US cancer mortality continued to decline through 2023, driven largely by sustained progress against lung cancer, according to the Annual Report to the Nation on the Status of Cancer published in Cancer. Overall cancer incidence, however, remained stable among males and increased slowly among females.
Researchers analyzed population-based cancer incidence data from registries funded by the Centers for Disease Control and Prevention and/or the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Mortality data came from the National Center for Health Statistics’ National Vital Statistics System. The analysis evaluated age-standardized incidence and mortality rates and trends by cancer type, sex, race and ethnicity, and age, with a special assessment of lung cancer risk factors and outcomes during 2000 to 2025.
During 2019 to 2023, overall cancer mortality declined 1.6% per year among males and 1.1% per year among females. The age-standardized overall cancer death rate was 171.5 per 100,000 males and 126.3 per 100,000 females. Lung cancer showed the largest mortality declines among the common cancers examined, with death rates decreasing 4.7% per year among males and 3% per year among females.
Longer-term trends underscored the magnitude of the change in lung cancer outcomes. From 2004 to 2023, lung cancer mortality decreased 52% among males, from 70.3 to 34 deaths per 100,000, and 37% among females, from 41 to 25.7 deaths per 100,000. Lung cancer also accounted for a smaller proportion of all cancer mortality, declining from 29% in 2004 to 21% in 2023.
Lung cancer incidence also declined. From 2003 to 2022, incidence decreased by 38% among males, from 88.7 to 55.2 cases per 100,000, and 15% among females, from 55.8 to 47.7 cases per 100,000. From 2018 to 2022, lung cancer incidence declined an average of 3.5% per year among males and 1.9% per year among females.
These changes occurred alongside substantial shifts in lung cancer risk factors and detection. Adult cigarette smoking prevalence declined 56%, from 22.6% in 2001 to 9.9% in 2024, while secondhand smoke exposure among nonsmoking persons aged 3 years or older declined 42%, from 41.8% in 2001/2002 to 24.3% in 2017/March 2020. Among adults eligible for lung cancer screening under the criteria applicable to each survey, the proportion reporting being up to date with screening increased from 4.5% in 2015 to 18.7% in 2024, although fewer than 1 in 5 eligible adults were up to date nationally. The authors identified continued tobacco prevention and cessation, increased screening uptake, comprehensive biomarker testing, and improved access to guideline-concordant treatment as opportunities to sustain progress.
Earlier-stage diagnosis and survival improved as well. From 2003 to 2022, the proportion of lung cancers diagnosed at a localized stage increased from 16% to 27% among males and from 19% to 33% among females. Five-year relative survival doubled from 15% in 2000 to 30% in 2018. During 2018 to 2022, however, incidence rates for localized-stage disease were stable, while rates for regional-, distant-, and unknown-stage disease declined.
Against these improvements in lung cancer, overall cancer incidence showed a different pattern. During 2018 to 2022, overall incidence increased an average of 0.2% per year. Observed 2020 incidence was excluded from trend modeling because diagnoses were substantially lower than expected during the COVID-19 pandemic, with a modeled 2020 rate used in the 5-year trend estimate. Incidence among males had been stable since 2013, whereas incidence among females increased 0.4% per year from 2011 to 2022. In the most recent 5-year period, overall cancer incidence increased among females of every racial and ethnic group examined and among Asian or Pacific Islander males, while remaining stable among males in the other racial and ethnic groups.
Cancer-specific trends also varied. Among males, declining lung cancer incidence was countered by increasing prostate cancer incidence. Among females, declining lung cancer incidence occurred alongside increasing breast cancer incidence and a leveling of the previous decline in colorectal cancer incidence. Lung cancer incidence decreased among Asian or Pacific Islander, Black, and White females but was stable among American Indian or Alaska Native and Hispanic females.
Several limitations may affect interpretation. The 20-year analytic period could also influence the selection of joinpoint models and estimated trends. In addition, incomplete or inaccurate recording of race or Hispanic origin may have affected subgroup findings, and rates may have been underestimated among American Indian or Alaska Native, Asian or Pacific Islander, and Hispanic populations. Confidence intervals were also wide for some subgroup estimates because of small numbers. Changes in cancer classification over time may also have affected trends for some cancer types.
The report documented sustained declines in cancer mortality alongside substantial changes in lung cancer prevention, detection, and outcomes, although overall cancer incidence continued to increase among females. “Cancer mortality continued to decline, in large part because of sustained progress in lung cancer prevention and control during the 21st century,” wrote lead study author S. Jane Henley, MSPH, of the Centers for Disease Control and Prevention, and colleagues.
The study was supported by the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries. Farhad Islami, MD, PhD, Ahmedin Jemal, DVM, PhD, Rebecca L. Siegel, MPH, and Hyuna Sung, PhD, were employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with health-sector companies, for research outside the submitted work; the authors were not funded by those grants, and their salaries were funded solely through American Cancer Society funds. Karen L. Knight, MS, was a fiduciary officer of the North American Association of Central Cancer Registries and reported grants or contracts from the Centers for Disease Control and Prevention and National Cancer Institute. The remaining authors reported no conflicts of interest.
Source: Cancer
