Cancer burden in the United States—a review
The cancer burden in the United States is substantial, with more than 1.6 million new invasive cases of cancer (excluding non-melanoma skin cancers) and about 600,000 cancer deaths occurring each year. In this review, we provide a brief description of recent trends in cancer incidence, mortality, and survival; prevalence and trends in major potentially modifiable risk factors for cancer; uptake of recommended cancer screening tests; access to cancer treatment; and health insurance coverage in the United States. During the most recent 10 years of available data (2005–2014), overall cancer incidence rates declined by about 2% annually in men and were stable in women. The overall decline in the incidence rate among men has been largely driven by decreasing prostate, lung, and colorectal cancer rates; among women, declines in lung and colorectal cancer rates have been offset by increases in breast, corpus uteri, and thyroid cancer rates. The overall cancer death rate in the United States has declined 26% since peaking in 1991, and from 2006 to 2015 decreased annually by about 1.8% in men and 1.4% in women. Death rates continue to decline for many cancer types, including cancers of the colorectum, lung, prostate, and female breast, but are increasing for cancers of the liver and intrahepatic bile duct and corpus uteri. Cigarette smoking is the greatest contributor to cancer incidence and mortality in the United States—despite a substantial decline in prevalence—followed by excess body weight. Screening prevalence has substantially increased since 2000 for colorectal cancer but not for female breast or cervical cancer, and use of screening tests remain below public health targets. In addition, despite overall declines in cancer death rates in the United States, substantial disparities in progress against cancer persist by race/ethnicity, geographic location, and socioeconomic status. Comprehensive implementation of proven interventions to curb potentially modifiable risk factors, optimal participation in recommended cancer screening programs, and equitable access to preventive care and treatment could substantially reduce the cancer burden and disparities.