2. US Mortality, 2003
No. of % of all
Rank Cause of Death deaths deaths
1. Heart Diseases 685,089 28.0
2. Cancer 556,902 22.7
3. Cerebrovascular diseases 157,689 6.4
4. Chronic lower respiratory diseases 126,382 5.2
5. Accidents (Unintentional injuries) 109,277 4.5
6. Diabetes mellitus 74,219 3.0
7. Influenza and pneumonia 65,163 2.7
8. Alzheimer disease 63,457 2.6
18. Nephritis 42,453 1.7
10. Septicemia 34,069 1.4
Source: US Mortality Public Use Data Tape 2003, National Center for Health Statistics, Centers for Disease Control
and Prevention, 2006.
3. Change in the US Death Rates* by Cause,
1950 & 2003
Rate Per 100,000
586.8
600
1950
500
2003
400
300
231.6
193.9 190.1
180.7
200
100
53.3 48.1
21.9
0
Heart Cerebrovascular Pneumonia/ Cancer
Diseases Diseases Influenza
* Age-adjusted to 2000 US standard population.
Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.
2003 Mortality Data: US Mortality Public Use Data Tape, 2003, NCHS, Centers for Disease Control and
Prevention, 2006
4. 2006 Estimated US Cancer Deaths*
Men Women
Lung & bronchus 31% 26% Lung & bronchus
291,270 273,560
Colon & rectum 10% 15% Breast
Prostate 9% 10% Colon & rectum
Pancreas 6% 6% Pancreas
Leukemia 4% 6% Ovary
Liver & intrahepatic 4% 4% Leukemia
bile duct
3% Non-Hodgkin
Esophagus 4% lymphoma
Non-Hodgkin 3% 3% Uterine corpus
lymphoma
2% Multiple myeloma
Urinary bladder 3%
2% Brain/ONS
Kidney 3%
23% All other sites
All other sites 23%
ONS=Other nervous system.
Source: American Cancer Society, 2006.
5. Trends in the Number of Cancer Deaths Among Men and
Women, US, 1930-2003
300,000 290,000
Men
Men 285,000
250,000 280,000
Number of Cancer Deaths
Women 275,000
200,000
270,000
Women
265,000
150,000 2000 2001 2002 2003
100,000
50,000
0
1930 1940 1950 1960 1970 1980 1990 2000
Source: US Mortality Public Use Data Tape, 2003, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2006.
6. Cancer Death Rates*, All Sites Combined, All Races,
US, 1975-2002
300 Rate Per 100,000
Men
250
Both Sexes
200
Women
150
100
50
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat
Database: Mortality - All COD, Public-Use With State, Total U.S. (1969-2002), National Cancer Institute, DCCPS,
Surveillance Research Program, Cancer Statistics Branch, released April 2005. Underlying mortality data
provided by NCHS (www.cdc.gov/nchs).
7. Cancer Death Rates*, for Men, US,1930-2002
100
Rate Per 100,000
Lung
80
60
Stomach
Prostate
40
Colon & rectum
20
Pancreas
Leukemia Liver
0
1940
1945
1950
1955
1970
1975
1980
1990
2000
1930
1935
1960
1965
1985
1995
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Public Use Data Tapes 1960-2002, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
8. Cancer Death Rates*, for Women, US,1930-2002
100
Rate Per 100,000
80
60
Lung
40 Uterus
Breast
Colon & rectum
Stomach
20
Ovary
Pancreas
0
1940
1945
1950
1955
1970
1975
1980
1990
2000
1930
1935
1960
1965
1985
1995
*Age-adjusted to the 2000 US standard population.
Source: US Mortality Public Use Data Tapes 1960-2002, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2005.
9. Cancer Death Rates*, by Race and Ethnicity,
US,1998-2002
400
Men Women
339.4
350
300
242.5
250
194.3
200 171.4
164.5 159.7
148.0
150
113.8 111.0
99.4
100
50
0
White African Asian/Pacific American Hispanic†
American Islander Indian/ Alaskan
Native
*Per 100,000, age-adjusted to the 2000 US standard population.
Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians/
†
Alaska Natives.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
10. Cancer Sites in Which African American Death Rates* Exceed
White Death Rates* for Men, US, 1998-2002
Ratio of African
Site African American White
American/White
All sites 339.4 242.5 1.4
Prostate 68.1 27.7 2.5
Larynx 5.2 2.3 2.3
Stomach 12.8 5.6 2.3
Myeloma 8.8 4.4 2.0
Oral cavity and pharynx 7.1 3.9 1.8
Esophagus 11.2 7.5 1.5
Liver and intrahepatic bile duct 9.5 6.2 1.5
Small intestine 0.7 0.5 1.4
Colon and rectum 34.0 24.3 1.4
Lung and bronchus 101.3 75.2 1.3
Pancreas 15.8 12.0 1.3
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control
and Population Sciences, National Cancer Institute, 2005.
11. Cancer Sites in Which African American Death Rates* Exceed
White Death Rates* for Women, US, 1998-2002
Ratio of African
Site African American White American/White
All sites 194.3 164.5 1.2
Stomach 6.3 2.8 2.3
Myeloma 6.5 2.9 2.2
Uterine cervix 5.3 2.5 2.1
Esophagus 3.2 1.7 1.9
Larynx 0.9 0.5 1.8
Uterine corpus 7.0 3.9 1.8
Small intestine 0.5 0.3 1.7
Pancreas 12.6 9.0 1.4
Colon and rectum 24.1 16.8 1.4
Liver and intrahepatic bile duct 3.8 2.7 1.4
Breast 34.7 25.9 1.3
Urinary bladder 2.9 2.3 1.3
Gallbladder 1.0 0.8 1.3
Oral cavity and pharynx 1.9 1.6 1.2
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control
and Population Sciences, National Cancer Institute, 2005.
12. Cancer Death Rates* by Sex and Race, US, 1975-2002
500
Rate Per 100,000
450
African American men
400
350
300 White men
250
African American women
200
White women
150
100
50
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
13. 2006 Estimated US Cancer Cases*
Men Women
720,280 679,510
31% Breast
Prostate 33%
12% Lung & bronchus
Lung & bronchus 13%
11% Colon & rectum
Colon & rectum 10%
6% Uterine corpus
Urinary bladder 6%
4% Non-Hodgkin
Melanoma of skin 5%
lymphoma
Non-Hodgkin4%
4% Melanoma of skin
lymphoma
3% Thyroid
Kidney 3%
3% Ovary
Oral cavity 3%
2% Urinary bladder
Leukemia 3%
2% Pancreas
Pancreas 2%
22% All Other Sites
All Other Sites 18%
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2006.
14. Cancer Incidence Rates*, All Sites Combined,
All Races, 1975-2002
Rate Per 100,000
700
600 Men
Both Sexes
500
400 Women
300
200
100
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population and adjusted for delay in reporting.
Source: Surveillance, Epidemiology, and End Results Program, 1973-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
15. Cancer Incidence Rates* for Men, 1975-2002
Rate Per 100,000
250
Prostate
200
150
Lung
100
Colon and rectum
50 Urinary bladder
Non-Hodgkin lymphoma
Melanoma of the skin
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
16. Cancer Incidence Rates* for Women, 1975-2002
Rate Per 100,000
250
200
150
Breast
100
Colon and rectum Lung
50
Uterine Corpus
Ovary
Non-Hodgkin lymphoma
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
17. Cancer Incidence Rates* by Race and Ethnicity, 1998-2002
Rate Per 100,000
800
Men Women
682.6
700
600 556.4
500
429.3 420.7
398.5 383.5
400
310.9
303.6
300 255.4
220.5
200
100
0
White African American Asian/Pacific Islander American Indian/ Hispanic†
Alaska Native
*Age-adjusted to the 2000 US standard population.
Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.
†
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
18. Cancer Incidence Rates* by Sex and Race, All Sites,
1975-2002
Rate Per 100,000
900
800
700 African-American men
White men
600
500
White women
400
African-American women
300
200
100
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control
and
19. Lifetime Probability of Developing Cancer, by Site, Men,
2000-2002*
Site Risk
All sites† 1 in 2
Prostate 1 in 6
Lung and bronchus 1 in 13
Colon and rectum 1 in 17
Urinary bladder‡ 1 in 28
Non-Hodgkin lymphoma 1 in 46
Melanoma 1 in 52
Kidney 1 in 64
Leukemia 1 in 67
Oral Cavity 1 in 73
Stomach 1 in 82
* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and
Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan
20. Lifetime Probability of Developing Cancer, by Site, Women, US,
2000-2002*
Site Risk
All sites† 1 in 3
Breast 1 in 8
Lung & bronchus 1 in 17
Colon & rectum 1 in 18
Uterine corpus 1 in 38
Non-Hodgkin lymphoma 1 in 55
Ovary 1 in 68
Melanoma 1 in 77
Pancreas 1 in 79
Urinary bladder‡ 1 in 88
Uterine cervix 1 in 135
* For those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.0 Statistical Research and
Applications Branch, NCI, 2005. http://srab.cancer.gov/devcan
21. Cancer Survival*(%) by Site and Race,1995-2001
%
African
Site White American Difference
All Sites 66 56 10
Breast (female) 90 76 14
Colon 65 55 10
Esophagus 16 10 6
Leukemia 49 38 11
Non-Hodgkin lymphoma 61 52 9
Oral cavity 62 40 22
Prostate 100 97 3
Rectum 65 56 9
Urinary bladder 83 64 19
Uterine cervix 75 66 9
Uterine corpus 86 62 24
*5-year relative survival rates based on cancer patients diagnosed from 1995 to 2001 and followed through 2002.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
22. Five-year Relative Survival (%)* during Three Time Periods
By Cancer Site
1983-1985 1995-2001
Site 1974-1976
All sites 50 53 65
Breast (female) 75 78 88
Colon 50 58 64
Leukemia 34 41 48
Lung and bronchus 12 14 15
Melanoma 80 85 92
Non-Hodgkin lymphoma 47 54 60
Ovary 37 41 45 †
Pancreas 3 3 5
Prostate 67 75 100
Rectum 49 55 65
Urinary bladder 73 78 82
*5-year relative survival rates based on follow up of patients through 2002.
†Recent changes in classification of ovarian cancer have affected 1995-2001 survival rates.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
23. Cancer Incidence & Death Rates* in Children 0-14 Years,
1975-2002
Rate Per 100,000
18
16 Incidence
14
12
10
8
6
Mortality
4
2
0
1975 1978 1981 1984 1987 1990 1993 1996 1999 2002
*Age-adjusted to the 2000 Standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
24. Cancer Incidence Rates* in Children 0-14 Years, by Site,
1998-2002
Site Male Female Total
All sites 15.6 14.3 15.0
Leukemia 4.9 4.2 4.6
Acute Lymphocytic 3.9 3.4 3.6
Brain/ONS 3.6 3.3 3.5
Soft tissue 1.1 0.9 1.0
Non-Hodgkin lymphoma 1.2 0.6 1.0
Kidney and renal pelvis 0.8 1.0 0.9
Bone and Joint 0.6 0.6 0.6
Hodgkin lymphoma 0.6 0.5 0.5
*Per 100,000, age-adjusted to the 2000 US standard population.
ONS = Other nervous system
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
25. Cancer Death Rates* in Children 0-14 Years, by Site,
US, 1998-2002
Site Male Female Total
All sites 2.7 2.3 2.5
Leukemia 0.8 0.7 0.8
Acute Lymphocytic 0.4 0.3 0.4
Brain/ONS 0.8 0.7 0.7
Non-Hodgkin lymphoma 0.1 0.1 0.1
Soft tissue 0.1 0.1 0.1
Bone and Joint 0.1 0.1 0.1
Kidney and Renal pelvis 0.1 0.1 0.1
*Per 100,000, age-adjusted to the 2000 US standard population.
ONS = Other nervous system
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
26. Trends in Survival, Children 0-14 Years, All Sites Combined
1974-2001
Year of
Age 5 - Year Relative Survival Rates *
Diagnosis
0 - 4 Years
1974 - 1976
19 9 5 -
5 - 9 Years 0
20 1
1974 - 1976
1 0 - 14
1974 - 1976
Years
1995 - 2001
19 9 5 -
2001
*5-year relative survival rates, based on follow up of patients through 2002.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2005.
27. Tobacco Use in the US, 1900-2002
5000 100
4500 90
4000 80
Per Capita Cigarette Consumption
Age-Adjusted Lung Cancer Death
3500 70
Per capita cigarette
3000 60
consumption
Rates*
2500 50
Male lung cancer
2000 40
death rate
1500 30
1000 20
Female lung cancer
500 10
death rate
0 0
1900
1905
1910
1915
1920
1925
1935
1945
1950
1955
1960
1965
1975
1980
1985
1990
1995
2000
1930
1940
1970
Year
*Age-adjusted to 2000 US standard population.
Source: Death rates: US Mortality Public Use Tapes, 1960-2002, US Mortality Volumes, 1930-1959, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2005. Cigarette consumption: US
Department of Agriculture, 1900-2002.
28. Trends in Cigarette Smoking Prevalence* (%), by Gender, Adults
18 and Older, US, 1965-2004
60
50
40
Prevalence (%)
30 Men
20
Women
10
0
1965
1974
1979
1983
1985
1992
1995
1997
1998
1999
2000
2001
2002
2004
1990
1994
2003
Year
*Redesign of survey in 1997 may affect trends.
Source: National Health Interview Survey, 1965-2004, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2005.
29. Trends in per capita cigarette consumption for selected
states and the average consumption across all states,
1980-2003
140
120
100 United States
Per Capit a Sales (# of Packs)
80
Massachusetts
California
60
40
20
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Year
Data from: Orzechowski W, Walker RC. The tax burden on tobacco: historical compilation 2003: Volume 36.
Arlington (VA): Orzechowski and Walker; 2003.
30. Current* Cigarette Smoking Prevalence (%), by Gender and
Race/Ethnicity, High School Students, US, 1991-2003
50
1991 1995 1997 1999 2001 2003
40
40 40
39
40 38
37
35 36 34
33 33
32 32
32 31
30
Prevalence (%)
30 28
28 28
27 27
26
23 23
22
19 19
18
20 18
17 16
13 14
11 12 11
10
0
White, non- White, non- African African Hispanic Hispanic Male
Hispanic Hispanic Male American, non- American, non- Female
Female Hispanic Hispanic Male
Female
*Smoked cigarettes on one or more of the 30 days preceding the survey.
Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2004.
31. Trends in Consumption of Five or More Recommended Vegetable
and Fruit Servings for Cancer Prevention, Adults 18 and Older,
US, 1994-2003
35
30
24.4 24.4
24.2 24.1 23.6
25
Prevalence (%)
20
15
10
5
0
1994 1996 1998 2000 2003
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000, 2003), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, 1997, 1999, 2000, 2001, 2004.
32. Trends in Prevalence (%) of No Leisure-Time Physical Activity, by
Educational Attainment, Adults 18 and Older, US, 1992-2004
60
Adults with less than a high school education
55
50
45
40
Prevalence (%)
35
30
25 All adults
20
15
10
5
0
1992
1994
1996
1998
2000
2002
2003
2004
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States. Educational attainment is for adults 25 and older.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000, 2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005.
33. Trends in Prevalence (%) of High School Students
Attending PE Class Daily, by Grade, US, 1991-2003
70
60
50
Prevalence (%)
40
9th
10th
30
11th
20
12th
10
0
1991 1993 1995 1997 1999 2001 2003
Year
Source: Youth Risk Behavior Surveillance System, 1991-2003, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, 2004. MMWR 2004;53(36):844-847.
34. Trends in Overweight* Prevalence (%), Children and Adolescents,
by Age Group, US, 1971-2002
20
16 16
15
Prevalence (%)
11 11
10
10
7
7
6
5 5 5
4
5
0
2 to 5 years 6 to 11 years 12 to 19 years
NHANES I (1971-74) NHANES II (1976-80) NHANES III (1988-94) NHANES 1999-2002
*Overweight is defined as at or above the 95th percentile for body mass index by age and sex based on
reference data.
Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002,
National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004.
35. Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20
to 74, US, 1960-2002†
45
40
34
35
31
28
30
26
Prevalence (%)
23
25
21
20 17
16 17
15
13 15
12 13
15
11
10
5
0
Both sexes Men Women
NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80)
NHANES III (1988-94) NHANES 1999-2002
*Obesity is defined as a body mass index of 30 kg/m2 or greater. † Age adjusted to the 2000 US standard
population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination
Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2002, 2004.
36. Trends in Overweight* Prevalence (%), Adults 18 and
Older, US, 1992-2004
1992 1995
1998 2004
Less than 50% 50 to 55% More than 55% State did not participate in survey
*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998)
and Public Use Data Tape (2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, 1997, 2000, 2005.
37. Screening Guidelines for the Early Detection of
Breast Cancer, American Cancer Society
Yearly mammograms are recommended starting at age 40.
A clinical breast exam should be part of a periodic health exam, about
every three years for women in their 20s and 30s, and every year for
women 40 and older.
Women should know how their breasts normally feel and report any breast
changes promptly to their health care providers. Breast self-exam is an
option for women starting in their 20s.
Women at increased risk (e.g., family history, genetic tendency, past
breast cancer) should talk with their doctors about the benefits and
limitations of starting mammography screening earlier, having additional
tests (i.e., breast ultrasound and MRI), or having more frequent exams.
38. Mammogram Prevalence (%), by Educational Attainment and
Health Insurance Status, Women 40 and Older, US, 1991-2004
70
60 All women 40 and older
50
Prevalence (%)
Women with less than a high school education
40
30
Women with no health insurance
20
10
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2004
Year
*A mammogram within the past year. Note: Data from participating states and the District of Columbia were
aggregated to represent the United States.
Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use
Data Tape (2000, 2002, 2004), National Centers for Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005.
39. Screening Guidelines for the Early Detection of
Cervical Cancer, American Cancer Society
Screening should begin approximately three years after a women begins
having vaginal intercourse, but no later than 21 years of age.
Screening should be done every year with regular Pap tests or every two
years using liquid-based tests.
At or after age 30, women who have had three normal test results in a row
may get screened every 2-3 years. However, doctors may suggest a
woman get screened more frequently if she has certain risk factors, such
as HIV infection or a weakened immune system.
Women 70 and older who have had three or more consecutive Pap tests
in the last ten years may choose to stop cervical cancer screening.
Screening after a total hysterectomy (with removal of the cervix) is not
necessary unless the surgery was done as a treatment for cervical cancer.
40. Trends in Recent* Pap Test Prevalence (%), by Educational
Attainment and Health Insurance Status, Women 18 and Older,
US, 1992-2004
100
All women 18 and older
80
Women with no health insurance
Women with less than a high school education
Prevalence (%)
60
40
20
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2004
Year
* A Pap test within the past three years. Note: Data from participating states and the District of Columbia
were aggregated to represent the United States. Educational attainment is for women 25 and older.
Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and
Public Use Data Tape (2000, 2002, 2004), National Center for Chronic Disease Prevention and Health
Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005.
41. Screening Guidelines for the Early Detection of
Colorectal Cancer, American Cancer Society
Beginning at age 50, men and women should follow one of the following
examination schedules:
A fecal occult blood test (FOBT) every year
A flexible sigmoidoscopy (FSIG) every five years
Annual fecal occult blood test and flexible sigmoidoscopy every five
years*
A double-contrast barium enema every five years
A colonoscopy every ten years
*Combined testing is preferred over either annual FOBT or FSIG every 5 years alone.
People who are at moderate or high risk for colorectal cancer should talk with
a doctor about a different testing schedule
42. Trends in Recent* Fecal Occult Blood Test Prevalence (%), by
Educational Attainment and Health Insurance Status, Adults 50
Years and Older, US, 1997-2004
30
1997 1999 2001 2002 2004
24
25
22
21
20
19
20 18
Prevalence (%)
16 16 16
14
15
12
9 9
9
10 8
5
0
Total Less than a high school No health insurance
education
*A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were
aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001,
2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention and Prevention, 1999, 2000, 2002, 2003, 2005.
43. Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy
Prevalence (%), by Educational Attainment and Health Insurance
Status, Adults 50 Years and Older, US, 1997-2004
50
45 1997 1999 2001 2002 2004
45 41
39
40 36
34
35 32 33
Prevalence (% )
31
29
28
30
25
18 19
20 16 16 17
15
10
5
0
Total Less than a high school No health insurance
education
*A flexible sigmoidoscopy or colonoscopy within the past five years. Note: Data from participating states and the
District of Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001,
2002, 2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention and Prevention, 1999, 2000, 2002, 2003, 2005.
44. Screening Guidelines for the Early Detection of
Prostate Cancer, American Cancer Society
The prostate-specific antigen (PSA) test and the digital rectal examination
(DRE) should be offered annually, beginning at age 50, to men who have a
life expectancy of at least 10 years.
Men at high risk (African-American men and men with a strong family
history of one or more first-degree relatives diagnosed with prostate cancer
at an early age) should begin testing at age 45.
For men at average risk and high risk, information should be provided
about what is known and what is uncertain about the benefits and
limitations of early detection and treatment of prostate cancer so that they
can make an informed decision about testing.
45. Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%),
by Educational Attainment and Health Insurance Status, Men 50
Years and Older, US, 2001-2004
70
2001 2002 2004
58
60 55
52
50 46
Prevalence (%)
42
39
40
30 28
30 25
20
10
0
Total Less than a high school No health insurance
education
*A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of
Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004), National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005.
46. Recent* Digital Rectal Examination (DRE) Prevalence (%), by
Educational Attainment and Health Insurance Status, Men 50
Years and Older, US, 2001-2004
60 57
53
2001 2002 2004
50
50
44
42
37
40
Prevalence (%)
29
30 26
22
20
10
0
Total Less than a high school No health insurance
education
*A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of
Columbia were aggregated to represent the United States.
Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004), National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005.
47. Sunburn* Prevalence (%) in the Past Year, Adults 18 and
Older, US, 1999
50
44.1
45 White non-
Hispanic
40
Age-Adjusted Prevalence (%)
35.3
American
35
Indian/Alaskan
Native
30 27.4
Other
23.5
25 22.0
18.0
20
Asian/ Pacific
13.3 Islander
15
11.0
10 Black non-
5.3 5.1 Hispanic
5
0
Male Female
*Reddening of any part of the skin (regardless of size) for more than 12 hours. Source: Saraiya et al. Am
J Prev Med 2002;23(2). Note: The overall prevalence of sunburn among adult males is 39.7% and among
females is 28.8%. Behavioral Risk Factor Surveillance System CD-ROM, 1999. National Center for
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2000.
48. Sunburn* Prevalence (%) During the Past Summer, Youth
11-18, US, 1998
90 85.5
77.2
80
74.1 74.1
70.8 70.8
70
64.1
58.4
60 55.2
Prevalence (%)
50
40 36.7
30
20
10
0
r
r ity
le ity
k ity
a le ite ia n de
he
ac
Ma itiv
itiv itiv
Wh Ot
Bl la n
Ind
em s s
s
Is
F en
en en
an ic
ric nS
nS nS
cif
e Su Su
Su
/ Pa
Am
igh
ian ow um
di
L
As H
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*Any reddening of the skin that lasts for at least 12 hours from either exposure to the sun or from a tanning booth or
sunlamp. Note: Prevalence estimates for racial/ethnic categories other than white may not be stable due to small sample
sizes and have wide confidence intervals. Source: Davis et al. Pediatrics 2002;110(1).
The American Cancer Society presents Cancer Statistics 2006.
Cancer accounts for nearly one-quarter of deaths in the United States, exceeded only by heart diseases. In 2003, there were 556,902 cancer deaths in the US.
Compared to the rate in 1950, the cancer death rate decreased slightly in 2003, while rates for other major chronic diseases decreased substantially during this period.
Lung cancer is, by far, the most common fatal cancer in men (31%), followed by colon & rectum (10%), and prostate (9%). In women, lung (26%), breast (15%), and colon & rectum (10%) are the leading sites of cancer death.
From 2002 to 2003, the number of recorded cancer deaths decreased by 778 in men, but increased by 409 in women, resulting in a net decrease of 369 total cancer deaths, the first such decrease since 1930, when nationwide mortality data began to be compiled.The decrease in the number of Americans dying from cancer is a result of declining cancer death rates outpacing the impact of growth and aging of the population.
The death rate from all cancers combined has decreased by 1.5% per year since 1993 among men and by 0.8% per year since 1992 among women. Compared to the peak rates in 1990 for men and 1991 for women, the cancer death rate for all sites combined in 2002 was 14.3% lower in men and 7.2% lower in women.
Most of the increase in cancer death rates for men prior to 1990 was attributable to lung cancer. However, since 1990, the age-adjusted lung cancer death rate in men has been decreasing. Stomach cancer mortality has decreased considerably since 1930. Death rates from prostate and colorectal cancers have also been declining.
Lung cancer is currently the most common cause of cancer death in women, with the death rate more than two times what it was 25 years ago. In comparison, breast cancer death rates were virtually unchanged between 1930 and 1990, and have since decreased on average 2.3% per year. The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for over 50 years.
Overall, cancer death rates are higher in men than women in every racial and ethnic group. African American men and women have the highest rates of cancer mortality. Asian and Pacific Islander men and women have the lowest cancer death rates, about half the rate of African American men and women, respectively. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported death rates that are lower than true death rates.
African Americans have higher cancer death rates than whites for numerous cancer sites. Death rates for myeloma and cancers of the prostate, larynx, stomach, oral cavity, esophagus, liver, small intestine, colon and rectum, lung and bronchus, and pancreas are all higher in African-American men than in white men.
Death rates are higher in African American women than white women for many cancer sites, including myeloma and cancers of the stomach, cervix, esophagus, larynx, uterus, small intestine, pancreas, colon & rectum, liver, breast, urinary bladder, gallbladder, and oral cavity.
Overall, cancer death rates are higher in African-American men than white men and in African-American women than white women. However, the cancer death rate is declining faster in African-American men than white men.
Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that almost 1.4 million new cases of cancer will be diagnosed in 2006. Cancers of the prostate and breast will be the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorectal cancers both in men and in women.
This slide shows trends in cancer incidence for all sites combined, for the years 1975-2002. Incidence rates stabilized in men from 1995 to 2002 and increased in women by 0.3% per year from 1987 to 2002.
Between 1988 and 1992, prostate cancer incidence rates increased dramatically due to earlier diagnosis with prostate-specific antigen (PSA) blood testing, after increasing steadily from 1975 to 1988. Incidence rates for both lung and colorectal cancers in men have declined in recent years.
In women, breast cancer incidence rates increased rapidly in the 1980s due to increased use of mammography and have increased gradually since that time. During the most recent time period (1998-2002), incidence rates of lung cancer have leveled off, while rates of colorectal cancer have decreased.
Overall, cancer incidence rates are higher in men than women. Among men, African Americans have the highest incidence followed by white, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Natives. Racial differences in cancer incidence among women are less pronounced; white women have the highest incidence rates followed by African American, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native women. Note: Rates for populations other than white and African American may be affected by problems in ascertaining race/ethnicity information from medical records. This is likely to result in reported incidence rates that are lower than true incidence rates. In addition, populations covered by SEER cancer registries may not be representative of these populations in other parts of the country. For example, American Indians/Alaskan Natives in the Southwestern areas covered by SEER have much lower rates of smoking and lung cancer than American Indians/Alaskan Natives in the Northern plains states.
Cancer incidence rates are consistently higher in African-American men than white men. In contrast, cancer incidence rates are generally higher in white women than African-American women, although the difference is not as great.
The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer.
Approximately one in three women in the United States will develop cancer over her lifetime. The leading sites are breast, lung, and colon and rectum.
The 5-year relative survival rate from cancer is 66% for whites and 56% for African Americans (taking normal life expectancy into consideration). For many sites, survival rates in African Americans are 10% to more than 20% lower than in whites. This is due, in part, to African Americans being less likely to receive a cancer diagnosis at an early, localized stage, when treatment can improve chances of survival. Additional factors that contribute to the survival differential include unequal access to medical care and a higher prevalence of coexisting medical conditions and other risk factors.
The survival rates for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, breast, colon, rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the not-too-distant future.
The next series of slides look at the burden of cancer among our nation's children. Cancer-related mortality has been decreasing in children ages 0-14 steadily for more than 2 decades.
Leukemia is the most common cancer among children ages 0-14 years and comprises approximately 30% of all childhood cancers. Acute lymphocytic leukemia is the most common form of leukemia in children. Cancer of the brain/other nervous system is the second most common incident cancer in both boys and girls.
Leukemia also accounts for the most cancer deaths in children, and comprises roughly a third of cancer deaths among boys and girls 0-14 years. Cancers of the brain/other nervous system are the second leading cause of cancer death in children 0-14.
The 5-year relative survival rate for all three age groups increased significantly between the mid 1970s and late 1990s. For example, the 5-year relative survival rate increased from 55.1% in 1974-76 to 79.2% in 1995-2001 for cases diagnosed among children 10-14 years old.
The last set of slides describes at the prevalence of cancer risk factors, such as tobacco use and physical inactivity, and the prevalence of cancer screening, such as use of mammography.
The reduction in cigarette consumption has been associated with a decrease in adult smoking prevalence in both men and women since 1965. The difference in cigarette smoking across gender narrowed from 1965 to 1985, a result of smoking becoming more popular among women and higher rates of quitting among male smokers following the Surgeon General’s Report.
In recent years, there have been increased efforts by states to implement comprehensive tobacco control programs. Between 1990 and 2003, tobacco consumption has declined from 133 to 79 packs per capita in the United States, with even greater declines among states with strong tobacco control programs.
Reduction in cigarette smoking among youth is an important factor in reducing prevalence and addiction in adulthood. Smoking among high school students increased from 1991 to 1997 and then began to decline. It is thought that the increase in smoking from 1991 to 1997 was due to aggressive youth targeted marketing and promotions; tobacco companies greatly increased their expenditures and promotions during that period. The subsequent decline is thought to be due to increased price of cigarettes as well as tobacco control efforts. Patterns were similar for Whites, African Americans, and Hispanics and for males and females.
The American Cancer Society recommends that individuals eat five or more servings of vegetables and fruits a day for cancer prevention. Fruit and vegetable consumption may protect against cancers of the mouth and pharynx, esophagus, lung, stomach, and colon and rectum. However, there has been little improvement in consumption since the mid-1990s. Less than one in four adults was eating the recommended servings in 2003.
The American Cancer Society recommends that adults engage in at least moderate physical activity for 30 or more minutes on 5 or more days of the week. However, similar to trends in nutrition, there has been little change in leisure-time physical activity during the 1990s. Almost one-fourth of adults do not engage in any leisure-time physical activity. Even more striking is that almost half of adults with less than a high school education do not participate in any leisure-time physical activity. It should be noted that leisure-time physical activity, as presented in this graph, does not reflect job-related physical activity for the currently employed population. While there has been little change in leisure-time physical activity since the early 1990s, data from other sources illustrates long-term social changes that have contributed to reduced total physical activity in US adults. For example, the number of trips outside the home made by walking has decreased by 42% between 1975 and 1995.
Regular physical activity has many important health benefits, including reducing risk factors for cardiovascular disease, cancer, and other chronic diseases. Today however, the prevalence of students attending physical education (PE) class daily is significantly lower than it was in 1991. Given the dramatic rise in the prevalence of overweight among teens (it has tripled since 1980), schools are increasingly being identified as an opportunity to increase physical activity among students.
People who become overweight in childhood and adolescence are more likely to be overweight or obese as adults. With at least half of the overweight children becoming overweight adults, future adult populations are at increased risk for developing cancer and other serious chronic diseases. The prevalence of overweight children and adolescents has increased since the 1970s, with the most dramatic increases occurring in the late 1980s and 1990s. In fact, over the past three decades the proportion of overweight children has doubled among 2-5 year olds and tripled among 6-19 year olds.
Obesity has reached epidemic proportions in the United States. The percentage of adults age 20 to 74 who are obese increased from 1960 to 2002 with the largest increases occurring in the 1990s. Similar trends were observed among men and women.
This slide highlights the obesity epidemic as mentioned in the previous slide. In 2004, over 50% of the adults in all states, including District of Columbia, were overweight or obese, compared to just 12 states in 1992.
The American Cancer Society states that women aged 40 and older should have an annual mammogram and clinical breast exam (CBE) as part of a periodic health exam. Women should know how their breasts normally feel and report any changes to their health care provider. A breast self-examination (BSE) is an option for women starting in their 20s.
The prevalence of women reporting a mammogram within the past year increased from 50% in 1991 to 64% in 2000, and has since declined to 58% in 2004. During this time, mammogram utilization varied considerably by educational attainment. The prevalence of women with less than a high school education reporting a recent mammogram was approximately 9 percentage points lower than the prevalence for all women. Even more striking is that the prevalence for women with no health insurance is approximately 25 percentage points lower than the prevalence for all women.
The American Cancer Society cervical cancer screening guidelines state that women should begin screening approximately three years after she begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal tests in a row may get screened every 2-3 years. Women 70 and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening.
This graph shows that the prevalence of women who have had a Pap test within the past three years has remained high, and has increased during the late 1990s. Throughout the decade, the prevalence among women with less than a high school education as well as the prevalence among women with no health insurance was approximately 10 percent lower than the percentage for all women.
The American Cancer Society recommends that beginning at age 50, men and women should receive a fecal occult blood test (FOBT) every year, or a flexible sigmoidoscopy (FSIG) every five years, or an annual FOBT and FSIG every five years (preferred to either method alone), or a double-contrast barium enema every five years, or a colonoscopy every ten years.
In 2004, approximately 19% of US adults 50 and older had a fecal occult blood test (FOBT) in the previous year. Adults with less than a high school education are less likely to report a recent FOBT. The prevalence for adults with no health insurance is approximately 10 percentage points lower than the prevalence for all adults.
While there has been a downward trend during recent years in the use of FOBT, the prevalence of flexible sigmoidoscopy (FSIG) or colonoscopy increased from 1999 to 2004. Adults with less than a high school education were less likely to report FSIG or colonoscopy than all adults. Even more striking is that the prevalence for adults with no health insurance is approximately 26 percentage points lower than the prevalence for all adults. Continuing efforts are needed to address health system barriers to colon cancer screening, to encourage health care practitioners to promote screening to their patients, and to raise awareness among eligible adults about the importance of getting screened for CRC.
The prostate-specific antigen (PSA) test and the digital rectal exam (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.
This graph shows that the percentage of men who have had a PSA test within the past year decreased by 6 percentage points from 2001. Men with less than a high school education and men with no health insurance were less likely to report a PSA test than all men 50 and older.
This graph shows that the percentage of men who have had a DRE within the past year decreased by approximately seven percentage points from 2001. Men with less than a high school education and men with no health insurance were less likely to report a DRE than all men 50 and older. The American Cancer Society suggests that men speak with their physician to make an informed decision on prostate cancer screening.
The vast majority of skin cancers are the result of unprotected and excessive ultraviolet radiation exposure. The American Cancer Society estimates that UV exposure is associated with more than one million cases of basal and squamous cell cancers and 62,190 cases of malignant melanoma in 2006. Sunburns, a short-term consequence of unprotected or excessive UV exposure, were reported more frequently by men than women. Variations by race, ethnicity, and gender were observed with the highest prevalence of sunburns among white non-Hispanic males and females.
Adolescence is a period of heightened unprotected sun exposure. Sunburn during childhood and intense intermittent unprotected sun exposure increases the risk of melanoma and other skin cancers. 72% of youth reported getting sunburned during the summer months. Sunburn prevalence varied by race and sun sensitivity.
