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November 15, 2007 / Volume 110 / Number 10

RESULTS. Overall cancer death rates decreased by 2.1% per year from 2002 through 2004, nearly twice the annual decrease of 1.1% per year from 1993 through 2002. Among men and women, death rates declined for most cancers. Among women, lung cancer incidence rates no longer were increasing and death rates, although they still were increasing slightly, were increasing at a much slower rate than in the past. Breast cancer incidence rates in women decreased 3.5% per year from 2001 to 2004, the first decrease observed in 20 years. Colorec- tal cancer incidence and death rates and prostate cancer death rates declined, with colorectal cancer death rates dropping more sharply from 2002 through 2004. Overall, rates for AI/AN were lower than for NHW from 1999 through 2004 for most cancers, but they were higher for cancers of the stomach, liver, cervix, kidney, and gallbladder. Regional analyses, however, revealed high rates for AI/ AN in the Northern and Southern Plains and Alaska. For cancers of the breast, colon and rectum, prostate, and cervix, AI/AN were less likely than NHW to be

diagnosed at localized stages.

CONCLUSIONS. For all races/ethnicities combined in the U.S., favorable trends in incidence and mortality were noted for lung and colorectal cancer in men and women and for breast cancer in women. For the AI/AN population, lower overall cancer incidence and death rates obscured important variations by geographic regions and less favorable healthcare access and socioeconomic status. Enhanced tobacco control and cancer screening, especially in the Northern and Southern Plains and Alaska, emerged as clear priorities. Cancer 2007;110:2119–52. Published 2007 by the American Cancer Society.*

KEYWORDS: cancer, incidence, mortality, American Indian, Alaska Native, National Program of Cancer Registries, Surveillance, Epidemiology, and End Results, Amer- ican Cancer Society, North American Association of Central Cancer Registries, U.S., health disparity.

T he American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North Amer- ican Association of Central Cancer Registries (NAACCR) collaborate annually to assess the cancer burden in the U.S. The 1998 report documented the first sustained decline in cancer death rates since the 1930s.1 Subsequent reports updated information on trends in incidence and death rates and featured timely, in-depth analyses of selected topics.2–9 The American Indian and Alaska Native (AI/AN) cancer experience has not been described well except for a few geographic areas. This 2007 report updates the cancer profile for the U.S. and describes regional pat- terns of cancer in AI/AN using methods that mitigate the effects of race misclassification.

(NPCR), in the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program, or both; and all are members of NAACCR. In this report, incidence data from these registries refer to invasive cancers, with the exception of in situ cancer of the urinary bladder (bladder). Primary cancer site and histology data were coded according to the International Classifica- tion of Diseases (ICD) for Oncology (ICD-O) edition in use at the time of diagnosis, converted to the

Third Edition coding10 SEER site groups.11

and categorized according to

U.S. cancer deaths, reported to state vital statis- tics offices and consolidated through CDC’s National Vital Statistics System,12 were coded using the ver- sion of the ICD in use at the time of death. Underlying causes of cancer death were grouped 13–16

MATERIALS AND METHODS Cancer Cases, Cancer Deaths, and Population Estimates Population-based cancer registries collect informa- tion on all reportable cancer cases. They participate in the CDC’s National Program of Cancer Registries

according to the SEER cause of death recode for maximum comparability among ICD versions.11 Mor- tality data were provided by all 50 states and the Dis- trict of Columbia; however, death rates for the Hispanic population did not include data from 5 states (Maine, Minnesota, New Hampshire, North Dakota, and Oklahoma) because of incomplete ethni- city information for at least one of the reporting years in the analyses. 17

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