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Geographic Disparities in Cancer Incidence in the US Population Aged 20 to 49 Years, 2016–2020

GIS SNAPSHOTS — Volume 21 — May 9, 2024

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Figure A is a lollipop chart displaying age-adjusted incidence rates (per 100,000 population) for 8 site groups.

Geographic disparities in cancer incidence in the US population aged 20 to 49 years, 2016–2020. The most prevalent cancer site groups diagnosed among adults aged <50 years are female breast, female genital, male genital, digestive, lymphohematopoietic, endocrine, skin, and urinary. The incidence of early-onset cancers is not distributed evenly across the US. Differing geographic patterns emerge by cancer site group as measured by overall incidence rates, advanced-stage incidence rates, and recent temporal trends. Some states have significantly higher rates of early-onset cancer than the nation overall. In A, dark circles indicate a group of cancer sites; light circles indicate cancer sites within the group. The category Skin excludes basal cell and squamous cell carcinomas. In B, for the male genital group, data on cancer stage were not available for cancer of the testis. In C, shaded bars indicate 95% CIs, and the vertical dashed line indicates the reference group, the US, excluding Puerto Rico. Abbreviations: IRR, incident rate ratio; NOS, not otherwise specified. Data source: Centers for Disease Control and Prevention (1).Figure A is a lollipop chart displaying age-adjusted incidence rates (per 100,000 population) for 8 site groups.Figure B consists of a series of 8 maps that illustrate which states have higher incidence and/or advanced-stage incidence of cancer compared with the US overall. Each map corresponds to 1 of the 8 site groups. Figure C is a stratified forest plot demonstrating how each state compares to the US regarding overall incidence and advanced-stage incidence for all early-onset cancers. States whose 95% CIs do not cross 1 are considered significantly different from the overall US in cancer incidence.
Site Rate
Breast 75.1
Female genital system 29.0
Corpus and uterus, NOS 11.0
Cervix uteri 10.4
Ovary 5.7
Vulva 1.1
Other female genital organs 0.7
Vagina 0.2
Male genital system 17.4
Testis 11.0
Prostate 6.0
Penis 0.3
Other male genital organs 0.1
Digestive system 22.7
Colon excluding rectum 8.6
Rectum and rectosigmoid junction 5.2
Stomach 2.1
Pancreas 2.1
Liver and intrahepatic bile duct 1.3
Small intestine 1.0
Anus, anal canal, and anorectum 0.8
Esophagus 0.7
Other biliary 0.3
Gallbladder 0.2
Retroperitoneum 0.2
Other digestive organs 0.2
Peritoneum, omentum, and mesentery 0.1
Lymphohematopoietic 16.9
Non-Hodgkin lymphoma 6.8
Hodgkin lymphoma 3.2
Myeloid and monocytic leukemia 3.0
Lymphocytic leukemia 1.7
Myeloma 1.5
Kaposi sarcoma 0.4
Other leukemia 0.3
Endocrine system 16.5
Thyroid 16.1
Other endocrine including thymus 0.5
Skin excluding basal and squamous 12.3
Melanoma of the skin 11.7
Other nonepithelial skin 0.6
Urinary system 8.2
Kidney and renal pelvis 7.3
Urinary bladder 0.8
Ureter 0
Other urinary organs 0

Figure B consists of a series of 8 maps that illustrate which states have higher incidence and/or advanced-stage incidence of cancer compared with the US overall. Each map corresponds to 1 of the 8 site groups.

Geographic disparities in cancer incidence in the US population aged 20 to 49 years, 2016–2020. The most prevalent cancer site groups diagnosed among adults aged <50 years are female breast, female genital, male genital, digestive, lymphohematopoietic, endocrine, skin, and urinary. The incidence of early-onset cancers is not distributed evenly across the US. Differing geographic patterns emerge by cancer site group as measured by overall incidence rates, advanced-stage incidence rates, and recent temporal trends. Some states have significantly higher rates of early-onset cancer than the nation overall. In A, dark circles indicate a group of cancer sites; light circles indicate cancer sites within the group. The category Skin excludes basal cell and squamous cell carcinomas. In B, for the male genital group, data on cancer stage were not available for cancer of the testis. In C, shaded bars indicate 95% CIs, and the vertical dashed line indicates the reference group, the US, excluding Puerto Rico. Abbreviations: IRR, incident rate ratio; NOS, not otherwise specified. Data source: Centers for Disease Control and Prevention (1).Figure A is a lollipop chart displaying age-adjusted incidence rates (per 100,000 population) for 8 site groups.Figure B consists of a series of 8 maps that illustrate which states have higher incidence and/or advanced-stage incidence of cancer compared with the US overall. Each map corresponds to 1 of the 8 site groups. Figure C is a stratified forest plot demonstrating how each state compares to the US regarding overall incidence and advanced-stage incidence for all early-onset cancers. States whose 95% CIs do not cross 1 are considered significantly different from the overall US in cancer incidence.
Cancer site Rate Rising Falling Compared with US
High overall High advanced-stage Both high overall and advanced-stage
Breast 23.3 Georgia, Illinois, Wisconsin None Delaware, Illinois, Massachusetts, New Hampshire, Rhode Island Florida, Georgia, Louisiana Connecticut, Hawaii, Maryland, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, Wisconsin
Digestive 14.4 Illinois, Maryland, New York None Alabama, Oklahoma, Puerto Rico Pennsylvania, South Carolina Arkansas, Georgia, Hawaii, Indiana, Kentucky, Louisiana, Mississippi, Missouri, New York, North Carolina, Ohio, Tennessee, West Virginia
Lymphohematopoietic 11.0 Alabama Alaska, Connecticut, Florida, Georgia, Maine Puerto Rico Ohio Connecticut, Florida, Georgia, Kentucky, Louisiana, Maryland, New Jersey, New York, Pennsylvania
Endocrine 10.7 None Arizona, Arkansas, Georgia, Indiana, Massachusetts, Mississippi, North Carolina, Pennsylvania, Tennessee Delaware, Kansas, Kentucky, North Dakota, Ohio, Rhode Island, West Virginia, Wyoming California, Colorado, Idaho, Illinois, Oregon Connecticut, Iowa, Massachusetts, Nebraska, New Jersey, New Mexico, New York, Pennsylvania, Puerto Rico, South Dakota, Utah, Vermont
Female genital 9.1 None None Alabama, Mississippi, Ohio, South Dakota California, Georgia Arkansas, Florida, Hawaii, Indiana, Kentucky, Missouri, Oklahoma, Puerto Rico, Texas, West Virginia
Skin 7.8 None Connecticut, Pennsylvania, New Hampshire Alabama, Arizona, Arkansas, Georgia, Idaho, Illinois, Kansas, Maine, Montana, North Carolina, North Dakota, Oregon, South Dakota, Washington Colorado, Delaware, Florida, Missouri, Pennsylvania, Tennessee Indiana, Iowa, Kentucky, Michigan, Minnesota, Nebraska, New Hampshire, Ohio, Utah, Wisconsin
Male genital 5.8 Louisiana, Texas Hawaii Connecticut, Iowa, Michigan, Minnesota, Montana, New Jersey, Puerto Rico, Tennessee, Utah, Wisconsin Kentucky, Maryland, Mississippi, North Carolina Georgia, Illinois, Louisiana, New York
Urinary 5.1 New York, West Virginia Pennsylvania Alabama, Iowa, Kansas, New Mexico, Oklahoma, Pennsylvania, Tennessee None Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Ohio, Texas, West Virginia

Figure C is a stratified forest plot demonstrating how each state compares to the US regarding overall incidence and advanced-stage incidence for all early-onset cancers. States whose 95% CIs do not cross 1 are considered significantly different from the overall US in cancer incidence.

Geographic disparities in cancer incidence in the US population aged 20 to 49 years, 2016–2020. The most prevalent cancer site groups diagnosed among adults aged <50 years are female breast, female genital, male genital, digestive, lymphohematopoietic, endocrine, skin, and urinary. The incidence of early-onset cancers is not distributed evenly across the US. Differing geographic patterns emerge by cancer site group as measured by overall incidence rates, advanced-stage incidence rates, and recent temporal trends. Some states have significantly higher rates of early-onset cancer than the nation overall. In A, dark circles indicate a group of cancer sites; light circles indicate cancer sites within the group. The category Skin excludes basal cell and squamous cell carcinomas. In B, for the male genital group, data on cancer stage were not available for cancer of the testis. In C, shaded bars indicate 95% CIs, and the vertical dashed line indicates the reference group, the US, excluding Puerto Rico. Abbreviations: IRR, incident rate ratio; NOS, not otherwise specified. Data source: Centers for Disease Control and Prevention (1).Figure A is a lollipop chart displaying age-adjusted incidence rates (per 100,000 population) for 8 site groups.Figure B consists of a series of 8 maps that illustrate which states have higher incidence and/or advanced-stage incidence of cancer compared with the US overall. Each map corresponds to 1 of the 8 site groups. Figure C is a stratified forest plot demonstrating how each state compares to the US regarding overall incidence and advanced-stage incidence for all early-onset cancers. States whose 95% CIs do not cross 1 are considered significantly different from the overall US in cancer incidence.
Order State Overall incidence rate ratio (95% CI) Advanced-stage incidence rate ratio (95% CI)
1 Kentucky 1.19 (1.17–1.21) 1.19 (1.16–1.22)
2 West Virginia 1.19 (1.16–1.22) 1.14 (1.10–1.19)
3 New York 1.12 (1.11–1.13) 1.11 (1.09–1.12)
4 Florida 1.05 (1.05–1.06) 1.16 (1.14–1.17)
5 Iowa 1.11 (1.09–1.13) 1.07 (1.04–1.11)
6 Pennsylvania 1.08 (1.07–1.09) 1.08 (1.03–1.10)
7 Louisiana 1.07 (1.05–1.09) 1.08 (1.06–1.11)
8 Ohio 1.07 (1.06–1.09) 1.07 (1.05–1.08)
9 Vermont 1.09 (1.04–1.14) 1.04 (0.96–1.11)
10 Maine 1.06 (1.03–1.10) 1.06 (1.01–1.11)
11 New Jersey 1.08 (1.06–1.09) 1.04 (1.02–1.06)
12 Delaware 1.06 (1.02–1.10) 1.04 (0.98–1.10)
13 Missouri 1.02 (1.01–1.04) 1.06 (1.04–1.08)
14 Nebraska 1.09 (1.06–1.12) 0.99 (0.95–1.04)
15 Arkansas 1.04 (1.02–1.07) 1.03 (1.00–1.07)
16 Georgia 1.02 (1.00–1.03) 1.06 (1.04–1.08)
17 Connecticut 1.04 (1.02–1.06) 1.04 (1.01–1.07)
18 North Carolina 1.02 (1.01–1.04) 1.05 (1.03–1.07)
19 Mississippi 1.02 (0.99–1.03) 1.04 (1.01–1.08)
20 Hawaii 1.04 (1.01–1.07) 1.01 (0.97–1.06)
21 Minnesota 1.09 (1.07–1.10) 0.97 (0.94–0.99)
22 Rhode Island 1.02 (0.98–1.05) 1.03 (0.97–1.09)
23 Indiana 1.02 (1.0–1.03) 1.03 (1.01–1.05)
24 South Dakota 1.04 (1.00–1.0) 1.00 (0.94–1.07)
25 Michigan 1.01 (1.00–1.02) 1.02 (1.00–1.04)
26 Wisconsin 1.02 (1.00–1.04) 1.01 (0.98–1.03)
27 Puerto Rico 1.12 (1.10–1.14) 0.92 (0.89–0.95)
28 Kansas 1.05 (1.03–1.08) 0.97 (0.94–1.00)
29 Illinois 1.02 (1.01–1.03) 1.00 (0.99–1.02)
30 Maryland 1.01 (1.00–1.03) 1.01 (1.00–1.03)
31 New Hampshire 1.04 (1.01–1.08) 0.97 (0.93–1.02)
32 Tennessee 1.01 (1.00–1.02) 1.00 (0.98–1.03)
33 North Dakota 1.03 (0.98–1.07) 0.98 (0.91–1.05)
34 Montana 1.03 (1.00–1.07) 0.96 (0.91–1.02)
35 Alabama 1.05 (1.03–1.06) 0.94 (0.92–0.97)
36 South Carolina 0.97 (0.96–0.99) 1.00 (0.97–1.02)
37 Idaho 0.98 (0.95–1.01) 0.98 (0.94–1.02)
38 Oklahoma 0.99 (0.97–1.01) 0.96 (0.93–0.99)
39 Utah 1.01 (0.99–1.03) 0.93 (0.90–0.96)
40 Massachusetts 0.99 (0.97–1.00) 0.94 (0.92–0.96)
41 Alaska 0.95 (0.91–0.99) 0.95 (0.89–1.02)
42 Washington 0.95 (0.94–0.96) 0.95 (0.93–0.97)
43 Oregon 0.93 (0.92–0.95) 0.93 (0.90–0.95)
44 Texas 0.92 (0.91–0.93) 0.92 (0.91–0.93)
45 California 0.90 (0.89–0.90) 0.92 (0.92–0.93)
46 District of Columbia 0.92 (0.88–0.96) 0.90 (0.84–0.97)
47 Virginia 0.92 (0.90–0.93) 0.89 (0.88–0.91)
48 Wyoming 0.93 (0.89–0.98) 0.85 (0.78–0.92)
49 Colorado 0.89 (0.88–0.90) 0.88 (0.86–0.90)
50 New Mexico 0.90 (0.87–0.92) 0.86 (0.83–0.90)
51 Arizona 0.87 (0.86–0.88) 0.80 (0.78–0.82)
52 Nevada 0.85 (0.83–0.88) 0.80 (0.77–0.83)

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