美國癌癥協(xié)會：美國癌癥報告Cancer Statistics

CancerStatistics,2021RebeccaL.Siegel,MPH1;KimberlyD.Miller,MPH2;AhmedinJemal,DVM,PhD3Abstract:Eachyear,theAmericanCancerSocietyestimatesthenumbersofnewcan-cercasesanddeathsthatwilloccurintheUnitedStatesinthecurrentyearandcom-pilesthemostrecentdataoncancerincidence,mortality,andsurvival.IncidencedatawerecollectedbytheSurveillance,Epidemiology,andEndResultsProgram;theNationalProgramofCancerRegistries;andtheNorthAmericanAssociationofCentralCancerRegistries.MortalitydatawerecollectedbytheNationalCenterforHealthStatistics.In2021,1,688,780newcancercasesand600,920cancerdeathsareprojectedtooccurintheUnitedStates.Forallsitescombined,thecancerincidencerateis20%higherinmenthaninwomen,whilethecancerdeathrateis40%higher.However,sexdisparitiesvarybycancertype.Forexample,thyroidcancerincidenceratesare3-foldhigherinwomenthaninmen(21vs7per100,000population),despiteequivalentdeathrates(0.5per100,000population),largelyreflectingsexdifferencesinthe“epidemicofdiag-nosis.〞Overthepastdecadeofavailabledata,theoverallcancerincidencerate(2004-2021)wasstableinwomenanddeclinedbyapproximately2%annuallyinmen,whilethecancerdeathrate(2005-2021)declinedbyabout1.5%annuallyinbothmenandwomen.From1991to2021,theoverallcancerdeathratedropped25%,translatingtoapproxi-mately2,143,200fewercancerdeathsthanwouldhavebeenexpectedifdeathrateshadremainedattheirpeak.Althoughthecancerdeathratewas15%higherinblacksthaninwhitesin2021,increasingaccesstocareasaresultofthePatientProtectionandAffordableCareActmayexpeditethenarrowingracialgap;from2021to2021,theproportionofblackswhowereuninsuredhalved,from21%to11%,asitdidforHispanics(31%to16%).GainsincoveragefortraditionallyunderservedAmericanswillfacilitatethebroaderapplicationofexistingcancercontrolknowledgeacrosseverysegmentofthepopulation.CACancerJClin2021;67:7–30.VC2021AmericanCancerSociety.Keywords:cancercases,cancerstatistics,deathrates,incidence,mortalityIntroductionCancerisamajorpublichealthproblemworldwideandisthesecondleadingcauseofdeathintheUnitedStates.Inthisarticle,weprovidetheexpectednumbersofnewcancercasesanddeathsin2021intheUnitedStatesnationallyandforeachstate,aswellasacomprehensiveoverviewofcancerincidence,mortality,andsurvivalratesandtrendsusingpopulation-baseddata.Themostcurrentcancerdataareavailablethrough2021forincidenceandthrough2021formortality.Wealsoestimatethetotalnumberofdeathsavertedasaresultofthecontinualdeclineincancerdeathratessincetheearly1990s.Inaddition,wepresenttheactualnumberofdeathsreportedin2021byageforthe10leadingcausesofdeathandforthe5leadingcausesofcancerdeath.MaterialsandMethodsIncidenceandMortalityDataMortalitydatafrom1930to2021wereprovidedbytheNationalCenterforHealthStatistics(NCHS).1-3Forty-sevenstatesandtheDistrictofColumbiametdataqualityrequirementsforreportingtothenationalvitalstatisticssystemin1930.Texas,Alaska,andHawaiibeganreportingmortalitydatain1933,1959,and1960,respectively.Themethodsforabstractionandageadjustmentofmortal-itydataaredescribedelsewhere.3,4Population-basedcancerincidencedataintheUnitedStateshavebeencollectedbytheNationalCancerInstitute’s(NCI’s)Surveillance,Epidemiology,andEnd1StrategicDirector,SurveillanceInformationServices,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;2Epidemiologist,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GA;VicePresident,SurveillanceandHealthServicesResearch,AmericanCancerSociety,Atlanta,GACorrespondingauthor:RebeccaL.Siegel,MPH,SurveillanceInformationServices,Sur-veillanceandHealthServicesResearch,Amer-icanCancerSociety,250WilliamsSt,NW,Atlanta,GA30303-1002;Rebecca.siegel@can-DISCLOSURES:Theauthorsreportnocon-flictsofinterest.doi:10.3322/caac.21387.Availableonlineatcacancerjournal3VOLUME67_NUMBER1_JANUARY/FEBRUARY20217CACANCERJCLIN2021;67:7–30TABLE1.EstimatedNewCancerCasesandDeathsbySex,UnitedStates,2021**Roundedtothenearest10;casesexcludebasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.About63,410casesofcarcinomainsituofthefemalebreastand74,680casesofmelanomainsituwillbenewlydiagnosedin2021.?Deathsforcolonandrectumcancersarecombinedbecausealargenumberofdeathsfromrectalcanceraremisclassifiedascolon.?Moredeathsthancasesmayreflectlackofspecificityinrecordingunderlyingcauseofdeathondeathcertificatesand/oranundercountinthecaseestimate.CancerStatistics,20218CA:

A

Cancer

Journal

for

CliniciansESTIMATED

NEW

CASESESTIMATED

DEATHSBOTH

SEXESMALEFEMALEBOTH

SEXESMALEFEMALEAll

Sites1,688,780836,150852,630600,920318,420282,500Oral

cavity

&

pharynx49,67035,72013,9509,7007,0002,700Tongue16,40011,8804,5202,4001,670730Mouth13,2107,8005,4102,5801,680900Pharynx17,00013,7803,2203,0502,340710Other

oral

cavity3,0602,2608001,6701,310360Digestive

system310,440175,650134,790157,70092,35065,350Esophagus16,94013,3603,58015,69012,7202,970Stomach28,00017,75010,25010,9606,7204,240Small

intestine10,1905,3804,8101,390770620Colon?95,52047,70047,82050,26027,15023,110Rectum39,91023,72016,190Anus,

anal

canal,

&

anorectum8,2002,9505,2501,100450650Liver

&

intrahepatic

bile

duct40,71029,20011,51028,92019,6109,310Gallbladder

&

other

biliary11,7405,3206,4203,8301,6302,200Pancreas53,67027,97025,70043,09022,30020,790Other

digestive

organs5,5602,3003,2602,4601,0001,460Respiratory

system243,170133,050110,120160,42088,10072,320Larynx13,36010,5702,7903,6602,940720Lung

&

bronchus222,500116,990105,510155,87084,59071,280Other

respiratory

organs7,3105,4901,820890570320Bones

&

joints3,2601,8201,4401,550890660Soft

tissue

(including

heart)12,3906,8905,5004,9902,6702,320Skin

(excluding

basal

&

squamous)95,36057,14038,22013,5909,2504,340Melanoma

of

the

skin87,11052,17034,9409,7306,3803,350Other

nonepithelial

skin8,2504,9703,2803,8602,870990Breast255,1802,470252,71041,07046040,610Genital

system279,800172,330107,47059,10027,50031,600Uterine

cervix12,82012,8204,2104,210Uterine

corpus61,38061,38010,92010,920Ovary22,44022,44014,08014,080Vulva6,0206,0201,1501,150Vagina

&

other

genital,

female4,8104,8101,2401,240Prostate161,360161,36026,73026,730Testis8,8508,850410410Penis

&

other

genital,

male2,1202,120360360Urinary

system146,650103,48043,17032,19022,2609,930Urinary

bladder79,03060,49018,54016,87012,2404,630Kidney

&

renal

pelvis63,99040,61023,38014,4009,4704,930Ureter

&

other

urinary

organs3,6302,3801,250920550370Eye

&

orbit3,1301,8001,330330180150Brain

&

other

nervous

system23,80013,45010,35016,7009,6207,080Endocrine

system59,25015,61043,6403,0101,4401,570Thyroid56,87014,40042,4702,0109201,090Other

endocrine2,3801,2101,1701,000520480Lymphoma80,50044,73035,77021,21012,0809,130Hodgkin

lymphoma8,2604,6503,6101,070630440Non-Hodgkin

lymphoma72,24040,08032,16020,14011,4508,690Myeloma30,28017,49012,79012,5906,6605,930Leukemia62,13036,29025,84024,50014,30010,200Acute

lymphocytic

leukemia5,9703,3502,6201,440800640Chronic

lymphocytic

leukemia20,11012,3107,8004,6602,8801,780Acute

myeloid

leukemia21,38011,9609,42010,5906,1104,480Chronic

myeloid

leukemia8,9505,2303,7201,080610470Other

leukemia?5,7203,4402,2806,7303,9002,830Other

&

unspecified

primary

sites?33,77018,23015,54042,27023,66018,610TABLE

2.EstimatedNewCasesforSelectedCancersbyState,2021*STATEALL

CASESFEMALE

BREASTUTERINECERVIXCOLON

&

RECTUMUTERINE

CORPUSLUNG

& MELANOMA

LEUKEMIA

BRONCHUS

OF

THE

SKINNON-HODGKIN

LYMPHOMAPROSTATEURINARY

BLADDER*Rounded

to

the

nearest

10;

excludes

basal

cell

and

squamous

cell

skin

cancers

and

in

situ

carcinomas

except

urinary

bladder.?Estimate

is

fewer

than

50

cases.Note:

These

are

model-based

estimates

that

should

be

interpreted

with

caution.

State

estimates

may

not

add

to

US

total

due

to

rounding

and

the

exclusion

ofstates

with

fewer

than

50

cases.CACANCERJCLIN2021;67:7–30VOLUME67_NUMBER1_JANUARY/FEBRUARY20219Alabama26,1603,9602102,2107207703,8801,3209602,4101,090Alaska3,600500?280120100450130140320150Arizona35,8104,8702402,6301,1101,1703,9402,0501,4102,9901,670Arkansas16,0402,1001501,3904805802,6206106601,440710California176,14027,9801,49013,8906,2806,74018,2709,1807,88014,5207,500Colorado24,3303,8401701,7708909602,4201,5901,0902,8801,120Connecticut21,9003,4201201,6008908002,5409709502,1401,220Delaware5,660840?440200180850340250590270Dist.

of

Columbia3,070520?2101109031012011038090Florida124,74018,1701,0409,9304,2305,07019,0007,6105,41012,8306,430Georgia48,8507,8204104,0401,5101,5506,6102,9301,8905,4101,880Hawaii6,5401,12050660290210700460260500240Idaho7,3101,08050610290310980550370870480Illinois64,72010,2105205,5802,7402,3508,6002,8102,7506,4103,070Indiana36,4405,1402903,0801,3701,2805,5401,7301,5603,4101,710Iowa17,2302,4001001,5107007602,4101,0208001,430870Kansas14,4002,1801101,1705405601,8808306301,320640Kentucky26,2203,5902102,2508301,0504,8301,4101,0702,0501,190Louisiana24,2203,3202302,1506307703,5109609902,620980Maine8,7501,350?7103803101,380450380720570Maryland31,8205,2502202,4301,2001,0004,0201,7001,2603,4001,390Massachusetts37,1305,9402002,7601,6001,2204,8901,8901,6303,9302,050Michigan57,6008,1603704,6602,3202,0108,1902,7802,4805,3503,050Minnesota30,0004,2301402,1701,0801,2903,6201,3301,3702,7501,320Mississippi17,2902,3401401,5204105302,5705605601,380620Missouri34,4004,9302402,8601,2501,2105,6201,6901,4202,9901,610Montana6,140900?500220260750400280750350Nebraska9,5201,450608403803801,220490440840450Nevada13,8402,0101101,1604004601,6805605601,190700New

Hampshire8,6701,260?6203502901,150470340770520New

Jersey51,6807,8903604,0002,1001,9905,5402,7902,3805,1802,560New

Mexico10,0401,410808003503701,010490400960390New

York107,53016,3108108,4904,4204,32012,7004,9004,76010,0605,410North

Carolina56,9008,5804004,2901,8101,9707,9403,0602,1805,5602,500North

Dakota4,180550?330140150480210170360200Ohio68,1809,4304605,5102,6702,27010,6603,1402,8605,8403,360Oklahoma18,7102,6901701,6105907603,0507908401,700860Oregon21,7803,4501401,6208707302,9001,5809702,0601,070Pennsylvania77,71011,3005206,3003,2702,8009,9304,1403,3107,3204,190Rhode

Island5,870930?480250190860270260780350South

Carolina28,6804,2502102,2708909904,3201,7401,1203,2501,260South

Dakota4,920690?410180200590240210430240Tennessee37,0805,5102903,0801,0901,3005,8301,8401,4902,8301,620Texas116,20017,0601,3009,6903,8904,55014,5604,2405,25012,5504,270Utah10,9901,460707404004608509504901,240430Vermont4,000580?280160110510220170380240Virginia42,7707,0202803,2601,4901,3805,4002,5001,7203,9501,870Washington35,5605,9502502,7201,3801,3904,3902,5901,7403,5801,830West

Virginia11,6901,520801,0504504101,980700480840610Wisconsin32,9904,8501802,6501,3601,4604,2801,5901,3803,5701,670Wyoming2,780410?220100100320190120320150United

States1,688,780252,71012,820135,43061,38062,130222,50087,11072,240161,36079,030Results(SEER)Programsince1973andbytheCentersforDiseaseControlandPrevention’s(CDC’s)NationalPro-gramofCancerRegistries(NPCR)since1995.TheSEERprogramistheonlysourceforlong-termpopulation-basedincidencedata.Long-termincidenceandsurvivaltrends(1975-2021)werebasedondatafromthe9oldestSEERareas(Connecticut,Hawaii,Iowa,NewMexico,Utah,andthemetropolitanareasofAtlanta,Detroit,SanFrancisco-Oakland,andSeattle-PugetSound),representingapproxi-mately9%oftheUSpopulation.5,6Thelifetimeprobabilityofdevelopingcancer,stagedistribution,andsurvivalbystageandforchildrenandadolescentswerebasedondatafromall18SEERregistries(theSEER9registriesplusAlaskaNatives,California,Georgia,Kentucky,Louisiana,andNewJersey),covering28%oftheUSpopulation.7TheprobabilityofdevelopingcancerwascalculatedusingNCI’sDevCansoftware(version6.7.4).8SomeofthestatisticalinformationpresentedhereinwasadaptedfromdatapreviouslypublishedintheSEERCancerStatisticsReview1975-2021.9NAACCRcompilesandreportsincidencedatafrom1995onwardforcancerregistriesthatparticipateintheSEERprogramand/ortheNPCR.Thesedataapproach100%coverageoftheUSpopulationinthemostrecenttimeperiodandwerethesourcefortheprojectednewcancercasesin2021andincidenceratesbystateandrace/ethnicity.10,11Someoftheincidencedatapresentedhereinwerepreviouslypublishedinvolumes1and2ofCancerinNorthAmerica:2021-2021.12,13AllcancercaseswereclassifiedaccordingtotheInterna-tionalClassificationofDiseasesforOncologyexceptchildhoodandadolescentcancers,whichwereclassifiedaccordingtotheInternationalClassificationofChildhoodCancer(ICCC).14,15CausesofdeathwereclassifiedaccordingtotheInternationalClassificationofDiseases.16AllincidenceFIGURE1.TenLeadingCancerTypesfortheEstimatedNewCancerCasesandDeathsbySex,UnitedStates,2021.Estimatesareroundedtothenearest10andcasesexcludebasalcellandsquamouscellskincancersandinsitucarcinomaexcepturinarybladder.CancerStatistics,202110CA:

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3.EstimatedDeathsforSelectedCancersbyState,2021*STATEALL

SITESBRAIN

&

OTHER

NERVOUS

SYSTEMFEMALE

COLON

&BREASTRECTUM

LEUKEMIALIVER

&INTRAHEPATICLUNG

&

NON-HODGKIN

BILE

DUCT BRONCHUS

LYMPHOMAOVARYPANCREAS

PROSTATE*Rounded

to

the

nearest

10.?Estimate

is

fewer

than

50

deaths.Note:

These

are

model-based

estimates

that

should

be

interpreted

with

caution.

State

estimates

may

not

add

to

US

total

due

to

rounding

and

the

exclusion

ofstates

with

fewer

than

50

deaths.CACANCERJCLIN2021;67:7–30VOLUME67_NUMBER1_JANUARY/FEBRUARY202111Alabama10,5303206509404204703,200320250710450Alaska1,070?70100?60280??8050Arizona12,0503808101,0205506602,820430310930600Arkansas6,8001804206002502802,160210150430260California59,4001,8304,4405,2402,6103,75012,0002,1401,5304,5103,130Colorado7,8402705706603403801,640260240580450Connecticut6,6101904304503003001,630230170490310Delaware2,0505013015070110590705015090Dist.

of

Columbia1,060?10090?90220??10070Florida43,8701,2502,9103,6201,8002,02011,7901,5109703,1702,050Georgia17,2804901,3201,5406208504,7205104201,160780Hawaii2,520501402409017059010050220100Idaho2,90010019025011012068011070230170Illinois24,0406101,6802,0309901,0406,4707905701,6501,040Indiana13,5903508601,1105505204,030450300900550Iowa6,4601903805702602401,740240150440280Kansas5,4401703304702602301,500180120400230Kentucky10,4002505908303904003,560330200640340Louisiana9,2402206208303205202,610300170700370Maine3,26010017022013012096011060220140Maryland10,6502808208604105602,630340260840470Massachusetts12,6203507609105406703,270410320950550Michigan21,0505701,4101,6808308605,6507605001,560830Minnesota9,8602806107604803902,450390230710470Mississippi6,5602204206502303001,940170110460280Missouri14,3803308601,0705505804,030390250910500Montana2,0306013017080805107050140120Nebraska3,52011023033015013090012070250180Nevada5,2001503805002002301,400160120360270New

Hampshire2,71080170200110907608060200120New

Jersey15,8804201,2501,4206407003,7605104101,270700New

Mexico3,63090250340150220760110100250200New

York35,9609102,4102,8701,4601,6808,6601,2109102,7501,560North

Carolina20,0206001,3601,5307609405,8306204401,350840North

Dakota1,290?7012060?340??9070Ohio25,4306401,6902,1309909907,3008605701,8101,020Oklahoma8,2002005307103403602,450270200520350Oregon8,1402605206603204402,030290230580410Pennsylvania28,5107001,9002,3901,2101,2207,4201,0106902,1101,200Rhode

Island2,1605012017090110610605014090South

Carolina10,3202607008303804402,920300230710460South

Dakota1,66060110160906045050?11070Tennessee14,8303809201,2205706704,590470310950550Texas40,2601,1002,8303,7001,6902,6209,5401,3809202,7801,650Utah3,180130270260170150460120100270210Vermont1,40050701005050400??11070Virginia14,8703901,0601,1905506703,8104903701,080650Washington12,7204108509705206803,100460330920620West

Virginia4,7801102804301901701,45016090280160Wisconsin11,7103607408805404403,070420220870570Wyoming960?608060?220??70?United

States600,92016,70040,61050,26024,50028,920155,87020,14014,08043,09026,730anddeathrateswereage-standardizedtothe2000USstan-dardpopulationandexpressedper100,000population,ascalculatedbyNCI’sSEER*Statsoftware(version8.3.2).17TheannualpercentchangeinrateswasquantifiedusingNCI’sJoinpointRegressionProgram(version).18Wheneverpossible,cancerincidenceratespresentedinthisreportwereadjustedfordelaysinreporting,whichoccurbecauseofalagincasecaptureordatacorrections.Delayadjustmenthasthelargesteffectonthemostrecentyearsofdataforcancersthatarefrequentlydiagnosedinoutpatientsettings(eg,melanoma,leukemia,andprostatecancer)andprovidesamoreaccurateportrayalofthecancerburdeninthemostrecenttimeperiod.19Forexample,theleukemiaincidenceratefor2021is14%higherafteradjustingforreportingdelays.20ProjectedCancerCasesandDeathsin2021Themostrecentyearforwhichincidenceandmortalitydataareavailablelags2to4yearsbehindthecurrentyearduetothetimerequiredfordatacollection,compilation,qualitycontrol,anddissemination.Therefore,weprojectedthenumbersofnewcancercasesanddeathsintheUnitedStatesin2021toprovideanestimateofthecontemporarycancerburden.Thenumberofinvasivecancercaseswasestimatedusinga3-stepspatio-temporalmodelbasedonhigh-qualityincidencedatafrom49statesandtheDistrictofColumbiarepresentingapproximately95%populationcoverage(datawerelackingforallyearsforMinnesotaandforsomeyearsforotherstates).First,completeincidencecountswereesti-matedforeachcounty(orhealthserviceareaforrarecancers)from1999through2021usinggeographicvariationsinsoci-odemographicandlifestylefactors,medicalsettings,andcancerscreeningbehaviorsaspredictorsofincidence.21Thenthesecountswereadjustedfordelaysincancerreportingusingregistry-specificorcombinedNAACCRdelayratiosandaggregatedtoobtainnational-andstate-levelcountsforeachyear.Finally,atemporalprojectionmethod(thevectorautoregressivemodel)wasappliedtoall15yearsofdatatoestimatecountsfor2021.Thismethodcannotestimatenumbersofbasalcellorsquamouscellskincancersbecausedataontheoccurrenceofthesecancersarenotrequiredtobereportedtocancerregistries.Forcompletedetailsofthecaseprojectionmethodology,pleaserefertoZhuetal.22Newcasesoffemalebreastcarcinomainsituandmelano-mainsitudiagnosedin2021wereestimatedbyfirstapproxi-matingthenumberofcasesoccurringannuallyfrom2004through2021basedonage-specificNAACCRincidencerates(datafrom46statesandtheDistrictofColumbiawithhigh-qualitydataeveryyear)andUSpopulationestimatesprovidedinSEER*Stat.Theaverageannualpercentchangeincasecountsfrom2004through2021generatedbythejoinpointregressionmodelwasthenusedtoprojectcasesto2021.Theestimatesforinsitucaseswerenotadjustedforreportingdelays.Thenumberofcancerdeathsexpectedtooccurin2021wasestimatedbasedonthemostrecentjoinpoint-generatedannualpercentchangeinreportednumbersofcancerdeathsfrom2000through2021atthestateandnationallevelsasreportedtotheNCHS.Forthecompletedetailsofthismethodology,pleaserefertoChenetal.23OtherStatisticsThenumberofcancerdeathsavertedinmenandwomenduetothereductioninoverallcancerdeathrateswasestimatedbysubtractingthenumberofrecordeddeathsfromthenumberthatwouldhavebeenexpectedifcancerdeathrateshadremainedattheirpeak.Theexpectednumberofdeathswasestimatedbyapplyingthe5-yearage-specificcancerdeathratesinthepeakyearforage-standardizedcancerdeathrates(1990inmenand1991inwomen)tothecorrespondingage-specificpopulationsinsubsequentyearsthrough2021.Thedifferencebetweenthenumberofexpectedandrecordedcancerdeathsineachagegroupandcalendaryearwasthensummed.SelectedFindingsExpectedNumbersofNewCancerCasesTable1presentstheestimatednumbersofnewcasesofinvasivecancerexpectedintheUnitedStatesin2021bysex.Theoverallestimateof1,688,780casesistheequiva-lentofmorethan4,600newcancerdiagnoseseachday.FIGURE2.TrendsinCancerIncidence(1975to2021)andDeathRates(1975to2021)bySex,UnitedStates.Ratesareageadjustedtothe2000USstandardpopulation.Incidenceratesalsoareadjustedfordelaysinreporting.CancerStatistics,202112CA:

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CliniciansInaddition,about63,410casesoffemalebreastcarcinomainsituand74,680casesofmelanomainsituareexpectedtobediagnosedin2021.TheestimatednumbersofnewcasesbystateforselectedcancersitesareshowninTable2.Figure1depictsthemostcommoncancersexpectedtooccurinmenandwomenin2021.Prostate,lungandbron-chus,andcolorectalcancersaccountfor42%ofallcasesinmen,withprostatecanceraloneaccountingforalmost1in5newdiagnoses.Forwomen,the3mostcommonlydiag-nosedcancersarebreast,lungandbronchus,andcolorec-tum,whichcollectivelyrepresentone-halfofallcases;breastcanceraloneisexpectedtoaccountfor30%ofallnewcancerdiagnosesinwomen.ExpectedNumbersofCancerDeathsAnestimated600,920Americanswilldiefromcancerin2021,correspondingtoabout1,650deathsperday(Table1).Themostcommoncausesofcancerdeatharecancersofthelungandbronchus,colorectum,andpros-tateinmenandlungandbronchus,breast,andcolorec-tuminwomen(Fig.1).These4cancersaccountfor46%ofallcancerdeaths,withmorethanone-quarter(26%)duetolungcancer.Table3providestheestimatednumbersofcancerdeathsin2021bystateforselectedcancersites.TrendsinCancerIncidenceFigure2illustrateslong-termtrendsincancerincidenceratesforallcancerscombinedbysex.Cancerincidencepat-ternsreflecttrendsinbehaviorsassociatedwithcancerriskandchangesinmedicalpractice,suchastheintroductionofscreening.Thevolatilityinincidenceformalescomparedwithfemalesreflectsrapidchangesinprostatecancerinci-dence,whichspikedinthelate1980sandearly1990s(Fig.3)duetoasurgeinthedetectionofasymptomaticdiseaseasaresultofwidespreadprostate-specificantigen(PSA)testing.24Overthepastdecadeofdata,theoverallcancerincidencerateinmendeclinedbyabout2%peryear,withthepaceacceleratinginmorerecentyears(Table4).Thistrendreflectslargecontinuingdeclinesforcancersofthelungandcolorectum,inadditiontoasharpreductioninprostatecancerincidenceofmorethan10%annuallyfrom2021to2021.ThisdropisattributedtodecreasedPSAtestinginthewakeofUSPreventiveServicesTaskForcerecommendationsagainstroutineuseofthetesttoscreenforprostatecancerbecauseofgrowingconcernsaboutoverdiagnosisandovertreatment.25,26Theeffectofreducedscreeningontheoccurrenceofadvanceddiseaseisbeingwatchedclosely.Incidenceratesfordistantstagedis-ease,whichaccountedfor4%ofdiagnosesduring2006to2021(Fig.4),havebeenstablesincethemid-2000sfollow-ingatleastadecadeofdecline.6FIGURE3.TrendsinIncidenceRatesforSelectedCancersbySex,UnitedStates,1975to2021.Ratesareageadjustedtothe2000USstandardpopulationandadjustedfordelaysinreporting.*Includesintrahepaticbileduct.CACANCERJCLIN2021;67:7–30VOLUME67_NUMBER1_JANUARY/