Annual Report to the Nation on the Status of Cancer, 1975-2011
Overview
The Annual Report to the Nation on the Status of Cancer, 1975-2011, is an update of rates for new cases, deaths and trends for the most common cancers in the United States. All rates in the report are per 100,000 people in the U.S. population.Experts from the North American Association of Central Cancer Registries (NAACCR), the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), and the National Cancer Institute (NCI) jointly issue the Annual Report to the Nation.
The latest report was published online March 30, 2015, in the Journal of the National Cancer Institute. Major findings from the report include the following:
Key Points
- The report highlights the period from 1975-2011 to provide the best perspective on long-term trends in cancer incidence (new cases) and mortality (death) rates for all races combined.
- Researchers found continued declining mortality rates for men, women, and children.
- The incidence rate of thyroid cancer is increasing among both men and women, as well as the mortality rate for liver cancer.
- The incidence rate of oral/oropharyngeal cancers is increasing among white men despite a decline in oral cancers that are more closely associated with tobacco use.
- With a focus on breast cancer, the researchers used comprehensive national data on hormone receptor (HR) and HER2 status to determine the incidence of the four major molecular subtypes of breast cancer by age, race/ethnicity, poverty level, and several other factors.
- Moreover, researchers found unique racial/ethnic group-specific patterns by age, poverty level, geography, and by specific breast tumor characteristics.
- Read the full report
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Mortality Highlights
The report showed continuing declines in cancer death rates for both men and women, for children, and for nearly all major cancer sites. The report also found that there has been a relatively consistent decline in overall cancer death rates since the early 1990s.
Specifically, cancer death rates decreased:
- Among men, by about 1.8 percent per year from 2002 through 2011
- Among women, by about 1.4 percent per year from 2002 through 2011
- Among children up to 19 years old, death rates have continued to mostly decrease since 1975
Incidence Highlights
Overall cancer incidence rates continued to decrease among men, remained stable among women, and increased among children. Cancers with the largest decreases in incidence from 2002 through 2011 among men were cancers of the colon and rectum, lung and bronchus, and prostate. Among women, the largest decreases were for cancers of the colon and rectum and for cervical cancer.The report also noted some trends that require greater evaluation:
- Incidence rates of thyroid and kidney cancers are increasing among both men and women. Increases in rates for new cases of thyroid and kidney cancers may be due to several factors, but no increase in mortality has been noted for these diseases.
- Incidence and mortality rates of liver cancer are increasing among both men and women. These increases may reflect, in part, increasing rates of hepatitis C and/or behavioral risk factors, such as alcohol abuse, for which there are opportunities for intervention.
- Unlike the declines in incidence of other tobacco-related cancers, incidence rates are increasing for oral/oropharyngeal cancers overall among white men. This may be associated with increasedHPV-associated oropharyngeal cancers, despite a decline in oral cancers that are more closely associated with tobacco use.
- Incidence and mortality rates are increasing for uterine cancer among white, black, and Asian Pacific Islander women, with the largest increase seen in black women. The cause of these increases is unknown.
Special Section: Breast Cancer Incidence by Molecular Subtype
In addition to reporting rates and trends for the most common cancers, this year’s report also includes a special section on breast cancer by molecular subtype. Breast cancer subtypes have major implications for determining treatment and may hold important clues to the origins of the disease. These subtypes are now being recorded by cancer registries across the nation, giving statisticians the ability to examine breast cancer rates based on clinically meaningful subtypes.There are four major molecular subtypes of breast cancer that are defined by whether they express hormone receptors (estrogen receptor and progesterone receptor) and whether they produce excess amounts of a protein called HER2. A hormone receptor (HR) is a cellular protein that binds a specific hormone. Many changes take place in a cell after a hormone binds to its receptor.
The four molecular subtypes of breast cancer have different combinations of expression of HR and HER2, as follows:
- Luminal A (HR+/HER2-)
- Luminal B (HR+/HER2+)
- HER2-enriched (HR-/HER2+)
- Triple negative (HR-/HER2-)
For the first time, comprehensive national data on HR and HER2 status were available to determine the incidence of the four breast cancer subtypes by age, race/ethnicity, poverty level, and several other factors.
Data on HR status and the overexpression of HER2 are detailed in the latest Annual Report to the Nation.
Treatment Implications Based on Breast Cancer Subtype
There are a number of drugs currently available, including tamoxifen and trastuzumab, which are used to treat different types of breast cancer.- Breast cancers that are HR+ can respond to drugs such as tamoxifen, which can also be used as a prevention agent for women at high risk of developing the disease based on family history and other factors.
- Breast cancers that are HER2+ may respond to trastuzumab, which was one of the first types of targeted cancer drugs developed. It has been shown to improve overall survival in late-stage disease by many months. In early stage breast cancer, it reduces the risk of cancer returning after surgery and also can reduce the risk of death.
Breast Cancer Rates by Racial and Ethnic Groups
Rates of HR+/HER2- breast cancer, the least aggressive subtype, were highest among non-Hispanic whites, aligning with previously reported findings.Rates of HR+/HER2- breast cancer decreased with increasing levels of poverty for every racial and ethnic group.
Also consistent with prior studies, non-Hispanic blacks had higher incidence rates of the most aggressive breast cancer subtype, triple negative, than other racial/ethnic groups.
This subtype of breast cancer is called triple negative because women with triple negative breast cancer have breast cancer cells that:
- Do not have estrogen receptors (estrogen receptor negative)
- Do not have progesterone receptors (progesterone receptor negative)
- Do not have excess amounts of HER2 protein (HER2 negative)
By helping researchers better understand the distribution of the molecular subtypes, the new data will answer several very important questions. For example, the new analysis demonstrates that some of the racial/ethnic disparities that have been observed in overall breast cancer incidence and survival reflect differences in the degree to which subtypes occur in racial/ethnic groups.
The findings are also important for patients. Treatment has long been determined by subtype, but women are not always aware of their subtype. As women with breast cancer become more familiar with the concept of breast cancer subtypes, they will be better able to understand what is guiding their treatment and the implications for their health outcomes based on their breast cancer subtype.
About the Report
This latest Annual Report to the Nation highlights the period from 1975-2011 to provide the best perspective on long-term trends in cancer death rates among all races combined. The period from 2007-2011 was used for describing the U.S. burden of cancer (rates), and the period from 2002-2011 was used for describing trends in cancer incidence and death rates for five major racial and ethnic groups. Finally, the period from 1992-2011 was chosen to provide the best perspective on long-term incidence trends.Cancer incidence is determined by sample populations across the United States and then extrapolated to the entire population; whereas cancer mortality is tracked similarly, it can also be confirmed by case reports via death certificates. The collection of these reports from individual clinics or physicians can take several years, and the data must be carefully validated, leading to a lag time of several years between collection and dissemination via the Annual Report to the Nation.
- Posted: March 30, 2015
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