hampshire, and Oklahoma. The APC is significantly different from zero (P0.05).

periods. During 1990 1995, the average annual decreases in cancer death rates primarily were confined
to persons who were age 65 years at the time of
death (Fig. 10).
The top four causes of cancer death in the U. S.
during 1990 1995 for all racial and ethnic groups were
the same sites as for incidence (Figs. 3 6); 50%
of all cancer deaths involved the lung, female breast,
prostate, or colon/rectum.12 Examination of cancer
death rates for each of these sites by gender, race, and
ethnicity revealed that, except for female lung cancer,
blacks had higher cancer death rates than whites,
Asians and Pacific Islanders, or Hispanics. The female
lung cancer death rate in whites (33.6 per 100,000) was
only slightly higher than in blacks (32.7 per 100,000).
Other mortality sites among the top ten that were common to all four racial and ethnic groups were cancers
of the pancreas, stomach, and ovary.
Otherwise, the causes of cancer death among the
ten leading sites varied by racial and ethnic group.
Deaths due to cancer of the brain and ONS were
among the top ten mortality sites only in whites;
deaths due to cancer of the esophagus, cervix, and
multiple myeloma were among the top ten sites only

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in blacks; and liver cancer deaths were among the

top ten sites only in Asians and Pacific Islanders and
Hispanics.
Between 1990 and 1995, the decline per year in
U.S. cancer death rates for all sites combined was
greater in males (00.9%) than in females (00.1%). Although the overall rates in males were higher than
in females, the average annual decrease for all sites
combined in males was statistically significant and the
decrease in females was not, due to the significant
annual increases in female lung cancer death rates of
1.6% per year. The declines per year in U.S. cancer
death rates for all sites combined were significant
in blacks (00.8%), whites (00.4%), and Hispanics
(00.6%). Cancer death rates for all sites combined in
Asians and Pacific Islanders were unchanged, due to
increasing rates in Asian and Pacific Islander females
and decreasing rates in males (Figs. 7 and 8).
There were several exceptions to these mortality
patterns among the major cancers (Figs. 7 and 8).
Among males, the only exception was prostate cancer
mortality in Hispanics, which increased at 1.6% per
year during 1990 1995. Among females, the exceptions included increasing cancer death rates in Asians

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FIGURE 9. ** Death rates are age-adjusted to the 1970 U.S. standard

million population. # Annual Percent Change (APC) is based on gender
specific rates. * The APC is significantly different from zero (P 0.05).
NOS: not otherwise specified; lym: lymphoma.

and Pacific Islanders for all of the major cancers, although none of these increasing trends was statistically significant. In addition, white and black females
had increasing lung cancer death rates (1.7% and 1.0%
per year, respectively).

DISCUSSION
Cancer incidence rates in the U. S. have been increasing since the 1930s,5,13,14 and appear to have peaked in
1992.5 Incidence rates for all sites combined decreased
significantly an average of 2.7% per year during 1992
1995. Because the decline in incidence occurred only
for the 3 most recent years of data, the trend for the
entire time period 1990 1995, although negative, was
not statistically significant.
The downturn in cancer incidence after long term
increases varied by site, gender, race, and ethnicity.5
Among the major cancers, the earliest decreases in
incidence occurred for male lung cancer in whites and
blacks in the mid-1980s, and for cancer of the colon/
rectum in whites during the same time period. Decreases in the incidence of some cancers among blacks
occurred later than among whites. Among blacks, decreases in the incidence of colon/rectum cancer began

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FIGURE 10. ** Death rates are age-adjusted by 5-year age groups to

the 1970 U.S. standard million population. * The Annual Percent Change
is significantly different from zero (P 0.05).

in the early 1990s. Decreases in prostate cancer in

blacks appeared to begin in the mid-1990s in contrast
to the early 1990s for whites.
To have a clear understanding of current successes and future challenges in cancer control, these
findings should be interpreted with caution in a context that includes information on risk factors, screening behaviors, treatment protocols, access to health
services, and the biology of specific cancer sites. Decreasing incidence and mortality from lung cancer
most likely result from decreased smoking rates over
the previous 30 years.15 However, smoking patterns
among women lag behind those of men. The decrease
in lung cancer incidence among black females provides hope that a downturn in mortality may soon
follow. Although we are observing some successes related to the occurrence of lung cancer, particularly
among males, these results derive from events that
occurred in the distant past, and the cancer control
and research programs that produced these results
need to continue. Of concern, declines in adult tobacco use have slowed,15 and tobacco use in youth is
increasing again.16
Changes in prostate cancer incidence rates may be

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due to the interaction of multiple factors that warrant

further investigation. A sizable proportion of the recent decrease in prostate cancer incidence rates
among white men in part may be related to the following sequence of events: 1) the dissemination of prostate specific antigen (PSA) testing into an unscreened
population in the late 1980s and early 1990s; 2) the
resultant diagnoses of previously undetected prevalent
cancer cases in the community during the same time
period; and 3) the consequent deficit of prevalent
cases that occurs after widespread screening. Some
of these cancers may be clinically significant whereas
others may be latent cancers that would not have progressed to be clinically detectable. Once the prevalent
cancers in the population have been identified
through screening, the incidence rates may fall toward
an eventual equilibrium reflecting truly incident cases
in the population.
Another proportion of the decrease observed in
prostate cancer incidence rates may be due to other
factors. An increasing number of diagnoses and treatment protocols are occurring in outpatient or nonhospital settings from which cancer reporting and registration for national statistics may be less complete or
delayed. In addition, there have been widely publicized, heated debates regarding the efficacy of screening for prostate cancer in the absence of randomized,
controlled trials to demonstrate the impact of screening on mortality. Decreased incidence rates in part
may be the result of decreased utilization of PSA
screening tests, precipitated by organizations that discouraged their use during the early 1990s.17 Although
the average annual percent change from 1990 1995
indicates a continued increase in the incidence of
prostate cancer among black men, it does not reveal
the declining incidence rates observed for these men
in 1994 and 1995.5
The reported decreases in prostate cancer mortality are even more difficult to explain. Regions of the
country that have experienced the greatest decreases
in mortality from prostate cancer are areas that have
lower utilization of PSA screening.17 The influence of
treatment such as radiation, brachytherapy, cryotherapy, nerve-sparing radical prostatectomy, and use of
antiandrogens on mortality and quality of life similarly
are unclear. Further studies to investigate the reasons
for the decrease in prostate cancer mortality in recent
years are warranted. It is noteworthy that prostate cancer mortality appeared to be increasing in Hispanic
males. However, this increase did not achieve statistical significance, and prostate cancer incidence and
mortality rates in Hispanic men remain substantially
lower than in whites and blacks.
Decreasing mortality from breast cancer in white

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1205

women most likely is a reflection of the increasingly

widespread diffusion of breast cancer screening into
routine medical care. The increased utilization of adjuvant therapies also contributes to the decline in breast
cancer mortality. Although recent studies indicate that
the gap between black and white women in self-reported utilization of mammography screening has
narrowed considerably,18 the mortality benefits have
not yet been observed in black women. Special efforts
are being made by the CDC in partnership with health
departments in all 50 states to make comprehensive
breast cancer screening available to minority and low
income women through the National Breast and Cervical Detection Program.19 Breast cancer incidence in
black women continues to increase, and mortality
trends in black women are not decreasing.5 Breast cancer is diagnosed at later stages in black women (52%
at regional and distant stages) than in white women
(41% at regional and distant stages), and the 5-year
relative survival rate is lower (57% and 71% for blacks
and whites, respectively). 5 Finally, black women with
breast cancer may have less favorable tumor characteristics (i.e., biologically more aggressive) than white
women.20
The reasons for decreasing incidence and mortality due to cancers of the colon/rectum among all racial
and ethnic populations are not well understood. The
very low utilization of screening tests (e.g., fecal occult
blood testing or sigmoidoscopy,18) suggests that factors other than screening may be involved. Increased
polyp removal, advances in treatment protocols (e.g.,
the increased use of newer surgical techniques and
adjuvant therapies), and other factors (e.g., daily use
of aspirin21 or estrogen replacement therapy,22 or
changes in population dietary patterns23) may be contributing factors. Although there may be minor improvements in diet in the U.S. population, the increasing prevalence of obesity argues against sustained dietary changes.24
During 1973 1990, the incidence of non-Hodgkins lymphoma increased significantly among younger
and older males.5 Given that non-Hodgkins lymphoma
in the presence of human immunodeficiency virus
(HIV) infection is an acquired immunodeficiency syndrome (AIDS)-defining illness, the increasing incidence among men age 55 years in the U. S. most
probably reflects the increasing impact of HIV infection. However, the average annual percent increase
in non-Hodgkins lymphoma appears to be slowing,
possibly due to the beneficial effects of antiretroviral
therapies on the rate of HIV disease progression.25
In this report, we used age-adjusted cancer incidence and cancer death rates. Although widely used
as summary indicators, age-adjusted rates have recog-

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nized limitations.26 First, they may mask important

variations in the deaths or incidence rates among specific age groups. For cancer in particular, declining
mortality at younger ages is offset by increases at older
ages, resulting in a small net mortality decline for all
ages and all sites combined, a pattern reflected in specific sites as well. For example, male lung cancer mortality rates began declining in younger age groups long
before the overall age-adjusted rate did. Male lung
cancer mortality rates peaked in 1970 for those age
45 years, in 1978 for those ages 45 54 years, and since
1978 for those ages 55 64 years. This is in contrast to
an overall age-adjusted rate that did not peak until
1990. Second, trends and patterns in incidence and
mortality may be sensitive in some situations to the
choice of the population standard used for age-adjustment, in particular the use of an earlier population,
such as 1940 compared with 1970 or the year 2000.
Recommendations currently are being formulated for
national and state agencies to adopt the year 2000 as
a uniform new standard, which will better reflect the
current (and older) age structure of the population.
A more current standard would result in somewhat
attenuated reductions in cancer incidence and mortality.
The incidence data presented in this report were
derived from selected geographic areas of the U.S. representing only 9.5% of the U.S. population. The National Program of Cancer Registries funded by the CDC
was established in 1994 with an emphasis on improving the completeness, timeliness, and quality of cancer
incidence data.27 Publications from the North American Association of Central Cancer Registries currently
provide a compilation of data from a number of state
registries.28 In the future, data regarding the occurrence of cancer will become available for most states 28
and will improve our ability to monitor cancer incidence trends and guide cancer control efforts throughout the U. S.
The ACS, NCI, and CDC including the NCHS expect to continue monitoring the occurrence of cancer
in the U. S. and to collaborate in the development of
an annual Report Card to the nation. Future assessments may include information on prevalence and
trends in areas of cancer control, health behaviors
such as tobacco use, diet, and utilization of cancer
screening procedures, as well as key successes in treatment, and significant cancer research findings.

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