Report highlights are categorized into one of the three following groups: Making Progress, Areas of Concern, and Other Trends to Consider.
The nation is making progress toward major cancer-related targets for Healthy People 2030, a comprehensive set of 10-year health objectives sponsored by the U.S. Department of Health and Human Services.
- Cigarette smoking prevalence among adults has declined steadily since we began monitoring trends in 1965. In 2019, 14.2% of adults aged 18 and older reported current cigarette smoking.
- Cigarette smoking prevalence among adolescents has declined since at least 2011, with 3.3% of middle and high school students in 2020 having smoked cigarettes in the past 30 days.
- Initiation of the use of cigarettes among adolescents and young adults aged 12 to 25 years has been falling. As of 2019, it was 2.6%.
- Cigarette smoking cessation among adults has risen since 2003. In 2018, 8.3% of adults who smoked successfully quit 6-12 months previously, approaching the Healthy People 2030 target of 10.2%. Since 2011, there has been an uptick in successful smoking cessation among those aged 18 to 24 years. However, some subgroups have a low percentage of recent smoking cessation success among adult smokers, such as non-Hispanic blacks and people with less than a high school education.
- Indoor tanning has decreased significantly among female high school students since 2013. Many states have enacted policies to control the indoor tanning industry, and some are restricting minors’ access to indoor tanning facilities. The most recent estimate (2019) of the percentage of female adolescents in grades 9 through 12 who used an indoor tanning device in the past year is 5.7% (4.5% for both sexes).
- Recent trends for inorganic arsenic exposure have been decreasing since 2009/2010. Inorganic arsenic compounds are more toxic than organic arsenic compounds, and inorganic arsenic has been linked to bladder, lung, skin, prostate, liver and intrahepatic bile duct, and some kidney cancers. Inorganic arsenic compounds are found in industry, in building products (in some “pressure-treated” woods), and in arsenic-contaminated water and soil. We typically take in small amounts of inorganic arsenic in the food we eat (in particular, rice and fish), the water we drink, and the air we breathe.
- The percentage of adolescents aged 13 to 17 years who are up-to-date on recommended HPV vaccinations (based on the guidelines set forth by the Centers for Disease Control and Prevention’s [CDC] Advisory Committee on Immunization Practices [ACIP]) has been increasing, and in 2019 was 56.8% for females and 51.8% for males.
- The percentage of adults aged 50 to 75 years who are up-to-date with colorectal cancer screening (based on the 2016 U.S. Preventive Services Task Force recommendations) has been increasing, and in 2019 it was 67.1%.
- Lung cancer incidence rates (new cases) have continued to fall since at least 1991 among males, and since 2006 among females.
- Recent trends show a decline in the incidence of thyroid, urinary bladder, ovarian, and larynx cancers at 2% or more a year, with smaller but still statistically significant decreases in stomach and brain cancers, and Hodgkin and non-Hodgkin lymphoma.
- Trends for distant-stage colon cancer have been decreasing since 2004.
- Colorectal cancer incidence rates have been decreasing since 1998, however the rate of decline slowed starting in 2011. Since then the trend has flattened somewhat. The declines in colorectal cancer incidence can be attributed to increased screening, which not only contributes to reduced incidence through the identification and removal of precancerous lesions but also improves the detection of cancer at an earlier stage.
- The proportion of females with early-stage breast cancer treated with breast-conserving surgery (BCS) with radiation has been rising slowly since 2009.
- Between 1990 and 2015, there was a significant increase in receipt of guideline chemotherapy treatment among patients aged 65 years and older with stage III colon cancer and stages II and III rectal cancer, with 57% receiving guideline therapy in 2015.
Life After Cancer
- The proportion of adult cancer survivors who are current smokers continues to decline, with the greatest improvement seen among survivors aged 18 to 44 years.
- The percentage of cancer survivors aged 18 years and older reporting no physical activity in their leisure time has been declining steadily since 2005. Likewise, the percentage of survivors who meet current Federal guidelines for aerobic and muscle-strengthening physical activity continues to rise.
End of Life
- The rate of death from cancer continues to decline among both males and females in all major racial and ethnic groups.
- Mortality for three of the most common types of cancer (colorectal, female breast, and lung) continues to fall.
- Recent trends show a decline of 2% or more a year in mortality for ovarian and larynx cancers, non-Hodgkin and Hodgkin lymphomas, melanoma of the skin, and leukemia, with smaller but still statistically significant decreases for myeloma, esophagus, cervix uteri, kidney and renal pelvis, and stomach cancers.
Areas of Concern
The nation is losing ground in other important areas that demand attention.
- Although the percentage of smokers making a quit attempt in the past year has been rising since 2005 and was 54.1% in 2018, it is still well below the Healthy People 2030 target of 65.7%.
- Progress has been made in reducing exposure to secondhand smoke among all populations, but non-Hispanic blacks still have higher rates of exposure than other racial/ethnic groups; those living at less than 200% of the federal poverty level still have higher rates of exposure than those living at 200% or greater than the federal poverty level; and those aged 25 years and older with a high school education or less still have higher rates than those with more education.
- Since 2014, e-cigarettes have been the most commonly used tobacco product by youth. In 2020, 19.6% of high school students and 4.7% of middle school students reported current use of e-cigarettes.
- Tobacco advertising and promotion are causally related to increased tobacco initiation and use. The U.S. Federal Trade Commission reports cigarette and smokeless tobacco advertising and promotion expenditures for the largest cigarette companies and major smokeless tobacco product manufacturers. In 2018, the combined annual expenditure for advertising and promotion (adjusted to 2018 dollars) was $8.4 billion for cigarettes and $658.5 million for smokeless tobacco products —amounting to about $24.8 million every day.
- Although more than 70.8% of adults reported practicing sun-protective behaviors in 2015, more than 35.3% reported having had one or more sunburns in the past 12 months. An even higher rate of sunburn (57.2% in 2017) was reported among teens. Sunburn is a primary modifiable risk factor for melanoma skin cancer, and the rate has changed very little from 2000-2015 for adults and between 2015-2017 among teens. While non-Hispanic whites were more likely to experience sunburn than other racial/ethnic groups, sunburn occurs more often among those aged 18 to 24 years (46.0% in 2015) than among those aged 25 years and older (33.7%). Within groups the rate has remained relatively steady.
- Sun sensitivity occurs in all racial/ethnic groups. Sun-sensitive adults, who are at greatest risk for melanoma, continue to report slightly higher tanning bed use and higher sunburn incidence than those without sun sensitivity (51.7% for sun-sensitive individuals versus 17.7% among those who are not sun- sensitive in 2017).
- Although sunbathing and tanning are strongly associated with sunburn, recent data indicate that most sunburns occur in contexts unrelated to intentional tanning. Results suggest the need to promote multiple forms of sun protection tailored to specific contexts, especially when engaged in physical activity and when spending time near the water.
- Per capital alcohol consumption, which can increase the risk of some cancers, has risen slightly since the mid-1990s.
- Excess weight or obesity, physical inactivity, and poor nutrition are preventable conditions that are associated with elevated cancer risk. Obesity prevalence continues to increase, with 42.4% of adults estimated to be obese and an additional 31.2% overweight. Despite modest increases over time, only 25.4% of adults report meeting federal guidelines for aerobic and muscle-strengthening physical activity. Rates among low-income and low-education groups of any race were well below the Healthy People 2030 target of 28.4%. Overall diet quality has not improved for years; Americans are not meeting recommendations for intake of fruits and vegetables, which have been linked to prevention of several cancer types.
- The Cancer Trends Progress Report includes rates of triennial Pap testing since 1987. To accommodate the addition of HPV testing as a recommended approach to cervical cancer screening, the current report tracks the percentage of females who were up-to-date with current cervical cancer screening recommendations. In 2019, 73.5% of females aged 21 to 65 years were up-to-date with respect to their cervical screening recommendations, which is below the Healthy People 2030 target of 84.3%.
- Since 2010, uptake of lung cancer screening with chest computed tomography (CT) has been fairly stable —but limited. The U.S. Preventive Services Task Force (USPSTF) first recommended low-dose radiation CT screening for lung cancer in 2013 for adults aged 55 to 80 years who had a 30 pack-year smoking history or more and who currently smoked or had quit within the past 15 years. In 2015, 4.5% of individuals who met the 2013 USPSTF criteria had a CT scan to check for lung cancer within the past year. In March 2021, the USPSTF published revised guidelines and now recommends annual low-dose radiation CT (LDCT) screening for lung cancer in adults aged 50 to 80 years who have a 20 pack-year smoking history or more and who currently smoke or have quit within the past 15 years.
- The incidence of several cancers, including leukemia, melanoma of the skin, oral cavity and pharynx, testis, pancreas, and esophageal adenocarcinoma cancers, has been increasing annually.
- Although age-specific trends in incidence and mortality are not generally covered in this report, it should be noted that incidence trends of colorectal cancer for those aged under 50 years have been rising and are of enough concern that some guideline setting organizations either have, or are considering, lowering the age to initiate screening.
- The proportion of patients aged 20 years and older diagnosed with stage IIIB or IV non-small cell lung cancer receiving any chemotherapy has not been rising since 2005.
Life After Diagnosis
- Even for patients with health insurance, out-of-pocket costs for cancer care often pose a significant financial burden. Estimates of national expenditures for cancer care in 2020 for the top five most costly cancer sites were $29.8, $24.3, $23.8, $22.3, and $18.6 billion for female breast, colorectal, lung, and prostate cancers and non-Hodgkin lymphoma, respectively. As the U.S. population ages and newer technologies and treatments become available, national expenditures for cancer will continue to rise, and cancer costs may increase at a faster rate than overall medical expenditures.
- The proportion of adult cancer survivors who are obese has been rising and is now 33%. Efforts are needed to help cancer survivors adopt or maintain a healthy lifestyle after cancer, which has the potential to reduce both cancer- and non-cancer-related morbidity.
End of Life
- Recent trends in the death rates for several cancers, including thyroid, liver and intrahepatic bile duct, brain and other nervous system, oral cavity and pharynx, and corpus uteri (endometrial) cancers, have been increasing.
Other Trends to Consider
While this report provides trends in cancer rates, and factors that influence cancer rates, for some trends it is not possible to characterize the direction of the trend as either progress or an area of concern.
- Prostate cancer: After a long decline, the incidence rates for prostate cancer started rising in 2014, and death rates flattened out starting in 2013. Prostate cancer incidence rates are very sensitive to changes in PSA screening rates and subsequent referral for biopsy. In 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening. In 2018, the task force changed its recommendations. Prostate cancer testing rates in the past year fell rather dramatically from 2010 to 2013 (from 46.1% to 38.2%), probably as a result of the 2012 USPSTF guidelines, but have been fairly stable since then. Mortality rates are a function of many factors, including changes in screening rates and advances in treatment. While PSA screening may reduce mortality for some patients, it must be balanced against a significant number of patients who are diagnosed with disease that is relatively indolent and may not have progressed prior to the person eventually dying of other unrelated causes.