Surveillance for Cancers Associated with Tobacco Use — United States, 2010–2014

Surveillance Summaries / November 2, 2018 / 67(12);1–42

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M. Shayne Gallaway, PhD1,2; S. Jane Henley, MSPH1; C. Brooke Steele, DO1; Behnoosh Momin, DrPH1; Cheryll C. Thomas, MSPH1; Ahmed Jamal, MBBS3; Katrina F. Trivers, PhD3; Simple D. Singh, MD1; Sherri L. Stewart, PhD1 (View author affiliations)

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Abstract

Problem/Condition: Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.

Period Covered: 2010–2014.

Description of System: Cancer incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010–2014 and trends in annual age-adjusted incidence rates for 2010–2014. These cancer incidence data cover approximately 99% of the U.S. population. This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.

Results: During 2010–2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010–2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).

Interpretation: Although tobacco-associated cancer incidence decreased overall during 2010–2014, the incidence remains high in several states and subgroups, including among men, whites, blacks, non-Hispanics, and persons in nonmetropolitan counties. These disproportionately high rates of tobacco-related cancer incidence reflect overall demographic patterns of cancer incidence in the United States and also reflect patterns of tobacco use.

Public Health Action: Tobacco-associated cancer incidence can be reduced through prevention and control of tobacco use and comprehensive cancer-control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately affected by cancer. Ongoing surveillance to monitor cancer incidence can identify populations with a high incidence of tobacco-associated cancers and evaluate the effectiveness of tobacco control programs and policies. Implementation research can be conducted to achieve wider adoption of existing evidence-based cancer prevention and screening programs and tobacco control measures, especially to reach groups with the largest disparities in cancer rates.

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Introduction

Tobacco use is the leading cause of preventable disease and death in the United States, and approximately 480,000 deaths per year are caused by cigarette smoking and secondhand smoke exposure, or nearly one in five deaths annually (1,2). This includes approximately 41,000 deaths among adults and 400 deaths among infants resulting from secondhand smoke exposure (1,3,4). Tobacco smoke contains approximately 7,000 chemicals, including hundreds that are toxic. Approximately 70 of these chemicals can cause cancer (1,5). Forms of tobacco used in the United States include cigarettes, cigars, smokeless tobacco (i.e., chewing tobacco, snuff, dip, snus, and dissolvable tobacco), pipes, hookah (water pipes), bidis, and electronic cigarettes. In addition, smoking accounts for approximately $300 billion annually in direct health care expenditures ($170 billion) and lost productivity ($156 billion) (1,6).

The relation between smoking and lung cancer was first classified as causal in a landmark report released by the U.S. Surgeon General in 1964 (7). Subsequent Surgeon General reports have concluded that smoking causes acute myeloid leukemia (AML) and cancer in many other organ sites, including the cervix, esophagus, kidney and renal pelvis, larynx, trachea, lung and bronchus, oral cavity and pharynx (OCP), pancreas, stomach, and urinary bladder (2,7–18). Surgeon General reports also have concluded that the use of smokeless tobacco (i.e., snuff and chewing tobacco) causes cancers of the OCP and esophagus; cigar use causes cancers of the oral cavity, esophagus, larynx, and lung; and secondhand smoke exposure causes lung cancer (19). During 1999–2004, approximately 2.4 million new cases of tobacco-associated cancer were reported in the United States (19). In 2014, the Surgeon General expanded the list of cancer sites to include the liver, colon, and rectum (1). Approximately 30% of cancer deaths in the United States, including approximately 80% of lung cancer deaths, are attributable to tobacco (1,2,20–23). The International Agency for Research on Cancer has drawn conclusions (24–28) similar to the findings in the Surgeon General’s reports on tobacco and health.

When the first Surgeon General’s report on the health hazards of smoking was released in 1964, the prevalence of cigarette smoking in the United States was 42% but has since decreased (1). During 2005–2016, the prevalence of cigarette smoking among U.S. adults decreased from 20.9% to 15.5%, and the proportion of ever smokers (i.e., persons who have smoked at least 100 cigarettes during their lifetime) who quit increased from 50.8% to 59.0% (29). Despite this progress, the United States has not yet achieved the Healthy People 2020 target of reducing the proportion of U.S. adults aged ≥18 years who smoke cigarettes to ≤12.0% (1,30). Moreover, large disparities in tobacco use remain across populations defined by race/ethnicity, sociodemographic status, U.S. census region, disability or limitation status, sexual orientation, and presence of serious psychological distress (1,29,31).

Furthermore, increases have occurred in the use of other tobacco products and the use of multiple products among youths. In 2016, among current tobacco product users, 47.2% of high school students and 42.4% of middle school students used two or more tobacco products, and electronic cigarettes were the most commonly used tobacco products among high school (11.3%) and middle school (4.3%) students (32). Since 2000, the prevalence of smokeless tobacco use in the United States has increased among adult males (6.7%) (1,33) and males in high school (8.3%) (1,32).

At least half of persons who smoke cigarettes for 20 years are expected to die from a tobacco-related disease, although tobacco cessation significantly decreases this risk (34–36). Therefore, among the 37.8 million persons in the United States who were current cigarette smokers in 2016 (29), approximately 18.9 million persons might die prematurely from a tobacco-related disease, including 6 million from cancer. Many tobacco-associated cancers could be prevented by population-level reduction of tobacco use through sustained, comprehensive state tobacco control programs. Proven population-based interventions, including increased tobacco prices, comprehensive smoke-free laws, antitobacco mass media campaigns, and barrier-free access to cessation assistance are critical to reduce cigarette smoking and smoking-related disease and deaths among U.S. adults (29). To help evaluate the effectiveness of tobacco control programs and policies and identify populations at greatest risk for developing cancers associated with tobacco use, ongoing surveillance of these cancers is essential.

This report describes the incidence of tobacco-associated cancers in the United States by cancer type, demographic and tumor characteristics, and state and U.S. census region. In addition, recent trends in cancer incidence are described. Cancer incidence data enable public health professionals to more effectively identify needs for cancer prevention and control at the national, state, and local levels (37–39). These data can be used to develop public health actions to reduce disparities in cancer outcomes (40) and to help measure the effectiveness of state-level tobacco control strategies such as tobacco-price increase implementation and smoke-free laws (41).

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Methods

To describe the incidence of tobacco-associated cancers in the United States, cancer incidence data from CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) program (39) were analyzed. Each year, NPCR- and SEER-funded central registries submit data on cancer diagnosed during the most recent year to the respective program. Rigorous quality-control edits, data completeness evaluations, and data quality assessment are performed on all data, and a registry’s data must meet multiple criteria (i.e., case ascertainment, missing information, and required fields) to be included in U.S. Cancer Statistics. The average annual age-adjusted rates and trends in rates for the most recent 5-year period with available data (2010–2014) are presented and cover 100% of the U.S. population. Combined data from the NPCR and SEER programs provide the best source of information on population-based cancer incidence for the United States (42).

Incidence Data

Data on new cases of cancer diagnosed during 2010–2014 were obtained from 51 population-based cancer registries affiliated with NPCR and SEER programs in each state, the District of Columbia (DC), and Puerto Rico. Data from all registries except Nevada met U.S. Cancer Statistics publication criteria (43) for all years during 2010–2014. Data for Nevada were excluded from all analyses. Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses. Cases were first classified by anatomic site according to the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) (44), and cases with hematopoietic histologies were classified further using the 2008 WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (45). Only cases of invasive cancer were included for all analyses, except for urinary bladder cancer, for which in situ tumors also were included.

Tobacco-associated cancers were defined as those classified by the U.S. Surgeon General as causally related to cigarette smoking (1). These include AML (ICD-O-3 histology codes: 9840, 9861, 9865–9867, 9869, 9871–9874, 9895–9898, 9910–9911, and 9920) and cancers of the OCP (C00.0–C14.8); esophagus (C15.0–C15.9); stomach (C16.0–16.9); colon and rectum (C18.0–20.9 and C26.0); liver (C22.0); pancreas (C25.0–25.9); larynx (C32.0–32.9); trachea, lung, and bronchus (C33.9–34.9); cervix (C53.0–53.9); kidney and renal pelvis (C64.9–65.9); and urinary bladder (C67.0–67.9). Anatomic sites were restricted to cancers with histology codes 8000–9049, 9056–9139, and 9141–9589 (excluding mesothelioma, Kaposi sarcoma, and hematopoietic cancers). Because information on tobacco use was not routinely collected by all cancer registries, cases of all cancer classified as causal by the U.S. Surgeon General (1) are reported. Therefore, cases of cancer included in this report might or might not be in persons who used tobacco.

Demographic and Tumor Characteristics

Incidence rates were estimated by several demographic characteristics including sex, age, race/ethnicity, and U.S. census region. Age was categorized as <40, 40–49, 50–59, 60–69, 70–79, and ≥80 years. Information about race/ethnicity was collected from medical records; race was classified as white, black, American Indian/Alaska Native (AI/AN), and Asian/Pacific Islander (A/PI) and ethnicity as Hispanic or non-Hispanic. Cases among persons with other or unknown race (2%) or unknown ethnicity (2%) were included in overall rates but were not included as separate categories because population denominators were not available. U.S. census regions included the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont); Midwest (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin); South (Alabama, Arkansas, DC, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia); and West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, New Mexico, Oregon, Utah, Washington, and Wyoming).

For some cancer sites, several tumor characteristics are described, including histology, anatomic subsite (i.e., a specific location within a cancer site, such as the lip [subsite] for OCP [site]), and stage at diagnosis. Histologic groups for each cancer site were determined by incidence or clinical relevance. SEER Summary Stage 2000 was used to characterize stage at diagnosis as localized (cancer that is confined to the primary site), regional (cancer that has spread directly beyond the primary site or to regional lymph nodes), distant (cancer that has spread to other organs), or unknown stage using clinical and pathologic tumor characteristics, such as tumor size, depth of invasion and extension to regional or distant tissues, involvement of regional lymph nodes, and distant metastases (https://seer.cancer.gov/tools/ssm). Analyses by tumor characteristics excluded cases that were reported only by death certificate or autopsy and cases that were not microscopically confirmed (except for liver cancer because a large percentage of these cancers [29%] were confirmed by radiography).

Statistical Analysis

Population estimates for incidence rate denominators were a modification of annual county population estimates by age, sex, bridged race, and ethnicity produced by the U.S. Census Bureau in collaboration with CDC and with support from the National Cancer Institute (https://seer.cancer.gov/popdata). Incidence rates per 100,000 population were age adjusted to the 2000 U.S. standard population; 95% confidence intervals were calculated as modified gamma intervals (46) and are presented to allow for informal comparison among rates, without defining a referent group. Although using the overlap between confidence intervals to determine significance is conservative, the confidence intervals provide a measure of the variability in the rates and perspective for making comparisons. Trends in age-adjusted incidence rates of invasive cancer were examined (by site and sex [men, women, and combined]), and the annual percentage change (APC) was used to quantify changes in rates during 2010–2014 by using least-squares regression. A t-test was used to determine whether an APC was significantly different from zero. The APC and associated p value corresponds to the overall increasing or decreasing trends observed during this time. Rates were considered to increase if the APC >0 (p<0.05) and to decrease if the APC <0 (p<0.05); otherwise, rates were considered stable. State-specific age-adjusted tobacco-associated cancer incidence rates were mapped using quartiles as cut points.

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Results

Lung Cancer

A total of 1,070,504 new cases (61.3 per 100,000 persons) of cancers of the lung, bronchus, and trachea (lung cancer) were reported in the United States during 2010–2014 (Table 1). Incidence rates were substantially higher among men (72.7) than among women (52.7). Rates increased with increasing age and peaked among persons aged 70–79 years (390.0). Among men, blacks had the highest rates (85.9), followed by whites (72.4), AI/ANs (52.2), and A/PIs (45.1). Among women, whites had the highest rates (54.3), followed by blacks (49.2), AI/ANs (39.0), and A/PIs (27.9). Rates were two times higher among non-Hispanics than among Hispanics (64.1 versus 31.9, respectively). Among those with known tumor characteristics (88.1%), approximately 81% of all lung cancer cases were non–small cell carcinomas. Adenocarcinoma was the most common histologic subtype, although women had greater percentages of adenocarcinomas than men (52.4% and 43.2%, respectively). Men had greater percentages of squamous cell carcinoma than women (28.9% and 19.4%, respectively). More than half (52.6%) of lung cancer cases were diagnosed at the distant stage. During 2010–2014, lung cancer incidence rates were higher in nonmetropolitan counties (69.4) than in metropolitan counties (59.8). Among men, rates were highest in the South (80.8) and lowest in the West (53.5). Among women, rates were highest in the Midwest (57.4) and lowest in the West (42.7). Kentucky and West Virginia had some of the highest rates both among men (98.8–116.3) and women (66.3–79.7) (Figures 1 and 2).

Laryngeal Cancer

A total of 62,479 new cases (3.5 per 100,000 persons) of laryngeal cancer were reported in the United States during 2010–2014 (Table 2). Incidence rates were substantially higher among men (6.0) than among women (1.3). Rates increased with increasing age and peaked among persons aged 70–79 years (16.2). Among men, blacks had the highest rates (8.5), followed by whites (5.9), AI/ANs (3.6), and A/PIs (2.2). Rates were higher among non-Hispanics than among Hispanics (3.6 and 2.5, respectively). Among those with known tumor characteristics (97.1%), almost all (96.9%) laryngeal cancers were squamous cell carcinomas. The majority (53.6%) were diagnosed at a localized stage; however, a smaller percentage of localized cases occurred among women (47.1%) than men (55.3%). Women had a greater percentage of regional stage laryngeal cancer diagnoses than men (32.2% and 22.0%, respectively), whereas men had slightly greater percentages of distant stage diagnoses than women (17.9% for men and 16.5% for women). During 2010–2014, laryngeal cancer incidence rates were higher in nonmetropolitan counties (4.2) than in metropolitan counties (3.3). Among men, rates were highest in the South region of the United States (6.8) and lowest in the West (4.0). Among women, rates were similar in the South, Midwest, and Northeast (1.4–1.6) and were lower in the West (0.8). Kentucky, Louisiana, Mississippi, and West Virginia had some of the highest rates both among men (8.3–9.4) and women (1.9–2.6) (Figures 3 and 4).

Oral Cavity and Pharyngeal Cancer

A total of 204,537 new cases (11.5 per 100,000 persons) of OCP cancer were reported in the United States during 2010–2014 (Table 3). Incidence rates were substantially higher among men (17.4) than among women (6.4). Rates increased with age and peaked among men aged 70–79 years (63.6) and women aged ≥80 years (29.4). Among men, whites had the highest rates (17.8), followed by blacks (14.5), A/PIs (11.2), and AI/ANs (10.9). Among women, whites had the highest rates (6.5), followed by blacks (5.1), A/PIs (5.0), and AI/ANs (4.1). Rates were higher among non-Hispanics than Hispanics (12.0 and 7.1, respectively). The most common subsites were the oral cavity (7.9) and tonsils (3.6) among men and the oral cavity (3.5) and salivary glands (1.0) among women. Among those with known tumor characteristics (97.5%), the majority of OCP cancers were squamous cell carcinomas (85.9%). Most were diagnosed at the localized (31.7%) and regional (45.3%) stages. However, a greater percentage of cases were diagnosed at the localized stage among women than men (43.0% and 27.1%, respectively), and a greater percentage of cases were diagnosed at the regional stage among men than women (49.0% and 36.3%, respectively). During 2010–2014, OCP cancer incidence rates were higher in nonmetropolitan counties (12.5) than in metropolitan counties (11.3). Among men, rates were highest in the South region of the United States (18.6) and lowest in the West (15.5). Among women, rates of OCP cancers were similar in the South, Midwest, and Northeast (6.5) and were lower in the West (5.9). Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi, and Oklahoma had some of the highest rates both among men (19.9–21.8) and women (6.6–7.4) (Figures 5 and 6).

Esophageal Cancer

A total of 81,608 new cases (4.6 per 100,000 persons) of esophageal cancer were reported in the United States during 2010–2014 (Table 4). Incidence rates were higher among men (8.0) than among women (1.8). Rates increased with age and peaked among those aged ≥80 years (45.0 among men and 12.6 among women). Among men, rates were highest among whites (8.2), followed by blacks (7.1), AI/ANs (5.3), and A/PIs (3.7). Among women, rates were highest among blacks (2.3), followed by whites (1.7), AI/ANs (1.4), and A/PIs (1.0). Rates were higher among non-Hispanics (4.8) than Hispanics (2.8). Among those with known tumor characteristics (94.7%), approximately two thirds (65.4%) of all esophageal cancer cases were adenocarcinomas, and slightly less than one third were squamous cell carcinomas (29.6%). This pattern was consistent among men (71.1% adenocarcinomas and 24.2% squamous cell carcinomas). However, the pattern differed among women, who had greater percentages of squamous cell carcinomas (50.1%) than adenocarcinomas (43.9%). More esophageal cancers were diagnosed at regional (32.9%) and distant (36.6%) stages than at the localized stage (19.4%). Men had slightly smaller percentages of localized disease (18.9%) than women (21.6%) and slightly greater percentages of distant disease (38.3%) than women (30.1%). During 2010–2014, esophageal cancer rates were higher in nonmetropolitan counties (5.1) than in metropolitan counties (4.5). Rates among men were highest in the Midwest (8.9) and lowest in the West (6.9). Rates among women were highest in the Northeast and Midwest (1.9–2.0) and lowest in the South and West (1.6–1.7). Vermont, Maine, and New Hampshire had some of the highest rates among men (10.2–11.7) and women (2.3–2.4) (Figures 7 and 8).

Stomach Cancer

A total of 115,147 new cases (6.7 per 100,000 persons) of stomach cancer were reported in the United States during 2010–2014 (Table 5). Incidence rates were higher among men than among women (9.2 and 4.6, respectively). Rates increased with increasing age and peaked among adults aged ≥80 years (43.6). A/PIs had the highest rate (10.7), followed by blacks (10.3), AI/ANs (6.3), and whites (6.0). Hispanics had higher rates than non-Hispanics (9.9 and 6.3, respectively). Among those with known tumor characteristics (96.2%), approximately 86.3% of stomach cancers were adenocarcinomas; gastrointestinal stromal tumors accounted for 8.9%. Approximately 60% of stomach cancers were diagnosed at the regional (26.3%) or distant stage (33.6%), with women having greater percentages of localized disease than men (34.2% and 26.7%, respectively). During 2010–2014, stomach cancer rates were higher in metropolitan counties (6.9) than in nonmetropolitan counties (5.8). Among men, rates were highest in the Northeast (10.7) and lowest in the Midwest and South (8.7). Among women, rates were highest in the Northeast (5.2) and lowest in the Midwest (4.0). DC, Hawaii, New Jersey, New York, Puerto Rico, and Rhode Island had some of the highest rates among men and women (Figures 9 and 10).

Colon and Rectal Cancers

A total of 689,738 new cases (39.8 per 100,000 persons) of colon and rectal cancers were reported in the United States during 2010–2014 (Table 6). Incidence rates were substantially higher among men (45.8) than among women (34.8). Rates increased with age and peaked in women and men aged ≥80 years. Rates were highest among blacks (46.7), followed by whites (38.9), A/PIs (31.4), and AI/ANs (30.9). Non-Hispanics had higher rates than Hispanics (40.3 and 35.0, respectively). Among those with known tumor characteristics (96.1%), approximately two thirds (67.9%) of all colon and rectal cancers were adenocarcinomas; adenomas accounted for 17.5%. Approximately 60% of colon and rectal cancers were diagnosed at the regional or distant stage (55.8%), with similar distributions among women and men. During 2010–2014, colon and rectal cancer rates were slightly higher in nonmetropolitan counties (43.1) than in metropolitan counties (39.1). Rates among men and women were highest in the Midwest (48.0 and 36.4, respectively) and lowest in the West (41.4 and 32.0, respectively). Louisiana, Mississippi, and Kentucky had the highest rates both among men (56.0–59.3) and women (41.4–42.4) (Figures 11 and 12).

Liver Cancer

A total of 126,165 new cases (6.9 per 100,000 persons) of liver cancer were reported in the United States during 2010–2014 (Table 7). Incidence rates were higher among men than among women (11.0 and 3.3, respectively). Among persons aged <80 years, rates increased with increasing age and peaked among adults aged 70–79 years (27.2). Among men, rates were highest among A/PIs (18.5), followed by blacks (16.0), AI/ANs (12.8), and whites (9.8). Among women, rates were highest among A/PIs (6.6), followed by AI/ANs (5.6), blacks (4.3), and whites (2.9). Hispanics had higher rates than non-Hispanics (12.1 and 6.4, respectively). Among those with known tumor characteristics (94.2%), 86.4% of cases of liver cancer were hepatocellular carcinoma, and 7.2% were adenocarcinoma. Men had greater percentages of hepatocellular carcinomas than women (89.1% and 78.3%, respectively), whereas women had greater percentages of adenocarcinomas than men (12.4% and 5.5%, respectively). The majority of liver cancer cases (44.8%) were diagnosed at the localized stage. Women had greater percentages of localized stage liver cancer diagnoses than men (47.5% and 43.9%, respectively), whereas men had greater percentages of regional stage liver cancer diagnoses (28.0% and 24.2%, respectively). During 2010–2014, liver cancer rates were higher in metropolitan counties (7.2) than in nonmetropolitan counties (5.8). Among men and women, liver cancer cases were highest in the West (12.2 and 4.0, respectively) and lowest in the Midwest (8.8 and 2.8, respectively). California, DC, Hawaii, New Mexico, and Texas had some of the highest rates of liver cancer among men (13.6–19.5) and women (3.9–5.3) (Figures 13 and 14).

Pancreatic Cancer

A total of 218,919 new cases (12.5 per 100,000 persons) of pancreatic cancer were reported in the United States during 2010–2014 (Table 8). Incidence rates were higher among men than among women (14.2 and 11.0, respectively). Rates increased with increasing age and peaked among adults aged ≥80 years (93.1). Blacks had the highest rates (15.5), followed by whites (12.3), A/PIs (9.3), and AI/ANs (8.2). Non-Hispanics had higher rates than Hispanics (12.6 and 11.1, respectively). Among those with known tumor characteristics (81.9%), 79.7% of pancreatic cancer cases were adenocarcinomas, and 3.3% were mucinous adenocarcinomas. Ductal carcinomas accounted for 9.8% of pancreatic cancer diagnoses. Approximately half (51.5%) of pancreatic cancer cases were diagnosed at the distant stage; 33.8% of pancreatic cancers were diagnosed at the regional stage, and 10.5% were diagnosed at the localized stage. During 2010–2014, pancreatic cancer rates were slightly higher in metropolitan counties (12.6) than in nonmetropolitan counties (12.1). Among men and women, pancreatic cancer rates were highest in the Northeast (15.4 and 12.0, respectively) and lowest in the West (13.2 and 10.4, respectively). DC, Delaware, Hawaii, Louisiana, Mississippi, New Jersey, New York, and Pennsylvania had some of the highest rates of pancreatic cancer among men (15.4–18.0) and women (11.9–13.8) (Figures 15 and 16).

Kidney and Renal Pelvis Cancers

A total of 280,883 new cases (16.1 per 100,000 persons) of kidney and renal pelvis cancers were reported in the United States during 2010–2014 (Table 9). Incidence rates were almost twice as high among men (21.8) than among women (11.3). In persons aged <80 years, rates increased with increasing age and peaked among men and women aged 70–79 years (97.5 and 48.5, respectively). Blacks had the highest rates (17.6), followed by whites (16.3), AI/ANs (15.7), and A/PIs (7.5). Rates were similar among non-Hispanics (16.2) and Hispanics (16.0). Among those with known tumor characteristics (89.7%), the majority (87.9%) of cases of kidney cancer were renal cell carcinomas. Transitional cell carcinoma accounted for 6.7% of cases, and other adenocarcinomas accounted for 2.5% of cases. At diagnosis, 67.2% of cases of kidney cancer were at a localized stage. During 2010–2014, kidney cancer rates were higher in nonmetropolitan counties (17.1) than in metropolitan counties (15.9). Among men, kidney cancer incidence rates were highest in the South, Northeast, and Midwest (22.2–22.9) and lowest in the West (19.7). Among women, rates were highest in the Midwest (12.1) and lowest in the West (9.9). Kentucky, Louisiana, and Mississippi had some of the highest rates of kidney cancer among men (26.2–28.4) and women (14.4–15.8) (Figures 17 and 18).

Urinary Bladder Cancer

A total of 354,478 new urinary bladder cancer cases (20.5 per 100,000 persons) were reported in the United States during 2010–2014 (Table 10). Incidence rates were approximately four times higher among men (35.8) than among women (8.8). Rates increased with increasing age and peaked among adults aged ≥80 years (340.8 and 73.2 among men and women aged ≥80 years, respectively). Whites had the highest rates (21.8), followed by blacks (11.7), AI/ANs (9.0), and A/PIs (8.5). Rates were higher among non-Hispanics (21.3) than Hispanics (11.2). Among those with known tumor characteristics (97.8%), the majority of cases of urinary bladder cancer were transitional cell carcinomas (94.9%) and were diagnosed at a localized stage (85.6%). Among men during 2010–2014, urinary bladder cancer incidence rates were higher in nonmetropolitan counties (36.2) than in metropolitan counties (35.7). Among women, bladder cancer incidence rates did not differ between nonmetropolitan and metropolitan counties. Among men and women, bladder cancer incidence rates were highest in the Northeast (42.5 and 11.0, respectively) and lowest in the West (32.5 and 7.8, respectively). Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, and Rhode Island had the highest rates of urinary bladder cancer among men (40.5–48.1) and women (10.5–12.8) (Figures 19 and 20).

Cervical Cancer

A total of 61,499 new cervical cancer cases (7.5 per 100,000 women) were reported in the United States during 2010–2014 (Table 11). Women aged 40–49 years had the highest rates of cervical cancer (14.3). Rates were highest among blacks (9.3), followed by whites (7.3), AI/ANs (6.5), and A/PIs (6.1). Rates were higher among Hispanics (9.7) than among non-Hispanics (7.3). Among those with known tumor characteristics (97.1%), the majority of cervical cancer cases were squamous cell carcinomas (66.1%); adenocarcinomas accounted for 27.6%. Most cervical cancer cases were diagnosed at the localized (43.8%) or regional (36.2%) stage. During 2010–2014, cervical cancer rates were higher in nonmetropolitan counties (8.4) than in metropolitan counties (7.4). Cervical cancer cases were highest in the South (8.3) and lowest in the Northeast, Midwest, and West (6.9–7.1). Alabama, Arkansas, DC, Florida, Kentucky, Louisiana, Mississippi, Oklahoma, Puerto Rico, Texas, and West Virginia had the highest rates of cervical cancers (8.6–12.9) (Figure 21).

Acute Myeloid Leukemia

A total of 70,960 new AML cases (4.2 per 100,000 persons) were reported in the United States during 2010–2014 (Table 12). Incidence rates were higher among men than among women (5.2 and 3.5, respectively). Rates increased with increasing age and peaked among adults aged ≥80 years (26.3). Whites had the highest rates (4.3), followed by blacks (3.5), A/PIs (3.4), and AI/ANs (2.7). Non-Hispanics had higher rates than Hispanics (4.3 and 3.6, respectively). During 2010–2014, AML incidence rates were similar between metropolitan and nonmetropolitan counties (4.2). Among men and women, AML incidence rates were highest in the Northeast and Midwest (5.5 among men and 3.7 among women) and lowest in the South and West (4.9–5.0 among men and 3.4 among women). Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine, Pennsylvania, South Dakota, and Wisconsin had some of the highest rates among men (5.6–6.3) and women (3.7–4.1) (Figures 22 and 23).

Estimated Annual Percentage Change in Incidence Rates of Tobacco-Associated Cancers

During 2010–2014, APCs in incidence rates of tobacco-associated cancers varied by site, sex, and men and women combined (Table 13) (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/59431; Supplementary Table 2, https://stacks.cdc.gov/view/cdc/59432). Significant decreases in cancers of the lung (2.17% per year), larynx (3.00%), esophagus (0.86%), stomach (1.01%), urinary bladder (1.28%), and colon and rectum (2.07%) occurred among men and women combined (Table 13). Although esophageal and stomach cancer rates decreased overall, rates remained stable among women. The decrease in lung cancer rates was significantly greater among men (2.88%) than among women (1.47%). Significant increases in liver (1.98% per year) and kidney (0.54%) cancer and AML (0.34%) occurred in men and women combined. Rates for OCP, pancreatic, and cervical cancers were stable during 2010–2014.

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Discussion

Interpretation of Tobacco-Associated Cancer Incidence

Approximately 3.3 million cases of tobacco-associated cancer were reported in the United States during 2010–2014 (approximately 667,000 each year), with lung cancer accounting for about a third of these diagnoses. The incidence of tobacco-associated cancers was higher among men than women. Black, white, and non-Hispanic populations had consistently higher incidence rates than other racial/ethnic populations, with a few exceptions. The majority of tobacco-associated cancers occurred among persons aged ≥70 years. Except for AML and cancers of the stomach, liver, and pancreas, tobacco-associated cancer rates were higher among nonmetropolitan counties than in metropolitan counties. The high rates among men, whites, blacks, non-Hispanics, older adults, and nonmetropolitan county residents reflect overall demographic patterns of cancer incidence in the United States (39) and patterns of tobacco use. In 2016, an estimated 15.5% of adults in the United States (37.8 million persons) smoked cigarettes, with smoking being more common among men (17.5%) than among women (13.5%) (29). The prevalence of cigarette smoking in 2016 varied among racial/ethnic groups; the highest prevalence was among AI/ANs (31.8%), followed by persons of multiple races (25.2%), whites (16.6%), blacks (16.5%), Hispanics (10.7%), and A/PIs (9.0%) (29). Smoking prevalence among AI/ANs varies by region of the country, and cancer rates tend to parallel these differences (47). Blacks and whites had the highest tobacco-associated cancer incidence rates in this report and the second- and third-highest smoking prevalence, respectively, among racial/ethnic populations.

Substantial variation in tobacco use prevalence exists by state among adults in the United States (48). During 2014–2015, nine of the 10 states with the highest prevalence of current use of any tobacco product were in either the South (West Virginia [26.9%], Kentucky [26.2%], Arkansas [24.0%], Oklahoma [23.8%], Alabama [23.1%], and Tennessee [22.7%]) or in the Midwest (Ohio [23.8%], South Dakota [23.0%], and North Dakota [22.6%]) (47). States with the lowest prevalence of current use of any tobacco product were in the West (California [10.2%] and Utah [10.9%]) (48). In this report, lung, laryngeal, OCP, kidney, and cervical cancer incidence rates were highest in the South and the Midwest. Cancer incidence rates were consistently lowest in the West for all the cancers in this report, with the exception of kidney and stomach cancers.

Cancers of the lung and bronchus, larynx, and OCP have the greatest average relative risks (1,22,49) associated with tobacco use. Lung cancer is the second most commonly diagnosed cancer among men (after prostate cancer) and women (after breast cancer) and is the leading cause of cancer death both among men and women in the United States (39). The average tobacco-associated lung cancer relative risk ranges from 15.0 to 30.0 (1,22,49). Tobacco use causes all histologic types of lung cancer (1,50). Similar to previous studies, this study demonstrates that the percentage of squamous cell carcinoma of the lung is higher among men than among women, whereas the percentage of adenocarcinoma of the lung is higher among women than among men (19,51). In the United States, the decrease in squamous cell carcinoma followed the trend of decreasing smoking prevalence (1). Adenocarcinoma rates in the United States increased in the 1980s and 1990s before decreasing through 2004 and reportedly increasing again during 2006–2010; however, much of this latter increase reflects improved classification of tumors previously designated as “other non–small cell lung cancer” (1,52). The proportion of lung cancers classified as adenocarcinoma has increased over time and adenocarcinoma is now the most common type of lung cancer both among men and women smokers (1,27).

In 2013, the U.S. Preventive Services Task Force recommended annual screening with low-dose computed tomography (LDCT) for persons at high risk for lung cancer (i.e., adults aged 55–80 years who have a history of smoking 30 packs per year and currently smoke or have quit within the past 15 years) (53). However, the percentage of persons screened has been low, with 3.3% of eligible smokers reporting LDCT screening in the past 12 months in 2010 and 3.9% in 2015 (54). The reasons for underuse of screening might include smokers’ lack of awareness about this test and limited health care access, as well as physicians’ lack of knowledge about screening recommendations and concerns about false-positive results (55). Some studies have reported that eligible patients who benefit most from screening are those with chronic obstructive pulmonary disease (COPD) (56,57). Compared with patients with normal baseline spirometry who receive annual screening with LDCT, patients with COPD have a greater incidence of lung cancer and are more likely to be detected with early stage disease (56,57). Additional research is needed to determine whether current screening recommendations can be modified to include COPD status.

Laryngeal cancer is relatively rare in the United States (39). The average tobacco-associated relative risk for laryngeal cancer ranges from 10.0 to 17.0 (1,22,49). Tobacco use is the single most important risk factor for developing laryngeal cancer (1,2,7). The decrease in laryngeal cancer incidence rates observed in this study among men and women is consistent with decreasing incidence rates reported outside the United States (58). The decrease might be partially explained by changes in tobacco use (1). Alcohol use also is a risk factor for laryngeal cancer, and when used together, alcohol and tobacco have a synergistic effect on laryngeal cancer development (26,59). However, the prevalence of alcohol consumption among U.S. adults has not decreased substantially in recent years (60). Decreased dietary fiber intake also might be associated with risk for laryngeal cancer, particularly among women (61–63).

OCP cancer is the ninth most common cancer in the United States among men but is less common among women (39). This type of cancer includes tumors with origins in several anatomic organs of the head and neck. The average relative risk for tobacco-associated OCP cancer is 4.0–5.0 (1,22,49). Use of all tobacco products, including cigarettes, cigars, pipes, and smokeless tobacco, are linked to head and neck cancer (2,7,28). Strong evidence implicates tobacco as a carcinogenic factor in squamous cell cancers of the head and neck (1,28). The predominant histologic tumor type of OCP cancer observed in this study was squamous cell carcinoma. Previous studies have demonstrated that cessation of tobacco use leads to a decrease in the risk for OCP cancer (64). Alcohol use is a risk factor for the development of OCP cancer, independent of the effects of tobacco use (65–67). The use of both alcohol and tobacco have a synergistic effect on the development of OCP cancers (26), accounting for as many as 64% of oral cavity and 72% of pharyngeal cancers (59,65,68). Infection with human papillomavirus (HPV), particularly HPV16, increases the risk for cancer at certain OCP sites, including the oropharynx, base of the tongue, and tonsils (69,70).

Cancers of the pancreas, urinary bladder, and colon and rectum have similar relative risks associated with tobacco use (pancreas, 2.0–4.0; urinary bladder, 3.0; colon and rectum, 1.9–2.5) (1,22,49,71). Pancreatic cancer is among the 10 most common cancers diagnosed in the United States and is the fifth leading cause of cancer death among men and women in the United States (39). Although recent increases in pancreatic cancer incidence might be due to increases in the prevalence of excess body weight (72), previous decreases were attributed to decreases in smoking prevalence (1). One study indicated that cigarette smoke increased tumor growth and metastases in pancreatic cancer cells (73). Human and animal studies have found that functional nicotinic receptors are present on pancreatic islet and beta cells, and nicotine can reduce the release of insulin through neuronal nicotinic acetylcholine receptors on islet cells (74). The collection of multiple studies in animals and humans strongly supports the hypothesis that cigarette smoking and exposure to nicotine can adversely affect insulin action and the function of pancreatic cells, both of which play fundamental roles in the pathogenesis of diabetes (75). Being overweight or having obesity, having a personal history of diabetes or chronic pancreatitis, and several genetic syndromes also are associated with increased risk for pancreatic cancer (76,77). Findings from a recent meta-analysis show that increased fruit and vegetable intake is associated with decreased risk for pancreatic cancer (78).

Urinary bladder cancer is the fourth most commonly diagnosed cancer and the seventh leading cause of cancer death among men in the United States (39). Among women, urinary bladder cancer is much less common. The average tobacco-associated bladder cancer relative risk is 4.0 (22,49). The decrease in bladder cancer incidence rates reported in this study among men and women is consistent with findings from other studies (19,79). The incidence of urinary bladder cancer has decreased among men and women in the United States since 1999 (79). The strongest risk factor for bladder cancer in the United States is cigarette smoking. Approximately half of all bladder cancers are caused by cigarette smoking (80–82). Quitting smoking decreases the risk for bladder cancer by approximately 40% within 1–4 years (80,81,83). Pipe and cigar use (among noncigarette smokers) also is associated with increased risk for bladder cancer among men (81).

Colorectal cancer (i.e., cancer of the colon and rectum) is the second most common cancer diagnosed and the second leading cause of cancer death among men and women combined in the United States (39). Colorectal cancer is one of two additional cancers (including liver cancer) that were causally linked to tobacco use in the 2014 Surgeon General’s report (1). The incidence of colorectal cancer has decreased steadily since 2001; most recently, incidence decreased an average of 3% annually during 2005–2014 (84). This decrease might be due to increased colorectal cancer screening through the detection of precancerous polyps, which can then be removed before becoming cancerous, thus decreasing cancer incidence (72,85). Risk for colorectal cancer has been reported to increase with increased daily cigarette consumption and duration of smoking (86,87). Long-term cigarette smoking is associated with increased incidence of colorectal cancer and risk for death from colorectal cancer in men and women (1,27). In a study examining metabolites of tobacco smoking and colorectal cancer risk, persons with detectable levels of serum hydroxycotinine were reported to have a greater risk than those with undetectable levels (88). Additional research using biomarkers for smoking behaviors might help refine estimates of the association between cigarette smoking and colorectal cancer risk. An increased risk for colorectal cancer is associated with excessive alcohol use (89), being overweight or having obesity (90), consumption of processed or red meat (91), and certain genetic factors. Physical activity and fiber consumption might reduce the risk for colorectal cancer (92).

AML, esophageal, kidney, stomach, liver, and cervical cancers have similar relative risks associated with tobacco use (1.5–2.5) (1,22,49). Esophageal cancer is not as commonly diagnosed in the United States as other cancers included in this report; however, esophageal cancer is one of the top 10 leading causes of cancer death among most racial/ethnic male populations (39). Squamous cell carcinoma of the esophagus was the more prevalent histologic subtype in the United States until the mid-1990s, when the incidence of squamous cell carcinoma decreased while the incidence of adenocarcinoma increased, resulting in adenocarcinoma becoming the most common histologic subtype (93–95). Current smokers have a three to five times higher risk for developing squamous cell carcinoma compared with never smokers, and former smokers have a significantly lower risk for developing this subtype compared with current smokers (96,97). Increased time since quitting smoking is associated with decreased risk for squamous cell carcinomas (96,97). The incidence of squamous cell carcinoma of the esophagus has decreased sharply in North America since the early 1970s, which is likely due to lower rates of smoking (96,98,99). In contrast, during this same period, the incidence of adenocarcinoma of the esophagus has increased (95). Both current and former smokers have approximately twice the risk for developing this subtype as never smokers (96,97). Esophageal adenocarcinoma also is associated with obesity and alcohol use (96). The prevalence of obesity among U.S. adults aged ≥20 years increased from 1999–2000 through 2015–2016 (100). Obesity has been most strongly associated with early onset (among persons aged <50 years) esophageal adenocarcinoma (101). In 2016, 55.0% of adults in the United States reported drinking alcohol in the past month, a slight increase from 1997 (53.5%) (102).

Kidney cancer is among the 10 most common cancers diagnosed both among men and women in the United States (39). Smoking is an important risk factor for kidney cancers (103). Cohort studies have reported positive associations between smoking and kidney cancer incidence (104,105) and death (106,107). In addition to smoking, excess body weight, and hypertension are risk factors for kidney cancer (104,108,109). Both for men and women, incidence rates of kidney cancer during 2010–2014 were higher compared with previously published estimates for 1999–2004 (19). Certain studies suggest that these increases might have resulted from increased detection of kidney cancer through recent increased use of ultrasound and computed tomography for non–cancer-related conditions (110–112) or from increases in the prevalence of overweight and obesity (42).

Stomach cancer is common among certain racial/ethnic populations in the United States (39). Among current smokers, risk for stomach cancer increases with the number of cigarettes smoked per day and duration of smoking (113). The risk for stomach cancer decreases as time since stopping smoking increases (113). Tobacco use is related to both cardia and noncardia stomach cancer (96). Former, light, and moderate cigarette smokers have slightly higher risks for developing gastric cardia cancer than noncardia cancer (113). The incidence rate of stomach cancer in this report was higher among A/PIs, non-Hispanic blacks, and Hispanics compared with non-Hispanic whites. The finding in this report that stomach cancer incidence has been decreasing in recent years is consistent with a decrease that has been occurring since the middle of the 20th century in high-income countries in North America and Western Europe and also more recently in areas with historically high rates of stomach cancer (e.g., Asia and Latin America) (114). Trends in decreasing stomach cancer rates might be attributable to decreased prevalence of Helicobacter pylori infection resulting from improved sanitation and use of antibiotics, increased availability of fresh produce, and lower consumption of salt-preserved and smoked food (92,115). In addition, decreases in smoking (in countries with high rates of tobacco use) might have contributed to the decreasing trends of stomach cancer incidence (116). H. pylori is a major risk factor for noncardia gastric cancer; therefore, the decrease in stomach cancer incidence largely reflects decreasing occurrence at this anatomic subsite (114,117). In contrast to noncardia gastric cancer, rates of cardia gastric cancer are increasing in the United States and other high-income countries (114). This increase might be associated with increases in obesity or improvements in classification of stomach tumors (118).

Liver cancer is among the 10 most common cancers diagnosed among nonwhite men in the United States and the fifth leading cause of cancer death among all men in the United States (39). Although liver cancer occurs more frequently in less developed regions of the world (1,119), this cancer type is still a substantial health concern in the United States. Liver cancer is one of two additional cancers (including colorectal) that was causally linked to tobacco use in the 2014 Surgeon General’s report (1). Approximately 30,000 new cases of liver cancer are diagnosed every year in the United States, with approximately 20,000 associated deaths (1,39). In addition to cigarette smoking, metabolic disorders (including obesity), infection with hepatitis B virus or hepatitis C virus, and alcohol use are risk factors for developing liver cancer (120). Long-term exposure to carcinogens in smoke might cause cellular damage in the liver and contribute to the development of cancer (1). Smoking has also been recognized as a risk factor for primary biliary cirrhosis, a condition that can progress to hepatocellular carcinoma, or primary liver cancer (121–123), and smoking cessation has benefitted patients with chronic liver diseases (122). A 2009 meta-analysis (124) showed an estimated 50% increased risk for liver cancer among current smokers compared with never smokers (i.e., adults who have never smoked or who have smoked <100 cigarettes in their lifetime).

Although the overall incidence of cervical cancer is low in the United States, black and Hispanic women continue to have a higher incidence than white women (39). Smoking has been consistently associated with an increased risk for cervical cancer, and risk increases with increased daily cigarette smoking and duration of smoking (125–127). Although tobacco use is associated with cervical cancer, the primary risk factor is HPV infection, which is thought to be responsible for approximately 90% of cervical cancers (128). In this report, HPV infection likely contributed to the lower incidence rate among women aged 40–49 years, as well as the high rate among black and Hispanic women (128,129). The combination of smoking and HPV infection might increase the risk, such that women who are HPV-positive and smoke have a twofold increased risk for cervical cancer compared with women who are HPV-positive and have never smoked (126,127). Women who have quit smoking cigarettes for long periods have a decreased risk for cervical cancer compared with current smokers, even after adjusting for the presence of an HPV infection (126). Cervical cancer is largely preventable with the HPV vaccine, current recommendations are to routinely vaccinate girls and boys aged 11–12 years; women up to age 26 years and men up age 21 years also might be vaccinated if they were not previously (130). Routine screening remains an important part of cervical cancer prevention (131,132). Two tests can be used for cervical cancer screening: a Papanicolaou (Pap) test and an HPV test; one or both of these tests is recommended, depending on the age of the woman (132). Special outreach efforts to increase cervical cancer screening among black and Hispanic women are underway (131). Targeted education about the dangers of tobacco use in these populations might also be warranted.

AML is a relatively rare cancer in the United States (39). Cigarette smoking is an established risk factor for AML in adults (133,134). One of the carcinogens contained in cigarette smoke is benzene, which is strongly associated with increased risk for AML (3). Current smokers have a 40% increased risk for developing AML compared with nonsmokers (134). AML risk also increases with higher intensity (i.e., number of cigarettes smoked daily) and longer duration (i.e., number of years) of smoking (134). Smoking cessation might decrease AML risk (135). In this report, AML incidence rates were highest among white men and women, and the Midwest and Northeast had the highest incidence rates among men. A previous report noted U.S. state incidence rates of AML were inconsistent with smoking patterns (19). In this report, many states with the highest observed AML incidence rates among men (i.e., Connecticut, Hawaii, Illinois, Iowa, Maine, New York, Pennsylvania, and Wisconsin) also were not those with the highest rates of smoking in the United States (48). The etiology for most cases of AML is unclear. Other environmental exposures and genetic risk factors might play a role (136).

Public Health Implications

Implementing tobacco control policies and programs as recommended by Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan by the U.S. Department of Health and Human Service (137) and Ending the Tobacco Problem: A Blueprint for the Nation by the National Academy of Medicine (NAM, formerly the Institute of Medicine) (138) would accelerate the decrease of tobacco use among youths and adults and accelerate progress toward achieving the Healthy People 2020 objectives to reduce cigarette smoking (1). The NAM report presented a blueprint for action to reduce tobacco use to a level that would eliminate smoking as a public health problem. The two-pronged strategy for achieving this goal included 1) strengthening and fully implementing traditional tobacco control measures and 2) changing the legal framework to permit policy innovations. Sustained implementation of comprehensive state tobacco control programs can accelerate progress toward reducing adult smoking prevalence (32,139).

CDC recommends that each state establish and sustain a comprehensive tobacco control program that contains the following overarching components: state and community interventions; health communication interventions that reach large audiences (i.e., mass-reach interventions); cessation interventions; surveillance and evaluation; and infrastructure, administration, and management (139). Evidence-based statewide tobacco control programs that are comprehensive, sustained, and accountable have decreased smoking rates and tobacco-associated diseases and deaths (139). A comprehensive statewide tobacco control program is a coordinated effort to establish smoke-free policies and social norms, promote and assist with cessation of tobacco, and prevent initiation of tobacco use. CDC’s Best Practices for Comprehensive Tobacco Control Programs—2014 is an evidence-based guide to help states plan and establish comprehensive tobacco control programs (139). The report describes an integrated programmatic structure for implementing effective interventions and estimates the recommended level of state investment to reach these goals and to reduce tobacco use in each state. Additional support for tobacco prevention and control is available from CDC’s National Comprehensive Cancer Control Program (NCCCP), which in 1998 began providing financial support and technical assistance to states, tribes, and territories to create, implement, and evaluate cancer control plans (140). A 2013 analysis of 69 NCCCP cancer plans showed that every plan contained at least one CDC-recommended, evidence-based tobacco control strategy (141). Strategies incorporated were consistent with CDC’s Best Practices for Comprehensive Tobacco Control Programs or The Guide to Community Preventive Services (141). CDC also funds the Consortium of National Networks to Impact Populations Experiencing Tobacco-Related and Cancer Health Disparities and the National Tobacco Control Program, which both promote tobacco use prevention and cancer prevention among persons at highest risk for tobacco use (140,142).

Increased state investments in tobacco control programs, compared with the overall U.S. investments, are more positively correlated with decreases in cigarette sales and the prevalence of smoking (143–145). For example, during 2001–2010, decreases in smoking prevalence among adults and youths in New York (as reported by the New York State Tobacco Control Program) were higher than overall U.S. decreases in smoking prevalence (146). As a result, smoking-attributable personal health care expenditures in New York in 2010 were $4.1 billion less than they would have been had the prevalence of smoking remained at 2001 levels (146). In addition to benefits of larger investments in tobacco control programs on smoking rates, research also shows that the longer states invest in such programs, the greater and more rapid the impact (138,139). For example, in California, which has the nation’s first and longest-running comprehensive tobacco control program, the prevalence of smoking among adults decreased from 22.7% in 1988 to 10.5% in 2015 (147). Correspondingly, lung cancer incidence has decreased nearly four times faster in California than in the rest of the United States (148). Other states such as Colorado (149), Florida (150), Massachusetts (151), and Minnesota (152) also have decreased smoking among adults and youths through various approaches. Data from continued monitoring of cancer incidence rates and death rates at the local, state, and national levels can be used to evaluate the impact of these and other public health successes in reducing the effects of tobacco use.

Preventive services recommended by the U.S. Preventive Services Task Force for decreasing tobacco-associated cancers include tobacco cessation counseling and treatment as well as screening for cervical, colorectal, and lung cancers to help detect the diseases at an early, often treatable, stage (153). The Advisory Committee for Immunization Practices recommends hepatitis B virus and HPV vaccinations to prevent infection with these viruses that are also known to cause tobacco-associated cancers (liver, cervical, and OCP). NCCCP funds states, DC, tribes, and territories to work through state and local level cancer coalitions to ensure access to these early detection and treatment services, implement evidence-based programs to prevent cancer, and support cancer survivorship activities. Federal initiatives also can help reduce tobacco use and tobacco-associated cancers. For example, a 1997 executive order established a smoke-free environment for federal employees and members of the public visiting or using federal facilities by prohibiting smoking of tobacco products in all interior spaces owned, rented, or leased by the executive branch of the federal government (154).

Continued research is important to identify additional types of cancer that might be associated with tobacco use as well as to enhance understanding of how tobacco exposure affects the cellular processes responsible for promotion and progression of the cancers examined in this report. In 2014, the Surgeon General’s report reviewed the evidence on smoking and cancers of prostate and breast; however, evidence to establish causality was inadequate or insufficient (1). Among men in the United States, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death (39). Evidence suggests that smoking, especially current or recent smoking, is a risk factor for death from prostate cancer but not for incidence, indicating that continued smoking might lead to higher risk for disease progression (1). Evidence of a positive association between smoking and prostate cancer deaths but no association with incidence is consistent across prospective cohort studies conducted in various settings and decades (1). Prostate cancer mortality is higher among smokers than nonsmokers (1). However, the mortality rates in former smokers who quit years in the past suggests that quitting smoking might reduce prostate cancer mortality (1). The Surgeon General’s report recommended future research needs to refine the temporal relation between smoking, cessation, and prostate cancer diagnoses and related mortality (1).

Breast cancer is the most frequently diagnosed type of cancer (other than nonmelanoma skin cancers) and the second leading cause of cancer death among women in the United States (39). The Surgeon General concluded that the evidence suggests but is not sufficient to infer a causal relation between active smoking or secondhand tobacco smoke exposure and breast cancer (1). Evidence (including several large cohort studies) suggests a person with a history of ever smoking has a 10% increased likelihood of receiving a breast cancer diagnosis, an association that although significant, is weak (1). The International Agency for Research on Cancer similarly concluded that the overall association between smoking and breast cancer is weaker than the association between smoking and other cancers and that the dose-response relations (i.e., pack years, cigarettes smoked per day, and age at initiation) are correspondingly small (27). As stated in the 2014 Surgeon General’s report, because breast cancer is the most common cancer type among women, decreases in smoking might have a substantial impact on the overall incidence of breast cancer (1).

Future Directions

This report examines the incidence of tobacco-associated cancers by demographic and tumor characteristics and by state and U.S. census region. Examination of county-level patterns within states might be helpful in determining areas with disproportionately high cancer incidence or death rates. Using tools such as State Cancer Profiles (https://statecancerprofiles.cancer.gov) could help identify prevalence of risk factors and use of screening tests that might affect these rates. Additional research and data evaluation are needed to determine whether a causal relation exists between smoking and cancers of the prostate and breast.

Limitations

The findings in this report are subject to at least four limitations. First, because information about tobacco use and other risk factors for cancer is not available in all cancer registry data, these results should not be used to describe cancer rates among smokers. Rather, the incidence rates are limited to cancers that are known to be associated with tobacco use. Second, cancer has many different risk factors and combinations of factors, including tobacco use; therefore, the number of cases and trends in tobacco-associated cancers also might be affected by changes in these other risk factors or cancer screening trends. Third, although this report includes estimates of tobacco-associated cancers, it does not estimate what proportion of these cancers are attributable to tobacco use. Although the 2014 Surgeon General’s report was used to define tobacco-associated cancers, not all incident cancers for each cancer site are necessarily caused by smoking; likewise, using this definition might underestimate the true incidence because evidence that tobacco use might cause additional cancers is still accumulating (1). Finally, findings related to race/ethnicity might have been affected if race/ethnicity information was incorrectly collected or recorded in the medical record; ongoing procedures are used to ensure that this information is as accurate as possible (155). For example, to minimize misclassification of AI/ANs, some previous studies have restricted analyses to Contract Health Service Delivery Area (CHSDA) counties and have found that rates for AI/ANs in CHSDA counties are generally higher than for AI/ANs in all U.S. counties (156). In general, CHSDA counties contain federally recognized tribal lands or are adjacent to tribal lands; however, rates restricted to these counties might not be generalizable to all AI/ANs because only 64% of AI/ANs live in a CHSDA county and because CHSDA counties tend to be in more rural areas and in Western states (156).

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Conclusion

Tobacco-associated cancer incidence can be reduced through efforts to prevent and control tobacco use and other comprehensive cancer control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately impacted by cancer. Continued surveillance to measure characteristics within states can help identify populations with tobacco-associated disparities (157). Continued monitoring of cancer incidence rates at the local, state, and national levels can identify populations with high rates of tobacco-associated cancers and help evaluate the effectiveness of targeted tobacco control programs and policies.

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Corresponding author: M. Shayne Gallaway, PhD; Telephone: 404-498-0491; Email: mgallaway@cdc.gov.

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1Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Commissioned Corps, U.S. Public Health Service, Rockville, Maryland; 3Office on Smoking and Health, National Center for Chronic Disease and Prevention and Health Promotion, CDC

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Conflict of Interest

No conflicts of interest were reported.

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TABLE 1. Incidence rates* and percentages† of invasive lung, bronchial, and tracheal cancers, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 1,070,504 61.3 (61.2–61.4) 566,713 72.7 (72.5–72.9) 503,791 52.7 (52.5–52.8)
Age group at diagnosis (yrs)
<40 5,413 0.7 (0.7–0.7) 2,624 0.7 (0.7–0.7) 2,789 0.7 (0.7–0.8)
40–49 34,419 15.6 (15.5–15.8) 16,262 14.9 (14.7–15.2) 18,157 16.4 (16.1–16.6)
50–59 163,296 74.3 (74.0–74.7) 87,194 81.3 (80.7–81.8) 76,102 67.8 (67.3–68.3)
60–69 313,543 202.8 (202.1–203.5) 172,045 234.2 (233.1–235.3) 141,498 174.4 (173.5–175.3)
70–79 340,129 390.0 (388.7–391.3) 180,917 461.9 (459.8–464.0) 159,212 331.6 (330.0–333.3)
≥80 213,704 374.5 (372.9–376.1) 107,671 502.7 (499.7–505.7) 106,033 298.6 (296.7–300.4)
Race
White 920,427 62.1 (61.9–62.2) 483,499 72.4 (72.2–72.6) 436,928 54.3 (54.1–54.4)
Black 113,633 64.0 (63.6–64.4) 63,233 85.9 (85.2–86.7) 50,400 49.2 (48.7–49.6)
American Indian/Alaska Native 6,000 44.7 (43.5–45.9) 3,111 52.2 (50.2–54.2) 2,889 39.0 (37.6–40.6)
Asian/Pacific Islander 25,905 35.2 (34.8–35.6) 14,286 45.1 (44.3–45.9) 11,619 27.9 (27.4–28.4)
Ethnicity
Hispanic 44,500 31.9 (31.6–32.2) 24,297 40.8 (40.2–41.3) 20,203 25.5 (25.2–25.9)
Non-Hispanic 1,025,933 64.1 (64.0–64.2) 542,388 75.7 (75.5–75.9) 483,545 55.3 (55.1–55.4)
County classification
Metropolitan 841,631 59.8 (59.7–59.9) 438,447 70.4 (70.1–70.6) 403,184 51.9 (51.8–52.1)
Nonmetropolitan 178,536 69.4 (69.0–69.7) 100,611 84.9 (84.4–85.4) 77,925 57.0 (56.6–57.4)
Census region
Northeast 208,137 62.6 (62.3–62.9) 104,465 72.0 (71.5–72.4) 103,672 56.0 (55.7–56.4)
Midwest 258,247 66.5 (66.2–66.7) 136,591 78.6 (78.2–79.0) 121,656 57.4 (57.1–57.7)
South 430,881 65.5 (65.3–65.7) 237,375 80.8 (80.4–81.1) 193,506 53.8 (53.6–54.0)
West 173,239 47.4 (47.2–47.6) 88,282 53.5 (53.1–53.8) 84,957 42.7 (42.4–43.0)
Tumor characteristic** No. % No. % No. %
Total 942,919 100.0 498,902 100.0 444,017 100.0
Histology
Non–small cell carcinoma 764,914 81.1 408,889 81.9 356,025 80.1
   Adenocarcinoma 448,320 47.5 215,628 43.2 232,692 52.4
   Squamous cell carcinoma 230,569 24.5 144,310 28.9 86,259 19.4
   Non–small cell carcinoma, NOS 70,142 7.4 39,900 8.0 30,242 6.8
Large cell carcinoma 15,883 1.7 9,051 1.8 6,832 1.5
Small cell carcinoma 133,192 14.1 65,925 13.2 67,267 15.1
Epithelial carcinoma 23,319 2.5 13,540 2.7 9,779 2.2
All other histologies 21,494 2.3 10,548 2.1 10,946 2.5
Stage††
Localized 189,113 20.1 89,436 17.9 99,677 22.4
Regional 227,876 24.2 120,567 24.2 107,309 24.2
Distant 495,671 52.6 272,506 54.6 223,165 50.3
Unknown 30,259 3.2 16,393 3.3 13,866 3.1

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 1. Incidence rates* for male lung, bronchial, and tracheal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male lung, bronchial, and tracheal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 53.5; Midwest: 78.6; Northeast: 72.0; South: 80.8. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 2. Incidence rates* for female lung, bronchial, and tracheal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female lung, bronchial, and tracheal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 42.7; Midwest: 57.4; Northeast: 56.0; South: 53.8. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 2. Incidence rates* and percentages† of invasive laryngeal cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 62,479 3.5 (3.4–3.5) 49,605 6.0 (6.0–6.1) 12,874 1.3 (1.3–1.4)
Age group at diagnosis (yrs)
<40 563 0.1 (0.1–0.1) 374 0.1 (0.1–0.1) 189 0.0 (0.0–0.1)
40–49 3,888 1.8 (1.7–1.8) 2,855 2.6 (2.5–2.7) 1,033 0.9 (0.9–1.0)
50–59 16,028 7.3 (7.2–7.5) 12,437 11.7 (11.5–11.9) 3,591 3.2 (3.1–3.3)
60–69 20,840 13.4 (13.2–13.5) 16,802 22.7 (22.3–23.0) 4,038 4.9 (4.8–5.1)
70–79 14,176 16.2 (15.9–16.4) 11,470 29.1 (28.6–29.6) 2,706 5.6 (5.4–5.8)
≥80 6,984 12.2 (12.0–12.5) 5,667 26.5 (25.8–27.2) 1,317 3.7 (3.5–3.9)
Race
White 51,997 3.4 (3.4–3.5) 41,239 5.9 (5.8–5.9) 10,758 1.4 (1.3–1.4)
Black 8,751 4.5 (4.4–4.6) 6,911 8.5 (8.3–8.7) 1,840 1.7 (1.6–1.7)
American Indian/Alaska Native 331 2.1 (1.8–2.3) 260 3.6 (3.1–4.1) 71 0.8 (0.6–1.0)
Asian/Pacific Islander 878 1.1 (1.1–1.2) 752 2.2 (2.1–2.4) 126 0.3 (0.2–0.3)
Ethnicity
Hispanic 3,865 2.5 (2.4–2.6) 3,299 4.8 (4.7–5.0) 566 0.7 (0.6–0.7)
Non-Hispanic 58,606 3.6 (3.5–3.6) 46,300 6.1 (6.1–6.2) 12,306 1.4 (1.4–1.4)
County classification
Metropolitan 48,624 3.3 (3.3–3.4) 38,562 5.8 (5.7–5.9) 10,062 1.3 (1.3–1.3)
Nonmetropolitan 10,920 4.2 (4.2–4.3) 8,685 7.1 (6.9–7.3) 2,235 1.7 (1.6–1.8)
Census region
Northeast 11,835 3.5 (3.4–3.5) 9,320 6.1 (6.0–6.2) 2,515 1.4 (1.3–1.4)
Midwest 15,154 3.8 (3.7–3.9) 11,845 6.4 (6.3–6.5) 3,309 1.6 (1.5–1.6)
South 26,865 4.0 (3.9–4.0) 21,346 6.8 (6.8–6.9) 5,519 1.5 (1.5–1.6)
West 8,625 2.3 (2.2–2.3) 7,094 4.0 (3.9–4.1) 1,531 0.8 (0.7–0.8)
Tumor characteristic** No. % No. % No. %
Total 60,676 100.0 48,165 100.0 12,511 100.0
Histology
Squamous cell carcinoma 58,810 96.9 46,767 97.1 12,043 96.3
Adenocarcinoma 381 0.6 238 0.5 143 1.1
Epithelial carcinoma, NOS 881 1.5 687 1.4 194 1.6
All other histologies 604 1.0 473 1.0 131 1.0
Stage††
Localized 32,534 53.6 26,646 55.3 5,888 47.1
Regional 14,640 24.1 10,608 22.0 4,032 32.2
Distant 10,702 17.6 8,632 17.9 2,070 16.5
Unknown 2,800 4.6 2,279 4.7 521 4.2

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 3. Incidence rates* for male laryngeal cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male laryngeal cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 4.0; Midwest: 6.4; Northeast: 6.1; South: 6.8. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 4. Incidence rates* for female laryngeal cancer, by state/ area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female laryngeal cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 0.8; Midwest: 1.6; Northeast: 1.4; South: 1.5. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 3. Incidence rates* and percentages† of invasive oral cavity and pharyngeal cancers, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 204,537 11.5 (11.4–11.5) 144,851 17.4 (17.3–17.4) 59,686 6.4 (6.3–6.4)
Age group at diagnosis (yrs)
<40 7,562 1.0 (0.9–1.0) 4,153 1.1 (1.0–1.1) 3,409 0.9 (0.8–0.9)
40–49 19,866 9.1 (9.0–9.3) 14,391 13.3 (13.1–13.6) 5,475 5.0 (4.9–5.1)
50–59 56,098 25.8 (25.6–26.0) 42,834 40.3 (40.0–40.7) 13,264 11.9 (11.7–12.1)
60–69 60,210 38.4 (38.1–38.7) 45,247 60.7 (60.1–61.2) 14,963 18.3 (18.0–18.6)
70–79 37,022 42.3 (41.8–42.7) 25,140 63.6 (62.8–64.4) 11,882 24.7 (24.3–25.2)
≥80 23,779 41.3 (40.8–41.8) 13,086 61.2 (60.1–62.3) 10,693 29.4 (28.8–29.9)
Race
White 176,221 11.8 (11.8–11.9) 125,496 17.8 (17.7–17.9) 50,725 6.5 (6.4–6.5)
Black 18,089 9.2 (9.0–9.3) 12,574 14.5 (14.3–14.8) 5,515 5.1 (5.0–5.2)
American Indian/Alaska Native 1,191 7.3 (6.8–7.7) 843 10.9 (10.1–11.7) 348 4.1 (3.7–4.6)
Asian/Pacific Islander 6,519 7.8 (7.6–8.0) 4,257 11.2 (10.9–11.6) 2,262 5.0 (4.8–5.2)
Ethnicity
Hispanic 11,854 7.1 (6.9–7.2) 8,096 10.5 (10.3–10.8) 3,758 4.2 (4.1–4.3)
Non-Hispanic 192,676 12.0 (12.0–12.1) 136,750 18.2 (18.1–18.3) 55,926 6.6 (6.6–6.7)
County classification
Metropolitan 163,768 11.3 (11.2–11.3) 115,587 17.1 (17.0–17.2) 48,181 6.3 (6.2–6.3)
Nonmetropolitan 31,220 12.5 (12.3–12.6) 22,450 18.7 (18.4–18.9) 8,770 6.7 (6.6–6.9)
Census region
Northeast 37,358 11.1 (11.0–11.3) 25,665 16.6 (16.4–16.8) 11,693 6.5 (6.4–6.6)
Midwest 46,294 11.7 (11.6–11.9) 32,792 17.7 (17.5–17.9) 13,502 6.5 (6.4–6.6)
South 80,910 12.1 (12.0–12.2) 58,190 18.6 (18.5–18.8) 22,720 6.5 (6.4–6.6)
West 39,975 10.4 (10.3–10.6) 28,204 15.5 (15.4–15.7) 11,771 5.9 (5.8–6.0)
Anatomic subsite
Lip 10,035 0.6 (0.6–0.6) 7,284 0.9 (0.9–1.0) 2,751 0.3 (0.3–0.3)
Oral cavity 99,539 5.6 (5.5–5.6) 66,678 7.9 (7.9–8.0) 32,861 3.5 (3.4–3.5)
Salivary gland 21,517 1.3 (1.3–1.3) 12,629 1.7 (1.6–1.7) 8,888 1.0 (1.0–1.0)
Tonsil 38,061 2.1 (2.1–2.1) 31,175 3.6 (3.5–3.6) 6,886 0.7 (0.7–0.7)
Oropharynx 9,428 0.5 (0.5–0.5) 7,189 0.8 (0.8–0.9) 2,239 0.2 (0.2–0.2)
Nasopharynx 14,393 0.8 (0.8–0.8) 10,925 1.3 (1.3–1.3) 3,468 0.4 (0.4–0.4)
Hypopharynx 6,004 0.3 (0.3–0.3) 4,700 0.6 (0.5–0.6) 1,304 0.1 (0.1–0.1)
Other oral cavity and pharynx 5,560 0.3 (0.3–0.3) 4,271 0.5 (0.5–0.5) 1,289 0.1 (0.1–0.1)
Tumor characteristic** No. % No. % No. %
Total 199,496 100.0 141,383 100.0 58,113 100.0
Histology
Squamous cell carcinoma 171,299 85.9 126,036 89.1 45,263 77.9
Adenocarcinoma 7,579 3.8 4,014 2.8 3,565 6.1
Mucoepidermoid carcinoma 6,259 3.1 2,802 2.0 3,457 5.9
Epithelial carcinoma, NOS 5,711 2.9 4,094 2.9 1,617 2.8
All other histologies 8,648 4.3 4,437 3.1 4,211 7.2
Stage††
Localized 63,275 31.7 38,268 27.1 25,007 43.0
Regional 90,347 45.3 69,275 49.0 21,072 36.3
Distant 35,439 17.8 26,741 18.9 8,698 15.0
Unknown 10,435 5.2 7,099 5.0 3,336 5.7

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 5. Incidence rates* for male oral cavity and pharyngeal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male oral cavity and pharyngeal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 15.5; Midwest: 17.7; Northeast: 16.6; South: 18.6. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 6. Incidence rates* for female oral cavity and pharyngeal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female oral cavity and pharyngeal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 5.9; Midwest: 6.5; Northeast: 6.5; South: 6.5. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 4. Incidence rates* and percentages† of invasive esophageal cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 81,608 4.6 (4.6–4.6) 64,311 8.0 (7.9–8.0) 17,297 1.8 (1.8–1.8)
Age group at diagnosis (yrs)
<40 706 0.1 (0.1–0.1) 562 0.2 (0.1–0.2) 144 0.0 (0.0–0.0)
40–49 3,951 1.8 (1.8–1.9) 3,223 3.0 (2.9–3.1) 728 0.7 (0.6–0.7)
50–59 15,943 7.3 (7.1–7.4) 13,075 12.2 (12.0–12.4) 2,868 2.6 (2.5–2.7)
60–69 25,765 16.5 (16.3–16.7) 21,335 28.8 (28.4–29.2) 4,430 5.4 (5.3–5.6)
70–79 20,982 24.0 (23.7–24.3) 16,480 41.9 (41.3–42.6) 4,502 9.4 (9.1–9.7)
≥80 14,261 24.8 (24.4–25.2) 9,636 45.0 (44.1–45.9) 4,625 12.6 (12.3–13.0)
Race
White 71,002 4.7 (4.7–4.8) 56,735 8.2 (8.2–8.3) 14,267 1.7 (1.7–1.8)
Black 7,984 4.3 (4.2–4.4) 5,581 7.1 (6.9–7.3) 2,403 2.3 (2.2–2.4)
American Indian/Alaska Native 460 3.2 (2.8–3.5) 357 5.3 (4.7–5.9) 103 1.4 (1.1–1.7)
Asian/Pacific Islander 1,659 2.2 (2.1–2.3) 1,257 3.7 (3.5–3.9) 402 1.0 (0.9–1.1)
Ethnicity
Hispanic 4,157 2.8 (2.7–2.9) 3,284 4.9 (4.7–5.1) 873 1.1 (1.0–1.2)
Non-Hispanic 77,446 4.8 (4.7–4.8) 61,025 8.3 (8.2–8.3) 16,421 1.8 (1.8–1.9)
County classification
Metropolitan 64,726 4.5 (4.5–4.5) 50,559 7.8 (7.7–7.9) 14,167 1.8 (1.8–1.8)
Nonmetropolitan 13,056 5.1 (5.0–5.1) 10,693 8.9 (8.7–9.1) 2,363 1.7 (1.6–1.8)
Census region
Northeast 16,751 4.9 (4.9–5.0) 12,913 8.6 (8.5–8.8) 3,838 2.0 (1.9–2.1)
Midwest 20,158 5.1 (5.0–5.2) 15,996 8.9 (8.8–9.1) 4,162 1.9 (1.8–2.0)
South 29,532 4.4 (4.4–4.5) 23,471 7.7 (7.6–7.8) 6,061 1.7 (1.6–1.7)
West 15,167 4.0 (4.0–4.1) 11,931 6.9 (6.8–7.0) 3,236 1.6 (1.6–1.7)
Tumor characteristic** No. % No. % No. %
Total 77,252 100.0 61,024 100.0 16,228 100.0
Histology
Squamous cell carcinoma 22,900 29.6 14,768 24.2 8,132 50.1
Adenocarcinoma 50,492 65.4 43,361 71.1 7,131 43.9
Epithelial carcinoma, NOS 2,853 3.7 2,173 3.6 680 4.2
All other histologies 1,007 1.3 722 1.2 285 1.8
Stage††
Localized 15,021 19.4 11,522 18.9 3,499 21.6
Regional 25,437 32.9 19,992 32.8 5,445 33.6
Distant 28,248 36.6 23,359 38.3 4,889 30.1
Unknown 8,546 11.1 6,151 10.1 2,395 14.8

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 7. Incidence rates* for male esophageal cancer, by state/ area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male esophageal cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 6.9; Midwest: 8.9; Northeast: 8.6; South: 7.7. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 8. Incidence rates* for female esophageal cancer, by state/ area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female esophageal cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 1.6; Midwest: 1.9; Northeast: 2.0; South: 1.7. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 5. Incidence rates* and percentages† of invasive stomach cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 115,147 6.7 (6.6–6.7) 71,429 9.2 (9.1–9.3) 43,718 4.6 (4.6–4.7)
Age group at diagnosis (yrs)
<40 3,543 0.5 (0.4–0.5) 1,812 0.5 (0.4–0.5) 1,731 0.4 (0.4–0.5)
40–49 8,145 3.8 (3.7–3.9) 4,733 4.4 (4.3–4.6) 3,412 3.2 (3.1–3.3)
50–59 19,704 9.0 (8.9–9.2) 12,852 12.1 (11.9–12.3) 6,852 6.2 (6.0–6.3)
60–69 29,093 18.7 (18.5–18.9) 19,548 26.4 (26.1–26.8) 9,545 11.7 (11.5–12.0)
70–79 29,473 33.9 (33.5–34.3) 18,938 48.4 (47.7–49.1) 10,535 22.0 (21.6–22.4)
≥80 25,189 43.6 (43.0–44.1) 13,546 63.4 (62.3–64.5) 11,643 31.8 (31.2–32.4)
Race
White 86,976 6.0 (5.9–6.0) 55,378 8.3 (8.3–8.4) 31,598 4.0 (3.9–4.0)
Black 17,936 10.3 (10.1–10.5) 10,169 14.1 (13.8–14.4) 7,767 7.7 (7.6–7.9)
American Indian/Alaska Native 877 6.3 (5.8–6.7) 521 8.3 (7.6–9.2) 356 4.7 (4.2–5.2)
Asian/Pacific Islander 8,011 10.7 (10.4–10.9) 4,596 14.1 (13.6–14.5) 3,415 8.1 (7.8–8.4)
Ethnicity
Hispanic 15,364 9.9 (9.8–10.1) 8,722 12.8 (12.5–13.1) 6,642 7.7 (7.6–7.9)
Non-Hispanic 99,765 6.3 (6.3–6.4) 62,697 8.8 (8.8–8.9) 37,068 4.3 (4.2–4.3)
County classification
Metropolitan 96,346 6.9 (6.8–6.9) 59,281 9.5 (9.4–9.5) 37,065 4.8 (4.8–4.9)
Nonmetropolitan 14,432 5.8 (5.7–5.9) 9,256 8.0 (7.8–8.2) 5,176 3.9 (3.8–4.0)
Census region
Northeast 25,142 7.6 (7.5–7.7) 15,455 10.7 (10.5–10.8) 9,687 5.2 (5.1–5.3)
Midwest 23,656 6.1 (6.1–6.2) 15,148 8.7 (8.6–8.9) 8,508 4.0 (4.0–4.1)
South 41,502 6.4 (6.4–6.5) 25,497 8.7 (8.6–8.9) 16,005 4.6 (4.5–4.6)
West 24,847 6.8 (6.7–6.9) 15,329 9.1 (9.0–9.3) 9,518 4.8 (4.7–4.9)
Tumor characteristic** No. % No. % No. %
Total 110,731 100.0 68,956 100.0 41,775 100.0
Histology
Squamous cell carcinoma 1,091 1.0 772 1.1 319 0.8
Adenocarcinoma 95,611 86.3 60,701 88.0 34,910 83.6
Epithelial carcinoma, NOS 2,881 2.6 1,810 2.6 1,071 2.6
Gastrointestinal stromal tumor 9,819 8.9 4,887 7.1 4,932 11.8
All other histologies 1,329 1.2 786 1.1 543 1.3
Stage††
Localized 32,689 29.5 18,397 26.7 14,292 34.2
Regional 29,104 26.3 19,554 28.4 9,550 22.9
Distant 37,226 33.6 24,515 35.6 12,711 30.4
Unknown 11,712 10.6 6,490 9.4 5,222 12.5

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 9. Incidence rates* for male stomach cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male stomach cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 9.1; Midwest: 8.7; Northeast: 10.7; South: 8.7. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 10. Incidence rates* for female stomach cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female stomach cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 4.8; Midwest: 4.0; Northeast: 5.2; South: 4.6 (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 6. Incidence rates* and percentages† of invasive colon and rectal cancers, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 689,738 39.8 (39.7–39.9) 358,980 45.8 (45.6–45.9) 330,758 34.8 (34.7–34.9)
Age group at diagnosis (yrs)
<40 19,731 2.6 (2.5–2.6) 9,987 2.6 (2.5–2.6) 9,744 2.5 (2.5–2.6)
40–49 52,570 24.3 (24.1–24.5) 28,010 26.1 (25.8–26.5) 24,560 22.5 (22.3–22.8)
50–59 132,893 61.5 (61.2–61.8) 74,955 71.0 (70.5–71.5) 57,938 52.5 (52.0–52.9)
60–69 167,619 107.8 (107.3–108.3) 96,144 130.0 (129.2–130.9) 71,475 87.6 (87.0–88.3)
70–79 162,100 186.3 (185.4–187.3) 85,303 218.0 (216.6–219.5) 76,797 160.5 (159.3–161.6)
≥80 154,825 267.2 (265.9–268.5) 64,581 302.4 (300.0–304.7) 90,244 246.3 (244.7–248.0)
Race
White 568,027 38.9 (38.8–39.0) 297,149 44.7 (44.5–44.8) 270,878 33.9 (33.8–34.1)
Black 84,797 46.7 (46.4–47.1) 42,304 55.1 (54.6–55.7) 42,493 40.9 (40.5–41.3)
American Indian/Alaska Native 4,533 30.9 (29.9–31.9) 2,367 34.7 (33.2–36.3) 2,166 27.8 (26.6–29.0)
Asian/Pacific Islander 24,651 31.4 (31.0–31.8) 12,927 37.0 (36.3–37.6) 11,724 27.0 (26.5–27.5)
Ethnicity
Hispanic 54,664 35.0 (34.7–35.3) 29,604 42.0 (41.5–42.6) 25,060 29.4 (29.0–29.8)
Non-Hispanic 635,010 40.3 (40.2–40.4) 329,348 46.3 (46.2–46.5) 305,662 35.4 (35.3–35.5)
County classification
Metropolitan 550,090 39.1 (39.0–39.2) 284,709 45.0 (44.8–45.2) 265,381 34.2 (34.1–34.3)
Nonmetropolitan 107,117 43.1 (42.8–43.4) 56,914 49.3 (48.9–49.8) 50,203 37.7 (37.4–38.0)
Census region
Northeast 134,889 40.8 (40.5–41.0) 67,880 46.7 (46.3–47.0) 67,009 36.0 (35.7–36.3)
Midwest 160,438 41.6 (41.4–41.8) 83,150 48.0 (47.6–48.3) 77,288 36.4 (36.1–36.6)
South 259,826 40.0 (39.9–40.2) 137,204 46.6 (46.3–46.8) 122,622 34.7 (34.5–34.9)
West 134,585 36.3 (36.1–36.5) 70,746 41.4 (41.1–41.7) 63,839 32.0 (31.8–32.3)
Tumor characteristic** No. % No. % No. %
Total 663,134 100.0 346,670 100.0 316,464 100.0
Histology
Adenocarcinoma 450,086 67.9 237,862 68.6 212,224 67.1
Adenoma 115,940 17.5 62,459 18.0 53,481 16.9
Mucinous carcinoma 50,295 7.6 24,365 7.0 25,930 8.2
Carcinoid 28,410 4.3 13,624 3.9 14,786 4.7
Epithelial carcinoma, NOS 7,140 1.1 3,723 1.1 3,417 1.1
All other histologies 11,263 1.7 4,637 1.3 6,626 2.1
Stage††
Localized 260,739 39.3 135,705 39.1 125,034 39.5
Regional 233,918 35.3 121,636 35.1 112,282 35.5
Distant 135,731 20.5 72,393 20.9 63,338 20.0
Unknown 32,746 4.9 16,936 4.9 15,810 5.0

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 11. Incidence rates* for male colon and rectal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male colon and rectal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 41.4; Midwest: 48.0; Northeast: 46.7; South: 46.6. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 12. Incidence rates* for female colon and rectal cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female colon and rectal cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 32.0; Midwest: 36.4; Northeast: 36.0; South: 34.7. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 7. Incidence rates* and percentages† of invasive liver cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 126,165 6.9 (6.8–6.9) 94,425 11.0 (10.9–11.0) 31,740 3.3 (3.2–3.3)
Age group at diagnosis (yrs)
<40 2,589 0.3 (0.3–0.3) 1,609 0.4 (0.4–0.4) 980 0.2 (0.2–0.3)
40–49 5,965 2.7 (2.6–2.8) 4,660 4.3 (4.1–4.4) 1,305 1.2 (1.1–1.3)
50–59 37,661 17.0 (16.9–17.2) 30,832 28.6 (28.3–29.0) 6,829 6.0 (5.9–6.2)
60–69 41,278 26.2 (25.9–26.4) 32,632 43.3 (42.9–43.8) 8,646 10.6 (10.3–10.8)
70–79 23,722 27.2 (26.8–27.5) 16,095 40.9 (40.3–41.5) 7,627 15.9 (15.6–16.3)
≥80 14,950 26.1 (25.7–26.5) 8,597 40.1 (39.3–41.0) 6,353 17.6 (17.1–18.0)
Race
White 94,355 6.2 (6.1–6.2) 70,871 9.8 (9.7–9.9) 23,484 2.9 (2.9–3.0)
Black 19,566 9.5 (9.3–9.6) 14,820 16.0 (15.7–16.3) 4,746 4.3 (4.2–4.4)
American Indian/Alaska Native 1,463 9.0 (8.5–9.6) 1,017 12.8 (12.0–13.7) 446 5.6 (5.1–6.2)
Asian/Pacific Islander 9,463 11.9 (11.7–12.2) 6,734 18.5 (18.1–19.0) 2,729 6.6 (6.3–6.8)
Ethnicity
Hispanic 19,644 12.1 (11.9–12.3) 14,334 18.7 (18.4–19.0) 5,310 6.5 (6.3–6.7)
Non-Hispanic 106,512 6.4 (6.4–6.4) 80,084 10.3 (10.2–10.3) 26,428 3.0 (3.0–3.0)
County classification
Metropolitan 106,798 7.2 (7.1–7.2) 79,865 11.5 (11.4–11.6) 26,933 3.4 (3.4–3.5)
Nonmetropolitan 15,220 5.8 (5.7–5.9) 11,479 9.2 (9.0–9.4) 3,741 2.8 (2.7–2.9)
Census region
Northeast 23,350 6.8 (6.7–6.8) 17,752 11.2 (11.0–11.3) 5,598 3.0 (2.9–3.1)
Midwest 22,601 5.6 (5.5–5.6) 16,698 8.8 (8.6–8.9) 5,903 2.8 (2.7–2.8)
South 49,130 7.1 (7.1–7.2) 37,028 11.5 (11.4–11.6) 12,102 3.3 (3.3–3.4)
West 31,084 7.9 (7.8–8.0) 22,947 12.2 (12.1–12.4) 8,137 4.0 (3.9–4.1)
Tumor characteristic** No. % No. % No. %
Total 118,896 100.0 89,081 100.0 29,815 100.0
Histology
Hepatocellular carcinoma 102,719 86.4 79,381 89.1 23,338 78.3
Adenocarcinoma 8,584 7.2 4,890 5.5 3,694 12.4
Epithelial carcinoma, NOS 1,997 1.7 1,319 1.5 678 2.3
All other histologies 5,596 4.7 3,491 3.9 2,105 7.1
Stage††
Localized 53,260 44.8 39,105 43.9 14,155 47.5
Regional 32,202 27.1 24,977 28.0 7,225 24.2
Distant 18,662 15.7 14,421 16.2 4,241 14.2
Unknown 14,772 12.4 10,578 11.9 4,194 14.1

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Excludes cases identified only through death certificate or autopsy reports.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 13. Incidence rates* for male liver cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male liver cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 12.2; Midwest: 8.8; Northeast: 11.2; South: 11.5. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 14. Incidence rates* for female liver cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female liver cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 4.0; Midwest: 2.8; Northeast: 3.0; South: 3.3. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 8. Incidence rates* and percentages† of invasive pancreatic cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 218,919 12.5 (12.4–12.6) 111,730 14.2 (14.1–14.3) 107,189 11.0 (11.0–11.1)
Age group at diagnosis (yrs)
<40 2,502 0.3 (0.3–0.3) 1,182 0.3 (0.3–0.3) 1,320 0.3 (0.3–0.4)
40–49 9,445 4.3 (4.2–4.4) 5,345 5.0 (4.8–5.1) 4,100 3.7 (3.6–3.8)
50–59 34,179 15.6 (15.4–15.7) 19,892 18.6 (18.3–18.8) 14,287 12.7 (12.5–12.9)
60–69 59,397 38.2 (37.9–38.6) 33,373 45.2 (44.7–45.7) 26,024 32.0 (31.6–32.4)
70–79 59,506 68.4 (67.8–68.9) 30,244 77.3 (76.4–78.1) 29,262 61.1 (60.4–61.8)
≥80 53,890 93.1 (92.3–93.9) 21,694 101.5 (100.2–102.9) 32,196 87.9 (86.9–88.9)
Race
White 182,531 12.3 (12.2–12.3) 94,557 14.1 (14.0–14.2) 87,974 10.7 (10.6–10.8)
Black 27,174 15.5 (15.3–15.7) 12,671 16.9 (16.6–17.2) 14,503 14.4 (14.2–14.6)
American Indian/Alaska Native 1,131 8.2 (7.7–8.7) 587 9.1 (8.3–10.0) 544 7.4 (6.7–8.0)
Asian/Pacific Islander 6,787 9.3 (9.1–9.5) 3,227 10.0 (9.6–10.4) 3,560 8.7 (8.4–9.0)
Ethnicity
Hispanic 16,048 11.1 (10.9–11.3) 7,854 12.0 (11.7–12.3) 8,194 10.3 (10.1–10.6)
Non-Hispanic 202,859 12.6 (12.6–12.7) 103,870 14.5 (14.4–14.5) 98,989 11.1 (11.0–11.2)
County classification
Metropolitan 178,483 12.6 (12.5–12.7) 90,388 14.3 (14.2–14.4) 88,095 11.2 (11.1–11.2)
Nonmetropolitan 30,997 12.1 (12.0–12.3) 16,246 13.9 (13.6–14.1) 14,751 10.6 (10.4–10.8)
Census region
Northeast 45,414 13.5 (13.4–13.6) 22,564 15.4 (15.2–15.6) 22,850 12.0 (11.8–12.1)
Midwest 49,381 12.6 (12.5–12.7) 25,272 14.4 (14.3–14.6) 24,109 11.1 (11.0–11.2)
South 80,688 12.4 (12.3–12.4) 41,527 14.1 (14.0–14.3) 39,161 10.9 (10.7–11.0)
West 43,436 11.7 (11.6–11.8) 22,367 13.2 (13.0–13.4) 21,069 10.4 (10.3–10.6)
Tumor characteristic** No. % No. % No. %
Total 179,360 100.0 93,822 100.0 85,538 100.0
Histology
Mucinous adenocarcinoma 5,874 3.3 2,943 3.1 2,931 3.4
Other adenocarcinomas 142,872 79.7 74,884 79.8 67,988 79.5
Epithelial carcinoma, NOS 8,105 4.5 4,427 4.7 3,678 4.3
Ductal carcinoma 17,655 9.8 8,999 9.6 8,656 10.1
All other histologies 4,854 2.7 2,569 2.7 2,285 2.7
Stage††
Localized 18,904 10.5 9,114 9.7 9,790 11.4
Regional 60,545 33.8 30,867 32.9 29,678 34.7
Distant 92,435 51.5 50,179 53.5 42,256 49.4
Unknown 7,476 4.2 3,662 3.9 3,814 4.5

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 15. Incidence rates* for male pancreatic cancer, by state/ area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male pancreatic cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 13.2; Midwest: 14.4; Northeast: 15.4; South: 14.1. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 16. Incidence rates* for female pancreatic cancer, by state/ area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female pancreatic cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 10.4; Midwest: 11.1; Northeast: 12.0; South: 10.9. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 9. Incidence rates* and percentages† of invasive kidney and renal pelvis cancers, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 280,883 16.1 (16.1–16.2) 176,108 21.8 (21.7–21.9) 104,775 11.3 (11.2–11.4)
Age group at diagnosis (yrs)
<40 13,898 1.8 (1.8–1.8) 7,650 2.0 (1.9–2.0) 6,248 1.6 (1.6–1.7)
40–49 27,897 13.0 (12.8–13.1) 17,920 16.8 (16.5–17.0) 9,977 9.2 (9.0–9.4)
50–59 61,403 28.2 (28.0–28.4) 40,198 37.9 (37.5–38.2) 21,205 19.0 (18.7–19.3)
60–69 81,318 52.2 (51.9–52.6) 53,099 71.8 (71.1–72.4) 28,219 34.6 (34.2–35.0)
70–79 61,763 70.5 (70.0–71.1) 38,439 97.5 (96.5–98.5) 23,324 48.5 (47.9–49.1)
≥80 34,604 60.5 (59.9–61.1) 18,802 87.8 (86.5–89.1) 15,802 44.1 (43.4–44.8)
Race
White 236,281 16.3 (16.2–16.3) 148,897 21.9 (21.8–22.0) 87,384 11.4 (11.3–11.5)
Black 33,396 17.6 (17.4–17.8) 20,108 24.2 (23.8–24.5) 13,288 12.6 (12.4–12.8)
American Indian/Alaska Native 2,526 15.7 (15.1–16.4) 1,510 20.1 (19.0–21.3) 1,016 11.9 (11.2–12.7)
Asian/Pacific Islander 6,057 7.5 (7.3–7.7) 3,926 10.9 (10.5–11.2) 2,131 4.8 (4.6–5.1)
Ethnicity
Hispanic 27,057 16.0 (15.8–16.2) 16,067 20.8 (20.4–21.1) 10,990 12.1 (11.8–12.3)
Non-Hispanic 253,801 16.2 (16.1–16.3) 160,031 22.0 (21.9–22.1) 93,770 11.2 (11.2–11.3)
County classification
Metropolitan 226,032 15.9 (15.9–16.0) 141,835 21.7 (21.6–21.8) 84,197 11.1 (11.0–11.2)
Nonmetropolitan 41,830 17.1 (16.9–17.2) 25,957 22.2 (21.9–22.5) 15,873 12.5 (12.3–12.7)
Census region
Northeast 52,819 16.1 (16.0–16.3) 33,417 22.3 (22.1–22.6) 19,402 10.9 (10.8–11.1)
Midwest 65,551 17.1 (16.9–17.2) 40,907 22.9 (22.7–23.1) 24,644 12.1 (11.9–12.2)
South 108,341 16.6 (16.5–16.7) 67,177 22.2 (22.1–22.4) 41,164 11.8 (11.7–11.9)
West 54,172 14.5 (14.3–14.6) 34,607 19.7 (19.5–19.9) 19,565 9.9 (9.8–10.1)
Tumor characteristic** No. % No. % No. %
Total 251,844 100.0 158,949 100.0 92,895 100.0
Histology
Renal cell carcinoma 221,417 87.9 140,989 88.7 80,428 86.6
Other adenocarcinomas 6,286 2.5 4,060 2.6 2,226 2.4
Transitional cell carcinoma 16,767 6.7 9,805 6.2 6,962 7.5
Epithelial carcinoma, NOS 1,942 0.8 1,217 0.8 725 0.8
All other histologies 5,432 2.2 2,878 1.8 2,554 2.7
Stage††
Localized 169,202 67.2 104,164 65.5 65,038 70.0
Regional 42,681 16.9 28,202 17.7 14,479 15.6
Distant 34,681 13.8 23,306 14.7 11,375 12.2
Unknown 5,280 2.1 3,277 2.1 2,003 2.2

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 17. Incidence rates* for male kidney and renal pelvis cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male kidney and renal pelvis cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 19.7; Midwest: 22.9; Northeast: 22.3; South: 22.2. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 18. Incidence rates* for female kidney and renal pelvis cancers, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female renal and pelvis cancers for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 9.9; Midwest: 12.1; Northeast: 10.9; South: 11.8. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 10. Incidence rates* and percentages† of invasive urinary bladder cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 354,478 20.5 (20.4–20.6) 268,872 35.8 (35.7–35.9) 85,606 8.8 (8.8–8.9)
Age group at diagnosis (yrs)
<40 3,145 0.4 (0.4–0.4) 2,170 0.6 (0.5–0.6) 975 0.3 (0.2–0.3)
40–49 10,369 4.8 (4.7–4.9) 7,491 6.9 (6.8–7.1) 2,878 2.6 (2.5–2.7)
50–59 42,345 19.2 (19.1–19.4) 31,916 29.7 (29.4–30.1) 10,429 9.3 (9.1–9.5)
60–69 90,204 58.4 (58.0–58.8) 69,828 95.2 (94.5–95.9) 20,376 25.1 (24.7–25.4)
70–79 108,913 125.4 (124.6–126.1) 84,699 217.5 (216.0–218.9) 24,214 50.6 (49.9–51.2)
≥80 99,502 172.4 (171.3–173.5) 72,768 340.8 (338.3–343.2) 26,734 73.2 (72.3–74.1)
Race
White 322,431 21.8 (21.7–21.9) 246,446 38.0 (37.8–38.1) 75,985 9.3 (9.2–9.3)
Black 19,647 11.7 (11.5–11.9) 13,174 19.5 (19.1–19.9) 6,473 6.6 (6.4–6.8)
American Indian/Alaska Native 1,155 9.0 (8.4–9.5) 849 15.3 (14.1–16.4) 306 4.2 (3.7–4.7)
Asian/Pacific Islander 6,084 8.5 (8.3–8.7) 4,558 14.9 (14.5–15.4) 1,526 3.8 (3.6–4.0)
Ethnicity
Hispanic 15,308 11.2 (11.0–11.3) 11,365 19.5 (19.1–19.9) 3,943 5.0 (4.9–5.2)
Non-Hispanic 339,122 21.3 (21.3–21.4) 257,478 37.2 (37.1–37.4) 81,644 9.2 (9.1–9.2)
County classification
Metropolitan 284,262 20.4 (20.3–20.4) 214,733 35.7 (35.5–35.9) 69,529 8.8 (8.8–8.9)
Nonmetropolitan 53,332 21.0 (20.8–21.1) 41,193 36.2 (35.8–36.6) 12,139 8.8 (8.6–9.0)
Census region
Northeast 81,032 24.3 (24.2–24.5) 60,232 42.5 (42.2–42.9) 20,800 11.0 (10.8–11.1)
Midwest 84,088 21.7 (21.6–21.9) 63,670 37.9 (37.6–38.2) 20,418 9.4 (9.3–9.5)
South 121,179 18.8 (18.7–18.9) 92,425 33.0 (32.8–33.2) 28,754 8.0 (7.9–8.1)
West 68,179 18.7 (18.6–18.9) 52,545 32.5 (32.3–32.8) 15,634 7.8 (7.6–7.9)
Tumor characteristic** No. % No. % No. %
Total 346,522 100.0 263,415 100.0 83,107 100.0
Histology
Transitional cell carcinoma 328,814 94.9 251,579 95.5 77,235 92.9
Squamous cell carcinoma 5,506 1.6 3,170 1.2 2,336 2.8
Adenocarcinoma 3,829 1.1 2,551 1.0 1,278 1.5
Epithelial carcinoma, NOS 6,249 1.8 4,645 1.8 1,604 1.9
All other histologies 2,124 0.6 1,470 0.6 654 0.8
Stage††
Localized 296,493 85.6 227,058 86.2 69,435 83.5
Regional 25,399 7.3 18,696 7.1 6,703 8.1
Distant 14,366 4.1 10,047 3.8 4,319 5.2
Unknown 10,264 3.0 7,614 2.9 2,650 3.2

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 19. Incidence rates* for male urinary bladder cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male urinary bladder cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 32.5; Midwest: 37.9; Northeast: 42.5; South: 33.0. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 20. Incidence rates* for female urinary bladder cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female urinary bladder cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 7.8; Midwest: 9.4; Northeast: 11.0; South: 8.0. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 11. Incidence rates* and percentages† of invasive cervical cancer, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic No. Rate (95% CI)
Total 61,499 7.5 (7.5–7.6)
Age group at diagnosis (yrs)
<40 15,061 3.9 (3.8–3.9)
40–49 15,242 14.3 (14.1–14.6)
50–59 13,551 12.3 (12.1–12.6)
60–69 9,538 11.6 (11.3–11.8)
70–79 5,003 10.4 (10.1–10.7)
≥80 3,104 8.6 (8.3–8.9)
Race
White 47,007 7.3 (7.2–7.4)
Black 9,837 9.3 (9.1–9.5)
American Indian/Alaska Native 609 6.5 (6.0–7.1)
Asian/Pacific Islander 2,900 6.1 (5.9–6.3)
Ethnicity
Hispanic 10,236 9.7 (9.5–9.9)
Non-Hispanic 51,259 7.3 (7.2–7.3)
County classification
Metropolitan 50,808 7.4 (7.4–7.5)
Nonmetropolitan 8,440 8.4 (8.2–8.6)
Census region
Northeast 10,935 7.1 (6.9–7.2)
Midwest 12,530 7.1 (7.0–7.3)
South 25,587 8.3 (8.2–8.4)
West 12,447 6.9 (6.8–7.0)
Tumor characteristic** No. %
Total 59,726 100.0
Histology
Squamous cell carcinoma 39,480 66.1
Adenocarcinoma 16,456 27.6
Epithelial carcinoma, NOS 2,235 3.7
All other histologies 1,555 2.6
Stage††
Localized 26,183 43.8
Regional 21,650 36.2
Distant 8,824 14.8
Unknown 3,069 5.1

Abbreviations: CI = confidence interval; NOS = not otherwise specified.
* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.
** Only includes microscopically confirmed cases; excludes cases identified only through death certificate or autopsy report.
†† Localized: cancer that is confined to the primary site; regional: cancer that has spread directly beyond the primary site or to regional lymph nodes; distant: cancer that has spread to other organs.

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Return to your place in the textFIGURE 21. Incidence rates* for cervical cancer, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for cervical cancer for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 6.9; Midwest: 7.1; Northeast: 7.1; South: 8.3. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 12. Incidence rates* and percentages† of acute myeloid leukemia, by demographic and tumor characteristics — United States,§ 2010–2014Return to your place in the text
Demographic characteristic Total Male Female
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI)
Total 70,960 4.2 (4.2–4.2) 39,024 5.2 (5.1–5.2) 31,936 3.5 (3.5–3.6)
Age group at diagnosis (yrs)
<40 8,576 1.0 (1.0–1.1) 4,254 1.0 (1.0–1.1) 4,322 1.1 (1.0–1.1)
40–49 4,967 2.3 (2.3–2.4) 2,512 2.4 (2.3–2.5) 2,455 2.3 (2.2–2.4)
50–59 9,408 4.3 (4.2–4.4) 5,099 4.8 (4.7–4.9) 4,309 3.9 (3.8–4.0)
60–69 15,497 10.0 (9.8–10.2) 9,068 12.3 (12.1–12.6) 6,429 7.9 (7.7–8.1)
70–79 17,344 20.0 (19.7–20.3) 10,119 26.0 (25.5–26.5) 7,225 15.1 (14.7–15.4)
≥80 15,168 26.3 (25.9–26.8) 7,972 37.3 (36.5–38.1) 7,196 19.9 (19.4–20.3)
Race
White 60,923 4.3 (4.3–4.3) 33,980 5.3 (5.2–5.3) 26,943 3.6 (3.5–3.6)
Black 6,368 3.5 (3.4–3.6) 3,157 4.1 (4.0–4.3) 3,211 3.1 (3.0–3.2)
American Indian/Alaska Native 432 2.7 (2.5–3.0) 214 3.1 (2.6–3.6) 218 2.5 (2.2–2.9)
Asian/Pacific Islander 2,645 3.4 (3.2–3.5) 1,361 4.0 (3.7–4.2) 1,284 2.9 (2.8–3.1)
Ethnicity
Hispanic 6,362 3.6 (3.5–3.7) 3,351 4.2 (4.0–4.4) 3,011 3.2 (3.0–3.3)
Non-Hispanic 64,594 4.3 (4.2–4.3) 35,671 5.2 (5.2–5.3) 28,923 3.5 (3.5–3.6)
County classification
Metropolitan 57,611 4.2 (4.2–4.2) 31,583 5.2 (5.1–5.2) 26,028 3.5 (3.5–3.5)
Nonmetropolitan 10,050 4.2 (4.1–4.3) 5,611 5.1 (4.9–5.2) 4,439 3.6 (3.5–3.7)
Census region
Northeast 14,211 4.5 (4.4–4.5) 7,763 5.5 (5.4–5.6) 6,448 3.7 (3.6–3.8)
Midwest 16,751 4.5 (4.4–4.5) 9,143 5.5 (5.3–5.6) 7,608 3.7 (3.7–3.8)
South 25,375 4.0 (4.0–4.1) 14,003 5.0 (4.9–5.0) 11,372 3.4 (3.3–3.4)
West 14,623 4.0 (4.0–4.1) 8,115 4.9 (4.8–5.0) 6,508 3.4 (3.3–3.5)

Abbreviation: CI = confidence interval.
* New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
† New cases diagnosed.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
Ethnicity is not mutually exclusive from race.

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Return to your place in the textFIGURE 22. Incidence rates* for male acute myeloid leukemia, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for male acute myeloid leukemia for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 males, age adjusted to the 2000 U.S. standard population.

† West: 4.9; Midwest: 5.5; Northeast: 5.5; South: 5.0. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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Return to your place in the textFIGURE 23. Incidence rates* for female acute myeloid leukemia, by state/area and U.S. census region† — United States,§ 2010–2014
This figure is a U.S. map showing the incidence rates for female acute myeloid leukemia for 2010–2014.

Abbreviations: DC = District of Columbia; PR = Puerto Rico.

* New cases diagnosed per 100,000 females, age adjusted to the 2000 U.S. standard population.

† West: 3.4; Midwest: 3.7; Northeast: 3.7; South: 3.4. (West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Oregon, New Mexico, Utah, Washington, and Wyoming; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.)

§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.) Data for Puerto Rico are included in state-specific analyses but not in U.S. census region analyses.

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TABLE 13. Annual percentage change* in incidence rates† of tobacco-associated cancers, by cancer site and sex — United States,§ 2010–2014Return to your place in the text
Cancer site Total Male Female
APC p value** APC p value APC p value
All tobacco-related cancer sites -1.20 <0.001 -1.40 0.001 -1.10 <0.001
Oral cavity and pharynx 0.63 0.09 0.79 0.18 0.06 0.81
Esophagus -0.86 0.02 -1.12 0.006 -0.54 0.24
Stomach -1.01 <0.001 -1.25 0.02 -0.92 0.08
Colon and rectum -2.07 0.002 -2.19 0.001 -2.04 0.005
Liver 1.98 0.02 1.72 0.04 2.43 0.02
Pancreas 0.53 0.08 0.70 0.05 0.36 0.10
Larynx -3.00 0.004 -3.18 0.008 -2.81 0.004
Trachea, lung, and bronchus -2.17 <0.001 -2.88 <0.001 -1.47 0.007
Cervix uteri — — — — -0.87 0.15
Kidney and renal pelvis 0.54 0.01 0.69 0.004 0.07 0.73
Urinary bladder -1.28 0.02 -1.51 0.02 -1.29 0.04
Acute myeloid leukemia 0.34 0.03 0.36 0.22 0.17 0.59

Abbreviations: APC = annual percentage change.
* Calculated by least squares regression.
† New cases diagnosed per 100,000 persons, age adjusted to the 2000 U.S. standard population.
§ Cancer incidence data were compiled from cancer registries that met the data quality criteria for all invasive cancer sites combined, representing approximately 99% of the U.S. population. (Data from Nevada did not meet U.S. Cancer Statistics publication criteria for 2010–2014.)
See also Supplementary Table 1 (https://stacks.cdc.gov/view/cdc/59431) and Supplementary Table 2 (https://stacks.cdc.gov/view/cdc/59432).
** p<0.05 was considered statistically significant.

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Suggested citation for this article: Gallaway MS, Henley SJ, Steele CB, et al. Surveillance for Cancers Associated with Tobacco Use — United States, 2010–2014. MMWR Surveill Summ 2018;67(No. SS-12):1–42. DOI: http://dx.doi.org/10.15585/mmwr.ss6712a1.

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