Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

The changing landscape of cancer in the USA — opportunities for advancing prevention and treatment

Nature Reviews Clinical Oncology volume 17, pages 631–649 (2020)Cite this article

Subjects

Abstract

The cancer landscape of the USA is continually evolving owing to changing risk factor patterns and disease classifications, improvements in detection and treatment, and demographic changes, such as ageing and population growth. Monitoring the burden of cancer, including incidence and mortality, is a key tool for assessing progress, identifying emerging trends and setting priorities to reduce the burden. In this Perspective, we describe trends in cancer incidence and mortality in the USA overall, and for major cancer types, and describe the main contributing factors, including risk factors, screening, treatment and access to care. When relevant, we provide information based on sex and common classifications of race/ethnicity, socioeconomic status and geographical region. We then discuss the implications of the patterns of cancer incidence and mortality for cancer research, prevention and care.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: US trends in cancer incidence (1975–2016) and death (1975–2017) rates for all cancers by sex.
Fig. 2: US trends in incidence (1975–2016) and death (1975–2017) rates for selected cancers by sex.
Fig. 3: US trends in death rates for selected cancers by sex and race/ethnicity (1990–2017).

Similar content being viewed by others

References

  1. Siegel, R. L., Miller, K. D. & Jemal, A. Cancer statistics, 2020. CA Cancer J. Clin. 70, 7–30 (2020).

    PubMed  Google Scholar 

  2. Henley, S. J. et al. Annual report to the nation on the status of cancer, part I: national cancer statistics. Cancer 124, 2785–2800 (2018).

    PubMed  Google Scholar 

  3. National Institutes of Health Cancer Trends Progress Report. National Cancer Institute https://progressreport.cancer.gov (2019).

  4. Heston, J. F., Cusano, M. M., Young, J. L. & National Cancer Institute. Forty-five years of cancer incidence in Connecticut: 1935–79. 1–706 (Department of Health and Human Services, 1986).

  5. Freeman, H. P. Poverty, culture, and social injustice: determinants of cancer disparities. CA Cancer J. Clin. 54, 72–77 (2004).

    PubMed  Google Scholar 

  6. White, M. C. et al. The history and use of cancer registry data by public health cancer control programs in the United States. Cancer 123 (Suppl. 24), 4969–4976 (2017).

    PubMed  Google Scholar 

  7. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: incidence–SEER 9 Regs research data, Nov 2018 Sub (1975–2016) –linked to county attributes–total U.S., 1969–2017 counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2019. SEER www.seer.cancer.gov (2019).

  8. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: mortality–all COD, total U.S. (1969–2017) –linked to county attributes–total U.S., 1969–2017 counties, National Cancer Institute, DCCPS, Surveillance Research Program, released May 2019. Underlying mortality data provided by NCHS (www.cdc.gov/nchs). SEER www.seer.cancer.gov (2019).

  9. Howlader N. et al. (eds) SEER Cancer Statistics Review, 1975–2016 https://seer.cancer.gov/csr/1975_2016/ (National Cancer Institute, 2020).

  10. US Census Bureau. Race & Ethnicity. US Census Bureau https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf (2017).

  11. Murphy, S. L., Xu, J., Kochanek, K. D. & Arias, E. Mortality in the United States, 2017. NCHS Data Brief no. 328 (National Center for Health Statistics, 2018).

  12. Colby, S. L. & Ortman, J. M. Projections of the size and composition of the U.S. population: 2014 to 2060. Current Population Reports P25-1143. (US Census Bureau, 2014).

  13. Wingo, P. A., Tong, T. & Bolden, S. Cancer statistics, 1995. CA Cancer J. Clin. 45, 8–30 (1995).

    CAS  PubMed  Google Scholar 

  14. Kochanek, K. D., Murphy, S. L., Xu, J. & Arias, E. Deaths: final data for 2017. Natl Vital. Stat. Rep. 68, 1–77 (2019).

    PubMed  Google Scholar 

  15. National Center for Health Statistics. Health, United States, 2017: With special feature on mortality. (US Department of Health and Human Services, 2018).

  16. Mokdad, A. H. et al. Trends and patterns of disparities in cancer mortality among US counties, 1980-2014. JAMA 317, 388–406 (2017).

    PubMed  PubMed Central  Google Scholar 

  17. Islami, F. et al. Potentially preventable premature lung cancer deaths in the USA if overall population rates were reduced to those of educated whites in lowerrisk states. Cancer Causes Control 26, 409–418 (2015).

    PubMed  Google Scholar 

  18. Sineshaw, H. M., Ng, K., Flanders, W. D., Brawley, O. W. & Jemal, A. Factors that contribute to differences in survival of black vs white patients with colorectal cancer. Gastroenterology 154, 906–915 (2018).

    PubMed  Google Scholar 

  19. Daly, B. & Olopade, O. I. A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J. Clin. 65, 221–238 (2015).

    PubMed  Google Scholar 

  20. American Society of Clinical Oncology. The state of cancer care in America, 2017: a report by the American Society of Clinical Oncology. J. Oncol. Pract. 13, e353–e394 (2017).

    Google Scholar 

  21. Yabroff, K. R., Gansler, T., Wender, R. C., Cullen, K. J. & Brawley, O. W. Minimizing the burden of cancer in the United States: goals for a high-performing health care system. CA Cancer J. Clin. 69, 166–183 (2019).

    PubMed  Google Scholar 

  22. Malvezzi, M. et al. European cancer mortality predictions for the year 2019 with focus on breast cancer. Ann. Oncol. 30, 781–787 (2019).

    CAS  PubMed  Google Scholar 

  23. Cheng, E. S., Weber, M., Feletto, E., Smith, M. A. & Yu, X. Q. Cancer burden and control in Australia: lessons learnt and challenges remaining. Ann. Cancer Epidemiol. 2, 1–15 (2018).

    Google Scholar 

  24. Katanoda, K. et al. An updated report on the trends in cancer incidence and mortality in Japan, 1958–2013. Jpn. J. Clin. Oncol. 45, 390–401 (2015).

    PubMed  Google Scholar 

  25. Lim, D., Ha, M. & Song, I. Trends in major cancer mortality in Korea, 1983–2012, with a joinpoint analysis. Cancer Epidemiol. 39, 939–946 (2015).

    PubMed  Google Scholar 

  26. Thun, M., Peto, R., Boreham, J. & Lopez, A. D. Stages of the cigarette epidemic on entering its second century. Tob. Control 21, 96–101 (2012).

    Article  PubMed  Google Scholar 

  27. US Department of Health and Human Services. The Health Consequences of Smoking — 50 Years of Progress: a Report of the Surgeon General (Centers for Disease Control and Prevention, 2014).

  28. Ward, E. et al. Annual report to the nation on the status of cancer, 1999–2015, featuring cancer in men and women ages 20–49. J. Natl Cancer Inst. 111, 1279–1297 (2019).

    PubMed  PubMed Central  Google Scholar 

  29. Siegel, R. L. et al. Colorectal cancer statistics, 2020. CA Cancer J. Clin. https://doi.org/10.3322/caac.21601 (2020).

    Article  PubMed  Google Scholar 

  30. Sung, H., Siegel, R. L., Rosenberg, P. S. & Jemal, A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Lancet Public Health 4, e137–e147 (2019).

    PubMed  Google Scholar 

  31. Islami, F. et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J. Clin. 68, 31–54 (2018).

    PubMed  Google Scholar 

  32. Amos, A. & Haglund, M. From social taboo to “torch of freedom”: the marketing of cigarettes to women. Tob. Control 9, 3–8 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Jemal, A. et al. Higher lung cancer incidence in young women than young men in the United States. N. Engl. J. Med. 378, 1999–2009 (2018).

    PubMed  PubMed Central  Google Scholar 

  34. Sauer, A. G., Siegel, R. L., Jemal, A. & Fedewa, S. A. Updated review of prevalence of major risk factors and use of screening tests for cancer in the United States. Cancer Epidemiol. Biomarkers Prev. 26, 1192–1208 (2017).

    PubMed  Google Scholar 

  35. Lortet-Tieulent, J. et al. State-level cancer mortality attributable to cigarette smoking in the United States. JAMA Intern. Med. 176, 1792–1798 (2016).

    PubMed  Google Scholar 

  36. Centers for Disease Control and Prevention. Underlying Cause of Death 1999–2017. CDC WONDER http://wonder.cdc.gov/ucd-icd10.html (accessed 2019).

  37. Jemal, A. et al. Annual report to the nation on the status of cancer, 1975–2014, featuring survival. J. Natl Cancer Inst. 109, djx030 (2017).

    PubMed Central  Google Scholar 

  38. Jemal, A. & Fedewa, S. A. Lung cancer screening with low-dose computed tomography in the United States-2010 to 2015. JAMA Oncol. 3, 1278–1281 (2017).

    PubMed  PubMed Central  Google Scholar 

  39. Jones, G. S. & Baldwin, D. R. Recent advances in the management of lung cancer. Clin. Med. 18, s41–s46 (2018).

    Google Scholar 

  40. Singh, G. K., Miller, B. A. & Hankey, B. F. Changing area socioeconomic patterns in U.S. cancer mortality, 1950–1998: part II–lung and colorectal cancers. J. Natl Cancer Inst. 94, 916–925 (2002).

    PubMed  Google Scholar 

  41. Smith, R. A. et al. Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J. Clin. 69, 184–210 (2019).

    PubMed  Google Scholar 

  42. Siegel, R. L., Miller, K. D. & Jemal, A. Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970–2014. JAMA 318, 572–574 (2017).

    PubMed  PubMed Central  Google Scholar 

  43. Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut 68, 2179–2185 (2019).

    PubMed  Google Scholar 

  44. Naishadham, D., Lansdorp-Vogelaar, I., Siegel, R., Cokkinides, V. & Jemal, A. State disparities in colorectal cancer mortality patterns in the United States. Cancer Epidemiol. Biomarkers Prev. 20, 1296–1302 (2011).

    PubMed  Google Scholar 

  45. Jemal, A. et al. Inequalities in premature death from colorectal cancer by state. J. Clin. Oncol. 33, 829–835 (2015).

    PubMed  Google Scholar 

  46. Neuhouser, M. L. et al. Overweight, obesity, and postmenopausal invasive breast cancer risk: a secondary analysis of the Women’s Health Initiative randomized clinical trials. JAMA Oncol. 1, 611–621 (2015).

    PubMed  PubMed Central  Google Scholar 

  47. Liu, Y., Nguyen, N. & Colditz, G. A. Links between alcohol consumption and breast cancer: a look at the evidence. Womens Health 11, 65–77 (2015).

    CAS  Google Scholar 

  48. DeSantis, C. E., Ma, J., Goding Sauer, A., Newman, L. A. & Jemal, A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J. Clin. 67, 439–448 (2017).

    PubMed  Google Scholar 

  49. Grucza, R. A. et al. Trends in adult alcohol use and binge drinking in the early 21st-century United States: a meta-analysis of 6 national survey series. Alcohol. Clin. Exp. Res. 42, 1939–1950 (2018).

    PubMed  PubMed Central  Google Scholar 

  50. Waks, A. G. & Winer, E. P. Breast cancer treatment: a review. JAMA 321, 288–300 (2019).

    CAS  PubMed  Google Scholar 

  51. Hsieh, M. C. et al. Population-based study on cancer subtypes, guideline-concordant adjuvant therapy, and survival among women with stage I–III breast cancer. J. Natl Compr. Canc. Netw. 17, 676–686 (2019).

    CAS  PubMed  Google Scholar 

  52. Jemal, A. et al. Factors that contributed to black-white disparities in survival among nonelderly women with breast cancer between 2004 and 2013. J. Clin. Oncol. 36, 14–24 (2018).

    PubMed  Google Scholar 

  53. Islami, F., Moreira, D. M., Boffetta, P. & Freedland, S. J. A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur. Urol. 66, 1054–1064 (2014).

    PubMed  PubMed Central  Google Scholar 

  54. Lauby-Secretan, B. et al. Body fatness and cancer–viewpoint of the IARC Working Group. N. Engl. J. Med. 375, 794–798 (2016).

    PubMed  PubMed Central  Google Scholar 

  55. Houston, K. A., King, J., Li, J. & Jemal, A. Trends in prostate cancer incidence rates and prevalence of prostate specific antigen screening by socioeconomic status and regions in the United States, 2004 to 2013. J. Urol. 199, 676–682 (2018).

    PubMed  Google Scholar 

  56. Negoita, S. et al. Annual report to the nation on the status of cancer, part II: recent changes in prostate cancer trends and disease characteristics. Cancer 124, 2801–2814 (2018).

    PubMed  Google Scholar 

  57. Kelly, S. P., Anderson, W. F., Rosenberg, P. S. & Cook, M. B. Past, current, and future incidence rates and burden of metastatic prostate cancer in the United States. Eur. Urol. Focus. 4, 121–127 (2018).

    PubMed  Google Scholar 

  58. Ahlering, T. et al. Unintended consequences of decreased PSA-based prostate cancer screening. World J. Urol. 37, 489–496 (2019).

    PubMed  Google Scholar 

  59. US Preventive Services Task Force. et al. Screening for prostate cancer: US preventive services task force recommendation statement. JAMA 319, 1901–1913 (2018).

    Google Scholar 

  60. Rebbeck, T. R. Prostate cancer genetics: variation by race, ethnicity, and geography. Semin. Radiat. Oncol. 27, 3–10 (2017).

    PubMed  Google Scholar 

  61. Moses, K. A., Orom, H., Brasel, A., Gaddy, J. & Underwood, W. 3rd. Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter? Urology 99, 76–83 (2017).

    PubMed  Google Scholar 

  62. Krimphove, M. J. et al. Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 22, 125–136 (2019).

    PubMed  Google Scholar 

  63. Jacobs, E. J. et al. The association of body mass index with pancreatic cancer: variation by age at body mass index assessment. Am. J. Epidemiol. https://doi.org/10.1093/aje/kwz251 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  64. Zohar, L. et al. Adolescent overweight and obesity and the risk for pancreatic cancer among men and women: a nationwide study of 1.79 million Israeli adolescents. Cancer 125, 118–126 (2019).

    PubMed  Google Scholar 

  65. Tavakkoli, A. et al. Racial disparities and trends in pancreatic cancer incidence and mortality in the United States. Clin. Gastroenterol. Hepatol. 18, 171–178 (2019).

    PubMed  Google Scholar 

  66. Makarova-Rusher, O. V. et al. Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Cancer 122, 1757–1765 (2016).

    PubMed  Google Scholar 

  67. Kanwal, F. et al. Trends in the burden of nonalcoholic fatty liver disease in a United States cohort of veterans. Clin. Gastroenterol. Hepatol. 14, 301–308 (2016).

    PubMed  Google Scholar 

  68. Islami, F. et al. Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA Cancer J. Clin. 67, 273–289 (2017).

    PubMed  Google Scholar 

  69. Moore, K. J., Gauri, A. & Koru-Sengul, T. Prevalence and sociodemographic disparities of hepatitis C in baby boomers and the US adult population. J. Infect. Public. Health 12, 32–36 (2019).

    PubMed  Google Scholar 

  70. Hales, C. M., Fryar, C. D., Carroll, M. D., Freedman, D. S. & Ogden, C. L. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA 319, 1723–1725 (2018).

    PubMed  PubMed Central  Google Scholar 

  71. Allen, A. M. et al. Nonalcoholic fatty liver disease incidence and impact on metabolic burden and death: a 20 year-community study. Hepatology 67, 1726–1736 (2018).

    CAS  PubMed  Google Scholar 

  72. Menke, A., Casagrande, S., Geiss, L. & Cowie, C. C. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA 314, 1021–1029 (2012).

    Google Scholar 

  73. Denniston, M. M. et al. Chronic hepatitis C virus infection in the United States, national health and nutrition examination survey 2003 to 2010. Ann. Intern. Med. 160, 293–300 (2014).

    PubMed  PubMed Central  Google Scholar 

  74. Kowdley, K. V., Wang, C. C., Welch, S., Roberts, H. & Brosgart, C. L. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology 56, 422–433 (2012).

    PubMed  Google Scholar 

  75. Roberts, H. et al. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: national health and nutrition examination survey (NHANES), 1988–2012. Hepatology 63, 388–397 (2016).

    CAS  PubMed  Google Scholar 

  76. Clarke, M. A., Devesa, S. S., Harvey, S. V. & Wentzensen, N. Hysterectomy-corrected uterine corpus cancer incidence trends and differences in relative survival reveal racial disparities and rising rates of nonendometrioid cancers. J. Clin. Oncol. 37, 1895–1908 (2019).

    PubMed  PubMed Central  Google Scholar 

  77. Henley, S. J., Miller, J. W., Dowling, N. F., Benard, V. B. & Richardson, L. C. Uterine cancer incidence and mortality - United States, 1999–2016. MMWR Morb. Mortal. Wkly Rep. 67, 1333–1338 (2018).

    PubMed  PubMed Central  Google Scholar 

  78. Welch, H. G., Skinner, J. S., Schroeck, F. R., Zhou, W. & Black, W. C. Regional variation of computed tomographic imaging in the United States and the risk of nephrectomy. JAMA Intern. Med. 178, 221–227 (2018).

    PubMed  Google Scholar 

  79. Choueiri, T. K. & Motzer, R. J. Systemic therapy for metastatic renal-cell carcinoma. N. Engl. J. Med. 376, 354–366 (2017).

    CAS  PubMed  Google Scholar 

  80. Guy, G. P. Jr. et al. Vital signs: melanoma incidence and mortality trends and projections - United States, 1982–2030. Morb. Mortal. Wkly Rep. 64, 591–596 (2015).

    Google Scholar 

  81. Shaikh, W. R. et al. Melanoma thickness and survival trends in the United States, 1989 to 2009. J. Natl Cancer Inst. 108, djv294 (2016).

    PubMed  Google Scholar 

  82. Thrift, A. P. & Gudenkauf, F. J. Melanoma incidence among non-Hispanic whites in all 50 United States from 2001 through 2015. J. Natl Cancer Inst. 112, 533–539 (2019).

    PubMed Central  Google Scholar 

  83. Holman, D. M. et al. Prevalence of sun protection use and sunburn and association of demographic and behaviorial characteristics with sunburn among US adults. JAMA Dermatol. 154, 561–568 (2018).

    PubMed  PubMed Central  Google Scholar 

  84. Islami, F. et al. Cutaneous melanomas attributable to ultraviolet radiation exposure by state. Int. J. Cancer https://doi.org/10.1002/ijc.32921 (2020).

    Article  PubMed  Google Scholar 

  85. Lim, H., Devesa, S. S., Sosa, J. A., Check, D. & Kitahara, C. M. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317, 1338–1348 (2017).

    PubMed  PubMed Central  Google Scholar 

  86. Shi, L. L., DeSantis, C., Jemal, A. & Chen, A. Y. Changes in thyroid cancer incidence, post-2009 American Thyroid Association guidelines. Laryngoscope 127, 2437–2441 (2017).

    PubMed  Google Scholar 

  87. Van Dyne, E. A. et al. Trends in human papillomavirus-associated cancers – United States, 1999–2015. Morb. Mortal. Wkly Rep. 67, 918–924 (2018).

    Google Scholar 

  88. Islami, F., Ferlay, J., Lortet-Tieulent, J., Bray, F. & Jemal, A. International trends in anal cancer incidence rates. Int. J. Epidemiol. 46, 924–938 (2017).

    PubMed  Google Scholar 

  89. Berman, T. A. & Schiller, J. T. Human papillomavirus in cervical cancer and oropharyngeal cancer: one cause, two diseases. Cancer 123, 2219–2229 (2017).

    PubMed  Google Scholar 

  90. Islami, F., Fedewa, S. A. & Jemal, A. Trends in cervical cancer incidence rates by age, race/ethnicity, histological subtype, and stage at diagnosis in the United States. Prev. Med. 123, 316–323 (2019).

    PubMed  Google Scholar 

  91. Ronco, G. et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 383, 524–532 (2014).

    PubMed  Google Scholar 

  92. McClung, N. M. et al. Estimated number of cases of high-grade cervical lesions diagnosed among women – United States, 2008 and 2016. Morb. Mortal. Wkly Rep. 68, 337–343 (2019).

    Google Scholar 

  93. Steele, C. B. et al. Vital signs: trends in incidence of cancers associated with overweight and obesity – United States, 2005–2014. Morb. Mortal. Wkly Rep. 66, 1052–1058 (2017).

    Google Scholar 

  94. Islami, F., DeSantis, C. E. & Jemal, A. Incidence trends of esophageal and gastric cancer subtypes by race, ethnicity, and age in the United States, 1997–2014. Clin. Gastroenterol. Hepatol. 17, 429–439 (2019).

    PubMed  Google Scholar 

  95. Ward, E., DeSantis, C., Robbins, A., Kohler, B. & Jemal, A. Childhood and adolescent cancer statistics, 2014. CA Cancer J. Clin. 64, 83–103 (2014).

    PubMed  Google Scholar 

  96. Freireich, E. J., Wiernik, P. H. & Steensma, D. P. The leukemias: a half-century of discovery. J. Clin. Oncol. 32, 3463–3469 (2014).

    CAS  PubMed  Google Scholar 

  97. IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol 100 E: Personal Habits and Indoor Combustions (IARC, 2012).

  98. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Meat, fish and dairy products and the risk of cancer. World Cancer Research Fund Network https://www.wcrf.org/sites/default/files/Meat-Fish-and-Dairy-products.pdf (2018).

  99. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Wholegrains, vegetable and fruit and the risk of cancer. World Cancer Research Fund Network https://www.wcrf.org/sites/default/files/wholegrains-veg-and-fruit.pdf (2018)

  100. US Department of Health and Human Services. 2018 Physical Activity Guidelines Advisory Committee Scientific Report (US Department of Health and Human Services, 2018).

  101. IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 100 D: Radiation (IARC, 2012).

  102. IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 100 B: Biological Agents (IARC, 2012).

  103. IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 109: Outdoor air pollution (IARC, 2016).

  104. IARC Working Group. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol, 100 C: Arsenic, Metals, Fibres, and Dusts (IARC, 2012).

  105. Song, M. & Giovannucci, E. Preventable incidence and mortality of carcinoma associated with lifestyle factors among white adults in the United States. JAMA Oncol. 2, 1154–1161 (2016).

    PubMed  PubMed Central  Google Scholar 

  106. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs - 2014 (US Department of Health and Human Services, 2014).

  107. American Cancer Society. How do you measure up? A progress report on state legislative activity to reduce cancer incidence and mortality, 17th edn. Cancer Action Network https://www.fightcancer.org/how-do-you-measure-up (2019).

  108. Campaign for Tobacco-Free Kids. State excise and sales taxes per pack of cigarettes. Campaign for Tobacco-Free Kids https://www.tobaccofreekids.org/assets/factsheets/0202.pdf (2020).

  109. Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) system. Legislation–smokefree indoor air; updated April 23, 2020. CDC https://data.cdc.gov/Legislation/CDC-STATE-System-Tobacco-Legislation-Smokefree-Ind/2snk-eav4/data (2020).

  110. Tsai, J. et al. Exposure to secondhand smoke among nonsmokers - United States, 1988–2014. Morb. Mortal. Wkly Rep. 67, 1342–1346 (2018).

    Google Scholar 

  111. Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Executive Summary https://www.ncbi.nlm.nih.gov/books/NBK63956 (US Department of Health and Human Services, 2008).

  112. Jamal, A. et al. Tobacco use screening and counseling during physician office visits among adults–National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005–2009. MMWR Suppl. 61, 38–45 (2012).

    PubMed  Google Scholar 

  113. Rosenbaum, S. The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public. Health Rep. 126, 130–135 (2011).

    PubMed  PubMed Central  Google Scholar 

  114. Drope, J. et al. Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine. CA Cancer J. Clin. 67, 449–471 (2017).

    PubMed  Google Scholar 

  115. Watkins, S. L., Glantz, S. A. & Chaffee, B. W. Association of noncigarette tobacco product use with future cigarette smoking among youth in the Population Assessment of Tobacco and Health (PATH) study, 2013–2015. JAMA Pediatr. 172, 181–187 (2018).

    PubMed  PubMed Central  Google Scholar 

  116. Cullen, K. A. et al. e-Cigarette use among youth in the United States, 2019. JAMA 322, 2095–2103 (2019).

    PubMed Central  PubMed  Google Scholar 

  117. Drazen, J. M., Morrissey, S. & Campion, E. W. The dangerous flavors of e-cigarettes. N. Engl. J. Med. 380, 679–680 (2019).

    PubMed  Google Scholar 

  118. US Food and Drug Administration. FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. FDA https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children (2020).

  119. Kohler, L. N. et al. Adherence to diet and physical activity cancer prevention guidelines and cancer outcomes: a systematic review. Cancer Epidemiol. Biomarkers Prev. 25, 1018–1028 (2016).

    PubMed  PubMed Central  Google Scholar 

  120. Khan, L. K. et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm. Rep. 58, 1–26 (2009).

    PubMed  Google Scholar 

  121. Muhammad, A., Meade, B., Marquardt, D. R. & Mozaffarian, D. Global patterns in price elasticities of sugar-sweetened beverage intake and potential effectiveness of tax policy: a cross-sectional study of 164 countries by sex, age and global-income decile. BMJ Open. 9, e026390 (2019).

    PubMed  PubMed Central  Google Scholar 

  122. Teng, A. M. et al. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: systematic review and meta-analysis. Obes. Rev. 20, 1187–1204 (2019).

    PubMed  Google Scholar 

  123. US Preventive Services Task Force. et al. Screening for obesity in children and adolescents: U.S. preventive services task force recommendation statement. JAMA 317, 2417–2426 (2017).

    Google Scholar 

  124. US Preventive Services Task Force et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA 320, 1163–1171 (2018).

    Google Scholar 

  125. Wadden, T. A., Butryn, M. L., Hong, P. S. & Tsai, A. G. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA 312, 1779–1791 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  126. Alamuddin, N., Bakizada, Z. & Wadden, T. A. Management of obesity. J. Clin. Oncol. 34, 4295–4305 (2016).

    PubMed  Google Scholar 

  127. US Department of Health and Human Services. Helping patients who drink too much: a clinician’s guide (US Department of Health and Human Services, 2005).

  128. Keyes, K. M., Shev, A., Tracy, M. & Cerda, M. Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent-based modeling approach. Addiction 114, 236–247 (2019).

    PubMed  Google Scholar 

  129. National Institute on Alcohol Abuse and Alcoholism. Strategic Plan 2017–2021 (NIAAA, 2017).

  130. Knox, J., Hasin, D. S., Larson, F. R. R. & Kranzler, H. R. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 6, 1054–1067 (2019).

    PubMed  PubMed Central  Google Scholar 

  131. US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer (US Department of Health and Human Services, 2014).

  132. Iannacone, M. R., Youlden, D. R., Baade, P. D., Aitken, J. F. & Green, A. C. Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia. Int. J. Cancer 136, 603–609 (2015).

    CAS  PubMed  Google Scholar 

  133. Guy, G. P. Jr. et al. Trends in indoor tanning and its association with sunburn among US adults. J. Am. Acad. Dermatol. 76, 1191–1193 (2017).

    PubMed  PubMed Central  Google Scholar 

  134. Kann, L. et al. Youth risk behavior surveillance - United States, 2017. MMWR Surveill. Summ. 67, 1–114 (2018).

    PubMed  PubMed Central  Google Scholar 

  135. US Preventive Services Task Force. et al. Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement. JAMA 319, 1134–1142 (2018).

    Google Scholar 

  136. Jemal, A. et al. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. J. Natl Cancer Inst. 105, 175–201 (2013).

    PubMed  PubMed Central  Google Scholar 

  137. Hernandez-Ramirez, R. U., Shiels, M. S., Dubrow, R. & Engels, E. A. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 4, e495–e504 (2017).

    PubMed  PubMed Central  Google Scholar 

  138. Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccination coverage among adolescents 13–17 years by State, HHS Region, and the United States, National Immunization Survey-Teen (NIS-Teen), 2018. CDC https://www.cdc.gov/vaccines/imz-managers/coverage/teenvaxview/data-reports/hpv/reports/2018.html (2019).

  139. Jemal, A. & Fedewa, S. A. Recent hepatitis C virus testing patterns among baby boomers. Am. J. Prev. Med. 53, e31–e33 (2017).

    PubMed  Google Scholar 

  140. Lo, Re,V. 3rd. et al. Disparities in absolute denial of modern hepatitis C therapy by type of insurance. Clin. Gastroenterol. Hepatol. 14, 1035–1043 (2016).

    Google Scholar 

  141. Zibbell, J. E. et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am. J. Public. Health 108, 175–181 (2018).

    PubMed  PubMed Central  Google Scholar 

  142. Morse, A., Barritt, A. S. & Jhaveri, R. Individual state hepatitis C data supports expanding screening beyond baby boomers to all adults. Gastroenterology 154, 1850–1851 (2018).

    PubMed  Google Scholar 

  143. Jaffee, E. M. et al. Future cancer research priorities in the USA: a Lancet Oncology Commission. Lancet Oncol. 18, e653–e706 (2017).

    PubMed  PubMed Central  Google Scholar 

  144. Polite, B. N. et al. Charting the future of cancer health disparities research: a position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. CA Cancer J. Clin. 67, 353–361 (2017).

    PubMed  Google Scholar 

  145. National Institutes of Health. Cancer Moonshot Blue Ribbon Panel report 2016. National Cancer Institute https://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/blue-ribbon-panel/blue-ribbon-panel-report-2016.pdf (2016).

  146. McColl, E. R., Asthana, R., Paine, M. F. & Piquette-Miller, M. The age of omics-driven precision medicine. Clin. Pharmacol. Ther. 106, 477–481 (2019).

    PubMed  Google Scholar 

  147. Wild, C. P. The exposome: from concept to utility. Int. J. Epidemiol. 41, 24–32 (2012).

    PubMed  Google Scholar 

  148. US Preventive Services Task Force. et al. Screening for pancreatic cancer: US preventive services task force reaffirmation recommendation statement. JAMA 322, 438–444 (2019).

    Google Scholar 

  149. Schiffman, J. D., Fisher, P. G. & Gibbs, P. Early detection of cancer: past, present, and future. Am. Soc. Clin. Oncol. Educ. Book 35, 57–65 (2015).

    Google Scholar 

  150. US Preventive Services Task Force. et al. Screening for cervical cancer: US preventive services task force recommendation statement. JAMA 320, 674–686 (2018).

    Google Scholar 

  151. Menon, U. et al. Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. J. Clin. Oncol. 33, 2062–2071 (2015).

    PubMed  PubMed Central  Google Scholar 

  152. Cohen, J. D. et al. Detection and localization of surgically resectable cancers with a multi-analyte blood test. Science 359, 926–930 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  153. Heitzer, E., Haque, I. S., Roberts, C. E. S. & Speicher, M. R. Current and future perspectives of liquid biopsies in genomics-driven oncology. Nat. Rev. Genet. 20, 71–88 (2019).

    CAS  PubMed  Google Scholar 

  154. Mariotto, A. B., Etzioni, R., Hurlbert, M., Penberthy, L. & Mayer, M. Estimation of the number of women living with metastatic breast cancer in the United States. Cancer Epidemiol. Biomarkers Prev. 26, 809–815 (2017).

    PubMed  PubMed Central  Google Scholar 

  155. Conforti, F. et al. Cancer immunotherapy efficacy and patients’ sex: a systematic review and meta-analysis. Lancet Oncol. 19, 737–746 (2018).

    CAS  PubMed  Google Scholar 

  156. Perez-Ruiz, E. et al. Prophylactic TNF blockade uncouples efficacy and toxicity in dual CTLA-4 and PD-1 immunotherapy. Nature 569, 428–432 (2019).

    CAS  PubMed  Google Scholar 

  157. Chen, Y., Wang, H., Kantarjian, H. & Cortes, J. Trends in chronic myeloid leukemia incidence and survival in the United States from 1975 to 2009. Leuk. Lymphoma 54, 1411–1417 (2013).

    PubMed  Google Scholar 

  158. Marquart, J., Chen, E. Y. & Prasad, V. Estimation of the percentage of US patients with cancer who benefit from genome-driven oncology. JAMA Oncol. 4, 1093–1098 (2018).

    PubMed  PubMed Central  Google Scholar 

  159. Joyner, M. J. & Paneth, N. Promises, promises, and precision medicine. J. Clin. Invest. 129, 946–948 (2019).

    PubMed  PubMed Central  Google Scholar 

  160. Khoury, M. J. et al. A collaborative translational research framework for evaluating and implementing the appropriate use of human genome sequencing to improve health. PLoS Med. 15, e1002631 (2018).

    PubMed  PubMed Central  Google Scholar 

  161. All of Us Research Program Investigators. et al. The “All of Us” research program. N. Engl. J. Med. 381, 668–676 (2019).

    Google Scholar 

  162. Pal, S. K. et al. Clinical cancer advances 2019: annual report on progress against cancer from the American Society of Clinical Oncology. J. Clin. Oncol. 37, 834–849 (2019).

    PubMed  Google Scholar 

  163. Kotecha, R. R., Motzer, R. J. & Voss, M. H. Towards individualized therapy for metastatic renal cell carcinoma. Nat. Rev. Clin. Oncol. 16, 621–633 (2019).

    CAS  PubMed  Google Scholar 

  164. Le Tourneau, C., Borcoman, E. & Kamal, M. Molecular profiling in precision medicine oncology. Nat. Med. 25, 711–712 (2019).

    PubMed  Google Scholar 

  165. Pantel, K. & Alix-Panabieres, C. Liquid biopsy and minimal residual disease — latest advances and implications for cure. Nat. Rev. Clin. Oncol. 16, 409–424 (2019).

    CAS  PubMed  Google Scholar 

  166. White, A. et al. Cancer screening test use — United States, 2015. Morb. Mortal. Wkly Rep. 66, 201–206 (2017).

    Google Scholar 

  167. Doubeni, C. A. et al. Timely follow-up of positive cancer screening results: a systematic review and recommendations from the PROSPR Consortium. CA Cancer J. Clin. 68, 199–216 (2018).

    PubMed  PubMed Central  Google Scholar 

  168. Peters, D. H., Adam, T., Alonge, O., Agyepong, I. A. & Tran, N. Implementation research: what it is and how to do it. BMJ 347, f6753 (2013).

    PubMed  Google Scholar 

  169. Briant, K. J. et al. Using a culturally tailored intervention to increase colorectal cancer knowledge and screening among Hispanics in a rural community. Cancer Epidemiol. Biomarkers Prev. 27, 1283–1288 (2018).

    PubMed  PubMed Central  Google Scholar 

  170. Champion, V. L. et al. A randomized trial to compare a tailored web-based intervention and tailored phone counseling to usual care for increasing colorectal cancer screening. Cancer Epidemiol. Biomarkers Prev. 27, 1433–1441 (2018).

    PubMed  PubMed Central  Google Scholar 

  171. Nebraska Department of Health and Human Services. Immunization Program, 2018 legislative report. https://nebraskalegislature.gov/FloorDocs/105/PDF/Agencies/Health_and_Human_Services__Department_of/497_20181221-142336.pdf (2018).

  172. Institute of Medicine. Best Care at Lower Cost: The Path to Continuous Learning Health Care in America (National Academies Press, 2013).

  173. Qin, J., Saraiya, M., Martinez, G. & Sawaya, G. F. Prevalence of potentially unnecessary bimanual pelvic examinations and papanicolaou tests among adolescent girls and young women aged 15–20 years in the United States. JAMA Intern. Med. 180, 274–280 (2020).

    PubMed  PubMed Central  Google Scholar 

  174. Sineshaw, H. M. et al. Treatment patterns among de novo metastatic cancer patients who died within 1 month of diagnosis. JNCI Cancer Spectr. 3, pkz021 (2019).

    PubMed  PubMed Central  Google Scholar 

  175. Norton, W. E., Chambers, D. A. & Kramer, B. S. Conceptualizing de-implementation in cancer care delivery. J. Clin. Oncol. 37, 93–96 (2019).

    PubMed  Google Scholar 

  176. National Academies of Sciences, Engineering, and Medicine. Long-Term Survivorship Care After Cancer Treatment: Proceedings of a Workshop (The National Academies Press, 2018).

  177. Alfano, C. M., Jefford, M., Maher, J., Birken, S. A. & Mayer, D. K. Building personalized cancer follow-up care pathways in the united states: lessons learned from implementation in England, Northern Ireland, and Australia. Am. Soc. Clin. Oncol. Educ. Book. 39, 625–639 (2019).

    PubMed  Google Scholar 

  178. Yang, W. et al. Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J. Oncol. Pract. 10, 39–45 (2014).

    PubMed  Google Scholar 

  179. Rubin, G. et al. The expanding role of primary care in cancer control. Lancet Oncol. 16, 1231–1272 (2015).

    PubMed  Google Scholar 

  180. Halpern, M. T. & Argenbright, K. E. Evaluation of effectiveness of survivorship programmes: how to measure success? Lancet Oncol. 18, e51–e59 (2017).

    PubMed  Google Scholar 

  181. Ward, E. et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J. Clin. 58, 9–31 (2008).

    PubMed  Google Scholar 

  182. Halpern, M. T. et al. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol. 9, 222–231 (2008).

    PubMed  Google Scholar 

  183. Dickman, S. L., Himmelstein, D. U. & Woolhandler, S. Inequality and the health-care system in the USA. Lancet 389, 1431–1441 (2017).

    PubMed  Google Scholar 

  184. Ramsey, S. et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff. 32, 1143–1152 (2013).

    Google Scholar 

  185. Han, X. et al. Changes in noninsurance and care unaffordability among cancer survivors following the Affordable Care Act. J. Natl Cancer Inst. https://doi.org/10.1093/jnci/djz218 (2019).

  186. Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E. & Menachemi, N. The effects of Medicaid expansion under the ACA: a systematic review. Health Aff. 37, 944–950 (2018).

    Google Scholar 

  187. Guth, M., Garfield, R. & Rudowitz, R. The effects of Medicaid expansion under the ACA: updated findings from a literature review. Kaiser Family Foundation http://files.kff.org/attachment/Report-The-Effects-of-Medicaid-Expansion-under-the-ACA-Updated-Findings-from-a-Literature-Review.pdf (2020).

  188. Kaiser Family Foundation. Status of state action on the Medicaid expansion decision. Updated January 10, 2020. Kaiser Family Foundation https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act (2020).

  189. Sommers, B. D., Long, S. K. & Baicker, K. Changes in mortality after Massachusetts health care reform: a quasi-experimental study. Ann. Intern. Med. 160, 585–593 (2014).

    PubMed  Google Scholar 

  190. Sabik, L. M. et al. The Impact of Massachusetts health reform on colorectal and breast cancer stage at diagnosis. Med. Care 58, 183–191 (2020).

    PubMed  PubMed Central  Google Scholar 

  191. Grubbs, S. S. et al. Eliminating racial disparities in colorectal cancer in the real world: it took a village. J. Clin. Oncol. 31, 1928–1930 (2013).

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by the Intramural Research Department of the American Cancer Society.

Author information

Authors and Affiliations

  1. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA

    Farhad Islami, Rebecca L. Siegel & Ahmedin Jemal

Authors
  1. Farhad Islami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca L. Siegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmedin Jemal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made a substantial contribution to all aspects of the preparation of the manuscript.

Corresponding author

Correspondence to Farhad Islami.

Ethics declarations

Competing interests

The authors are employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health-care sector for research outside of the submitted work. The authors are not funded by any of these grants and their salaries are solely funded through American Cancer Society funds.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related links

Cancer Statistics Center: https://cancerstatisticscenter.cancer.org/

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Islami, F., Siegel, R.L. & Jemal, A. The changing landscape of cancer in the USA — opportunities for advancing prevention and treatment. Nat Rev Clin Oncol 17, 631–649 (2020). https://doi.org/10.1038/s41571-020-0378-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41571-020-0378-y

This article is cited by

Search

Advanced search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer