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NCI Annual Report to the Nation on the Status of Cancer

Cancer mortality continues to decline overall but increases in women from ages 20 to 49


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The latest Annual Report to the Nation on the Status of Cancer finds that, for all cancer sites combined, cancer death rates continued to decline in men, women, and children in the United States from 1999 to 2016. Overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. However, a special section of the report focusing on cancer rates and trends in adults between the ages of 20 and 49 showed a higher cancer incidence and mortality in women than men.

The annual report is a collaborative effort among the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared recently in the Journal of the National Cancer Institute.1 

Special Section Findings

The special section showed a different picture for cancer incidence and mortality among men and women between the ages of 20 and 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women between the ages of 20 and 49, they found that both incidence and death rates were higher among women.

The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 per 100,000 people among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 per 100,000 people among men and 27.1 among women in this age group.


The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors….
— J. Leonard Lichtenfeld, MD, MACP

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The most common cancers and their incidence rates among women between the ages of 20 and 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men between the ages of 20 and 49 were colon and rectal (13.1), testicular (10.7), and melanoma of the skin (9.8). In studying this age group, the authors also found that, from 2012 to 2016, death rates decreased 2.3% per year among men and 1.7% per year among women.

Moreover, the authors reported in the special section that the incidence rates of in situ breast cancer and nonmalignant central nervous system tumors among women and men between the ages of 20 and 49 are substantial. They wrote that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment. The authors concluded that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.

Overall Trends

This year’s report found that, among all ages combined, existing incidence and mortality trends for most types of cancer continue. Rates of new cases and deaths from lung, bladder, and laryngeal cancers continue to decrease as a result of long-term declines in tobacco smoking. In contrast, the rates of new cases of cancers related to excess weight and physical inactivity—including uterine, postmenopausal breast, and colorectal (only in young adults)—have been increasing in recent decades.

Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. The authors wrote that this could be due to changes in diagnostic processes related to revisions in the American Thyroid Association management guidelines for small thyroid nodules.

The report also showed rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.

“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” said J. Leonard Lichtenfeld, MD, MACP, Interim Chief Medical Officer of ACS.

Finally, the report revealed continuing racial and ethnic disparities in cancer mortality and incidence. When data for people of all ages were combined and compared by sex, across racial and ethnic groups, black men and black women had the highest cancer death rates, both for all cancer sites combined and for about half of the most common cancers in men and women. Black men and white women had the highest overall cancer incidence rates, and Asian/Pacific Islander men and women had the lowest overall rates. Non-Hispanic men and women had higher overall incidence rates than Hispanic men and women. 

REFERENCE

1. Ward E, Sherman RL, Henley SJ, et al: Annual Report to the Nation on the Status of Cancer, 1999–2015, Featuring Cancer in Men and Women ages 20–49. J Natl Cancer Inst. May 30, 2019 (early release online).


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