The SAGE Encyclopedia of Cancer and Society

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Edited by: Graham A. Colditz

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      A

      Reader’s Guide

      About the Editor

      Graham A. Colditz, M.D., Dr.PH, is Niess-Gain Professor of Surgery, and associate director of Prevention and Control at the Siteman Cancer Center, Washington University School of Medicine, in St. Louis, Missouri. He received his B.Sc., MBBS, and M.D. from the University of Queensland, Australia, and his doctorate in public health from the Harvard University School of Public Health.

      From 1996 to 2006, Colditz was the principal investigator of the Nurses’ Health Study, one of the largest prospective investigations of factors that influence women’s health. He founded the Growing Up Today study (GUTS), which focuses on the diet and lifestyle of 16,883 adolescents. His epidemiologic research addresses issues of etiology and potential for prevention of chronic diseases, largely among women. He continues to pursue approaches to the translation of epidemiologic data to improve risk stratification and tailor prevention messages and screening strategies.

      After 23 years at Harvard University, Colditz joined the Washington University School of Medicine, where he is now chief of the Division of Public Health Sciences in the Department of Surgery. He also serves as program director for the School of Medicine’s Master of Population Health Sciences degree.

      With a commitment to identifying preventable causes of chronic disease among women and adolescents, Colditz continues to study benign breast disease and other markers for risk of breast cancer. He leads studies of adolescent diet, activity, and growth in relation to risk of benign lesions as well as invasive breast cancer. Colditz developed the award-winning Your Disease Risk Web site, which communicates tailored prevention messages to the public. He has published over 950 peer-reviewed publications, six books, and contributed to six reports for the Institute of Medicine, National Academy of Sciences.

      Colditz has served in numerous leadership roles. He was the editor-in-chief of the journal Cancer Causes and Control and has contributed to reports of the U.S. Surgeon General on Tobacco and Health. He has served on several committees for the National Academy of Science and is a member of the Board of Scientific Advisors of the National Cancer Institute, among others.

      In October 2006, on the basis of professional achievement and commitment to public health, Colditz was elected to membership of the Institute of Medicine, an independent body that advises the U.S. government on issues affecting public health. In 2011, he was awarded the American Cancer Society Medal of Honor for cancer control research. In 2012, he received the AACRAmerican Cancer Society Award for Research Excellence in Cancer Epidemiology and Prevention. In 2014, he was the recipient of the ASCOAmerican Cancer Society award and lecture.

      List of Contributors

      Maysa Abu-Khalaf Yale Cancer Center

      Lalatendu Acharya Purdue University

      Samuel Ojima Adejoh University of Lagos

      Amber Afzal Independent Scholar

      Mohamad Reza Aghanoori Shiraz University of Medical Sciences

      Ainur Akilzhanova Nazarbayev University

      Kenneth B. Alexander Independent Scholar

      Ali Al-Jumaili University of Iowa

      Gordon Alley-Young Kingsborough Community College

      Samantha Armstrong Indiana University School of Medicine

      Jin R. Baker Health and Food Institute

      Poonam Bala Cleveland State University and University of South Africa

      Poonam Balani Independent Scholar

      Paula K. Baldwin Western Oregon University

      Linda Barley York College, University of New York

      Barbara A. Barton Western Michigan State University

      Joan Beder Yeshiva University

      Kourosh Beroukhim David Geffen School of Medicine at UCLA

      Arundhati Bhattacharyya Bhairab Ganguly College, West Bengal State University

      Anca Nicoleta Birzescu Bowling Green State University

      Jessica Bodoh-Creed California State University, Los Angeles

      Sarah E. Boslaugh Saint Louis University

      Kathryn Bouskill Emory University

      Andrew Robert Branagan Yale Medical School

      Brent Braveman University of Texas MD Anderson Cancer Center

      Benjamin Wilson Brewer University of Colorado, Denver

      Sherri Brown Case Western Reserve University

      William J. Brown Regent University

      Claudio Butticè Independent Scholar

      Leon James Bynum Columbia University

      Whitney Cann Independent Scholar

      John M. Carethers University of Michigan, Ann Arbor

      Catherine Cassara Bowling Green State University

      Melany Chambers Georgia State University

      Yung-Chia Chen Kaohsiung Medical University

      Liang Chen Nanyang Technological University

      Felix O. Chima Prairie View A&M University

      Mahati Chittem Indian Institute of Technology Hyderabad

      Elisia L. Cohen University of Kentucky

      Holly Cole-Hawkins University of Bristol

      Hope Comer Old Dominion University

      Alberto Costa European School of Oncology

      Jaslynn Cuff North Carolina Central University

      Karim Daliri Shiraz University of Medical Sciences

      George Dion Daniel University of North Carolina at Wilmington

      Rachel Diana Davidson University of Wisconsin–Milwaukee

      Lenna Dawkins-Moultin Texas A&M University

      Gary T. Deimling Case Western Reserve University

      David DeIuliis Duquesne University

      Ann Del Bianco York University

      Joseph Dewey Broward College

      Anh-Vu Do University of Iowa

      Catherine A. Dobris Indiana University–Purdue University

      Constance M. Dolecki Independent Scholar

      Eamon Duffy Yale School of Medicine

      David Dunning University of Nebraska Medical Center

      Arthur Durazo University of California, Merced

      Emad Abdulhamid Eddokali Independent Scholar

      Christopher Edwards Duke University Medical Center

      Sothy Eng Comparative International Education

      Ezgi Eyüboglu Maltepe University

      Navid Ezra Indiana University School of Medicine

      Natalia Fernández Díaz-Cabal Free University of Barcelona

      Cindy Ferraino Independent Scholar

      Diane Ferrero-Paluzzi Iona College

      Courtney Vail Fletcher University of Portland

      Michael Fox Independent Scholar

      Marcos E. García-Ojeda University of California, Merced

      Sean Geary University of Iowa

      Sana Ghafoor Independent Scholar

      Aubrey Gilbert Harvard Medical School

      Joy V. Goldsmith University of Memphis

      Ellen L. Goode Mayo Clinic College of Medicine

      William B. Grant Sunlight, Nutrition, and Health Research Center

      Tiarra Green North Carolina Central University

      Matthew J. Gritter Angelo State University

      Terje Grønning University of Oslo

      Jessica Smartt Gullion Texas Woman’s University

      Emily Joy Haas National Institute for Occupational Safety and Health

      Carin Halper Independent Researcher

      Chelsea Halstead University of Portland

      Lynn Marie Hamilton Independent Scholar

      Emily Hammad University of Colorado Denver

      Jessica Anne Hammer Independent Scholar

      Zachary Hargis Old Dominion University

      Joy L. Hart University of Louisville

      Katharine J. Head Indiana University–Purdue University Indianapolis

      Thomas L. Head Edith Cowan University

      James R. Hebert University of South Carolina

      Trina Henry Univeristy of Texas MD Anderson Cancer Center

      Steven Charles Hertler College of New Rochelle

      Justina D. Higgins Independent Scholar

      LaBarron K. Hill Duke University Medical Center

      Lisa Hines Wichita State University

      Servando Z. Hinojosa University of Texas –Rio Grande Valley

      Shirley S. Ho Nanyang Technological University

      Denise Hooks-Anderson Saint Louis University

      Elaine Hsieh University of Oklahoma

      Sherry C. Huang University of California, San Diego

      Anne Hubbell New Mexico State University

      Andrew Jon Hund United Arab Emirates University

      Jessica A. Hutchins Independent Scholar

      Nicholas T. Iannarino University of Michigan–Dearborn

      Godfrey Ilonzo Independent Scholar

      Qurratulain Muhammad Iqbal Heart and Vascular Institute

      Nicholas Reed Iverson Albert Einstein College of Medicine

      Margret Jaeger UMIT University for Health Sciences, Medical Informatics and Technology

      Constance J. Jeffery University of Illinois at Chicago

      Hueiwang Anna Jeng Old Dominion University

      Jakob Daniel Jensen University of Utah

      Vinit K. Jha Old Dominion University

      Ami P. Jhaveri Yale Smilow Cancer Center

      Keith R. Johnson Oakton Community College

      David Jourabchi University of California, Los Angeles School of Dentistry

      Natanel Jourabchi Johns Hopkins School of Medicine

      René Julyan Independent Scholar

      Boaz Kahana Cleveland State University

      Eva Kahana Case Western Reserve University

      Hagop Kantarjian University of Texas MD Anderson Cancer Center

      David Keleti Independent Scholar

      Sarah Kelleher Duke University Medical Center

      Amanda Kenny La Trobe University Rural Health School

      Abigail Keys Duke University Medical Center

      Saami Khalifian Johns Hopkins School of Medicine

      Ghulam Ishaq Khan Columbia University

      Behnoush Khorsand University of Iowa

      Ivana K. Kim Harvard Medical School

      Susan Knox Europa Donna, the European Breast Cancer Coalition

      Betsy Kohler North American Association of Central Cancer Registries

      Melinda Krakow University of Utah

      Gary L. Kreps George Mason University

      Bill Kte’pi Independent Scholar

      Christopher Kubajak University of Kentucky College of Medicine

      Rohit Kumar University Hospitals of South Manchester

      Brett Rodrique Labbe Bowling Green State University

      Johanne I. Laboy North Carolina State University

      Chervin Lam Purdue University

      Walter Landers Independent Scholar

      Mark Laudenslager University of Colorado, Denver

      Edmund W. J. Lee Nanyang Technological University

      Joseph H. Lee Sergievsky Center/Taub Institute, Columbia University

      Anthony F. Lemieux Georgia State University

      Lara Lengel Bowling Green State University

      Bridget Lepore Kean University

      Simmons Lessell Harvard Medical School

      Youqing Liao Nanyang Technological University

      Donald W. Light Rowan University School of Osteopathic Medicine

      Susan Lilly University of Texas MD Anderson Cancer Center

      Ingrid Marie Lizarraga University of Iowa

      Héctor E. López-Sierra Inter American University of Puerto Rico

      Kim Lorber Ramapo College of New Jersey

      Tamikia Lott Old Dominion University

      Jennette Lovejoy University of Portland

      L. L. Lundin Independent Scholar

      Natalia Luxardo University of Buenos Aires/CONICET

      Annette D. Madlock Gatison Southern Connecticut State University

      Marifel Malacara University of Texas MD Anderson Cancer Center

      Haylee Massaro Independent Scholar

      Marifran Mattson Purdue University

      Steve McCabe Independent Scholar

      Philip McCallion State University of New York, Albany

      Andrea McDonald Texas A&M University

      Kimberly McFarland University of Nebraska Medical Center

      Trudy M. Mercadal Florida Atlantic University

      Heather Mernitz Tufts University

      Laurie Michaels University of Toledo

      Shari Parsons Miller Independent Scholar

      Steven E. Mischler National Institute for Occupational Safety and Health

      Anirban P. Mitra University of Southern California

      Sheetal A. Mitra Children’s Hospital Los Angeles

      Manoranjan Mohanty University of the South Pacific

      Thomas Moors London Medical School

      Janice Marie Moreland Nationwide Children’s Hospital

      Jennifer J. Moreland Nationwide Children’s Hospital

      Kelly Morrison Michigan State University

      Vadim P. Moskvin Indiana University–Purdue University Indianapolis

      Katie Moss Independent Scholar

      Malik Muhammad Synthesis Behavioral Medicine PLLC

      Shizuo Mukai Harvard Medical School

      Lauro A. Munoz University of Texas MD Anderson Cancer Center

      William N. Myhill Burton Blatt Institute at Syracuse University

      Laura Nabors University of Cincinnati

      Keerty Nakray Jindal Global Law School

      Nima Nassiri David Geffen School of Medicine at UCLA

      Denese M. Neu National Louis University-Chicago

      Patricia Neville University of Bristol

      Kathleen Nthakomwa-Cassidy Coventry University

      Keisha N. O’Garo Duke University Medical Center

      Eva Olariu University of Kentucky College of Medicine

      Barbara Cook Overton Louisiana State University

      Burcu Ozdemir Ankara University

      Manisha Pahwa Occupational Cancer Research Centre

      Jong Y. Park Moffitt Cancer Center

      Jan Pascal La Trobe University Rural Health School

      Krunal Patel Independent Scholar

      Courtney Peasant Duke University Medical Center

      William M. Peaster Independent Scholar

      Prema P. Peethambaram Mayo Clinic College of Medicine

      David Petechuk Independent Scholar

      Sheila Peuchaud American University in Cairo

      James E. Phelan Department of Veterans Affairs

      Daniel Webster Phillips Lindsey Wilson College

      Samuel Xavier Pimienta Rodríguez Universidad Estatal de Cuenca

      Christine M. Platt University of Memphis

      John Pritchard III Independent Scholar

      John Michael Quinn University of Illinois at Chicago

      Rosellen Reif Duke University Medical Center

      Anthony J. Roberto Arizona State University

      Lorna Rogahn Independent Scholar

      Robin L. Rohrer Seton Hill University

      Jaroslaw Richard Romaniuk Case Western Reserve University

      Aliasger K. Salem College of Pharmacy, University of Iowa

      Tim Sannes University of Colorado, Denver

      Paul Richard Saunders Canadian College of Naturopathic Medicine

      Stephen T. Schroth Towson University

      Carol Scott-Conner University of Iowa

      Gail Seymour Tennessee Department of Human Services

      Chryslee Sherrill Lindsey Wilson College

      Mark D. Sherry University of Toledo

      Kelly Shimabukuro Moores UCSD Cancer Center

      Michael J. Simonton Northern Kentucky University

      Kelsey W. Snapp University of Kentucky College of Medicine

      Kristine Song University of Kentucky College of Medicine

      Narketta Sparkman Old Dominion University

      Lisa L. Sparks Chapman University

      Brad St. Martin University of Kentucky College of Medicine

      Jeanne Mager Stellman Columbia University

      Steven D. Stellman Columbia University

      Walter Scott Stepanenko University of Toledo

      Victor B. Stolberg Essex County College

      Daniele Struppa Chapman University

      Sonia L. Sugg University of Iowa Hospitals & Clinics

      Corey Helm Swartz University of Texas MD Anderson Cancer Center

      Whitney Szmodis Lehigh University

      Sharon A. Takiguchi Nurse Consultant

      Olusegun Moses Temilola University of Lagos

      Sachiko Terui University of Oklahoma

      Dinah Adjo Tetteh Bowling Green State University

      Ashland Thompson Synthesis Behavioral Medicine

      Kyle L. Thompson Appalachian State University

      David P. Tracer University of Colorado Denver

      Jay Trambadia Duke University Medical Center

      Paige Mayleen True California State University, Monterey Bay

      Yvonne Valdecanas University of Texas MD Anderson Cancer Center

      Rhea U. Vallente PreventionGenetics, LLC

      Ton van Helvoort Independent Scholar

      Rakesh Verma Yale University

      Cecilia Vindrola-Padros London South Bank University

      Mark Vrabel Oncology Nursing Society

      Krishna Subhash Vyas University of Kentucky College of Medicine

      Anna Wagstaff CancerWorld

      Brandy Harris Wallace University of Maryland, Baltimore County

      Michael J. Walsh University of Illinois at Chicago

      Guoyu Wang University of Oklahoma

      Xiang-Dong Wang Tufts University

      Courtney Ward North Carolina Central University

      Andrea Waylen University of Bristol

      Adele Weiner Metropolitan College of New York

      Jessemae L. Welsh University of Iowa Hospitals & Clinics

      Robert West Hospice of the Bluegrass

      Salli Whisman Hospice of the Bluegrass

      Andrew J. Widener University of Texas Medical School at Houston

      Fay V. Williams Northern Caribbean University

      Eric Wood Hawthorn University

      Mary Wood Duke University Medical Center

      Jody A. Worley University of Oklahoma

      Alan Yaghoubian David Geffen School of Medicine at UCLA

      Vivianne Yang University of Texas MD Anderson Cancer Center

      Daniel Yazdi David Geffen School of Medicine at UCLA

      Minzhi Ye Case Western Reserve University

      Melda N. Yildiz Kean University

      Yoshihiro Yonekawa Harvard Medical School

      Stephen M. Yoshimura University of Montana

      Brigitte Yuille B. Y. Communications Worldwide

      Tara Michele Zrinski Northampton Community College

      Introduction

      More than 12 million people were diagnosed with cancer worldwide in 2012, and more than 8 million people die from cancer each year. There is overwhelming evidence that lifestyle factors impact cancer risk and that positive, population-wide changes can significantly reduce the cancer burden. What drives the distribution of these modifiable risk factors and what slows our progress to improving the patterns of risk in our society? Broader social and political forces are a major component and are addressed in this encyclopedia. Not only do health care providers and regulatory approaches each have a role, but in addition individual behavior changes can substantially reduce the burden of cancer in our society. For example, how we design our cities and towns and how governments regulate and tax tobacco and alcohol sales all play a part in the risk of cancer in society.

      Current epidemiologic evidence links behavioral factors to a variety of diseases, including the most common cancers diagnosed in the developed world—lung, colorectal, and breast cancer, for example. These cancers account for 50 percent of the cancers diagnosed in high-income countries. Tobacco causes some 30 percent of cancer, lack of physical activity 5 percent, obesity 20 percent, diet 10 percent, alcohol 3 to 5 percent, viral infections 5 to 7 percent, and excess sun exposure 3 percent. In low- and middle-income countries, infections account for more than 23 percent of new cases of cancer. Because of the tremendous impact of modifiable factors on cancer risk, especially for the common cancers, it has been estimated that at least 50 percent of cancers are preventable. Currently, in the United States, not all risk factors are really distributed across race and social class. Thus, we not only address the causes of cancer in this encyclopedia but we also have entries on the relation between race and ethnicity and cancer risk. Because race and social class also co-vary with occupation and environmental exposures, these areas are also addressed in detail.

      Exposures at work have been related to cancer risk throughout history—from chimney sweeps and exposure to soot, to asbestos miners, to blast furnace operators. Many of these exposures have been reduced in Western society by regulations that reduce harm in the workplace. Within occupations, many different agents are still generated by manufacturing processes. These are described, and are related to occupations that give rise to carcinogens as they help produce the trappings of modern society. As regulations work to protect the West, are we simply exporting the manufacturing, occupational exposure, and cancer risk?

      Trends in risk factors should also be considered when assessing the potential for cancer prevention. To bring about dramatic reductions in cancer incidence, widespread lifestyle changes are necessary. Which strategies will likely work and how we can achieve these goals are further areas we must consider. To reduce the risk of disease in the population, substantial benefits can be achieved by a small reduction of risk for all members of society rather than just focusing on the high-risk group. Medical interventions can also reduce risk, and these are discussed in detail.

      When population-wide approaches to cancer prevention are considered, one must address the etiologic process, which covers a different time course and sequence from coronary heart disease. Although cardiovascular disease is the endpoint of the chronic process of atherosclerosis, treatment focuses on the reversal and subsequent prevention of the acute thrombotic process of myocardial infarction. Cancer, on the other hand, is the result of a long process of accumulating DNA damage, leading ultimately to the clinical detectable lesion such as in situ and invasive cancer. For example, studies of the progression in colon cancer from the first mutation to invading malignancy suggest that DNA changes accumulate over a period of at least 40 years. The goal of cancer prevention is to arrest this progression; different interventions interrupt carcinogenesis at different points in the process.

      Age is the dominant factor that drives cancer risk; for all major malignancies, risk rises markedly with age. The importance of age is exemplified by the fact that the aging U.S. population, together with projected population growth, will result in a doubling of the number of cases diagnosed annually by the year 2050, assuming that incidence rates remain constant. With this estimated growth in cancer from 1.3 million to 2.6 million new cases per year, it is expected that both the number and proportion of older persons with cancer will also rise dramatically. Entries in this encyclopedia help place this increase in cancer in context.

      Population-wide prevention strategies for cancer do work. For example, reductions in lung cancer rates in the United States mirror changes in smoking patterns, with marked decreases seen first in young men, then older men, and finally in women. In fact, lung cancer mortality has fallen by over one-third since 1991. Introduction of the Papanicolaou test for cervical cancer in the 1950s was followed by a dramatic decline in cervical cancer in those countries that made widespread screening available. The decline in Australian melanoma mortality for those born after 1950 is an additional example of effective intervention at the population level. Behavior change is possible and offers great potential for cancer prevention. The recommendations for cancer risk reduction include reducing tobacco use, increasing physical activity, maintaining a healthy weight, improving diet, limiting alcohol, avoiding excess sun exposure, utilizing safe sexual practices and vaccination against the human papillomavirus (HPV) infection, and obtaining routine cancer screening tests. Vaccination against the hepatitis B infection also protects against liver cancer. Emerging science in the prevention of cancer through drugs and vaccines in the past 20 years adds to our opportunities for prevention. They must also be considered as a prevention priority at a local, national, and international level. What are the barriers beyond costs that would limits access to these new preventive strategies for those most at risk of cancer?

      The Encyclopedia

      Over 600 entries, written for this second edition (90 percent of which are new articles) by experts from an incredible diversity of fields, is a first step to understanding the emerging knowledge and the burden of cancer in different countries, on cancer causes, strategies for prevention, placing these in the context of societal underlying forces that respond or ignore the role of industry and social structure driving the burden of cancer in society. The volume brings together an enormous range of topics, from causes of cancer, the biologic processes and treatment strategies, the places where treatment is delivered, and to organizations working to advance knowledge and conquer cancer. Together these entries provide a sweeping array of insightful perspectives that will be useful for students encountering issues in cancer causes and prevention, for those organizations and providers who are not yet aware of the scope of the problem, and those training in the many disciplines that relate to the challenges of addressing cancer in its full societal context.

      The encyclopedia was designed to include a vast range of different types of entries. This gives the reader the scope of the cancer problem and includes, what the editors believe, an integrated vision of cancer society. By bringing these entries together in one encyclopedia, we helped place in context the issue of cancer in society and provide a resource that will be useful for readers from around the world. By providing increase for many countries, we also offer the opportunity to compare and contrast the state of cancer and the potential for prevention that fairly substantially from region to region.

      The authors have included sample cancer incidence rates from many country articles from the International Agency for Research on Cancer (IARC). Readers are encouraged to visit the IARC Web site, www.iarc.fr, for more information.

      We live in a time when the cancer burden is rising globally, and the majority of cancers are diagnosed in low- and middle-income countries with less access to diagnosis and treatment. Yet advances in understanding the potential for prevention and the impact of social structures on the underlying risk of disease rapidly inform strategies to reduce the burden around the world. The editors hope the second edition of The SAGE Encyclopedia of Cancer and Society helps map out the lessons from past victories and strategies that can be applied to understand the problem and minimize the burden as we move forward.

      10.4135/9781483345758.n6

      Chronology

      ca. 3000 b.c.e.:

      The first known mention of cancer in the written record, in the Edwin Smith Papyrus; written in ancient Egypt, it describes surgical procedures including using cauterization to treat breast cancer.

      ca. 400 b.c.e.:

      Hippocrates uses the term carcinos to describe tumors; the term is derived from the Greek work for crab, and refers to the pattern of blood vessels, resembling the claws of a crab, observed on tumors.

      168 c.e.:

      The Roman physician Galen discusses the prevention and treatment of cancer; he suggests that food and climate were both related to the occurrence of cancer, and that cancer could be treated by surgery or cauterization.

      1675:

      The Dutch scientist Anton van Leeuwenhoek uses a microscope to examine many natural objects, and publishes descriptions of cells and bacteria.

      1713:

      The Italian physician Bernardino Ramazzino observes that nuns have a relatively high rate of breast cancer, and a low rate of cervical cancer, a discovery later understood to be related to hormones.

      1761:

      The English botanist John Hill publishes “Cautions Against the Immoderate Use of Snuff,” perhaps the first publication linking tobacco and cancer; he notes that nasal polyps occurred in patients who used nasal snuff.

      1775:

      In an early example of occupational medicine, the English physician Percival Pott noted scrotal cancer was common among chimney sweeps, and connects the disease to their exposure to soot.

      1779:

      The first hospital dedicated to treating cancer is created in Reims, France.

      1798:

      In the United States, the Marine Hospital Service is created, marking an early instance of federally funded public health and medical care.

      1836:

      Opening of the Library of the Office of the Surgeon General of the Army, which later becomes the National Library of Medicine.

      1887:

      The Laboratory of Hygiene is established at the Marine Hospital in Staten Island, New York; it is a precursor of the Centers for Disease Control and Prevention.

      1889:

      The English surgeon Steven Paget notes non-random patterns in breast cancer metastasis, which he explains through his “seed and soil” theory, arguing that specific tumor cells (seeds) will only grow in certain organs (the soil).

      1890:

      The German pathologist David Paul von Hansemann describes the mitotic figures of 13 carcinoma samples, and hypothesized that the observed aberrations caused the abnormal amounts of chromatin found in the cells.

      1890:

      The American physician William Stewart Halstead pioneers the radical mastectomy as a treatment for breast cancer in the United States. (it was already in use in France); Halstead was also noted for his role in developing the residency system of physician training in the United States.

      1901:

      French scientist Pierre Curie suggests the idea that tumors could be treated by putting a source of radiation directly into the tumor, an approach that later came to be known as brachytherapy.

      1903:

      The Austrian chemist Richard Adolf Zsigmondy develops the ultramicroscope, making it possible to study objects below the wavelength of light; he is awarded the Nobel Prize in Chemistry in 1925.

      1903:

      Radium is first used to treat skin cancer in two patients; this pioneers the way for radiation therapy to use many types of cancer, including breast, prostate, and cervical tumors.

      1909:

      The American biologist Paul Ehrlich suggests that the immune system normally suppressed the development of tumors in the body.

      1910:

      The viral theory of cancer receives support when the American physician Francis Peyton Rous successfully induces tumors in chickens by injecting them with the cells of tumors from other chickens.

      1913:

      The American Society for the Control of Cancer is founded in New York City by a group of businessmen and physicians; it is later renamed the American Cancer Society.

      1915:

      The American biologist Thomas Hunt Morgan demonstrates that the somatic mutation theory of cancer, which was originally proposed by the German biologist Theodor Boveri, is in fact correct.

      1922:

      The U.S. Public Health Service establishes a Cancer Investigations Laboratory at Harvard Medical School.

      1933:

      The Women’s Field Army joins the fight against cancer, raising money and educating people about the disease.

      1937:

      U.S. president Franklin Roosevelt signs the National Cancer Institute Act, legislation creating the National Cancer Institute, with a budget of $400,000 for the first year.

      1938:

      The German physicist Ernst Ruska develops the electron microscope, improving resolution; he is awarded the Nobel Prize in Physics in 1986.

      1939:

      Charles Brendon Huggins, while studying prostate cancer and androgen in dogs, discovers that hormones were influential in the growth of some types of cancer.

      1939:

      Gordon Ide and colleagues suggest that tumors might produce a substance fostering the creation of new blood vessels; their work is based on observing the growth of transplanted tumors in rabbits. Later research by Melvin Greenblatt and Philippe Shubik demonstrates that transplanted tumors cause blood vessels to proliferate even when a Millipore filter is used to create a physical barrier.

      1940:

      In August, the first issue of the Journal of the National Cancer Institute is published.

      1945:

      In Science: The Endless Frontier, Vannevar Bush argues for increased federal government funding for science and technology while allowing the community of scientists to be self-governing, without government interference.

      1946:

      Led by the philanthropist Mary Lasker, the American Cancer Society begins a research program with a budget of $1 million.

      1946:

      At the National Institutes of Health, the Research Grants Office is created to operate a program of fellowships and extramural research grants; it is later renamed the Division of Research Grants.

      1946:

      The American pharmacologist Louis S. Goodman reports the use of mustard gas in chemotherapy to treat leukemia, lymphosarcoma, and Hodgkin’s disease.

      1947:

      The Nuremberg Code is developed following evidence of Nazi abuse of humans, including prisoners, in the name of scientific research; it sets a precedent in establishing ethical guidelines for human research.

      1947:

      The physician and researcher Sidney Farber, working with funding from the American Cancer Society, develops the first successful chemotherapy treatment for cancer. Farber successfully treats a 4-year-old leukemia patient with aminopterin and later reports on additional cases of remission in a disease that at the time normally resulted in death soon after diagnosis.

      1948:

      The National Cancer Institute begins a program of grants to medical, osteopathic, and medical schools to improve the training of professionals in cancer diagnosis, research, and treatment.

      1948:

      The fight against cervical and uterine cancer is strengthened when the American Cancer Society advocates for widespread use of the Pap smear, a screening test developed by the physician Georgios Papanikolaou.

      1949:

      The U.S. Food and Drug Administration approves nitrogen mustard for the treatment of Hodgkin’s lymphoma, the first chemotherapeutic treatment approved for cancer.

      1950:

      American researchers Ernst Wynder ad Evarts Graham publish a case-control study that shows an association between tobacco smoking and lung cancer.

      1951:

      In the United Kingdom, the Medical Research Council begins the British Doctors Study, which will continue until 2001; among other results, this study provides strong evidence that smoking tobacco is a risk for the development of lung cancer.

      1953:

      At the University of Chicago, the Argonne Cancer Research Hospital begins operation; it is the first facility dedicated to using radioactive isotopes to diagnose and treat disease.

      1953:

      James Watson and Francis Crick discover the helical structure of DNA, a scientific breakthrough for which they are awarded the Nobel Prize in 1962.

      1954:

      Eugene Goldwasser, working at the University of Chicago, explains the basic working principles of erythropoietin; in 1977, he becomes the first person to isolate erythropoietin.

      1955:

      The National Cancer Institute creates the Clinical Trials Cooperative Group Program, a network facilitating cancer research and clinical trials.

      1956:

      Arthur von Hippel, working at the Massachusetts Institute of Technology, coins the term molecular engineering and develops many of the key concepts in the field.

      1958:

      Combination chemotherapy (using multiple drugs together) is demonstrated by scientists at the National Cancer Institute (part of the National Institutes of Health) as a successful approach to treating leukemia; this approach becomes common in chemotherapy in the future.

      1959:

      Physicist Richard Feyman delivers the lecture “There’s Plenty of Room at the Bottom” at an American Physical Society meeting in California; it is considered by many to be the first discussion of technology at the atomic scale.

      1960:

      Discovery of the chromosomal abnormality called the “Philadelphia chromosome” (because it was discovered by Peter Nowell and David Hungerford, researchers working in Philadelphia) that is linked to many leukemias; this abnormality later becomes the focus of one of the first targeted cancer drugs, Gleevec.

      1961:

      The American biologist Rachel Carson publishes Silent Spring, a highly influential book pointing out the health dangers of human exposure to DDT and other toxins; this book plays a key role in coalescing the environmental movement.

      1961:

      The National Cancer Institute establishes a Laboratory of Viral Oncology to investigate the role of viruses in cancer.

      1964:

      In the United States, the Surgeon General publishes a report that concludes that cigarette smoking bears a causal relationship to lung cancer in men, with an effect greater than all other factors combined.

      1964:

      The World Medical Association publishes the Declaration of Helsinki, an influential statement of research ethics in medical research; it has been revised multiple times, with the 2006 revision being the sixth.

      1965:

      Vincent DeVita and colleagues develop the MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) chemotherapy regime, which has a cure rate of around 50 percent, becomes standard treatment until replaced by the ABVD (doxorubicin, belomycin, vinblastine, and darcarbacine) regime in the 1970s.

      1966:

      Peyton Rous is awarded the Nobel Prize for Physiology or Medicine for his work in identifying the role played by viruses in some kinds of cancer.

      1966:

      Henry Beecher publishes an article in the New England Journal of Medicine identifying a number of unethical medical studies and claimed that they showed a systematic pattern of abuse rather than isolated incidents.

      1966:

      Charles Brenton Huggins, a Canadian-born American physician, is awarded the Nobel Prize for Physiology or Medicine for his work demonstrating that hormones could be used to treat some cancers.

      1967:

      The USPHS (U.S. Public Health Service) Hospital is created in Baltimore to conduct integrated laboratory and clinical research on cancer.

      1967:

      The FOBT (fecal occult blood test) is introduced as a simple method to screen patients for colorectal cancer; two more elaborate techniques, colonoscopy and flexible sigmoidoscopy, are also introduced within a few years, and together these methods contributed to a significant reduction in mortality from colorectal cancer.

      1968:

      Elwood V. Jensen develops a test for the presence of estrogen receptors in breast cancer cells, later concluding that about a third of breast cancer cells contain the receptors.

      1970s:

      The use of asbestos in construction decreases as scientific studies demonstrate a link between asbestos exposure and particular cancers.

      1971:

      Judah Folkman and colleagues announce the discovery of a tumor angiogenic factor (TAF) and hypothesize that if TAF activity could be blocked, the growth of malignancies might also be prevented.

      1971:

      Total mastectomy, which involves removing less tissue than radical mastectomy, is demonstrated to be equally effective in treating breast cancer in the early stages.

      1971:

      On December 23, U.S. President Richard Nixon signs the National Cancer Act, authorizing and funding the National Cancer Institute to create new research and treatment facilities, award research grants, and otherwise spur the War on Cancer.

      1972:

      Janet Rowley, working at the University of Chicago, pioneers the recognition of the genetic basis of cancer with her discovery of a chromosomal abnormality in leukemia.

      1972:

      Computerized tomography (CT) scanning is developed by the British engineer Godfrey Hounsfield and South African physicist Allan Comack. CT scans are first used on the head (the first clinical application is used to diagnose a woman with a suspected brain tumor) but are later used for all parts of the body.

      1973:

      A study reveals that mammography is the best tool for finding early-stage breast cancer.

      1973:

      In the United States, eight institutions are recognized as Comprehensive Cancer Centers (CCCs); the number of CCCs increases over the years, to 37 as of 2000.

      1973:

      John Ultmann and Donald Ferguson demonstrate that staging laparotomy, the surgical examination of part of the body, is useful in the evaluation of Hodgkin’s disease.

      1974:

      William Summerlin, a researcher at the Sloan Kettering Cancer Institute, admits fraud in his research on skin grafts; Summerlin claimed to have successfully grafted skin from unrelated animals but in fact had colored the grafts with ink.

      1974:

      The National Cancer Institute awards funds to state health departments to screen low-income women for cervical cancer.

      1975:

      Dr. Bernard Fisher and Dr. Gianni Bonadonna demonstrate that adjuvant chemotherapy—using chemotherapy after surgery—is effective in treating drug cancer.

      1975:

      In the United States, the Cancer Information Service is created to educate health professionals, patients, and the public about cancer.

      1975:

      The Australian philosopher Peter Singer publishes Animal Liberation, arguing against speciesism, the belief that some species (e.g., humans) are more important and should have greater rights than other species (e.g., animals, including those used for lab research).

      1976:

      The first Great American Smokeout is held in California, encouraging smokers to quit for at least one day; the program proves successful and becomes an annual, nationwide event.

      1976:

      The first oncogene, src, is discovered by Harold E. Varmus and J. Michael Bishop.

      1977:

      A clinical trial demonstrates that advanced testicular cancer can be treated by a combination of cisplatin, vinblastine, and bleomycin.

      1977:

      Studies demonstrate that breast-conserving surgery, in which only the tumor but not the entire breast is removed, is as effective in treating early-stage breast cancer as mastectomy (removing the entire breast), if followed by radiation therapy.

      1978:

      The U.S. Food and Drug Administration approves cisplatin as a chemotherapeutic drug for cancer.

      1979:

      The National Commission for the Protection of Human Subject of Biomedical and Behavioral Research publishes the Belmont Report, which sets out principles and guidelines to govern the treatment of human subjects. The core principles of the Belmont Report are beneficence, justice, and respect for the person, while procedures specified include informed consent, risk and benefit assessment, and subject selection.

      1980:

      The U.S. Supreme Court rules, in Diamond v. Chakrabarty, that life forms (in this particular case, a genetically modified bacterium) can be patented.

      1980:

      The estrogen receptor immunohistochemical test developed by University of Chicago researchers Elwood V. Jensen and Geoffrey Greene becomes standard practice in the treatment of breast cancer.

      1981:

      The U.S. Food and Drug Administration approves a vaccine for hepatitis B, a disease that is strongly associated with liver cancer.

      1981:

      The Centers for Disease Control and Prevention forms a Task Force on Kaposi’s Sarcoma and Opportunistic Infections to investigate a cluster of illnesses caused by what was later determined to be acquired immunodeficiency syndrome (AIDS).

      1981:

      Gerd Binnig and Heinrich Rohrer, working in Zurich, develop the scanning tunneling microscope, an instrument that allows scientists to create images of individual atoms; they are awarded the Nobel Prize in Physics in 1986 for this achievement.

      1981:

      The National Cancer Institute begins the Biological Response Modifiers Program to develop therapeutic agents that may alter biological responses relevant to cancer and to conduct clinical trials of such agents.

      1982:

      Total mesorectal excision provides a new treatment option for patients with rectal cancer; prior to this time, the standard treatment was colostomy, the removal of the colon, and the use of a colostomy bag for the rest of the patient’s life.

      1982:

      Aline van Pel and Thierry Boon find that mice can be vaccinated against cancer with mutagenized cancer cells, giving them specific immunity to spontaneous tumors.

      1983:

      The National Cancer Institute creates the R. A. Bloch International Cancer Information Center, housing information programs for scientists and health professionals.

      1986:

      Gerd Binnig, Christoph Gerber, and Calvin Quate develop the atomic force microscope, which allows scientists to view and manipulate materials as small as fractions of a nanometer.

      1986:

      The first tumor suppressor gene, Rb, is discovered by Stephen H. Friend and colleagues.

      1986:

      The U.S. Food and Drug Administration approves a PSA (prostate-specific antigen) test for prostate cancer screening, adding a new tool to the fight against the most common type of cancer in men.

      1986:

      The World Health Organization issues guidelines on the adequate treatment of pain for cancer patients, addressing common worries about addiction, tolerance, and abuse connected with opioid drugs.

      1986:

      U.S. cities begin to ban indoor smoking after the U.S. Surgeon General declares that second-hand smoke is a carcinogen.

      1986:

      Tamoxifen, a drug originally produced from the yew tree, is used to treat breast cancer in conjunction with surgery.

      1988:

      The first Consortium Cancer Center in the United States is created by a grant from the National Cancer Institute, supporting research into cancer prevention, control, epidemiology, and clinical trials at three historically black universities: Charles R. Drew University of Medicine and Science, Meharry Medical College, and Morehouse School of Medicine.

      1989:

      Epoetin Alpha is approved to stimulate the production of red blood cells, addressing the problem of anemia that is often a side effect of chemotherapy.

      1990:

      The California Supreme Court rules, in Moore v. Regents of the University of California, that researchers can claim intellectual property rights in a cell line developed from an individual’s tissue but that the individual does not have property rights to the tissue.

      1990:

      Michelle Le Beau and Janet Rowley use fluorescence in situ hybridization (FISH) to map chromosome dislocation, a method now commonly used to diagnose leukemia and lymphoma.

      1991:

      In the United States, childhood vaccination for hepatitis B becomes routine, resulting in a 98 percent decline of acute hepatitis B among children age 15 and under; in the long term, substantial reduction is also expected in liver cancer, a disease strong associated with hepatitis B.

      1991:

      In the first attempt at treating cancer with human gene therapy, patients with melanoma are treated with tumor-infiltrating lymphocytes modified by the addition of a gene for tumor necrosis.

      1991:

      The U.S. Food and Drug Administration approves Ondansetron to prevent vomiting, a common side effect of chemotherapy and radiation.

      1991:

      The National Cancer Institute and the nonprofit organization Produce for Better Health begin the Five-a-Day program, which is a public health campaign encouraging Americans to eat at least five servings of fruits and vegetables each day.

      1992:

      The technique of sentinel lymph node biopsy, which involves removing the lymph node closest to a primary tumor, offers a method to assess the spread of cancer without invasive surgery.

      1992:

      Paclitaxel is approved by the U.S. Food and Drug Administration to treat advanced ovarian cancer; it is later discovered to be useful for treating breast cancer as well.

      1994:

      Dr. Roger Poisson, a researcher at the University of Montreal and a member of the National Surgical Adjuvant Breast and Bowel Project, is found to have been enrolling ineligible women in breast cancer trials and maintaining false records to cover up the deception.

      1994:

      The BRCA1 gene, implicated in about 25 percent of breast cancers in women under age 30, is discovered by researchers at the National Institute of Environmental Health Sciences.

      1994:

      Victor DeNobel and Paul Mele, who work at the tobacco company Philip Morris, testify before U.S. Congress about suppressed research demonstrating the addictive properties of nicotine; this testimony leads to a $206 billion settlement between 46 states and the tobacco companies; some of the funds are devoted to antismoking campaigns.

      1994:

      Ralph Weichselbaum and Samuel Hellman propose the existence of “oligometastases,” which is an intermediate state in cancer between not having spread at all and having spread extensively.

      1995:

      The Centers for Disease Control and Prevention reports that the cancer death rate in the United States fell by 2.6 percent between 1991 and 1995, the first time cancer mortality rates declined since the 1930s (when recordkeeping began).

      1995:

      Kunio Doi, working at the University of Chicago, pioneers the clinical use of a computer-assisted system to read mammograms.

      1995:

      A group of religious leaders and ethicists protest the patenting of human body tissue, plants, and animals.

      1997:

      The American Cancer Society begins operating a call center, proving information to cancer patients and their families every day, around the clock.

      1998:

      The National Institutes of Health publishes guidelines on managing obesity in adults due to the associated between obesity and increased risk of serious health problems, including several types of cancer.

      1998:

      Results from the Breast Cancer Prevention Trial show that the drug tamoxifen can be effective in preventing breast cancer—women taking tamoxifen had 45 percent fewer diagnoses of breast cancer than the women in the control group.

      1998:

      The National Science and Technology Council forms the Interagency Working Group on Nanotechnology, which leads to the creation of the U.S. National Nanotechnology Initiative in 2000.

      1998:

      A large-scale prevention trial finds that a moderate dose of Vitamin E reduces the incidence of prostate cancer, as well as prostate cancer deaths, among male smokers.

      1998:

      Tamoxifen is approved for prophylactic use for women at high risk for breast cancer after a clinical trial shows it reduces the risk of breast cancer in women with a family history of breast cancer or with the BRCA1 and BRCA2 genetic mutations that are associated with a higher risk of breast cancer.

      1998:

      The benefits of neoadjuvant therapy, in which chemotherapy is used before surgery to shrink tumors before they are surgically removed, is shown to allow many patients to have breast-conserving surgery (removing only the tumor) rather than mastectomy.

      1999:

      The risks of human subjects research comes to public attention after a research subject, Jessie Gelsinger, dies during an experiment on human gene therapy conducted at the University of Pennsylvania.

      2000:

      Brian Duker develops the first successful molecularly-targeted cancer drug, Gleevec, which is used to treat myelogenous leukemia.

      2000:

      Radon exposure is associated with lung cancer in the Iowa Radon Lung Cancer Study, raising awareness about the risks of long-term exposure to radon in the home.

      2000:

      Research using microarray technology finds that non-Hodgkin’s lymphoma is actually two diseases, helping to explain why some patients respond to chemotherapy and others do not.

      2000:

      The Special Populations Networks for Cancer Awareness Research and Training program is created in the United States to address the unequal burden of cancer in particular subpopulations.

      2001:

      Gleevec is approved by the U.S. Food and Drug Administration to treat chronic myelogenous leukemia after three months of review, the fastest approval on record. The same year, Gleevec is shown to be effective against gastrointestinal stromal tumor, a rare type of abdominal tumor.

      2002:

      Helen Davies and colleagues publish research in Nature identifying a faulty BRAF gene as present in many cancers, including over half of all malignant melanomas.

      2002:

      In the United Kingdom, the Cancer Research Campaign and the Imperial Cancer Research Fund merge to form Cancer Research UK, the world’s largest independent cancer research organization.

      2002:

      John Crispino, working at the University of Chicago, discovers that the development of leukemia in Down syndrome children is linked to a gene defect.

      2002:

      The National Cancer Institute begins the National Lung Screening Trials to test the efficacy of two methods for screening current and former smokers for lung cancer: chest X-rays and spiral computed tomography.

      2003:

      Results from the Million Woman Study indicate that the current use of hormone replacement therapy (HRT) increases the incidence of breast cancer as well as increasing breast cancer mortality.

      2003:

      The Human Genome Project, a 13-year collaboration among researchers in seven countries, announces that they have completed mapping the DNA in the human genome; the results are made freely available to the international scientific community.

      2003:

      Research published in the New England Journal of Medicine shows that taking aspirin daily is associated with a reduction in the risk of colorectal polyps among people at high risk for colorectal cancer.

      2003:

      British researchers publish research demonstrating that combining chemotherapy and radiotherapy improves outcomes in treating the most common type of pediatric brain tumor, medulloblastoma.

      2003:

      Researchers at Rice University develop gold nanoshells that can be used in the discovery, diagnosis, and treatment of breast cancer.

      2003:

      Eugenia E. Calle and colleagues publish research in the New England Journal of Medicine demonstrating a strong relationship between obesity and many types of cancer, and estimates that if Americans maintained a healthy weight, 90,000 cancer-related deaths annually could be avoided.

      2004:

      The Alliance for Nanotechnology in Cancer is created to integrate nanotechnology into basic and applied cancer research, including supporting the development of nanomaterials and nanoscale devices for cancer detection and treatment.

      2004:

      Avastin (bevacizumab) becomes the first approved anti-angiogenic drug, a type of drug that treats cancer by blocking the growth of blood vessels that feed tumors.

      2004:

      University of Chicago researcher Olufunmilayo Olopade, studying women with breast cancer in North America, Nigeria, and Senegal, discovers that women with African ancestry, as compared to women of European ancestry, are more likely to be diagnosed with an aggressive form of breast cancer; in 2005 she receives a MacArthur Foundation “genius grant.”

      2004:

      Results from a large trial funded by Cancer Research UK involving people with operable pancreatic cancer indicate that using chemotherapy after surgery helps delay or prevent recurrence.

      2004:

      The Environmental Protection Agency strengthens its rules regarding human subjects research with children and pregnant women following public criticism of the Children’s Environmental Exposure Research Study (CHEERS).

      2004:

      The 50-year follow-up study of the British Doctors Study finds that prolonged cigarette smoking caused death 10 years earlier than among nonsmokers, based on results from men born between 1910 and 1930; the study also shows that cessation of smoking reduces this risk substantially.

      2005:

      In the United States, the National Human Genome Research Institute and the National Cancer Institute announce the Cancer Genome Atlas Project, whose first goal is to create an atlas of the genomes of lung and ovarian cancer and glioblastoma.

      2005:

      Results from the Women’s Health Study finds that supplemental vitamin E does not reduce the incidence of cancer among women.

      2005:

      The National Institutes of Health (NIH) in the United States strengthens its policies intended to prevent conflict of interest, including barring NIH researchers from consulting with or holding stock in pharmaceutical and biotechnology companies.

      2005:

      The National Cancer Institute creates the Community Networks Program to provide education, research, and training aimed at reducing cancer disparities among underserved populations.

      2005:

      The Childhood Cancer Survivors Study reveals that survivors of childhood cancer suffer from many health concerns later in life, including scarring of the lungs, other types of cancer, and heart trouble.

      2005:

      Eric Pohlman, a professor at the University of Vermont, pleads guilty to falsifying results in numerous scientific grants and research articles; in 2006, he becomes the first person in the United States to be sentenced to prison for research fraud.

      2006:

      The U.S. Food and Drug Administration approves Gardasil, a vaccine to prevent infection with human papillomavirus (HPV), associated with cervical cancer; Gardisil is approved for girls and women ages 9 to 26.

      2006:

      In the United Kingdom, the Network of Experimental Cancer Medicine Centres opens, with the goal of moving new treatments into clinical trials and practice quickly.

      2006:

      In the United States, the National Community Cancer Centers Program Pilot begins operation with the goal of improving cancer care in local communities as well as reducing cancer health disparities and increasing access to prevention and screening services.

      2007:

      Results from the United Kingdom (UK) QUASAR clinical trial of chemotherapy for bowel cancer demonstrates that chemotherapy improves survival for people with less advanced cancer.

      2008:

      Greg Karczmar, Suzanne Conzen and colleagues develop a procedure using magnetic resonance imagine (MRI) to detect very early breast cancer in mice.

      2008:

      Hans Schreiber demonstrates that, in mice, killing nonmalignant cells surrounding a tumor can prevent spread of the tumor.

      2009:

      Early results from the UK Collaborative Trial of Ovarian Cancer Screening finds that screening women with both a blood test and ultrasound produces more accurate results than ultrasound alone, perhaps because the blood test helps to rule out harmless cysts picked up through ultrasound scans.

      2009:

      Ezra Cohen discovers that grapefruit juice enhances the effectiveness of rapamycin, allowing patients to take lower dosages of the drug.

      2009:

      In the United States, the Family Smoking Prevention and Tobacco Control Act allows the Food and Drug Administration to regulate tobacco products, and creates a Tobacco Products Scientific Advisory Committee to advise the Department of Health and Human Services.

      2009:

      Results from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial casts doubt on whether routine screening for prostate cancer reduces mortality, and suggests that screening also leads to overdiagnosis and treatment of cancers unlikely to be life threatening.

      2009:

      The Prevent All Cigarette Trafficking Act prohibits tobacco products from being sent through the U.S. mail.

      2010:

      Results from the National Lung Screening Trial indicate that annual screening by computerized tomography (CT) scan of smokers and former smokers reduces the risk of death from lung cancer; this is the first lung cancer screening program successful in reducing mortality.

      2010:

      Research by Jennifer S. Temel and colleagues, published in the New England Journal of Medicine, shows that the combination of palliative care and chemotherapy improves both survival and quality of life in patients with advanced lung cancer.

      2011:

      An international research team identifies a new oncogene, ZNF703, which is believed to accelerate the development of breast cancer.

      2011:

      The Sunbeds Regulation Act in the United Kingdom bars people under the age of 18 from using tanning beds, associated with the development of skin cancer.

      2012:

      The American Cancer Society and the National Cancer Institute report that the number of Americans living with cancer has increased fourfold since 1971, from 3 million to 13.7 million.

      2013:

      On August 23, Song-Yi Park and colleagues announce results from the Multiethnic Cohort Study showing that, for women, increased consumption of fruits and vegetables is associated with a lower incidence of invasive bladder cancer.

      2013:

      In the September issue of the Texas Public Health Journal, researchers report that cancer is the most common cause of death for Hispanics living in Texas.

      2013:

      On November 6, Alastair Sutcliffe and colleagues report research based on children born in the United Kingdom as a result of in vitro fertilization, finding that they are no more likely than other children to develop cancer.

      2013:

      On December 20, Science announces that cancer immunotherapy has been selected as the breakthrough of the year.

      2014:

      On February 14, Cancer Research UK publishes a report and makes available two online interactive maps allowing the comparison of the incidence and mortality from cancer globally.

      2014:

      On April 17, a clinical trial studying the effectiveness of personalized treatment for lung cancer is announced by Cancer Research UK, AstraZeneca, and Pfizer.

      2014:

      On June 26, Martin Widschwendter and colleagues announce the discovery of a genetic marker or “switch” observable in blood samples associated with increased risk for breast cancer, suggesting the possibility that a simple blood test may be available in the future to help predict the likelihood of noninherited breast cancer.

      2014:

      On July 11, Min Yu and colleagues report in Science that they successfully isolated breast cancer cells in patients’ bloodstreams, including cells carrying the “seed” of metastasis.

      2014:

      In October, the International Agency for Research on Cancer added several recommendations, including for girls to get the HPV (human papillomavirus) vaccine and for mothers to breastfeed.

      2014:

      In December, Jan Durmanski and colleagues at Uppsala University in Sweden reported research linking smoking with the loss of Y chromosomes from the blood cells in men. In addition, the researchers found that the loss of Y chromosomes from at least one fifth of an individual’s blood cells was associated with almost four times the risk of developing certain cancers.

      2015:

      According to estimates by the American Cancer Society, approximately 1.66 million new cancer cases are expected to occur in the United States in 2015; this estimate does not include noninvasive cancers or basal cell or squamous cell skin cancers. In addition, about 589,430 Americans are expected to die of cancer in 2015.

      2015:

      In January, England’s National Health Service removed nine cancer drugs from the list of treatments it will pay for, based on the high cost of the drugs relative to the value they provide to patients. At the same time, NHS England reduced the number of conditions for which several other drugs were an approved treatment, reducing the total number of treatment options by 25.

      2015:

      In February, the World Health Organization (WHO) announces that cancers are among the leading worldwide causes of illness and death, with about 14 million new cases of cancer and 8.2 million deaths due to cancer, occurring in 2012. In addition, the WHO reports that the number of new cancer cases per year is expected to rise to 22 million within the next 20 years.

      2015:

      In March, Takaaki Hirotsu and colleagues at Kyushu University report that roundworms were able to correctly identify individuals with cancer, based on urine samples in Petri dishes, with 96 percent accuracy.

    • Glossary

      Abdomen:

      The part of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

      Accelerated phase:

      Refers to chronic myelogenous leukemia that is progressing. The number of immature, abnormal white blood cells in the bone marrow and blood is higher than in the chronic phase, but not as high as in the blast phase.

      Achlorhydria:

      A lack of hydrochloric acid in the digestive juices in the stomach. Hydrochloric acid helps digest food.

      Actinic keratosis:

      A precancerous condition of thick, scaly patches of skin; also called solar or senile keratosis.

      Acute leukemia:

      Leukemia that progresses rapidly.

      Adenocarcinoma:

      Cancer that begins in cells that line certain internal organs.

      Adenoma:

      A noncancerous tumor.

      Adjuvant therapy:

      Treatment given in addition to the primary treatment to enhance the effectiveness of the primary treatment.

      Adrenal glands:

      A pair of small glands, one located on top of each kidney. The adrenal glands produce hormones that help control heart rate, blood pressure, the way the body uses food, and other vital functions.

      Aflatoxin:

      A substance made by a mold that is often found on poorly stored grains and nuts. Aflatoxins are known to cause cancer in animals.

      Agranulocyte:

      A type of white blood cell; monocytes and lymphocytes are agranulocytes.

      Allogeneic bone marrow transplantation:

      A procedure in which a patient receives bone marrow from a compatible, though not genetically identical, donor.

      Alpha-fetoprotein:

      A protein often found in abnormal amounts in the blood of patients with liver cancer.

      Alveoli:

      Tiny air sacs at the end of the bronchioles.

      Anal cancer:

      Anal cancer, an uncommon cancer, is a disease in which cancer (malignant) cells are found in the anus. The anus is the opening at the end of the rectum (the end part of the large intestine) through which body waste passes.

      Anaplastic:

      A term used to describe cancer cells that divide rapidly and bear little or no resemblance to normal cells.

      Anastamosis:

      A procedure to connect healthy sections of the colon or rectum after the diseased portion has been surgically removed.

      Androgen:

      A hormone that promotes the development and maintenance of male sex characteristics.

      Anemia:

      A decrease in the normal amounts of red blood cells.

      Anesthesia:

      Loss of feeling or awareness. A local anesthetic causes loss of feeling in a part of the body. A general anesthetic puts the person to sleep.

      Anesthetic:

      A substance that causes loss of feeling or awareness. A local anesthetic causes loss of feeling in a part of the body. A general anesthetic puts the person to sleep.

      Angiogenesis:

      Blood vessel formation, which usually accompanies the growth of malignant tissue.

      Angiogram:

      An X-ray of blood vessels; the patient receives an injection of dye to outline the vessels on the X-ray.

      Angiography:

      A procedure to X-ray blood vessels. The blood vessels can be seen because of an injection of a dye that shows up in the X-ray pictures.

      Angiosarcoma:

      A type of cancer that begins in the lining of blood vessels.

      Antiandrogen:

      A drug that blocks the action of male sex hormones.

      Antibiotics:

      Drugs used to treat infection.

      Antibody:

      A protein produced by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind only to a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies disable antigens directly. Others make the antigen more vulnerable to destruction by white blood cells.

      Anticonvulsant:

      Medicine to stop, prevent, or control seizures (convulsions).

      Antigen:

      Any foreign or “non-self” substance that, when introduced into the body, causes the immune system to create an antibody.

      Antithymocyte globulin:

      A protein preparation used to prevent and treat graft-versus-host disease.

      Aplastic anemia:

      A deficiency of certain parts of the blood caused by a failure of the bone marrow’s ability to generate cells.

      Apoptosis:

      A normal cellular process involving a genetically programmed series of events leading to the death of a cell.

      Arterial embolization:

      Blocking an artery so that blood cannot flow to the tumor.

      Arteriogram:

      An X-ray of blood vessels, which can be seen after an injection of a dye that shows up in the X-ray pictures.

      Asbestos:

      A natural material that is made up of tiny fibers. If the fibers are inhaled, they can lodge in the lungs and lead to cancer.

      Ascites:

      Abnormal buildup of fluid in the abdomen.

      Aspiration:

      Removal of fluid from a lump, often a cyst, with a needle and a syringe.

      Astrocytoma:

      A type of brain tumor that begins in the brain or spinal chord in small, star-shaped cells called astrocytes.

      Ataxic gait:

      Awkward, uncoordinated walking.

      Atypical hyperplasia:

      A benign (noncancerous) condition in which tissue has certain abnormal features.

      Autologous bone marrow transplantation:

      A procedure in which bone marrow is removed from a patient and then is given back to the patient following intensive treatment.

      Axilla:

      The underarm.

      Axillary:

      Pertaining to the lymph nodes under the arm.

      Axillary dissection:

      Surgery to remove lymph nodes under the arm.

      B cells:

      White blood cells that develop in the bone marrow and are the source of antibodies. Also known as B lymphocytes.

      Barium enema:

      A series of X-rays of the lower intestine. The X-rays are taken after the patient is given an enema with a white, chalky solution that contains barium. The barium outlines the intestines on the X-rays.

      Barium solution:

      A liquid containing barium sulfate that is used in X-rays to highlight parts of the digestive system.

      Barrett’s esophagus:

      A change in the cells of the tissue that lines the bottom of the esophagus. The esophagus may become irritated when the contents of the stomach back up (reflux). Reflux that happens often over a long period of time can lead to Barrett’s esophagus.

      Basal cell carcinoma:

      A type of skin cancer that arises from the basal cells.

      Basal cells:

      Small, round cells found in the lower part, or base, of the epidermis, the outer layer of the skin.

      Basophil:

      A type of white blood cell. Basophils are granulocytes.

      BCG (Bacillus Calmette-Guerin):

      A substance that activates the immune system. Filling the bladder with a solution of BCG is a form of biological therapy for superficial bladder cancer.

      Benign:

      Not cancerous; does not invade nearby tissue or spread to other parts of the body.

      Benign prostatic hyperplasia:

      A noncancerous condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH.

      Benign tumor:

      A noncancerous growth that does not spread to other parts of the body.

      Beta-carotene:

      A substance from which vitamin A is formed; a precursor of vitamin A.

      Bilateral:

      Affecting both the right and left side of body.

      Bile:

      A yellow or orange fluid made by the liver. Bile is stored in the gallbladder. It passes through the common bile duct into the duodenum, where it helps digest fat.

      Bioimmunotherapy:

      Treatment to stimulate or restore the ability of the immune system to fight infection and disease.

      Biological response modifiers:

      Substances that stimulate the body’s response to infection and disease. The body naturally produces small amounts of these substances. Scientists can produce some of them in the laboratory in large amounts and use them in cancer treatment.

      Biological therapy:

      The use of the body’s immune system, either directly or indirectly, to fight cancer or to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier therapy.

      Biopsy:

      The removal of a sample of tissue, which is then examined under a microscope to check for cancer cells.

      Bladder:

      The hollow organ that stores urine.

      Bladder cancer:

      Bladder cancer is a disease in which cancer (malignant) cells are found in the bladder. The bladder, a hollow organ in the lower part of the abdomen, stores urine.

      Blast phase:

      Refers to advanced chronic myelogenous leukemia. In this phase, the number of immature, abnormal white blood cells in the bone marrow and blood is extremely high. Also called blast crisis.

      Blasts:

      Immature blood cells.

      Blood-brain barrier:

      A network of blood vessels with closely spaced cells that makes it difficult for potentially toxic substances (such as anticancer drugs) to penetrate the blood vessel walls and to enter the brain.

      Bone marrow:

      The soft, spongy tissue in the center of large bones that produces white blood cells, red blood cells, and platelets.

      Bone marrow aspiration or biopsy:

      The removal of a small sample of bone marrow (usually from the hip) through a needle for examination under a microscope to see whether cancer cells are present.

      Bone marrow biopsy:

      The removal of a sample of tissue from the bone marrow with a large needle. The cells are checked to see whether they are cancerous. If cancerous plasma cells are found, the pathologist estimates how much of the bone marrow is affected. Bone marrow biopsy is usually done at the same time as bone marrow aspiration.

      Bone marrow transplantation:

      A procedure in which doctors replace marrow destroyed by treatment with high doses of anticancer drugs or radiation. The replacement marrow may be taken from the patient before treatment or may be donated by another person.

      Bone scan:

      A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected and travels through the bloodstream. It collects in the bones, especially in abnormal areas of the bones, and is detected by a scanner.

      Bowel:

      Another name for the intestine. There is both a small and a large bowel.

      Brachytherapy:

      Internal radiation therapy using an implant of radioactive material placed directly into or near the tumor.

      Brain stem:

      The stemlike part of the brain that is connected to the spinal cord.

      Brain stem glioma:

      A type of brain tumor that occurs in the lowest, stemlike part of the brain.

      Brain tumor—astrocytoma:

      Astrocytomas are tumors that start in brain cells called astrocytes. There are different kinds of astrocytomas, which are defined by how the cancer cells look under a microscope.

      Brain tumor—ependymoma:

      Ependymal tumors are tumors that begin in the ependyma, the cells that line the passageways in the brain where special fluid that protects the brain and spinal cord (called cerebrospinal fluid) is made and stored. There are different kinds of ependymal tumors, which are defined by how the cells look under a microscope.

      Brain tumor—glioblastoma:

      Glioblastoma multiformes are tumors that grow very quickly and have cells that look very different from normal cells. Glioblastoma multiforme is also called grade IV astrocytoma.

      Brain tumor—medulloblastoma:

      Medulloblastomas are brain tumors that begin in the lower part of the brain. They are almost always found in children or young adults. This type of cancer may spread from the brain to the spine.

      BRCA1:

      A gene located on chromosome 17 that normally helps to restrain cell growth. Inheriting an altered version of BRCA1 predisposes an individual to breast, ovary, and prostate cancer.

      Breast reconstruction:

      Surgery to rebuild a breast’s shape after a mastectomy.

      Bronchi:

      Air passage that leads from the windpipe to the lungs.

      Bronchioles:

      The tiny branches of air tubes in the lungs.

      Bronchitis:

      Inflammation (swelling and reddening) of the bronchi.

      Bronchoscope:

      A flexible, lighted instrument used to examine the trachea and bronchi, the air passages that lead into the lungs.

      Bronchoscopy:

      A test that permits the doctor to see the breathing passages through a lighted tube.

      Buccal mucosa:

      The inner lining of the cheeks and lips.

      Burkitt’s lymphoma:

      A type of non-Hodgkin’s lymphoma that most often occurs in young people between the ages of 12 and 30. The disease usually causes a rapidly growing tumor in the abdomen.

      Bypass:

      A surgical procedure in which the doctor creates a new pathway for the flow of body fluids.

      Cancer:

      A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.

      Cancer screening:

      Different tests may show whether a person has a higher than normal risk for getting certain types of cancer. The person’s family history and medical history are also key parts of the cancer screening process.

      Carcinogen:

      Any substance that is known to cause cancer.

      Carcinogenesis:

      The process by which normal cells are transformed into cancer cells.

      Carcinoma:

      Cancer that begins in the lining or covering of an organ.

      Carcinoma in situ:

      Cancer that involves only the cells in which it began and has not spread to other tissues.

      Cartilage:

      Firm, rubbery tissue that cushions bones at joints. A more flexible kind of cartilage connects muscles with bones and makes up other parts of the body, such as the larynx and the outside of the ears.

      Cauterization:

      The use of heat to destroy abnormal cells.

      CEA assay:

      A laboratory test to measure the level of carcinoembryonic antigen (CEA), a substance that is sometimes found in an increased amount in the blood of patients with certain cancers.

      Cell:

      The basic unit of any living organism.

      Cell differentiation:

      The process during which young, immature (unspecialized) cells take on individual characteristics and reach their mature (specialized) form and function.

      Cell motility:

      The ability of a cell to move.

      Cell proliferation:

      An increase in the number of cells as a result of cell growth and cell division.

      Cellular adhesion:

      The close adherence (bonding) to adjoining cell surfaces.

      Central nervous system:

      The brain and spinal cord.

      Cerebellum:

      The portion of the brain in the back of the head between the cerebrum and the brain stem.

      Cerebral hemispheres:

      The two halves of the cerebrum.

      Cerebrospinal fluid:

      Watery fluid flowing around the brain and spinal cord.

      Cerebrum:

      The largest part of the brain. It is divided into two hemispheres, or halves.

      Cervical cancer:

      Cancer of the cervix, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix. The cervix is the opening of the uterus (womb).

      Cervical intraepithelial neoplasia:

      A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how extensive the abnormal cells are and how deeply they penetrate through the epithelium. Also called CIN.

      Cervix:

      The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

      Chemoprevention:

      The use of natural or laboratory made substances to prevent cancer.

      Chemotherapy:

      Treatment with anticancer drugs.

      Cholangiosarcoma:

      A type of cancer that begins in the bile ducts.

      Chondrosarcoma:

      A cancer that forms in cartilage, occurring mainly in the pelvis, femur, and shoulder areas.

      Chordoma:

      A form of bone cancer that usually starts in the lower spinal column.

      Chromosome:

      Part of a cell that contains genetic information. Normally, human cells contain 46 chromosomes that appear as a long thread inside the cell.

      Chronic leukemia:

      Leukemia that progresses slowly.

      Chronic phase:

      Refers to the early stages of chronic myelogenous leukemia or chronic lymphocytic leukemia. The number of immature, abnormal white blood cells in the bone marrow and blood is higher than normal, but lower than in the accelerated or blast phase.

      Clinical trials:

      Research studies that involve patients. Each study is designed to find better ways to prevent, detect, diagnose, or treat cancer and to answer scientific questions.

      CNS (central nervous system):

      The brain and the spinal cord.

      CNS prophylaxis:

      Chemotherapy or radiation therapy to the central nervous system (CNS). This is preventive treatment. It is given to kill cancer cells that may be in the brain and spinal cord, even though no cancer has been detected there.

      Colectomy:

      An operation to remove all or part of the colon. In a partial colectomy, the surgeon removes only the cancerous part of the colon and a small amount (called a margin) of surrounding healthy tissue.

      Colon:

      The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

      Colon cancer:

      Cancer of the colon, a common form of cancer, is a disease in which cancer (malignant) cells are found in the tissues of the colon. The colon is part of the body’s digestive system. The last six feet of intestine is called the large bowel or colon.

      Colonoscope:

      A flexible, lighted instrument used to view the inside of the colon.

      Colonoscopy:

      An examination in which the doctor looks at the colon through a flexible, lighted instrument called a colonoscope.

      Colony-stimulating factors:

      Substances that stimulate the production of blood cells. Treatment with colony-stimulating factors (CSF) can help the blood-forming tissue recover from the effects of chemotherapy and radiation therapy.

      Cryosurgery:

      Treatment performed with an instrument that freezes and destroys abnormal tissues.

      Cryptorchidsm:

      A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum; also called undescended testicles.

      CT (or CAT) scan:

      A series of detailed pictures of areas inside the body; the pictures are created by a computer linked to an X-ray machine. Also called computed tomography scan or computed axial tomography scan.

      Curettage:

      Removal of tissue with a curette.

      Curette:

      A spoon-shaped instrument with a sharp edge.

      Cutaneous:

      Related to the skin.

      Cutaneous T-cell lymphoma:

      Cutaneous T-cell lymphoma is a disease in which certain cells of the lymph system (called T lymphocytes) become cancer (malignant) and affect the skin. Lymphocytes are infection-fighting white blood cells that are made in the bone marrow and by other organs of the lymph system. T-cells are special lymphocytes that help the body’s immune system kill bacteria and other harmful things in the body.

      Cyst:

      A sac or capsule filled with fluid.

      Cystectomy:

      Surgery to remove the bladder.

      Cystoscope:

      An instrument that allows the doctor to see inside the bladder and remove tissue samples or small tumors.

      Cystoscopy:

      A procedure in which the doctor inserts a lighted instrument into the urethra (the tube leading from the bladder to the outside of the body) to look at the bladder.

      Dermis:

      The lower or inner layer of the two main layers of cells that make up the skin.

      Diabetes:

      A disease in which the body does not use sugar properly. (Many foods are converted into sugar, a source of energy for cells.) As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.

      Dialysis:

      The process of cleansing the blood by passing it through a special machine. Dialysis is necessary when the kidneys are not able to filter the blood.

      Diaphanography:

      An exam that involves shining a bright light through the breast to reveal features of the tissues inside. This technique is under study; its value in detecting breast cancer has not been proven. Also called transillumination.

      Diaphragm:

      The thin muscle below the lungs and heart that separates the chest from the abdomen.

      Diathermy:

      The use of heat to destroy abnormal cells. Also called cauterization or electrodiathermy.

      Diethylstilbestrol:

      A drug that was once widely prescribed to prevent miscarriage. Also called DES.

      Differentiation:

      In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and grow at a slower rate than undifferentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.

      Digestive system:

      The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, intestines, and rectum.

      Dilation and curettage:

      A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). This procedure also is called D and C.

      Dilator:

      A device used to stretch or enlarge an opening.

      DNA:

      The protein that carries genetic information; every cell contains a strand of DNA (deoxyribonucleic acid).

      Ductal carcinoma in situ:

      Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. About 15 to 20 percent of breast cancers are sometimes called carcinoma in situ. They may be either ductal carcinoma in situ (sometimes called intraductal carcinoma) or lobular carcinoma in situ. Even though it is referred to as a cancer, it is not actually cancer. However, patients with this condition have a 25 percent chance of developing breast cancer in either breast in the next 25 years. Also called DCIS or intraductal carcinoma.

      Dumping syndrome:

      A group of symptoms that occur when food or liquid enters the small intestine too rapidly. These symptoms include cramps, nausea, diarrhea, and dizziness.

      Duodenum:

      The first part of the small intestine.

      Dysplasia:

      Abnormal cells that are not cancer.

      Dysplastic nevi:

      Atypical moles; moles whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color often is not uniform, and ranges from pink or even white to dark brown or black; they usually are flat, but parts may be raised above the skin surface.

      Edema:

      Swelling; an abnormal buildup of fluid.

      Electrodesiccation:

      Use of an electric current to destroy cancerous tissue and control bleeding.

      Electrolarynx:

      A battery-operated instrument that makes a humming sound to help laryngectomees talk.

      Embolization:

      Blocking an artery so that blood cannot flow to the tumor.

      Encapsulated:

      Confined to a specific area; the tumor remains in a compact form.

      Endocervical curettage:

      The removal of tissue from the inside of the cervix using a spoon-shaped instrument called a curette.

      Endometrial cancer:

      Cancer of the endometrium, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the lining of the uterus (endometrium). The uterus is the hollow, pear-shaped organ where a baby grows. Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus.

      Endometriosis:

      A benign condition in which tissue that looks like endometrial tissue grows in the abdomen.

      Endometrium:

      The layer of tissue that lines the uterus.

      Endoscope:

      A thin, lighted tube through which a doctor can look at tissues inside the body.

      Endoscopic retrograde cholangiopancreatography:

      A procedure to X-ray the common bile duct. Also called ERCP.

      Endoscopy:

      An examination of the esophagus and stomach using a thin, lighted instrument called an endoscope.

      Ependymoma:

      A type of brain tumor that usually develops in the lining of the ventricles but may also occur in the spinal chord.

      Enterostomal therapist:

      A health professional trained in the care of urostomies and other stomas.

      Environmental tobacco smoke:

      Smoke that comes from the burning end of a cigarette and smoke that is exhaled by smokers. Also called ETS or second-hand smoke. Inhaling ETS is called involuntary or passive smoking.

      Enzyme:

      A substance that affects the rate at which chemical changes take place in the body.

      Ependymoma:

      Ependymal tumors are tumors that begin in the ependyma, the cells that line the passageways in the brain where special fluid that protects the brain and spinal cord (called cerebrospinal fluid) is made and stored. There are different kinds of ependymal tumors, which are defined by how the cells look under a microscope.

      Epidermis:

      The upper or outer layer of the two main layers of cells that make up the skin.

      Epidermoid carcinoma:

      A type of lung cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma.

      Epiglottis:

      The flap that covers the trachea during swallowing so that food does not enter the lungs.

      Epithelial carcinoma:

      Cancer that begins in the cells that line an organ.

      Epithelium:

      A thin layer of tissue that covers organs, glands, and other structures in the body.

      ERCP (endoscopic retrograde cholangiopancreatography):

      A procedure to X-ray the common bile duct.

      Erythrocytes:

      Cells that carry oxygen to all parts of the body. Also called red blood cells (RBCs).

      Erythroleukemia:

      Leukemia that develops in erythrocytes. In this rare disease, the body produces large numbers of abnormal red blood cells.

      Erythroplakia:

      A reddened patch with a velvety surface found in the mouth.

      Esophageal cancer:

      Cancer of the esophagus is a disease in which cancer (malignant) cells are found in the tissues of the esophagus. The esophagus is the hollow tube that carries food and liquid from the throat to the stomach.

      Esophageal speech:

      Speech produced with air trapped in the esophagus and forced out again.

      Esophagectomy:

      An operation to remove a portion of the esophagus.

      Esophagoscopy:

      Examination of the esophagus using a thin, lighted instrument.

      Esophagram:

      A series of X-rays of the esophagus. The X-ray pictures are taken after the patient drinks a solution that coats and outlines the walls of the esophagus. Also called a barium swallow.

      Esophagus:

      The muscular tube through which food passes from the throat to the stomach.

      Estrogen:

      A female hormone.

      Ewing’s sarcoma:

      Ewing’s sarcoma/primitive neuroepithelial tumor is a rare disease in which cancer (malignant) cells are found in the bone. The most common areas in which it occurs are the pelvis, the thigh bone (femur), the upper arm bone (humerus), and the ribs. Ewing’s sarcoma/primitive neuroepithelial tumor most frequently occurs in teenagers.

      External radiation:

      Radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body.

      Fallopian tubes:

      Tubes on each side of the uterus through which an egg moves from the ovaries to the uterus.

      Familial polyposis:

      An inherited condition in which several hundred polyps develop in the colon and rectum.

      Fecal occult blood test:

      A test to check for hidden blood in stool. (Fecal refers to stool. Occult means hidden.)

      Fibroid:

      A benign uterine tumor made up of fibrous and muscular tissue.

      Fibrosarcoma:

      A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place.

      Fluoroscope:

      An X-ray machine used to view internal organs in motion.

      Fluoroscopy:

      An X-ray procedure that makes it possible to see internal organs in motion.

      Fluorouracil:

      An anticancer drug. Its chemical name is 5-fluorouracil, commonly called 5-FU.

      Fractionation:

      Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days.

      Fulguration:

      Destroying tissue using an electric current.

      Gallbladder:

      The pear-shaped organ where bile from the liver is stored. The gallbladder is located beneath the liver.

      Gamma knife:

      Radiation therapy in which high-energy rays are aimed at a tumor from many angles in a single treatment session.

      Gastrectomy:

      An operation to remove all or part of the stomach.

      Gastric:

      Having to do with the stomach.

      Gastric atrophy:

      A condition in which the stomach muscles shrink and become weak. It results in a lack of digestive juices.

      Gastric cancer:

      Cancer of the stomach, also called gastric cancer, is a disease in which cancer (malignant) cells are found in the tissues of the stomach.

      Gastrointestinal tract:

      The part of the digestive tract where the body processes food and eliminates waste. It includes the esophagus, stomach, liver, small and large intestines, and rectum.

      Gastroscope:

      A thin, lighted instrument to view the inside of the stomach.

      Gastroscopy:

      An examination of the stomach with a gastroscope, an instrument to view the inside of the stomach.

      Gene:

      The biological or basic unit of heredity found in all cells in the body.

      Gene deletion:

      The total loss or absence of a gene.

      Gene therapy:

      Treatment that alters genes (the basic units of heredity found in all cells in the body). In studies of gene therapy for cancer, researchers are trying to improve the body’s natural ability to fight the disease or to make the tumor more sensitive to other kinds of therapy.

      Genetic:

      Inherited; having to do with information that is passed from parents to children through DNA in the genes.

      Genetic testing:

      Specific tests can be done to see whether a person has changes in certain genes that are known to be associated with cancer.

      Genitourinary system:

      The parts of the body that play a role in reproduction, in getting rid of waste products in the form of urine, or in both.

      Germ cells:

      The reproductive cells of the body, specifically, either egg or sperm cells.

      Germ cell tumors:

      A type of brain tumor that arises from primitive (developing) sex cells, or germ cells.

      Germinoma:

      The most frequent type of germ cell tumor in the brain.

      Germline mutation:

      See hereditary mutation.

      Gestational trophoblastic disease:

      Gestational trophoblastic tumor, a rare cancer in women, is a disease in which cancer (malignant) cells grow in the tissues that are formed following conception (the joining of sperm and egg). Gestational trophoblastic tumors start inside the uterus, the hollow, muscular, pear-shaped organ where a baby grows. This type of cancer occurs in women during the years when they are able to have children.

      Gland:

      An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production.

      Glioblastoma multiforme:

      A type of brain tumor that forms in the nervous (glial) tissue of the brain. They grow very quickly and have cells that look very different from normal cells. Glioblastoma multiforme is also called grade IV astrocytoma.

      Glioma:

      A name for brain tumors that begin in the glial cells, or supportive cells, in the brain. “Glia” is the Greek word for glue.

      Glottis:

      The middle part of the larynx; the area where the vocal cords are located.

      Grade:

      Describes how closely a cancer resembles normal tissue of its same type, and the cancer’s probable rate of growth.

      Grading:

      A system for classifying cancer cells in terms of how malignant or aggressive they appear microscopically. The grading of a tumor indicates how quickly cancer cells are likely to spread and plays a role in treatment decisions.

      Graft:

      Healthy skin, bone, or other tissue taken from one part of the body to replace diseased or injured tissue removed from another part of the body.

      Graft-versus-host disease:

      A reaction of donated bone marrow against a patient’s own tissue. Also called GVHD.

      Granulocyte:

      A type of white blood cell. Neutrophils, eosinophils, and basophils are granulocytes.

      Hairy cell leukemia:

      A rare type of chronic leukemia in which the abnormal white blood cells appear to be covered with tiny hairs.

      Helicobacter pylori:

      Bacteria that cause inflammation and ulcers in the stomach.

      Hematogenous:

      Orginating in the blood, or disseminated by the circulation or through the bloodstream.

      Hepatitis:

      Inflammation of the liver.

      Hepatitis B:

      A type of hepatitis that is carried and passed on through the blood. It can be passed on through sexual contact or through the use of “dirty” (bloody) needles.

      Hepatoblastoma:

      A type of liver tumor that occurs in infants and children.

      Hepatocellular carcinoma:

      The most common type of primary liver cancer.

      Hepatocyte:

      A liver cell.

      Hepatoma:

      A liver tumor.

      Hereditary mutation:

      A gene change in the body’s reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of off-spring; hereditary mutations are passed on from parents to offspring.

      Herpes virus:

      A member of the herpes family of viruses. One type of herpes virus is sexually transmitted and causes genital sores.

      HER-2/neu:

      Oncogene found in some breast and ovarian cancer patients that is associated with a poor prognosis.

      Hodgkin’s disease:

      Hodgkin’s disease is a type of lymphoma. Lymphomas are cancers that develop in the lymph system, part of the body’s immune system.

      Hormonal therapy:

      Treatment of cancer by removing, blocking, or adding hormones.

      Hormone receptor test:

      A test to measure the amount of certain proteins, called hormone receptors, in breast cancer tissue. Hormones can attach to these proteins. A high level of hormone receptors means hormones probably help the cancer grow.

      Hormone therapy:

      Treatment that prevents certain cancer cells from getting the hormones they need to grow.

      Hormones:

      Chemicals produced by glands in the body and circulated in the bloodstream. Hormones control the actions of certain cells or organs.

      Human papillomaviruses:

      Viruses that generally cause warts. Some papillomaviruses are sexually transmitted. Some of these sexually transmitted viruses cause wartlike growths on the genitals, and some are thought to cause abnormal changes in cells of the cervix.

      Hydrocephalus:

      The abnormal buildup of cerebrospinal fluid in the ventricles of the brain.

      Hypercalcemia:

      A higher-than-normal level of calcium in the blood. This condition can cause a number of symptoms, including loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and confusion.

      Hyperfractionation:

      Giving radiation therapy in smaller-than-usual doses two or three times a day.

      Hyperplasia:

      A precancerous condition in which there is an increase in the number of normal cells lining the uterus.

      Hyperthermia:

      Treatment that involves heating a tumor.

      Hypothalamus:

      The area of the brain that controls body temperature, hunger, and thirst.

      Hysterectomy:

      An operation in which the uterus and cervix are removed.

      Ileostomy:

      An opening created by a surgeon into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed.

      Imaging:

      Tests that produce pictures of areas inside the body.

      Immune system:

      The complex group of organs and cells that defends the body against infection or disease.

      Immunodeficiency:

      A lowering of the body’s ability to fight off infection and disease.

      Immunology:

      A science that deals with the study of the body’s immune system.

      Immunosuppression:

      The use of drugs or techniques to suppress or interfere with the body’s immune system and its ability to fight infections or disease. Immunosuppression may be deliberate, such as in preparation for bone marrow or other organ transplantation to prevent rejection by the host of the donor tissue, or incidental, such as often results from chemotherapy for the treatment of cancer.

      Immunotherapy:

      Treat ment that uses the body’s natural defenses to fight cancer. Also called biological therapy.

      Implant radiation:

      Radiation therapy that places radioactive materials in or close to the cancer.

      Infiltrating cancer:

      See invasive cancer.

      Inflammatory breast cancer:

      A rare type of breast cancer in which cancer cells block the lymph vessels in the skin of the breast. The breast becomes red, swollen, and warm, and the skin of the breast may appear pitted or have ridges.

      Inguinal orchiectomy:

      Surgery to remove the testicle through the groin.

      Insulin:

      A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood.

      Interferon:

      A type of biological response modifier (a substance that can improve the body’s natural response to disease). It stimulates the growth of certain disease-fighting blood cells in the immune system.

      Interleukin:

      A substance used in biological therapy. Interleukins stimulate the growth and activities of certain kinds of white blood cells.

      Interleukin 2:

      A type of biological response modifier (a substance that can improve the body’s natural response to disease). It stimulates the growth of certain blood cells in the immune system that can fight cancer. Also called IL-2.

      Internal radiation:

      Radiation therapy that uses radioactive materials placed in or near the tumor.

      Intestine:

      The long, tube-shaped organ in the abdomen that completes the process of digestion. It consists of the small and large intestines.

      Intraepithelial:

      Within the layer of cells that forms the surface or lining of an organ.

      Intrahepatic:

      Within the liver.

      Intrahepatic bile duct:

      The bile duct that drains bile from the liver.

      Intraoperative radiation therapy:

      Radiation treatment given during surgery. Also called IORT.

      Intraperitoneal chemotherapy:

      Treatment in which anticancer drugs are put directly into the abdomen through a thin tube.

      Intrathecal chemotherapy:

      Chemotherapy drugs infused into the thin space between the lining of the spinal cord and brain to treat or prevent cancers in the brain and spinal cord.

      Intravenous:

      Injected in a vein. Also called IV.

      Intravenous pyelogram:

      A series of X-rays of the kidneys and bladder. The X-rays are taken after a dye that shows up on X-ray film in injected into a vein. Also called IVP.

      Intravenous pyelography:

      X-ray study of the kidneys and urinary tract. Structures are made visible by the injection of a substance that blocks X-rays. Also called IVP.

      Invasion:

      As related to cancer, the spread of cancer cells into healthy tissue adjacent to the tumor.

      Invasive cancer:

      Cancer that has spread beyond the layer of tissue in which it developed. Invasive breast cancer is also called infiltrating cancer or infiltrating carcinoma.

      Invasive cervical cancer:

      Cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body.

      Islet cell cancer:

      Cancer arising from cells in the islets of Langerhans.

      Islets of Langerhans:

      Hormone-producing cells in the pancreas.

      IV (intravenous):

      Injected in a vein.

      Jaundice:

      A condition in which the skin and the whites of the eyes become yellow and the urine darkens. Jaundice occurs when the liver is not working properly or when a bile duct is blocked.

      Kaposi’s sarcoma:

      A relatively rare type of cancer that develops on the skin of some elderly persons or those with a weak immune system, including those with acquired immune deficiency syndrome (AIDS).

      Kidney cancer:

      Renal cell cancer (also called cancer of the kidney or renal adenocarcinoma) is a disease in which cancer (malignant) cells are found in certain tissues of the kidney. Renal cell cancer is one of the less common kinds of cancer. It occurs more often in men than in women.

      Kidneys:

      A pair or organs in the abdomen that remove waste from the blood. The waste leaves the blood as urine.

      Krukenberg tumor:

      A tumor of the ovary caused by the spread of stomach cancer.

      Laparoscopy:

      A surgical procedure in which a lighted instrument shaped like a thin tube is inserted through a small incision in the abdomen. The doctor can look through the instrument and see inside the abdomen.

      Laparotomy:

      An operation that allows the doctor to inspect the organs in the abdomen.

      Large cell carcinomas:

      A group of lung cancers in which the cells are large and look abnormal.

      Laryngectomee:

      A person who has had his or her voice box removed.

      Laryngectomy:

      An operation to remove all or part of the larynx.

      Laryngoscope:

      A flexible lighted tube used to examine the larynx.

      Laryngoscopy:

      Examination of the larynx with a mirror (indirect laryngoscopy) or with a laryngoscope (direct laryngoscopy).

      Larynx:

      An organ in the throat used in breathing, swallowing, and talking. It is made of cartilage and is lined by a mucous membrane similar to the lining of the mouth. Also called the voice box.

      Larynx cancer:

      Cancer of the larynx (or voice box) is a disease in which cancer (malignant) cells are found in the tissues of the larynx. Your larynx is a short passageway shaped like a triangle that is just below the pharynx in the neck. The pharynx is a hollow tube about five inches long that starts behind the nose and goes down to the neck to become part of the tube that goes to the stomach (the esophagus).

      Leiomyosarcoma:

      Leiomyosarcoma is a tumor of smooth muscle tissue. This cancer affects the uterus, lower abdomen, and extremities (hands and feet) most often.

      Lesion:

      An area of abnormal tissue change.

      Leukemia:

      Cancer of the blood cells.

      Leukemia—Acute lymphoblastic:

      Acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL) is a disease in which too many infection-fighting white blood cells called lymphocytes are found in the blood and bone marrow.

      Leukemia—Acute myeloblastic:

      Acute myeloid leukemia (AML) is a disease in which cancer (malignant) cells are found in the blood and bone marrow. Normally, the bone marrow makes cells called blasts that develop (mature) into several different types of blood cells that have specific jobs to do in the body. AML affects the blasts that are developing into white blood cells called granulocytes. In AML, the blasts do not mature and become too numerous.

      Leukemia—Chronic myelogenous:

      Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a disease in which too many white blood cells are made in the bone marrow. CML affects the blasts that are developing into white blood cells called granulocytes.

      Leukocytes:

      Cells that help the body fight infections and other diseases. Also called white blood cells (WBCs).

      Leukoplakia:

      A white spot or patch in the mouth.

      Li-Fraumeni Syndrome:

      A rare family predisposition to multiple cancers, caused by an alteration in the p53 tumor suppressor gene.

      Ligation:

      The process of tying off blood vessels so that blood cannot flow to a part of the body or to a tumor.

      Limb perfusion:

      A chemotherapy technique that may be used when melanoma occurs on an arm or leg. The flow of blood to and from the limb is stopped for a while with a tourniquet, and anticancer drugs are put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the melanoma occurred.

      Liver:

      A large, glandular organ located in the upper abdomen that cleanses the blood and aids in digestion by secreting bile.

      Liver cancer:

      Liver cancer is a disease in which cancer (malignant) cells start to grow in the tissues of the liver. The liver is one of the largest organs in the body, filling the upper right side of the abdomen and protected by the rib cage.

      Liver scan:

      An image of the liver created on a computer screen or on film. For a liver scan, a radioactive substance is injected into a vein and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner.

      Lobe:

      A portion of the liver, lung, breast, or brain.

      Lobectomy:

      The removal of a lobe.

      Lobular carcinoma in situ:

      Abnormal cells in the lobules of the breast. This condition seldom becomes invasive cancer. However, having lobular carcinoma in situ is a sign that the woman has an increased risk of developing breast cancer. Also called LCIS.

      Lobule:

      A small lobe.

      Local:

      Reaching and affecting only the cells in a specific area.

      Local therapy:

      Treatment that affects cells in the tumor and the area close to it.

      Lower GI series:

      A series of X-rays of the colon and rectum that is taken after the patient is given a barium enema. (Barium is a white substance that outlines the colon and rectum on the X-ray.)

      Lumbar puncture:

      The insertion of a needle into the lower part of the spinal column to collect cerebrospinal fluid or to give intrathecal chemotherapy. Also called a spinal tap.

      Lumpectomy:

      Surgery to remove only the cancerous breast lump; usually followed by radiation therapy.

      Luteinizing hormone-releasing hormone (LHRH) agonist:

      A substance that closely resembles LHRH, which controls the production of sex hormones. However, LHRH agonists affect the body differently than does LHRH. LHRH agonists keep the testicles from producing hormones.

      Lymph:

      The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.

      Lymph nodes:

      Small, bean-shaped organs located along the channels of the lymphatic system. The lymph nodes store special cells that can trap bacteria or cancer cells traveling through the body in lymph. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen.

      Lymphangiogram:

      An X-ray of the lymphatic system. A dye is injected to outline the lymphatic vessels and organs.

      Lymphangiography:

      X-ray study of lymph nodes and lymph vessels made visible by the injection of a special dye.

      Lymphatic system:

      The tissues and organs that produce, store, and carry white blood cells that fight infection and disease. This system includes the bone marrow, spleen, thymus, and lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.

      Lymphedema:

      A condition in which excess fluid collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed.

      Lymphoma:

      Cancer that arises in cells of the lymphatic system.

      Lymphocytes:

      White blood cells that fight infection and disease.

      Lymphocytic:

      Referring to lymphocytes, a type of white blood cell.

      Lymphoid:

      Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop.

      M proteins:

      Antibodies or parts of antibodies found in unusually large amounts in the blood or urine of multiple myeloma patients.

      Magnetic resonance imaging:

      A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. Also called MRI.

      Maintenance therapy:

      Chemotherapy that is given to leukemia patients in remission to prevent a relapse.

      Malignant:

      Cancerous; can invade nearby tissue and spread to other parts of the body.

      Mammogram:

      An X-ray of the breast.

      Mammography:

      The use of X-rays to create a picture of the breast.

      Mastectomy:

      Surgery to remove the breast (or as much of the breast as possible).

      Mediastinoscopy:

      A procedure in which the doctor inserts a tube into the chest to view the organs in the mediastinum. The tube is inserted through an incision above the breastbone.

      Mediastinotomy:

      A surgical procedure in which a small opening is made in the upper chest in order to allow examination of the lungs and chest.

      Mediastinum:

      The area between the lungs. The organs in this area include the heart and its large veins and arteries, the trachea, the esophagus, the bronchi, and lymph nodes.

      Medical oncologist:

      A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

      Medulloblastoma:

      A type of brain tumor that recent research suggests develops from primitive (developing) nerve cells that normally do not remain in the body after birth. Medulloblastomas are sometimes called primitive neuroectodermal tumors. They are almost always found in children or young adults.

      Melanin:

      A skin pigment (substance that gives the skin its color). Dark-skinned people have more melanin than light-skinned people.

      Melanocytes:

      Cells in the skin that produce and contain the pigment called melanin.

      Melanoma:

      Cancer of the cells that produce pigment in the skin. Melanoma usually begins in a mole.

      Membrane:

      A thin layer of tissue that covers a surface.

      Meninges:

      The three membranes that cover the brain and spinal cord.

      Meningioma:

      A type of brain tumor that develops in the meninges. Because these tumors grow very slowly, the brain may be able to adjust to their presence; meningiomas often grow quite large before they cause symptoms.

      Mesothelioma:

      Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.

      Metastasize:

      To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor.

      Microcalcifications:

      Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present.

      Mole:

      An area on the skin (usually dark in color) that contains a cluster of melanocytes.

      Monoclonal antibodies:

      Substances that can locate and bind to cancer cells wherever they are in the body. They can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to tumor cells.

      Monocyte:

      A type of white blood cell.

      Morphology:

      The science of the form and structure of organisms (plants, animals, and other forms of life).

      MRI (magnetic resonance imaging):

      A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body.

      Mucus:

      A thick fluid produced by the lining of some organs of the body.

      Multiple myeloma:

      Cancer that affects plasma cells. The disease causes the growth of tumors in many bones, which can lead to bone pain and fractures. In addition, the disease often causes kidney problems and lowered resistance to infection.

      Mutations:

      Changes in the way cells function or develop, caused by an inherited genetic defect or an environmental exposure. Such changes may lead to cancer.

      Mycosis fungoides:

      A type of non-Hodgkin’s lymphoma that first appears on the skin. Also called cutaneous T-cell lymphoma.

      Myelin:

      The fatty substance that covers and protects nerves.

      Myelodysplastic syndrome:

      Myelodysplastic syndromes, also called pre-leukemia or “smoldering” leukemia, are diseases in which the bone marrow does not function normally and not enough normal blood cells are made. (See Preleukemia)

      Myelogenous:

      Referring to myelocytes, a type of white blood cell. Also called myeloid.

      Myelogram:

      An X-ray of the spinal cord and the bones of the spine.

      Myeloid:

      Referring to myelocytes, a type of white blood cell. Also called myelogenous.

      Myometrium:

      The muscular outer layer of the uterus.

      Nasopharynx cancer:

      Cancer of the nasopharynx is a disease in which cancer (malignant) cells are found in the tissues of the nasopharynx. The nasopharynx is behind the nose and is the upper part of the throat (also called the pharynx). The pharynx is a hollow tube about five inches long that starts behind the nose and goes down to the neck to become part of the tube that goes to the stomach (the esophagus).

      Neck dissection:

      Surgery to remove lymph nodes and other tissues in the neck.

      Neoplasia:

      Abnormal new growth of cells.

      Neoplasm:

      A new growth of tissue. Can be referred to as benign or malignant.

      Nephrectomy:

      Surgery to remove the kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes just the affected kidney. Partial nephrectomy removes the tumor, but not the entire kidney.

      Nephrotomogram:

      A series of special X-rays of the kidneys. The X-rays are taken from different angles. They show the kidneys clearly, without the shadows of the organs around them.

      Neuroblastoma:

      Neuroblastoma is a disease in which cancer (malignant) cells are found in certain nerve cells in the body. Neuroblastoma most commonly starts in the abdomen, either in the adrenal glands (located just above the kidney in back of the upper abdomen) or around the spinal cord. Neuroblastoma can also start around the spinal cord in the chest, neck, or pelvis.

      Neuroma:

      A tumor that arises in nerve cells.

      Neurosurgeon:

      A doctor who specializes in surgery on the brain and other parts of the nervous system.

      Neutrophil:

      A type of white blood cell.

      Nevus:

      The medical term for a spot on the skin, such as a mole. A mole is a cluster of melanocytes that usually appears as a dark spot on the skin. The plural of nevus is nevi (NEE-vye).

      Nitrosoureas:

      A group of anticancer drugs that can cross the blood–brain barrier. Carmustine (BCNU) and lomustine (CCNU) are nitrosoureas.

      Non-Hodgkin’s lymphoma:

      Adult non-Hodgkin’s lymphoma is a disease in which cancer (malignant) cells are found in the lymph system. There are many types of non-Hodgkin’s lymphomas. Some types spread more quickly than others. The type is determined by how the cancer cells look under a microscope.

      Nonmelanoma skin cancer:

      Skin cancer that does not involve melanocytes. Basal cell cancer and squamous cell cancer are nonmelanoma skin cancers.

      Nonseminoma:

      A classification of testicular cancers that arise in specialized sex cells called germ cells. Nonseminomas include embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumor.

      Non-small cell lung cancer:

      A form of lung cancer associated with smoking, exposure to environmental tobacco smoke, or exposure to radon. Non-small cell lung cancer is classified as squamous cell carcinoma, adenocarcinoma, and large cell carcinoma depending on what type of cells are in the cancer.

      Oat cell cancer:

      A type of lung cancer in which the cells look like oats. Also called small cell lung cancer.

      Oligodendroglioma:

      A rare, slow-growing type of brain tumor that occurs in the cells that produce myelin, the fatty covering that protects nerves.

      Ommaya reservoir:

      A device implanted under the scalp and used to deliver anticancer drugs to the fluid surrounding the brain and spinal cord.

      Oncogene:

      The part of the cell that normally directs cell growth, but which can also promote or allow the uncontrolled growth of cancer if damaged (mutated) by an environmental exposure to carcinogens, or damaged or missing because of an inherited defect.

      Oncologist:

      A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment.

      Oncology:

      The study of tumors encompassing the physical, chemical, and biologic properties.

      Oophorectomy:

      The removal of one or both ovaries.

      Ophthalmoscope:

      A lighted instrument used to examine the inside of the eye, including the retina and the optic nerve.

      Optic nerve:

      The nerve that carries messages from the retina to the brain.

      Oral cavity cancer:

      Cancer of the oral cavity is a disease in which cancer (malignant) cells are found in the tissues of the lip or mouth. The oral cavity includes the front two-thirds of the tongue, the upper and lower gums (the gingiva), the lining of the inside of the cheeks and lips (the buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (the hard palate), and the small area behind the wisdom teeth (the retromolar trigone).

      Orchiectomy:

      Surgery to remove the testicles.

      Organisms:

      Plants, animals, and other forms of life that are made up of complex and interconnected systems of cells and tissue.

      Oropharynx:

      The area of the throat at the back of the mouth.

      Osteosarcoma:

      A cancer of the bone that is most common in children. Also called osteogenic sarcoma. It is the most common type of bone cancer.

      Ostomy:

      An operation to create an opening from an area inside the body to the outside. See Colostomy.

      Ovarian cancer:

      Cancer of the ovary is a disease in which cancer (malignant) cells are found in the ovary. Approximately 25,000 women in the United States are diagnosed with this disease each year. The ovary is a small organ in the pelvis that makes female hormones and holds egg cells that, when fertilized, can develop into a baby.

      Ovaries:

      The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the lower abdomen, one on each side of the uterus.

      p53:

      A gene in the cell that normally inhibits the growth of tumors, which can prevent or slow the spread of cancer.

      Palate:

      The roof of the mouth. The front portion is bony (hard palate), and the back portion is muscular (soft palate).

      Palliative treatment:

      Treatment that does not alter the course of a disease but improves the quality of life.

      Palpation:

      A technique in which a doctor presses on the surface of the body to feel the organs or tissues underneath.

      Pancreas:

      A gland located in the abdomen. It makes pancreatic juices, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

      Pancreatic cancer:

      Cancer of the pancreas is a disease in which cancer (malignant) cells are found in the tissues of the pancreas. The pancreas is about six inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine.

      Pancreatectomy:

      Surgery to remove the pancreas. In a total pancreatectomy, the duodenum, common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed.

      Pancreatic juices:

      Fluids made by the pancreas. Pancreatic juices contain proteins called enzymes that aid in digestion.

      Papillary tumor:

      A tumor shaped like a small mushroom with its stem attached to the inner lining of the bladder.

      Papilledema:

      Swelling around the optic nerve, usually caused by pressure on the nerve by a tumor.

      Pap test:

      Microscopic examination of cells collected from the cervix. It is used to detect changes that may be cancer or may lead to cancer, and it can show noncancerous conditions, such as infection or inflammation. Also called Pap smear.

      Paraneoplastic syndrome:

      A group of symptoms that may develop when substances released by some cancer cells disrupt the normal function of surrounding cells and tissue. Such symptoms do not necessarily mean that the cancer has spread beyond the original site.

      Parotid cancer:

      Cancer of the salivary gland is a disease in which cancer (malignant) cells are found in the tissues of the salivary glands. Your salivary glands make saliva, the fluid that is released into your mouth to keep it moist and to help dissolve your food. Major clusters of salivary glands are found below your tongue (sublingual glands), on the sides of your face just in front of your ears (parotid glands), and under your jawbone (sub-maxillary glands).

      Pathologist:

      A doctor who identifies diseases by studying cells and tissues under a microscope.

      Pelvis:

      The lower part of the abdomen, located between the hip bones.

      Penile cancer:

      Cancer of the penis, a rare kind of cancer in the United States, is a disease in which cancer (malignant) cells are found on the skin and in the tissues of the penis.

      Percutaneous transhepatic cholangiography:

      A test sometimes used to help diagnose cancer of the pancreas. During this test, a thin needle is put into the liver. Dye is injected into the bile ducts in the liver so that blockages can be seen on X-rays.

      Perfusion:

      The process of flooding fluid through the artery to saturate the surrounding tissue. In regional perfusion, a specific area of the body (usually an arm or a leg) is targeted, and high doses of anticancer drugs are flooded through the artery to reach the surrounding tissue and kill as many cancer cells as possible. Such a procedure is performed in cases in which the cancer is not thought to have spread past a localized area.

      Perineal prostatectomy:

      Surgery to remove the prostate through an incision made between the scrotum and the anus.

      Peripheral blood stem cell transplantation:

      A procedure that is similar to bone marrow transplantation. Doctors remove healthy immature cells (stem cells) from a patient’s blood and store them before the patient receives high-dose chemotherapy and possibly radiation therapy to destroy the leukemia cells. The stem cells are then returned to the patient, where they can produce new blood cells to replace cells destroyed by the treatment.

      Peripheral stem cell support:

      A method of replacing blood-forming cells destroyed by cancer treatment. Certain cells (stem cells) in the blood that are similar to those in the bone marrow are removed from the patient’s blood before treatment. The cells are given back to the patient after treatment.

      Peristalsis:

      The rippling motion of muscles in the digestive tract. In the stomach, this motion mixes food with gastric juices, turning it into a thin liquid.

      Peritoneal cavity:

      The lower part of the abdomen that contains the intestines (the last part of the digestive tract), the stomach, and the liver. It is bound by thin membranes.

      Peritoneum:

      The large membrane that lines the abdominal cavity.

      Pernicious anemia:

      A blood disorder caused by a lack of vitamin B12. Patients who have this disorder do not produce the substance in the stomach that allows the body to absorb vitamin B12.

      Petechiae:

      Tiny red spots under the skin; often a symptom of leukemia.

      Pharynx:

      The hollow tube about five inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach).

      Photodynamic therapy:

      Treatment that destroys cancer cells with lasers and drugs that become active when exposed to light.

      Pigment:

      A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair.

      Pineal gland:

      A small gland located in the cerebrum.

      Pineal region tumors:

      Types of brain tumors that occur in or around the pineal gland, a tiny organ near the center of the brain. The pineal region is very difficult to reach, therefore these tumors often cannot be removed.

      Pineoblastoma:

      A fast-growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

      Pineocytoma:

      A slow-growing type of brain tumor that occurs in or around the pineal gland, a tiny organ near the center of the brain.

      Pituitary cancer:

      Pituitary tumors found in the pituitary gland, a small organ about the size of a pea in the center of the brain just above the back of the nose. Your pituitary gland makes hormones that affect your growth and the functions of other glands in your body. Most pituitary tumors are benign. This means that they grow very slowly and do not spread to other parts of the body.

      Pituitary gland:

      The main endocrine gland; it produces hormones that control other glands and many body functions, especially growth.

      Plasma:

      The liquid part of the blood.

      Plasma cells:

      Special white blood cells that produce antibodies.

      Plasmacytoma:

      A tumor that is made up of cancerous plasma cells.

      Plasmapheresis:

      The process of removing certain proteins from the blood. Plasmapheresis can be used to remove excess antibodies from the blood of multiple myeloma patients.

      Platelets:

      Blood cells that help clots form to help control bleeding. Also called thrombocytes.

      Pleura:

      The thin covering that protects and cushions the lungs. The pleura is made of two layers of tissue separated by a small amount of fluid.

      Pleural cavity:

      A space enclosed by the pleura, thin tissue covering the lungs and lining the interior wall of the chest cavity. It is bound by serous membranes.

      Pneumatic larynx:

      A device that uses air to produce sound to help a laryngectomee talk.

      Pneumonectomy:

      An operation to remove an entire lung.

      Polyp:

      A mass of tissue that projects into the colon.

      Positron emission tomography scan:

      For this type of scan, a person is given a substance that reacts with tissues in the body to release protons (parts of an atom). Through measuring the different amounts of protons released by healthy and cancerous tissues, a computer creates a picture of the inside of the body. Also called PET scan.

      Postremission therapy:

      Chemotherapy to kill leukemia cells that survive after remission induction therapy.

      Precancerous:

      A term used to describe a condition that may or is likely to become cancer.

      Precancerous polyps:

      Growths in the colon that often become cancerous.

      Prednisone:

      A drug often given to multiple myeloma patients along with one or more anticancer drugs. Prednisone appears to act together with anticancer drugs in helping to control the effects of the disease on the body.

      Preleukemia:

      A condition in which the bone marrow does not function normally. It does not produce enough blood cells. This condition may progress and become acute leukemia. Preleukemia also is called myelodysplastic syndrome or smoldering leukemia.

      Primitive neuroectodermal tumors:

      A type of brain tumor that recent research suggests develops from primitive (developing) nerve cells that normally do not remain in the body after birth. Primitive neuroectodermal tumors are often called medulloblastomas.

      Proctoscopy:

      An examination of the rectum and the lower end of the colon using a thin, lighted instrument called a sigmoidoscope.

      Proctosigmoidoscopy:

      An examination of the rectum and the lower colon using a thin, lighted instrument called a sigmoidoscope.

      Progesterone:

      A female hormone.

      Prognosis:

      The probable outcome or course of a disease; the chance of recovery.

      Prophylactic cranial irradiation:

      Radiation therapy to the head to prevent cancer from spreading to the brain.

      Prostatectomy:

      An operation to remove all or part of the prostate.

      Prostate cancer:

      Cancer of the prostate, a common form of cancer, is a disease in which cancer (malignant) cells are found in the prostate. The prostate is one of the male sex glands and is located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It surrounds part of the urethra, the tube that carries urine from the bladder to the outside of the body. The prostate makes fluid that becomes part of the semen, the white fluid that contains sperm.

      Prostate gland:

      A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder. It produces a fluid that forms part of semen.

      Prostate-specific antigen:

      A protein whose level in the blood goes up in some men who have prostate cancer or benign prostatic hyperplasia.

      Prostatic acid phosphatase:

      An enzyme produced by the prostate. Its level in the blood goes up in some men who have prostate cancer. Also called PAP.

      Proteins:

      Substances that are essential to the body’s structure and proper functioning.

      PTC (percutaneous transhepatic cholangiography):

      A test sometimes used to help diagnose cancer of the pancreas. During this test, a thin needle is put into the liver. Dye is injected into the bile ducts in the liver so that blockages can be seen on X-rays.

      Radiation fibrosis:

      The formation of scar tissue as a result of radiation therapy to the lung.

      Radiation therapy:

      Treatment with high-energy rays to kill cancer cells.

      Radiation oncologist:

      A doctor who specializes in using radiation to treat cancer.

      Radiation therapy:

      Treatment with high-energy rays (such as X-rays) to kill cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (implant radiation). Also called radiotherapy.

      Radical cystectomy:

      Surgery to remove the bladder as well as nearby tissues and organs.

      Radical prostatectomy:

      Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy.

      Radionuclide scanning:

      An exam that produces pictures (scans) of internal parts of the body. The patient is given an injection or swallows a small amount of radioactive material. A scanner then measures the radioactivity in certain organs.

      Radiosensitizers:

      Drugs that make cells more sensitive to radiation.

      Rectal cancer:

      Cancer of the rectum, a common form of cancer, is a disease in which cancer (malignant) cells are found in the tissues of the rectum. The rectum is part of the body’s digestive system. The last six feet of intestine is called the large bowel or colon. The last eight to 10 inches of the colon is the rectum.

      Rectum:

      The last 8 to 10 inches of the large intestine. The rectum stores solid waste until it leaves the body through the anus.

      Red blood cells:

      Cells that carry oxygen to all parts of the body. Also called erythrocytes.

      Reed-Sternberg cell:

      A type of cell that appears in patients with Hodgkin’s disease. The number of these cells increases as the disease advances.

      Reflux:

      The term used when liquid backs up into the esophagus from the stomach.

      Regional chemotherapy:

      Treatment with anticancer drugs that affects mainly the cells in the treated area.

      Relapse:

      The return of signs and symptoms of a disease after a period of improvement.

      Remission:

      Disappearance of the signs and symptoms of cancer. When this happens, the disease is said to be “in remission.” A remission can be temporary or permanent.

      Remission induction therapy:

      The initial chemotherapy a patient with acute leukemia receives to bring about a remission.

      Renal capsule:

      The fibrous connective tissue that surrounds each kidney.

      Renal cell cancer:

      Cancer that develops in the lining of the renal tubules, which filter the blood and produce urine.

      Renal pelvis:

      The area at the center of the kidney. Urine collects here and is funneled into the ureter.

      Respiratory system:

      The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs.

      Respiratory therapy:

      Exercises and treatments that help patients recover lung function after surgery.

      Retinoblastoma:

      An eye cancer caused by the loss of both gene copies of the tumor-suppressor gene RB; the inherited form typically occurs in childhood, because one gene is missing at birth.

      Retropubic prostatectomy:

      Surgical removal of the prostate through an incision in the abdomen.

      Rhabdomyosarcoma:

      Rhabdomyosarcoma is a disease in which cancer (malignant) cells begin growing in muscle tissue somewhere in the body. Rhabdomyosarcoma is a type of a sarcoma, which means a cancer of the bone, soft tissues, or connective tissue (e.g., tendon or cartilage). Rhabdomyosarcoma begins in the soft tissues in a type of muscle called striated muscle. It can occur anywhere in the body.

      RNA (ribonucleic acid):

      One of the two nucleic acids found in all cells. The other is DNA (deoxyribonucleic acid). RNA transfers genetic information from DNA to proteins produced by the cell.

      Salivary glands:

      Glands in the mouth that produce saliva.

      Salpingo-oophorectomy:

      Surgical removal of the fallopian tubes and ovaries.

      Sarcoma:

      A malignant tumor that begins in connective and supportive tissue.

      Scans:

      Images of the organs or other parts of the body. Scans are often used in diagnosing, staging, and monitoring patients include liver scans, bone scans, and computed tomography (CT) or computed axial tomography (CAT) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an X-ray machine linked to a computer is used to produce detailed pictures of organs inside the body.

      Schiller test:

      A test in which iodine is applied to the cervix. The iodine colors healthy cells brown; abnormal cells remain unstained, usually appearing white or yellow.

      Schwannoma:

      A type of benign brain tumor that begins in the Schwann cells, which produce the myelin that protects the acoustic nerve the nerve of hearing.

      Seminal vesicles:

      Glands that help produce semen.

      Seminoma:

      A type of testicular cancer that arises from sex cells, or germ cells, at a very early stage in their development.

      Shunt:

      A catheter (tube) that carries cerebrospinal fluid from a ventricle in the brain to another area of the body.

      Sigmoidoscope:

      An instrument used to view the inside of the colon.

      Sigmoidoscopy:

      A procedure in which the doctor looks inside the rectum and the lower part of the colon (sigmoid colon) through a lighted tube. The doctor may collect samples of tissue or cells for closer examination. Also called proctosigmoidoscopy.

      Sinus cancer:

      Sinus cancer is a disease in which cancer (malignant) cells are found in the tissues of the paranasal sinuses or nasal cavity. Your paranasal sinuses are small hollow spaces around your nose. The sinuses are lined with cells that make mucus, which keeps the nose from drying out; the sinuses are also a space through which your voice can echo to make sounds when you talk or sing.

      Skin cancer:

      Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. The skin has two main layers and several kinds of cells. The top layer of skin is called the epidermis. It contains three kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes, which give your skin its color.

      Skin graft:

      Skin that is moved from one part of the body to another.

      Small cell lung cancer:

      A type of lung cancer in which the cells are small and round. Also called oat cell lung cancer.

      Small intestine:

      The part of the digestive tract that is located between the stomach and the large intestine.

      Smoldering leukemia:

      See Preleukemia.

      Soft tissue sarcoma:

      A sarcoma that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.

      Somatic cells:

      All the body cells except the reproductive cells.

      Somatic mutations:

      See mutation.

      Sperm banking:

      Freezing sperm before cancer treatment for use in the future. This procedure can allow men to father children after loss of fertility.

      SPF (sun protection factor):

      A scale for rating sunscreens. Sunscreens with an SPF of 15 or higher provide the best protection from the sun’s harmful rays.

      Spinal tap:

      A test in which a fluid sample is removed from the spinal column with a thin needle. Also called a lumbar puncture.

      Spleen:

      An organ that produces lymphocytes, filters the blood, stores blood cells, and destroys those that are aging. It is located on the left side of the abdomen near the stomach.

      Splenectomy:

      An operation to remove the spleen.

      Sputum:

      Mucus from the lungs.

      Squamous cell carcinoma:

      Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts.

      Squamous cells:

      Flat cells that look like fish scales; they make up most of the epidermis, the outer layer of the skin.

      Squamous intraepithelial lesion:

      A general term for the abnormal growth of squamous cells on the surface of the cervix. The changes in the cells are described as low grade or high grade, depending on how much of the cervix is affected and how abnormal the cells are. Also called SIL.

      Stage:

      The extent of a cancer, especially whether the disease has spread to other parts of the body.

      Staging:

      Doing exams and tests to learn the extent of the cancer, especially whether it has spread from its original site to other parts of the body.

      Stem cells:

      The cells from which all blood cells develop.

      Stereotaxis:

      Use of a computer and scanning devices to create three-dimensional pictures. This method can be used to direct a biopsy, external radiation, or the insertion of radiation implants.

      Steroids:

      Drugs used to relieve swelling and inflammation.

      Stoma:

      An opening in the abdominal wall; also called an ostomy or urostomy.

      Stool test:

      A test to check for hidden blood in the bowel movement.

      Subglottis:

      The lowest part of the larynx; the area from just below the vocal cords down to the top of the trachea.

      Supportive care:

      Treatment given to prevent, control, or relieve complications and side effects and to improve the patient’s comfort and quality of life.

      Supraglottis:

      The upper part of the larynx, including the epiglottis; the area above the vocal cords.

      Systemic:

      Reaching and affecting cells all over the body.

      Systemic therapy:

      Treatment that uses substances that travel through the bloodstream, reaching and affecting cancer cells all over the body.

      Systemic treatment:

      Treatment using substances that travel through the bloodstream, reaching and affecting cancer cells all over the body.

      T-cell lymphoma:

      A cancer of the immune system that appears in the skin; also called mycosis fungoides.

      Testicular cancer:

      Cancer of the testicle (also called the testis), a rare kind of cancer in men, is a disease in which cancer (malignant) cells are found in the tissues of one or both testicles. The testicles are round and a little smaller than golf balls. Sperm (the male germ cells that can join with a female egg to develop into a baby) and male hormones are made in the testicles. There are two testicles located inside of the scrotum (a sac of loose skin that lies directly under the penis).

      Testosterone:

      A male sex hormone.

      Thermography:

      A test to measure and display heat patterns of tissues near the surface of the breast. Abnormal tissue generally is warmer than healthy tissue. This technique is under study; its value in detecting breast cancer has not been proven.

      Thoracentesis:

      Removal of fluid in the pleura through a needle.

      Thoracic:

      Pertaining to the chest.

      Thoracotomy:

      An operation to open the chest.

      Thrombocytes:

      See Platelets.

      Thrombophlebitis:

      Inflammation of a vein that occurs when a blood clot forms.

      Thymoma:

      Malignant thymoma is a disease in which cancer (malignant) cells are found in the tissues of the thymus. The thymus is a small organ that lies under the breastbone. It makes white blood cells called lymphocytes, which travel through your body and fight infection. People with malignant thymoma often have other diseases of their immune system. The most common disease in people with thymoma is one in which the muscles are weak, called myasthenia gravis.

      Thymus:

      An organ in which lymphocytes mature and multiply. It lies behind the breastbone.

      Thyroid cancer:

      Cancer of the thyroid is a disease in which cancer (malignant) cells are found in the tissues of the thyroid gland. Your thyroid gland is at the base of your throat. It has two lobes, one on the right side and one on the left. Your thyroid gland makes important hormones that help your body to function normally.

      Tissue:

      A group or layer of cells that together perform specific functions.

      Tonsils:

      Small masses of lymphatic tissue on either side of the throat.

      Topical chemotherapy:

      Treatment with anticancer drugs in a lotion or cream.

      Total pancreatectomy:

      Surgery to remove the entire pancreas.

      Toxins:

      Poisons produced by certain animals, plants, or bacteria.

      Trachea:

      The airway that leads from the larynx to the lungs. Also called the windpipe.

      Tracheoesophageal puncture:

      A small opening made by a surgeon between the esophagus and the trachea. A valve keeps food out of the trachea but lets air into the esophagus for esophageal speech.

      Tracheostomy:

      Surgery to create an opening (stoma) into the windpipe. The opening itself may also be called a tracheostomy.

      Tracheostomy button:

      A small plastic tube placed in the stoma to keep it open.

      Tracheostomy tube:

      A two- to three-inch-long metal or plastic tube that keeps the stoma and trachea open. Also called a trach (“trake”) tube.

      Transformation:

      The change that a normal cell undergoes as it becomes malignant.

      Transfusion:

      The transfer of blood or blood products from one person to another.

      Transitional cell carcinoma:

      Cancer that develops in the lining of the renal pelvis. This type of cancer also occurs in the ureter and the bladder.

      Transitional cells:

      Cells lining some organs.

      Transplantation:

      The replacement of an organ with one from another person.

      Transrectal ultrasound:

      The use of sound waves to detect cancer. An instrument is inserted into the rectum. Waves bounce off the prostate and the pattern of the echoes produced is converted into a picture by a computer.

      Transurethral resection:

      Surgery performed with a special instrument inserted through the urethra. Also called TUR.

      Transurethral resection of the prostate:

      The use of an instrument inserted through the penis to remove tissue from the prostate. Also called TUR or TURP.

      Tumor:

      An abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may either be benign (not cancerous) or malignant (cancerous).

      Tumor debulking:

      Surgically removing as much of the tumor as possible.

      Tumor marker:

      A substance in blood or other body fluids that may suggest that a person has cancer.

      Tumor necrosis factor:

      A type of biological response modifier (a substance that can improve the body’s natural response to disease).

      Tumors of unknown primary origin:

      This is a disease in which cancer (malignant) cells are found somewhere in the body, but the place where they first started growing (the origin or primary site) cannot be found.

      Tumor-suppressor gene:

      Genes in the body that can suppress or block the development of cancer.

      Ulcerative colitis:

      A disease that causes long-term inflammation of the lining of the colon.

      Ultrasonography:

      A test in which sound waves (called ultrasound) are bounced off tissues and the echoes are converted into a picture (sonogram).

      Ultrasound:

      A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). Tissues of different densities reflect sound waves differently.

      Ultraviolet (UV) radiation:

      Invisible rays that are part of the energy that comes from the sun. UV radiation can burn the skin and cause melanoma and other types of skin cancer. UV radiation that reaches the Earth’s surface is made up of two types of rays, called UVA and UVB rays. UVB rays are more likely than UVA rays to cause sunburn, but UVA rays pass further into the skin. Scientists have long thought that UVB radiation can cause melanoma and other types of skin cancer. They now think that UVA radiation also may add to skin damage that can lead to cancer. For this reason, skin specialists recommend that people use sunscreens that block or absorb both kinds of UV radiation.

      Upper GI series:

      A series of X-rays of the upper digestive system that are taken after a person drinks a barium solution, which outlines the digestive organs on the X-rays.

      Ureter:

      The tube that carries urine from the kidney to the bladder.

      Urethra:

      The tube that empties urine from the bladder.

      Urinalysis:

      A test that determines the content of the urine.

      Urinary tract:

      The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra.

      Urostomy:

      An operation to create an opening from inside the body to the outside, making a new way to pass urine.

      Uterine cancer:

      Cancer of the endometrium, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the lining of the uterus (endometrium). The uterus is the hollow, pear-shaped organ where a baby grows. Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus. Sarcoma of the uterus, a very rare kind of cancer in women, is a disease in which cancer (malignant) cells start growing in the muscles or other supporting tissues of the uterus.

      Vaginal cancer:

      Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the birth canal.

      Ventricles:

      Hollow chambers within the body; the heart has two ventricles, and the brain has four ventricles.

      Vinyl chloride:

      A substance used in manufacturing plastics. It is linked to liver cancer.

      Viruses:

      Small living particles that can infect cells and change how the cells function. Infection with a virus can cause a person to develop symptoms. The disease and symptoms that are caused depend on the type of virus and the type of cells that are infected.

      Vocal cords:

      Two small bands of muscle within the larynx. They close to prevent food from getting into the lungs, and they vibrate to produce the voice.

      Waldenstrom’s macroglobulinemia:

      This is a rare, chronic cancer that affects white blood cells called B lymphocytes, or B cells. These cells form in the lymph nodes and the bone marrow, the soft, spongy tissue inside bones, and are an important part of the body’s immune (defense) system. Some B cells become plasma cells, which make, store, and release antibodies. Antibodies help the body fight viruses, bacteria, and other foreign substances. In Waldenstrom’s macroglobulinemia, abnormal B cells multiply out of control. They invade the bone marrow, lymph nodes, and spleen and produce excessive amounts of an antibody called IgM.

      Wart:

      A raised growth on the surface of the skin or other organ.

      Whipple procedure:

      A type of surgery used to treat pancreatic cancer. The surgeon removes the head of the pancreas, the duodenum, a portion of the stomach, and other nearby tissues.

      White blood cells:

      Cells that help the body fight infection and disease. These cells begin their development in the bone marrow and then travel to other parts of the body.

      Wilms’ tumor:

      Wilms’ tumor is a disease in which cancer (malignant) cells are found in certain parts of the kidney. The kidneys are a “matched” pair of organs found on either side of the backbone. Inside each kidney are tiny tubes that filter and clean the blood, taking out unneeded products, and making urine. Wilms’ tumor occurs most commonly in children under the age of 15 and is curable in the majority of affected children.

      Xerogram:

      An X-ray of soft tissue.

      Xeroradiography:

      A type of mammography in which a picture of the breast is recorded on paper rather than on film.

      X-ray:

      High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer.

      Resource Guide

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      Hesketh, Robin. Betrayed by Nature: The War on Cancer. New York: Palgrave Macmillan, 2012.
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      Joerger, Markus and Michant Gnant, eds. Prevention of Bone Metastases. New York: Springer, 2012.
      Johnson, Daniel E., ed. Cell Death Signaling in Cancer Biology and Treatment. New York: Humana Press, 2013.
      Jurisica, Igor, Dennis A. Wigle, and Bill Wong, eds. Cancer Informatics in the Post Genomic Era. New York: Springer Science Business Media, 2007.
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      Khan, Abdul Arif, ed. Bacteria and Cancer. New York: Springer, 2012.
      Khanna, Kum Kum and Yosef Shiloh, eds. The DNA Damage Response: Implications on Cancer Formation and Treatment. New York: Springer, 2009.
      Klein, Eric A. and Stephen Jones, eds. Management of Prostate Cancer. Totowa, NJ: Humana Press, 2013.
      Klein, Sarah A. and James P. Beckler, eds. Metastatic Melanoma: Symptoms, Diagnoses, and Treatments. New York: Nova Science Publishers, 2011.
      Knaul, Felicia Marie, ed. Closing the Cancer Divide: An Equality Imperative. Boston, MA: Harvard Global Equity Initiative, 2012.
      Koh, Howard K., ed. Toward the Elimination of Cancer Disparities: Clinical and Public Health Perspectives. New York: Springer, 2009.
      Krueger, Eduard and Berta Trommler, eds. Thyroid Cancer: Diagnosis, Treatment and Prognosis. New York: Nova Biomedical, 2013.
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      Lenz, Heinz-Josef, ed. Biomarkers in Oncology. New York: Springer, 2013.
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      Mathews, Lesley A., Stephanie M. Cabarcas, and Elaine M. Hurt, eds. DNA Repair of Cancer Stem Cells. New York: Springer, 2013.
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      Pecorino, Lauren. Why Millions Survive Cancer: The Successes of Science. New York: Oxford University Press, 2011.
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      Journals
      American Journal of Clinical Pathology
      American Journal of Medicine
      American Journal of Preventive Medicine
      Angiogenesis
      Annals of Cancer Research and Therapy
      BMC Cancer
      British Journal of Cancer
      British Medical Journal
      CA: A Cancer Journal for Clinicians
      Cancer & Metabolism
      Cancer and Metastasis Reviews
      Cancer Biology & Medicine
      Cancer Biology & Therapy
      Cancer Biotherapy
      Cancer Causes and Control
      Cancer Cell
      Cancer Chemotherapy and Pharmacology
      Cancer Control
      Cancer Detection and Prevention
      Cancer Epidemiology
      Cancer Epidemiology, Biomarkers & Prevention
      Cancer Gene Therapy
      Cancer Genetics
      Cancer Genomics & Proteomics
      Cancer Imaging
      Cancer Immunology, Immunotherapy
      Cancer Immunology Research
      Cancer Investigation
      Cancer Journal
      Cancer Letters
      Cancer Medicine
      Cancer Microenvironment
      Cancer Nursing
      Cancer Prevention Research
      Cancer Research Carcinogenesis
      Cancer Reviews Online
      Cancer Science
      Cancer Treatment and Research
      Cancer Treatment Communications
      Carotenoids in Health and Disease
      Cell
      Clinical Cancer Research
      Clinical Medicine Insights: Oncology
      Current Treatment Options in Oncology
      Environmental Health Perspective
      European Journal of Cancer Prevention
      Evidence-Based Oncology
      Frontiers in Oncology
      Journal of Cancer Education
      Journal of Cancer Research and Clinical Oncology
      Journal of Clinical Investigation
      Journal of Clinical Medicine and Research
      Journal of Clinical Oncology
      Journal of Mammary Gland Biology and Neoplasia
      Journal of Medical Sciences Monitor
      Journal of Molecular Diagnostics
      Journal of Nutrition
      Journal of Oncology Pharmacy Practice
      Journal of Physical Anthropology
      Journal of the American Medical Association
      Journal of the National Cancer Institute
      Lancet Oncology
      Molecular Aspects of Medicine
      Molecular Cancer Research
      Nature Clinical Practice. Oncology
      Nature Reviews. Cancer
      Nature Reviews. Clinical Oncology
      New England Journal of Medicine
      Nucleic Acids Research
      Nutrition and Cancer
      Oncology
      Oncology Reports
      Oncology Research
      Perspectives in Biology and Medicine
      Pharmacogenetics
      Reports of Practical Oncology and Radiotherapy
      Science and Medicine
      Seminars in Cancer Biology
      Statistics in Medicine
      Toxicology Science
      Internet
      Agency for Healthcare Research and Quality http://www.ahrq.gov
      American Cancer Society http://www.cancer.org
      Canadian Cancer Society http://www.cancer.ca
      Cancer Genome Atlas (NCI) http://cancergenome.nih.gov
      Cancer Prevention and Control http://www.cdc.gov/cancer
      CRN Cancer Communication Research Center http://www.crn-ccrc.org
      European Association for Cancer Research http://www.eacr.org
      International Agency for Research on Cancer http://www.iarc.fr
      International Cancer Genome Consortium https://icgc.org
      National Cancer Institute http://www.cancer.gov
      National Institutes of Health Database of Clinical Trials http://www.clinicaltrials.gov
      Proceedings of the National Academy of Sciences http://www.pnas.org
      SEER: Surveillance, Epidemiology, and End Results Program http://seer.cancer.gov
      Sitemann Cancer Center, Washington University School of Medicine http://www.yourdiseaserisk.wustl.edu
      World Health Organization http://www.who.int

      Appendix

      National Cancer Institute, Surveillance, Epidemiology, and End Results Program

      SEER Cancer Statistics Review, 1975-2011

      Cancer Statistics Review 1975-2011: Introduction

      The annual SEER Cancer Statistics Review (CSR) contains incidence, mortality, prevalence, and survival statistics from 1975 through the most recent year for which data are available. This report is published by the Surveillance Research Program of the National Cancer Institute, which manages the Surveillance, Epidemiology, and End Results (SEER) Program. The scope and purpose of the CSR follow a report to the Senate Appropriations Committee (Breslow, 1988), which recommended that a broad profile of cancer be presented regularly to the American public.

      The SEER program is an authoritative source of information on cancer incidence and survival in the United States. SEER collects and publishes these statistics from population-based registries covering 28% of the US population. The 18 SEER registries routinely collect data on patient demographics, primary tumor site, tumor morphology, extent of disease, first course of treatment, and active follow-up for vital status. Detailed information describing these fields can be found at http://seer.cancer.gov/resources/.

      This report presents statistics on 29 primary sites and subsites, organized into site-specific chapters. Detailed statistics on cancer incidence, mortality, survival, and prevalence are reported by sex, race and ethnicity, age, stage at diagnosis, and geographic area. Information on tumor morphology is also presented. In addition, the CSR features a chapter on adolescent and young adult cancers and a chapter on childhood cancers. Information on some rare cancers can be found in the summary tables of section I. For a detailed list of primary sites, the summary tables provide incidence and death rates for the most recent 5-year period, trends from 1975 to the most recent year, median age at diagnosis, median age at death, and survival rates.

      Delay-adjusted cancer incidence rates are a distinctive feature of the CSR. Delay-adjustment corrects the current case count to account for underreporting and corrections to the data. The final delay-adjusted rates are valuable in more precisely estimating trends.

      New features added to the CSR include:

      • Statistics for lung and bronchus cancer are shown by new histology groupings in Chapter 15 (Lewis DR, et al., 2014).
      • Confidence intervals for state ranks in mortality were added (Zhang S, et al., 2014).

      Changes in methodology to CSR include:

      • New standard error calculation for delay-adjusted incidence rates was used. See http://surveillance.cancer.gov/reports/tech2014.01.pdf for more information.
      • The default censoring age for survival calculations has changed from 199 to 99 years when using newly available expected survival tables. For most survival calculations there are no changes. Minimal changes may occur in survival for older age groups. See http://seer.cancer.gov/expsurvival/ for more information.

      The CSR files are provided in both PDF and HTML formats. The HTML format is provided as an alternative and accessible version of the SEER Cancer Statistics Review. The current edition of the CSR is available on the web at http://seer.cancer.gov/csr/. Statistics from SEER may also be obtained via FastStats (http://seer.cancer.gov/faststats/) or Cancer Query Systems (http://seer.cancer.gov/canques/), which allow the user to access over 10,000,000 cancer statistics. The SEER Research Data file (http://seer.cancer.gov/data/) may be accessed by the public, either through SEER*Stat software or in an ASCII text format that can be analyzed with standard statistical software.

      While most of the rates in this publication have been age-adjusted to the 2000 US standard population, some previous SEER publications have used the 1970 US standard million population. Therefore, rates given in this publication cannot be compared to rates given in those publications. This change conforms to a federal policy for reporting disease rates; it allows for the age-adjusted rate to more accurately reflect the current age distribution and burden of cancer.

      Interpretation of Cancer Statistics

      A number of factors may affect the interpretation of cancer incidence, mortality, and survival statistics provided in this report.

      Survival rates for all cancers combined: The mix of cancers changes over time as the incidence of some cancers increases and the incidence of others decreases. The overall cancer survival rate can fluctuate even when the survival rates for site-specific cancers remain unchanged. (While it is possible to adjust the survival rate for all cancers combined on the basis of the relative frequencies of the component cancers, rates adjusted in this manner differ by only a small amount from unadjusted rates. In the future, such an adjustment may become more important if there are substantial changes in the incidence of various cancers.)

      Early detection/screening: The improved earlier detection and diagnosis of cancers caused by new screening procedures may produce an increase in both incidence rates and survival rates. These increases can occur as a result of the introduction of a new procedure to screen subgroups of the population for a specific cancer; they need not be related to whether use of the screening test results in a decrease in mortality from that cancer. As the proportion of cancers detected at screening increases, presumably as a result of increased screening of the population, patient survival rates will increase, because they are based on survival time after diagnosis. The interval between the time a cancer is diagnosed by a screening procedure and the time when the cancer would have been diagnosed in the absence of screening is called lead-time (Zelen, 1976). (Screening for breast cancer has been demonstrated to result in increased survival over and above that resulting from lead-time alone and to reduce breast cancer mortality. The benefit of screening is being studied for some other cancers.)

      If a new screening procedure consistently detects cancer in a preinvasive phase, it may result in a decrease in survival rates for invasive cancer. In this case, length-biased sampling (Zelen, 1976) may be operating. Length-biased sampling would result in the preferential detection—in a preinvasive phase—of those cancers that would have had a relatively good prognosis had they progressed to invasive disease; these potentially invasive cancers would be systematically eliminated. If this occurs, the mix of cancers that are not detected at screening and then progress to invasive behavior may become less prognostically favorable, resulting in a decrease in survival rates for patients with invasive cancers. (Length-biased sampling may at least partially explain survival trends for cervical cancer. Other cancers possibly affected include breast, colon, rectum, and prostate.)

      Changes in diagnostic criteria: Early detection of cancer resulting from either screening or earlier response to symptoms may result in the increasing diagnosis of small tumors that are not yet life-threatening. This may have the effect of raising the incidence rates and survival estimates without changing the mortality rates. Breast, colon, prostate, cervix uteri, bladder, and skin (melanoma) are the cancer sites most likely to be affected.

      Technological advances in diagnostic procedures: In this report, trends in survival by stage at diagnosis for specific cancers are not presented; trends in stage distributions are presented rarely. However, it is possible to compare survival by stage.

      The assignment of a given stage to a particular cancer may change over time due to advances in diagnostic technology. Introduction of new technology can give rise to a phenomenon known as stage migration. Stage migration occurs when diagnostic procedures change over time, resulting in an increase in the probability that a given cancer will be diagnosed in a more advanced stage. For example, certain distant metastases that would have been undetectable a few years ago can now be diagnosed by a computer tomography (CT) scan or by magnetic resonance imaging (MRI). Therefore, some patients who would have been diagnosed previously as having cancer in a localized or regional stage are now diagnosed as having cancer in a distant stage. The likely result would be to remove the worst survivors, those with previously undetected distant metastases, from the localized and regional categories and put them into the distant category. As a result, the stage-at-diagnosis distribution for a cancer may become less favorable over time, but the survival for each stage may improve: The early stage will lose cases that will survive shorter than those remaining in that category, while the advanced stage will gain cases that will survive longer than those already in that category. However, overall survival would not change (Feinstein et al., 1985). Stage migration is an important concept to understand when examining temporal trends in survival by stage at diagnosis as well as temporal trends in stage distributions; it could affect the analysis of virtually all solid tumors.

      Evolution of stage classifications: Every few years, the American Joint Committee on Cancer produces a new cancer-staging manual; the seventh edition is the most recent (Edge et al., 2010). The evolution of such classifications reflects the identification of new prognostic factors that may influence choice of treatment. Historically, the SEER Program has only collected data on extent of disease (EOD), rather than stage. EOD is more specific than stage and usually determines stage, even when stage definitions change. Thus, SEER easily adapts to changes in stage definitions; moreover, trends in a newly redefined stage can usually be calculated. Recently the SEER Program has begun collecting Collaborative Stage. Collaborative Stage has the advantage of being a consolidated data collection system of three main staging systems (TNM, EOD, and Summary Stage) and allows combined pathological and clinical stage to be captured. New prognostic variables are introduced into staging for some cancers and so previously collected EOD data cannot determine new stage categories. There can be problems in assessing trends in stage of disease for these cancers. Only by reviewing the evolution of staging for a given cancer is it possible to determine what effects changes in stage definitions have had on stage-specific survival and on stage-at-diagnosis distributions. Stage migration (mentioned above) and EOD migration need also be taken into account. For some sites, the historic stage (localized, regional, or distant) is not shown, either because of inconsistencies in its definition over time or because stage is not appropriate (such as for leukemias, which are all considered to be distant at diagnosis).

      Interpreting relative survival: The relative survival estimate is the ratio of observed survival to expected survival for a given patient cohort. Expected survival is based on mortality rates for the entire population, taking into account, as appropriate, the age, sex, race, and year of diagnosis of the patients. Assuming that the presence of cancer is the only factor that distinguishes the cancer patient cohort from the general population, relative survival estimates the probability that a patient will not die of the diagnosed cancer within the given time interval. This is the same as the probability that the patient will either survive the interval or die of a different cause.

      A factor related to the risk of a cancer may also be related to the risk of dying from causes unrelated to the cancer. An example of such a factor is smoking. Smoking is a major risk factor for lung cancer; therefore, a cohort of lung cancer patients will contain a much higher proportion of smokers than the general population. However, smoking is also a risk factor for other diseases so smokers have a shorter life expectancy than nonsmokers. For this reason, expected survival estimates for lung cancer patients based on life tables for the general population will be unrealistically high; since relative survival = observed / expected, this will result in relative-survival estimates that are lower than they would be if the population consisted only of smokers. The problem cannot be easily corrected because separate life tables for smokers and nonsmokers are not available. Moreover, amount of smoking (usually measured in pack-years) is an important variable and cannot be easily quantified. In addition, expected survival may not be appropriate for patients with cancers of the cervix uteri or breast because the risk of these cancers has been associated with socioeconomic status (Baquet et al., 1991) which may be related to life expectancy. This should be considered when interpreting relative survival for these cancers.

      Previous to the CSR for 1973–1996, the expected survival tables used were for 1970 and 1980; there were separate tables for whites, blacks, American Indians, Chinese, Japanese, Filipinos, white Hispanics, and Hawaiians. In updating the tables for 1990, several problems emerged.

      The US life tables are based on age, race, and sex information from death certificates. The information on race on the death certificate may not be accurate (Rosenberg et al., 1999). One reason is that funeral directors may inaccurately report race on a death certificate. Also, reported age at death, especially for those older than 85, may not be accurate because birth certificates were not issued with as much regularity in the early 1900s as they are today. Although race misclassification and age-at-death misreporting exist across all races, they may be more problematic for races other than white or black because of those races’ smaller population sizes. Therefore, life tables were generated for 1970, 1980, 1990, and 2000 only for white, black, and other; these life tables were used to produce the relative survival estimates in this review. There may be small variations among survival estimates calculated in this CSR and those in CSRs prior to 1973–1996.

      Comparison with other databases: The SEER data are obtained from population-based cancer registries covering about 28 percent of the US population. It is sometimes of interest to compare cancer statistics for SEER areas with those from other registries both in the US and worldwide. In making such comparisons, one must carefully consider the factors mentioned above for both data sources. In addition, one should assess all of the following: (1) completeness of case ascertainment, (2) rules used to determine multiple primaries, (3) follow-up, (4) rules used in assigning and coding cause of death, and (5) the sources and procedures used in obtaining population estimates. Depending on the rates being compared, there could be other confounding factors which should be considered. The same standard or standard million population should be used for the age-adjustment of each group being compared; most statistics from outside the US are based on the 2000 world standard million population. Examples of other databases are US Cancer Statistics (http://apps.nccd.cdc.gov/uscs) and CINA+ Online (http://www.cancer-rates.info/naaccr/).

      It is sometimes of interest to compare survival for cancer patients in SEER areas with data from clinical trials. This must be done with great caution. Survival data from clinical trials may have been obtained from a patient population that differs from that of SEER patients in prognostic factors for the given cancer; any survival comparisons would have to adjust for such differences. Also, it is necessary to verify that the methodology used in computing survival is the same for both data sources. Furthermore, patients on clinical trials may differ from SEER patients in characteristics that may be related to survival but are not recorded in either database. If this were true for a given cancer, it would not be possible to make valid comparisons of this type.

      Errors in data collection: In the process of registering cancer patients, errors may be made in abstracting and coding the data, which include demographic information, cancer site, histology, extent of disease, treatment, and patient survival. Quality control studies are periodically carried out to detect and correct this type of error, but no attempt is made to incorporate this source of error into the variance estimates of cancer rates reported here.

      Comparison of this report with previous reports: The cancer registries that participate in the SEER Program submit data on all cancers diagnosed in their coverage areas to the NCI each year. Because of the dynamic nature of the registries’ databases, the reported number of new cancer cases in a particular race, sex, age, cancer category in a given calendar year may change from that which has been reported in a previous publication. For a given diagnosis year, additional cancer cases that were previously overlooked may have been found and reported to the central registry. There may have been follow-back of cancers diagnosed by death certificate only; successful efforts to establish the dates of diagnosis for such patients will change the number of patients reported for a given diagnosis year. Code changes may occur when a patient dies; for example, information on race is generally available on the death certificate and may be used to update a previously unknown value. There may have been elimination of duplicate records for the same patient, often due to name changes or misspellings.

      Thus, a recent report may have a different number of cases for a given diagnosis year than an earlier report, with resulting effects on incidence and possibly survival. Population estimates may also change from one report to another for some calendar years. This occurs because the NCI receives population estimates that are regularly revised and updated by the Bureau of the Census (BOC). Such changes may result in some differences between incidence and mortality rates for a given calendar period as published in different reports. See our website for the most current information about the population estimates (http://seer.cancer.gov/popdata/).

      References
      Baquet CR, Horm JW, Gibbs T, Greenwald P. Socioeconomic factors and cancer incidence among blacks and whites. J Natl Cancer Inst 1991; 83:551-557.
      Breslow L (Chairman, Extramural Committee to Assess Measures of Progress Against Cancer). Measurement of progress against cancer: Final report to the Senate Appropriations Committee. Bethesda: National Cancer Institute; 1988.
      Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual,
      7th ed
      . New York (NY): Springer; 2010.
      Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon: Stage migration and new diagnostic techniques as a source of misleading statistics for survival of cancer. New Engl J Med 1985;312:1604-1608.
      Lewis DR, Check DP, Caporaso NE, Travis WD, Devesa SS. U.S. Lung Cancer Trends by Histologic Type. Cancer, accepted March 13, 2014, in production.
      Rosenberg HM, Maurer JD, Sorlie PD, Johnson NJ, MacDorman MF, Hoyert DL, Spitler JF, Scott C. Quality of death rates by race and Hispanic origin: A summary of current research. Hyattsville (MD): National Center for Health Statistics; Vital and Health Statistics, Series 2, No. 128, 1999.
      Zelen M. Theory of early detection of breast cancer in the general population. In: Heuson J-C, Mattheiem WH, Rozencweig M, editors. Breast Cancer: Trends in Research and Treatment. New York (NY): Raven Press; 1976. p. 287-299.
      Zhang S, Luo J, Zhu L, Stinchcomb D, Campbell D, Carter G, Gilkeson S, Feuer EJ. (2014), Confidence intervals for ranks of age-adjusted rates across states or counties. Statistics in Medicine. doi: http://dx.doi.org/10.1002/sim.6071
      Technical Notes

      There are four measures commonly used to assess the impact of a cancer in the general population and are reported in this review. The incidence rate is the number of new cases per year per 100,000 persons. The death (or mortality) rate is the number of deaths per year per 100,000 persons. The survival estimate is the proportion of patients alive at some point subsequent to the diagnosis of their cancer. The prevalence count is the number of people alive that have ever been diagnosed with a cancer. The Surveillance, Epidemiology, and End Results (SEER) Program (http://seer.cancer.gov) (based within the Surveillance Research Program (SRP) at the National Cancer Institute (NCI) collects incidence and survival data for all areas that participate in the Program. The National Center for Health Statistics (NCHS) provides mortality data for the entire United States (US). All incidence and mortality rates in this report are age-adjusted (see below) to the 2000 US standard population (see Appendix) unless otherwise specified. Age-adjustment minimizes the effect of a difference in age distributions when comparing rates.

      The Seer Program

      The National Cancer Act of 1971 mandated the collection, analysis, and dissemination of data useful in the prevention, diagnosis, and treatment of cancer. This mandate led to the establishment of the SEER Program. The population-based cancer registries participating in NCI’s SEER Program routinely collect data on all cancers occurring in residents of the participating areas. Trends in cancer incidence and patient survival in the US are derived from this database. See the SEER Research Data (http://seer.cancer.gov/data/) for more information.

      The SEER Program is a sequel to two earlier NCI programs—the End Results Program and the Third National Cancer Survey. The initial SEER reporting areas were the States of Connecticut, Iowa, New Mexico, Utah, and Hawaii; the metropolitan areas of Detroit, Michigan, and San Francisco-Oakland, California; and the Commonwealth of Puerto Rico. Case ascertainment began with January 1, 1973, diagnoses.

      In 1974-1975, the program was expanded to include the metropolitan area of New Orleans, Louisiana, the thirteen-county Seattle-Puget Sound area in the State of Washington, and the metropolitan area of Atlanta, Georgia. New Orleans participated in the program only through the 1977 data collection year. In 1978, ten predominantly African-American counties in rural Georgia were added. American Indian residents of Arizona were added in 1980. In 1983, four counties in New Jersey were added with coverage retrospective to 1979. New Jersey and Puerto Rico participated in the program until the end of the 1989 reporting year. The National Cancer Institute also began funding a cancer registry that, with technical assistance from SEER, collects information on cancer cases among Alaska Native populations residing in Alaska. In 1992, the SEER Program was expanded to increase coverage of minority populations, especially Hispanics, by adding Los Angeles County and four counties in the San Jose-Monterey area south of San Francisco. In 2001, the SEER Program expanded coverage to include Kentucky, Greater California (the counties of California that were not already covered by SEER), New Jersey, and Louisiana. In 2012, Greater Georgia (the parts of Georgia not included in Atlanta and Rural Georgia) was added to the SEER Program, with data retroactive to 2000.

      The long-term incidence trends and survival data for this report are from five states (Connecticut, Hawaii, Iowa, New Mexico, and Utah) and four metropolitan areas (Detroit, Atlanta, San Francisco-Oakland, and Seattle-Puget Sound) (Fig. I-1); this set of registries is called the SEER 9. Additional tables show more recent incidence trends for the SEER 13 areas (the 9 areas above plus Los Angeles, San Jose-Monterey, Alaska Native Registry, and rural Georgia) since 1992 and additional information on race and ethnicity. Other tables give statistics for the SEER 18 areas; these are the SEER 13 plus Kentucky, Greater California, New Jersey, Louisiana, and Greater Georgia.

      The participating regions were selected principally for their ability to operate and maintain a population-based cancer reporting system and for their epidemiologically significant population subgroups. With respect to selected demographic and epidemiologic factors, they are when combined a reasonably representative subset of the US population. Data from the 9, 13, or 18 SEER geographic areas are used in this report; the given groups contain, respectively, approximately 9, 14, or 28 percent of the US population. By the end of the 2011 diagnosis year, the database of the 18 SEER registries (plus Arizona Indians) contained information on over 7 million cases diagnosed since 1973. New cases added in the most recent data year numbered over 449,000.

      The goals of the SEER Program are:

      • to assemble and report, on a periodic basis, estimates of cancer incidence, mortality, survival, and prevalence in the US;
      • to monitor annual cancer incidence trends to identify unusual changes in specific forms of cancer occurring in population subgroups defined by geographic and demographic characteristics;
      • to provide continuing information on trends over time in the extent of disease at diagnosis, trends in therapy, and associated changes in patient survival; and
      • to promote studies designed to identify factors amenable to cancer control interventions, such as: (a) environmental, occupational, socioeconomic, dietary, and health-related exposures; (b) screening practices, early detection and treatment; and (c) determinants of the length and quality of patient survival.
      Data Sources
      Incidence and Survival Data

      The SEER Program contracts with nonprofit, medically-oriented organizations having statutory responsibility for registering diagnoses of cancer among residents of their respective geographic coverage areas. Each SEER contractor:

      • maintains a cancer information reporting system;
      • abstracts records for resident cancer patients seen in every hospital both inside and outside the coverage area;
      • abstracts all death certificates of residents (dying both inside and outside the coverage area) on which cancer is listed as a cause of death;
      • strives for complete ascertainment of cases by searching records of private laboratories, radiotherapy units, nursing homes, and other health services units that provide diagnostic service;
      • registers all in situ and malignant neoplasms (with the exceptions of certain histologies for cancer of the skin and—beginning in 1996—in situ neoplasms of the cervix uteri);
      • records data on all newly diagnosed cancers, including selected patient demographics, primary site, morphology, diagnostic confirmation, extent of disease, and first course of cancer-directed therapy;
      • provides active follow-up on all living patients (except for those with in situ cancer of the cervix uteri);
      • maintains confidentiality of patient records;
      • at least annually submits electronically to NCI data on all reportable diagnoses of cancer made in residents of the coverage area.

      For 1992 to 2000 diagnoses, the SEER program codes site and histology by the International Classification of Diseases for Oncology, second edition (ICD-O-2) (Percy et al., 1990). All cases before 1992 were machine-converted to ICD-O-2. Cases diagnosed 2001-2009 have been coded according to the third edition (ICD-O-3) (Fritz et al., 2000). Starting with patients diagnosed in 2007, the new multiple primary and histology coding rules may impact their incidence data for some cancer sites (e.g., female breast). However, the impact of the new rule on observed incidence is negligible for a majority of the cancer sites. To learn more about the multiple primary rules, visit: http://seer.cancer.gov/tools/mphrules/. Beginning with 2010 diagnoses, cases are coded based on ICD-O-3 updated for hematopoetic codes based on WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (2008). The primary site groupings used for incidence are found in the Appendix. Changes were made to the site recode for ICD-O-2 for comparability with cases coded to ICD-O-3. Follow-up rates are also in the Appendix.

      Underreporting Adjustment for Veterans Affairs Cases: A CSR section on Department of Veterans Affairs (VA) underreporting (Howlader et al., 2009) was included in recent versions of the CSR. As of the current CSR this section was removed since available evidence indicates that VA underreporting is resolved as of diagnosis year 2010. The section of the CSR introduction about the reporting delay describes measures to address any backlog of VA cases reported after the initial reporting year.

      Excluded cancers: Some cancers were excluded from most of the analyses. Myelodysplastic syndrome (MDS), for example, was reclassified in ICD-O-3 (effective diagnosis year 2001) from nonmalignant to malignant; other cancers so reclassified include endometrial stromal sarcoma (low grade), papillary ependymoma, papillary meningioma, polycythemia vera, chronic myeloproliferative disease (NOS), myelosclerosis with myeloid metaplasia, essential thrombocythemia, refractory anemia, refractory anemia with sideroblasts, refractory anemia with excess blasts, and refractory anemia with excess blasts in transformation. In contrast, borderline tumors of the ovary were reclassified from malignant to nonmalignant at the same time. In addition, benign brain/CNS tumors were collected beginning for 2004 diagnoses. All of these cancers were excluded from most of the analyses, especially time trends. Pilocytic astrocytoma, although reclassified in ICD-O-3, was not excluded. Separate tables for MDS and benign brain/CNS are shown.

      Mortality Data

      The SEER Program annually obtains from the National Center for Health Statistics (NCHS) a file containing information on all deaths occurring in the US by calendar year. Information on each death includes age at death, sex, geographic area of residence, and underlying and contributing causes of death. For this publication, only the underlying cause of death is used in the calculation of death rates. Cause of death for 1969-1978 was coded according to ICD-8; for 1979-1998, ICD-9 was used; beginning with deaths in 1999, ICD-10 was used. Mortality rates for the SEER geographic areas, for each state, and for the entire US are obtained from these data. A list of the mortality site groupings used in this publication is in the Appendix and reflects updates made in 2004.

      Population Data

      The population estimates used in the SEER*Stat software to calculate cancer incidence and mortality rates for this report are a modified version of the intercensal and Vintage 2011 annual time series of July 1 county population estimates by age, sex, race, and Hispanic origin that are produced by the Population Estimates Program of the US Census Bureau (http://www.census.gov/popest/) with support from the NCI through an interagency agreement. Descriptions of the methodologies employed by the Census Bureau for various sets of estimates may be found on the same website. Vintage 2011 population estimates were used; these estimates were developed from the actual 2010 census results.

      County population estimates for 2000 and later years must be bridged from 31 race categories used in Census 2000 to the four race categories specified under the 1997 OMB standards in order to report long-term cancer trends. The bridging methodology was developed by the National Center for Health Statistics and is described in a report (Ingram et al., 2003) and on their website http://www.cdc.gov/nchs/nvss/bridged_race.htm

      Modifications made by the NCI to the population estimates are documented in “Population Estimates Used in NCI’s SEER*Stat Software” (http://seer.cancer.gov/popdata/methods.html) and the population data files are available for download (see “Download US Population Data” from http://seer.cancer.gov/popdata/download.html). Several of the modifications pertaining to the grouping of specific counties needed to assure the compatibility of all incidence, mortality and population datasets. Another modification affects only population estimates for the State of Hawaii. The Epidemiology Program of the Hawaii Cancer Research Center has developed its own set of population estimates, based on sample survey data collected by the Hawaii Department of Health. This effort grew out of a concern that the native Hawaiian population has been vastly undercounted in previous censuses. The “Hawaii adjustment” to the Census Bureau’s estimates has the net result of reducing the estimated white population and increasing the estimated Asian and Pacific Islander population for the state. The estimates for the total population, black population, and American Indian and Alaska Native populations in Hawaii are not modified.

      The cancer incidence and mortality rates for American Indians and Alaska Natives (AI/AN) are based on the geographic areas (counties) included in the Indian Health Service’s Contract Health Service Delivery Area (CHSDA). This reflects a concern that previously reported AI/AN rates were underestimated due to racial/ethnic misclassification of American Indian cases in geographic areas outside of CHSDA. This change has the net effect of higher, and more accurate, incidence and mortality rates for this population. Beginning in 2013, CSR reporting diagnoses 1975-2010, CHSDA counties were updated with 9 new counties designated as CHSDA. Four of these are in SEER areas. This addition was made to better reflect AI/AN populations that had been living in these counties.

      Usually the use of a population estimate for July 1 of a particular year reflects the average population of that area for the year. Both Hurricane Katrina and Hurricane Rita struck the Gulf Coast area of the United States in 2005. This had the effect of displacing large populations. Since there weren’t any population estimates by age, race, sex, and county for time periods just after the hurricanes, it is very difficult to estimate the actual population at risk for certain areas along the Gulf Coast for 2005. For Louisiana, only the first six months of incidence data for 2005 coupled with ½ of the population estimate for July 1, 2005, were used to calculate cancer incidence. For death rate calculations, no adjustments were made to the total US population, but for the Gulf area, an adjustment for displaced populations was made for 2005 state rates. For more details, see http://seer.cancer.gov/popdata/methods.html.

      2000 US Standard Population

      Starting with the November 2004 SEER submission of data (diagnoses through 2002), the SEER Program age-adjusts using the 2000 US standard population based on single years of age from the Census P25-1130 series estimates of the 2000 US population (Day, 1996). For the CSR, 19 age groupings were used for age-adjustment: <1, 1–4, 5–9, …, 80–84, 85+.

      Statistical Methods
      Estimated Cancer Cases and Deaths in 2014

      The American Cancer Society (ACS) projects the numbers of new cancer cases and cancer deaths in the US in 2014 (American Cancer Society, 2012). The ACS projects incidence in 2014 based on incidence rates for 1995-2009 from 49 states and the District of Columbia, representing about 98% of the US population. These high-quality incidence data were submitted to the North American Association of Central Cancer Registries (NAACCR) by 49 states (and District of Columbia) belonging to the SEER Program and/or the National Program of Cancer

      Registries (NPCR). For additional details please refer to http://www.cancer.org/docroot/STT/STT_0.asp

      Long-Term Trends, 1950-2011

      Trends in cancer mortality from 1950 to 2011 are summarized by age both for all cancers combined and for lung cancer (Table 1-2). These cancer mortality trends are based on the mortality experience in the entire US. Summaries of long-term trends back to 1950 in cancer survival are also shown for whites.

      Use caution when interpreting these statistics. Evaluating trends over a long period of time may hide recent changes in the trends.

      Years of Life Lost due to Premature Death from Various Causes

      Death rates alone give an incomplete picture of the burden that deaths impose on the population. Another measure is the years of life lost due to premature death. This shows the extent to which life is cut short by a particular cause or disease.

      This measure is estimated by linking life table data to each death of a person of a given age and sex. The life table permits a determination of the number of additional years an average person of that age, race, and sex would be expected to live. In this report, the age groups used in the calculation were 1-year intervals. These remaining years of life left are summed over all deaths due to a particular cause, yielding the estimate of the number of person-years of life lost (PYLL). The average years of life lost (AYLL) is obtained by dividing the PYLL by the number of deaths. Both of these measures can be calculated for any cause of death.

      Relative Survival

      Relative survival (Ederer, 1961) was developed to provide an objective measure of the probability of survival of cancer in the absence of other causes of death. It is a measure that is not influenced by changes in mortality from other causes and, therefore, provides a useful measure for both tracking survival across time and comparisons between racial/ethnic groups or between registries. For most cancer registries, cause-of-death information obtained from death certificates is either unavailable or unreliable due to misclassification error. Therefore, instead of calculating the probability of surviving cancer in the usual (cause-specific) way, considering deaths from other causes as censoring events, relative survival compares the observed survival proportion of a group of cancer patients with the survival of a “similar” theoretical cancer-free group. Relative survival is formally defined as the ratio of the observed survival (all causes of death) of a cohort of cancer patients to the expected survival of a comparable set of cancer-free individuals. Since a cohort of cancer-free individuals is difficult to obtain, life tables representing survival of the general population are used instead. The underlying assumption is that the cancer deaths are a negligible proportion of all deaths. To learn more on this topic, visit: http://surveillance.cancer.gov/survival/measures.html.

      Expected survival can be calculated using different methods which vary with respect to the definition of the matching group. The three most common methods are: Ederer I (Ederer, et al., 1961), Ederer II (Ederer and Heise, 1959) and Hakulinen (Hakulinen, 1982). In previous versions of SEER*Stat, relative survival has been calculated using Ederer I and Hakulinen methods, Ederer I being the default for calculations in the Cancer Statistics Review. In the Ederer I and Hakulinen methods, theoretical individuals are matched to each patient and are considered to be at risk for the entire follow-up. Hakulinen adjusts for potential follow-up times. Relative survival using expected rates derived via these two methods are very similar. However, recent research on relative survival has resuscitated the initial method to estimate expected rate: the Ederer II method. Although none of the three methods can be considered a gold standard, the Ederer II method has be shown to be in better alignment with the concept of net cancer survival. For that reason, as of 2011, we have switched to Ederer II as our default choice for calculating expected rate in SEER*Stat and the CSR. For more detail regarding this topic, read Cho et al., 2011 at: http://surveillance.cancer.gov/reports/. As of 2013, Survival time was calculated using pre-calculated months based on the exact day information. See http://seer.cancer.gov/survivaltime/. As of 2014, the default censoring age for survival calculations has changed from 199 to 99 year when using newly available expected survival tables. Minimal changes may occur in survival for older age groups. See http://seer.cancer.gov/expsurvival/ for more information.

      Cause-Specific Survival

      Cause-specific survival is a net-survival measure representing survival of a specified cause of death in the (theoretical) absence of other causes of death. Estimates are calculated by specifying the cause of death. Individuals who die of causes other than the specified cause are censored. This requires a cause-of-death variable that accurately captures all causes related to the specific cause. Cancer registries use algorithms to process causes of death from death certificates in order to identify a single, disease-specific, underlying cause of death. In some cases, attribution of a single cause of death may be difficult and misattribution may occur. For example, a death may be attributed to the site of metastasis instead of the primary site (Percy et al., 1981).

      To capture deaths related to the specific cancer but not coded as such, the SEER cause-specific death classification variable is defined by taking into account causes of deaths in conjunction with tumor sequence (i.e., only one tumor or the first of subsequent tumors), site of the original cancer diagnosis, and comorbidities (e.g., AIDS and/or site-related diseases). To learn more on this topic, please read the recent article published at the Journal of National Cancer Institute (Howlader et al., 2010) or visit: http://seer.cancer.gov/causespecific/.

      Cancer Prevalence

      Methods: In this report prevalence is calculated at 1/1/2011. Limited-duration prevalence is calculated using the counting method implemented in the SEER*Stat software. This method calculates the number or proportion of people alive at the prevalence date who had a diagnosis of the disease within the past x years (e.g., x = 5, 10, 20, or the full history of the registry).

      Because SEER has available information for the various racial/ethnic groups for different numbers of years, different years and registries were used to estimate limited-duration prevalence. Prevalence estimates for all races combined, for whites, and for blacks use cases from 1975 through 2010 from the SEER 9 registries; prevalence estimates for Asian Pacific Islanders and Hispanics use cases diagnosed from 1990 through 2011 from the SEER 11 areas and rural Georgia.

      The limited-duration prevalence method includes a correction for people lost to follow-up. For each individual lost to follow-up, a probability of being alive at the prevalence date is estimated from an appropriate survival function stratified by age at diagnosis (0–59, 60–69, 70+), sex, cancer site, year of diagnosis, and race, conditional on being alive at the time of loss to follow-up. Year of diagnosis is stratified into 5-year groups from the prevalence date, with the least recent interval being of varying length (4-8 years), depending on the length of years used to calculate prevalence. Race is stratified into white, black, other (American Indian/Alaska Native, Asian/Pacific Islander), and unknown/other-unspecified. When we use the SEER 11 registries, the same stratification as before is used, with American Indian/Alaska Native separated from Asian/Pacific Islander. Prevalence calculations for Hispanics use race stratified into: white, nonwhite, and unknown.

      Different methods can be used to determine which tumors are to be included for people diagnosed with multiple tumors. Unless otherwise specified, prevalence calculations include only the first malignant tumor per person; that is, in situ cancers and second-or-later primary cancers were not included. Thus, if a woman had a melanoma prior to a breast cancer diagnosis, her melanoma would contribute to the prevalence of melanoma and to the prevalence of all sites, but the breast cancer would not contribute to the prevalence of breast cancer. Counting only one cancer per individual avoids some ambiguity in prevalence counts, and allows the counts for individual sites to sum to the all sites total. Prevalence using different selection criteria is compared in a table in the overview chapter. For more information on tumor selection criteria refer to http://surveillance.cancer.gov/prevalence/methods.html.

      Complete prevalence is an estimate of the number of persons (or the proportion of population) alive on a specified date who had been diagnosed with the given cancer, no matter how long ago that diagnosis was. It was estimated for all races, whites, and blacks by applying the completeness index method (Capocaccia & De Angelis, 1997; Merrill et al., 2000; Mariotto et al., 2002) to limited-duration prevalence. The completeness index method is implemented in the COMPREV software, which can be found at http://surveillance.cancer.gov/comprev/. Validation of the completeness index for all races and for whites was made by using data from the Connecticut Tumor Registry (CTR) beginning with 1940. For blacks, SEER 9 data beginning with 1975 were used; identification of blacks is not possible in the CTR data prior to 1970. To validate the completeness index for blacks, we have compared the performance of the method to obtain 24-year prevalence from 10-year limited-duration prevalence. For all races combined and for whites, in cases where the validation indicated some lack of fit of the model, an approximation to the completeness index was derived from the CTR data. If there was a lack of fit for blacks, no estimate of complete prevalence was reported. Complete prevalence for Asian/Pacific Islanders and Hispanics is not available at this time. Complete prevalence by age for all races combined was validated by comparing estimated 10-year complete prevalence with observed prevalence from the CTR data. Prevalence by age is reported for the sites that validated well.

      The US cancer prevalence counts at 1/1/2011 were estimated by multiplying the SEER age- and race-specific prevalence proportions by the corresponding US population estimates based on the average of 2010 and 2011 population estimates from the US Census Bureau. US cancer prevalence counts for all races were estimated by summing the US estimated counts for whites/unknown, blacks, and other races. For Hispanics, the estimates for Hispanics of white or unknown race and for Hispanics of other races were summed.

      Complete prevalence estimates of the number of individuals in the US diagnosed with cancer as children (ages 0-19), including those surviving for more than 36 years, is calculated using a statistical method that estimates the number of childhood survivors diagnosed before 1975 (Simonetti et al., 2008; Mariotto et al., 2009). Limited-duration prevalence proportions by age at prevalence are not shown for childhood cancers (age at diagnosis 0-19) since many of these estimates are not informative. For example, the number of people diagnosed with childhood cancers in the last 25 years and who are currently age 50-59 is zero by definition. For more details on available prevalence estimates, see http://surveillance.cancer.gov/prevalence/.

      The overview chapter contains two prevalence tables. The first table reports US complete prevalence counts by age at prevalence and sex for some main cancer sites. The second table reports US prevalence counts for people diagnosed in the 5 years and 36 years prior to the prevalence date using different tumor inclusion criteria. Each site-specific chapter contains a prevalence table that reports limited-duration US prevalence counts by time since diagnosis for different racial/ethnic groups. US complete prevalence estimates are also reported when available. The second part of the site-specific tables displays the percent of the population in the SEER 11 areas diagnosed in the previous 19 years with the specific cancer by 10-year age groups for the different racial/ethnic groups.

      Probability of being Diagnosed with or Dying from Cancer

      Lifetime and interval risks of being diagnosed with cancer: The probability of being diagnosed with cancer is computed by applying cross-sectional age-specific 2008-2011 incidence rates from the SEER 17 areas and death rates from those same areas to a hypothetical cohort of 10,000,000 live births. This cohort is considered to be at risk for two mutually exclusive events: (1) developing the specified cancer, and (2) dying of other causes without developing the specified cancer. Using these two types of events, a standard multiple decrement life table (with 20 age groups from 0-4 to 90-94 and 95+) is derived. For each age interval, the number alive and free of the specified cancer at the beginning of the interval is decremented by the number who develop the specified cancer and the number who die of other causes. The lifetime risk of being diagnosed with the specified cancer is derived by summing all cancer cases from age 0-4 through age 95+ and dividing by 10,000,000. This calculation does not assume that an individual lives to any particular age; rather, it is the sum over all age intervals of the probability of living to the beginning of that interval without developing the given cancer times the probability of developing the cancer in that interval. The probability of developing cancer during any time period (e.g., between age 50 and age 60) is calculated by adding up all the cancers in the life table over the specified age range and dividing by the number of individuals alive and free of the specified cancer at the beginning of the period. The methodology is described in detail in (Fay et al., 2003) and (Fay, 2004). To improve the precision of the calculations, rates were calculated beyond the usual last open ended age interval (i.e. 85+) for the age groups 85-89, 90-94, and 95+.

      Lifetime risk of dying from cancer: The lifetime risk of dying from a specified cancer is derived using a standard multiple decrement life table (Elandt-Johnson & Johnson, 1980). For each age, the risks of dying of the specified cancer and of all other causes are calculated, based on mortality data from the entire United States.

      Detailed methodology and software: The estimates of developing and dying from cancer are implemented in DevCan (Probablity of DEVeloping or dying from CANcer software). More details on the software, various databases, and the methodology can be found at http://surveillance.cancer.gov/devcan/.

      US Cancer Death Rates by State

      Each cancer-site-specific section presents the death rate for the given cancer for each state and the District of Columbia, specifying the five highest and the five lowest death rates by state for the most recent 5-year period for all persons, males only, and females only. The rates are per 100,000 persons; they are age-adjusted to the 2000 US standard population. (In some previous editions of the CSR, the 1970 US standard million population was used; death rates standardized to the 2000 US standard million population cannot be compared to death rates standardized to the 1970 US standard million population.)

      The percent difference (PD) between a state rate and the rate for the total US is given by the formula:

      PD = [(State Rate – Total US Rate)/Total US Rate] * 100

      The standard error for each age-adjusted state death rate is calculated, based on the assumptions that (1) for each age-specific rate, the number of deaths is a Poisson random variable (Keyfitz, 1966) and (2) the variance of the age-adjusted rate is a linear combination of the variances of the age-specific rates (Snedecor & Cochran, 1980; pp. 188-9).

      The standard error of the difference (SEd) between a state rate and the total US rate is given by the formula:

      where SES and SEU are the standard errors of a state rate and of the total US rate, respectively, and Cov S,U is the covariance between the two rates. The variance of each rate (i.e., the square of the standard error) and the covariance between the two rates are based on the Poisson assumption. The standard error does not represent the total error that may be present in the age-adjusted rate; it is merely the square root of the variance associated with the rates. In addition to this variance, there also exist potential biases and errors in the measurement of the rate that are difficult to assess accurately and probably impact differently on the error calculations for different states.

      The difference between each age-adjusted state rate and the age-adjusted US rate is tested for statistical significance (see below) by calculating a Z (standard normal) statistic from the formula:

      Z = (State rate – Total US rate) / SEd

      Although the rates being compared are not independent because each state is part of the US, the statistical test may not be substantially affected if the state represents a small proportion of the total US. There is also an adjustment for multiple comparisons; see below under Statistical Significance.

      Joinpoint Regression Analysis of Cancer Trends

      An advance in the presentation of cancer trends is the use of joinpoint models (Kim et al., 2000). In some past issues of the Cancer Statistics Review, certain time intervals (e.g., 1973– 1996) were specified and the annual percent changes (APC) were computed over those intervals. The choices of where to start and where to end an interval were arbitrary and sometimes did not give an accurate picture of the trend for a given cancer site. For example, the rates might be increasing and decreasing in different parts of the same interval. For some sites, increases occurred in the earlier years, followed by declines in more recent years.

      To achieve greater descriptive accuracy, a statistical algorithm finds the optimal number and location of places where a trend changes. The point (in time) when a trend changes is called a joinpoint. Trends may change in different ways at a joinpoint: from up to down, from down to up, from up to up at a different rate, or from down to down at a different rate. A joinpoint regression model describes the trends by a continuous, piecewise-exponential function. Adjacent segments are connected at a joinpoint. The segments are connected because we assume that rates generally change smoothly, rather than “jump” abruptly. In each segment, the rates are assumed to grow or decay exponentially (y = emx+b), i.e., to change by a constant percentage each year. Thus the “slope” m in each segment can be associated with a fixed annual percent change (APC) by APC = 100(em − 1).

      Joinpoint analysis first assumes no joinpoints are needed to describe the data accurately, i.e., the trend over the entire interval 1975-2011 does not change. Joinpoints are added in turn if they are statistically significant. Thus, in the final model, each joinpoint represents a significant change in trend. Smoother polynomial models may provide a good fit overall, but are less sensitive to what is occurring at the ends of the data.

      In running the Joinpoint program, we set the program parameters as follows:

      • Joinpoints occur only at exact years; the joinpoint is not necessarily the same as the data point for that year;
      • The minimum time interval between consecutive joinpoints is three years;
      • The first joinpoint is not earlier than two years after the first year of data;
      • The last joinpoint is not later than two years before the last year of data;
      • The maximum number of joinpoints is five for 1975-2011 (SEER 9) data and three for 1992-2011 (SEER 13) data.

      These restrictions provide some added stability to the resultant models. Different values for these parameters may yield a different joinpoint model. Since the test statistic to determine if additional joinpoints are necessary cannot be compared against any known standard distribution to determine significance (e.g., the normal, t, or f), a permutation test is used which simulates the distribution of the test statistic under the null hypothesis. Thus an element of randomness is introduced by the random number stream used. However, for greater consistency in the p-values obtained if one were to change the random seed for each run, we run the program for 4499 permutations.

      A Windows-based program, Joinpoint, is freely available at http://surveillance.cancer.gov/joinpoint/; it accepts data from the SEER*Stat program, as well as user-defined data. Further details on joinpoint regression may be found at the website. Starting with the 2011 edition of CSR, we have generated all our cancer trend statistics using a Linux-based Joinpoint program as opposed to the downloadable Windows-based program. As a result of using a different platform, in rare instances the results (e.g., # of joinpoints) may differ.

      Average Annual Percent Change (AAPC) is a summary measure of a trend over a pre-specified fixed interval based on an underlying joinpoint model. It allows us to use a single number to describe the average trend over a period of multiple years. It can be estimated even if the joinpoint model indicates that there were changes in trends during those years, since it is estimated as a geometric weighted average of the joinpoint APCs, with the weights equal to the lengths of each segment over the pre-specified fixed interval. In this report, we have included AAPCs as an addendum to the underlying joinpoint trends, and as a summary measure to compare fixed interval trends by race/ethnicity. For more information on how the AAPC is calculated and the advantages of reporting an AAPC over APCs, see http://surveillance.cancer.gov/joinpoint/aapc.html.

      Reporting Delay

      Timely and accurate calculation of cancer incidence rates is hampered by reporting delay, the time lapse before a diagnosed cancer case is reported to the NCI or the delay in receiving updated information for an existing case. Currently, the NCI allows a standard delay of 22 months between the end of the diagnosis year and the time the cancers are reported to the NCI in November, almost two years later. The data are released to the public in the spring of the following year. For example, cases diagnosed in 2011 were first reported to the NCI in November 2013 and released to the public in April 2014. However, in each subsequent release of the SEER data, records from all prior diagnosis years (e.g., diagnosis years 2010 and earlier in the 2013 submission to the NCI) are updated as either new cases are found or new information is received about previously submitted cases.

      The submissions for the most recent diagnosis year are, in general, about two percent below the total number of cancers that will eventually be submitted for that year, although this varies by cancer site and other factors.

      The idea behind modeling reporting delay is to adjust the recent rates to anticipate future corrections (additions, changes, and deletions) to the data. These adjusted rates and the associated delay model are valuable in more precisely determining current cancer trends, as well as in monitoring the timeliness of data collection—an important aspect of quality control (Clegg et al., 2002). Reporting delay models have been previously used in the reporting of AIDS cases (Brookmeyer & Damiano, 1989; Pagano et al., 1994; Harris, 1990).

      In this report, we show SEER age-adjusted incidence rates and trends, along with their calculated delay adjustments for SEER 9 and SEER 13 areas. The adjusted rates, factors, and trends are available for all cancers combined (malignant only except for urinary bladder), for female breast in situ, for urinary bladder (in situ and malignant combined), and for 22 malignant cancer sites: melanoma (for all races combined and whites only), lung/bronchus, colon/rectum, prostate, female breast, liver and intrahepatic bile duct, pancreas, cervix uteri, corpus and uterus, ovary, testis, kidney and renal pelvis, brain and other nervous system, Hodgkin lymphoma, non-Hodgkin lymphoma, all leukemias, esophagus, larynx, myeloma, oral cavity and pharynx, thyroid, and stomach.

      For more information on cancer incidence rates adjusted for reporting delay, see http://surveillance.cancer.gov/delay/. Estimates of observed incidence rates, delay-adjusted incidence rates, and delay-adjustments factors may be found in the Cancer Query Systems at http://seer.cancer.gov/canques/.

      Adjustment for VA Case Backlog, Submission Year 2011

      A policy change of the Department of Veterans Affairs (VA) regarding data sharing on VA cancer cases resulted in underreporting on VA hospital cases for submission years 2007-2011. Some special adjustments to case counts are necessary to fit the delay adjustment model. Beginning with the 2009 submission of SEER data, some SEER registries began accounting for the backlog of VA cases that would have been reported in 2006-2008. This upsurge in cases could cause perturbation in the delay model if fit in the usual manner.

      As with the 2009 to 2011 submissions, to take account of the effect of the VA backlog in the 2012 submission on the delay adjustment model, the counts are adjusted by re-distributing VA cases to previous submission years according to the expected counts from the delay distribution conditional on the current submission. Specifically, for each of the diagnosis years 2004-2009, given the total cancer count in submission year 2012, the proportion of cumulative cancer count in each subsequent submission year is calculated based on the estimated parameters from previous year’s reporting delay model. The VA cases in the 2012 submission are re-distributed to each of the prior submission years according to this proportion. The adjusted total cancer count in that submission year was then calculated by combining the non-VA cases and the redistributed VA counts.

      Delay-adjusted incidence rates and trends are reported for all cancers combined (malignant only except for urinary bladder), for female breast in situ, for urinary bladder (in situ and malignant combined), and for 22 malignant cancer sites: melanoma (for all races combined and whites only), lung/bronchus, colon/rectum, prostate, female breast, liver and intrahepatic bile duct, pancreas, cervix uteri, corpus and uterus, ovary, testis, kidney and renal pelvis, brain and other nervous system, Hodgkin lymphoma, non-Hodgkin lymphoma, all leukemias, esophagus, larynx, myeloma, oral cavity and pharynx, thyroid, and stomach.

      Statistical Significance

      Errors may be made in the estimation of a given statistic. In order to test whether two groups (such as the populations of a state and the entire US) have the same or different actual rates, the observed rates for the groups are compared. Statisticians consider that a difference in observed rates can be explained by one of two hypotheses: (H0) The actual rates are really the same, but the observed rates are different because of some combination of error-causing factors, or (H1) the actual rates of the groups are really different. H0 is called the null hypothesis (because it says there is no real difference); H1 is called the alternate hypothesis. Typically, H0 is rejected only if there is strong evidence in favor of H1. (Thus, if the observed rates are equal, we cannot reject H0.)

      Using statistical theory, one can determine the distribution of the rate difference under the assumption that H0 is true. Then values of the rate difference that are very unlikely to occur if H0 is true are identified. More specifically, a small positive number, called alpha (α), is chosen; usually, α is 0.05 or 0.01. (Alpha is called the significance level of the hypothesis test.) One can then identify limits for the difference in rates such that, if H0 is true, the probability of the difference being outside of those limits is α. If the observed difference is outside of these limits, then the observed result is very unlikely to happen if H0 is true, so H0 is rejected.

      Another way of looking at the same process is to calculate, assuming H0 is true, the probability that the observed difference or any greater difference would occur; this number is called the P-value of the observed result. If the P-value of a comparison is less than α (that is, the observed difference is very unlikely to happen if the null hypothesis is true), H0 will be rejected. If the P-value of a test is greater than the significance level α, H0 will not be rejected. When a difference in rates is sufficiently large to cause the null hypothesis to be rejected for a given value of α (usually 0.05), it is called a statistically significant difference.

      When a null hypothesis is rejected, there remains a small chance that a wrong decision has been made. If many statistical comparisons are done, even with α = 0.01, the chance of making at least one wrong decision becomes a concern. In testing the differences between the total US rate and the rate for each state (or for the District of Columbia) for a given cancer, 51 statistical comparisons of the type described above are performed. Based on one of Bonferroni’s inequalities (if there are n events and pi is the probability of success in event i, then P(at least 1 success) < p1 + … + pn) (Snedecor & Cochran,1980; p. 115-117), the significance level α for each individual comparison was set equal to 0.01/51 ≈ 0.0002. Thus, only individual-state-to-total-US comparisons with an associated P-value less than 0.0002 are considered to be statistically significant. That is, a very small significance level α (0.0002) is used in order to minimize the total risk (0.01) of falsely deciding that some pair of equal rates are unequal.

      Use caution in assessing statistically significant differences. Population size has an important role in any calculation of statistical significance. Some states may have estimated rates that are very close to the estimated total US rate, but because of their large population, the difference between their estimated rate and the estimated total US rate is found to be statistically significant. In this case, the true state rate and the true US rate are almost certainly different, because the observed difference, though small, is nearly impossible if the null hypothesis (equal rates) is true. A small difference in rates, however, may have no practical importance. On the other hand, some smaller states may have estimated rates that differ substantially from the estimated total US rate, but because of their relatively small population, the differences are found to be statistically nonsignificant. When this happens, if the true state rate and the true US rate were equal, the probability of obtaining a difference at least as large as what has been observed is greater than α ≈ 0.0002. Therefore, because the evidence against it isn’t strong enough, the null hypothesis (equal rates) is not rejected.

      If the percent difference (PD) between the two rates is small, there may be some question about the importance of the difference. It is difficult to specify a minimally significant absolute PD, below which the difference would always be unimportant, because the observed PD will depend on the populations of the areas involved. It may be of value to consider the size of the PD between a state rate and the US rate in assessing the importance of a statistically significant difference.

      Comparing individual state rates with the US rate and assessing statistical significance is not an appropriate procedure for assessing geographic clustering of state rates. Identification of states which may represent regional clusters of high or low rates would require additional statistical and graphical analyses.

      For a number of cancers, the District of Columbia has the highest death rates. Use caution when comparing cancer rates for the District with those from the 50 states. The District is an entirely urban area, whereas a state includes urban, suburban, and rural areas. Mortality rates for many cancers are higher in urban areas. Also, the District has a higher percentage of blacks —51% of the total population in 2010 (US Census Bureau, 2013)—than any state. In addition, their higher mortality rates for several types of cancer elevate the overall rate for the District.

      Standard Errors of Rates

      Survival rates: In the tables presenting survival estimates, the magnitude of the standard error is given as a measure of the reliability of a given rate: the greater the standard error, the more uncertainty associated with the estimated rate. In addition, if there were fewer than 25 diagnoses in the first interval of the life table constructed to calculate survival, or if all cases became lost to follow-up within an interval, a valid survival estimate could not be calculated, as is noted in the table footnotes.

      The standard error (SE) of a relative survival estimate is obtained as follows (Ederer et al., 1961):

      SE(CRt) = CRt * square root of [q1/(e1-d1) + q2/(e2-d2) +… + qt/(et-dt)]

      where CRt is the t-year relative survival estimate, and for i = 1, …, t,

      qi is the probability of dying in year i after diagnosis,

      ei is the effective number of patients at risk in year i after diagnosis, and

      di is the number of deaths in year i after diagnosis.

      Incidence and mortality rates: The standard errors of age-adjusted incidence and mortality rates are often not specified. However, the reader can approximate the SE of a particular incidence or mortality rate by the SE of a crude incidence or mortality rate (Keyfitz, 1966), that is, the SE can be approximated by the rate divided by the square root of the number of cancer cases (or the number of deaths).

      Appendix tables provide numbers of cancer diagnoses within SEER areas and numbers of deaths in the entire US, respectively, by race and sex for the most recent 5-year period. These can be used to obtain approximations of the standard errors for associated age-adjusted rates for the same time period using the above formula. To approximate the standard error of a rate for a single year, use the formula but replace the number of cancer cases or deaths with the number of cancer cases or deaths divided by 5.

      Definitions

      Several technical terms are used in presenting the data in this report. Their definitions are presented here to clarify them for the reader.

      Incidence rate: The cancer incidence rate is the number of new cancers of a specific site/type occurring in a specified population during a year, usually expressed as the number of cancers per 100,000 persons at risk. That is,

      Incidence rate = (New cancers / Population) * 100,000.

      The numerator of the incidence rate is the number of new cancers; the denominator of the incidence rate is the size of the population. The number of new cancers may include multiple primary cancers occurring in one patient. The primary site reported is the site of origin and not the metastatic site. In general, the incidence rate would not include recurrences. The population used depends on the rate to be calculated. For cancer sites that occur in only one sex, the sex-specific population (e.g., females for cervical cancer) is used.

      The incidence rate can be computed for a given type of cancer or for all cancers combined. Except for 5-year age-specific rates, all incidence rates in this report are age-adjusted (see below) to the 2000 US standard population (or, where appropriate, to the world standard million population). (In some previous editions of the CSR, the 1970 US standard million population was used; therefore, incidence rates in this edition cannot be compared to rates published in those editions.) Incidence rates are for invasive cancer only, unless otherwise specified. (Exceptions are the incidence rate for cancer of the urinary bladder (where both in situ and invasive cancers are counted) and breast cancer in situ, which is shown separately.)

      Death rate: The cancer death (or mortality) rate is the number of deaths with cancer given as the underlying cause of death occurring in a specified population during a year, usually expressed as the number of deaths due to cancer per 100,000 persons. That is,

      Death Rate = (Cancer Deaths / Population) * 100,000.

      The numerator of the death rate is the number of deaths; the denominator of the death rate is the size of the population. As with the incidence rate, the population used depends on the rate to be calculated. The death rate can be computed for a given cancer site or for all cancers combined. Except for 5-year age-specific rates, all death rates in this report are age-adjusted (see below) to the 2000 US standard population (or, where appropriate, to the world standard million population). (In some previous editions of the CSR, the 1970 US standard million population was used; therefore, death rates in this edition cannot be compared to rates published in those editions.)

      Age distribution: A table showing a partition of the entire lifespan into disjoint age intervals, along with the proportion of the population in each interval.

      Median age: The age at which half of a population is younger and half is older.

      Standard population: A standard population for a geographic area, such as the US or the world, is a table giving the proportions of the population falling into the age groups 0, 1-4, 5-9, …, 80-84, and 85+. A standard million population for a geographic area is a table giving the number of persons in each age group 0, 1-4, …, 85+ out of a theoretical cohort of 1,000,000 persons that is distributed by age in the same proportions as the standard population. Table A-7 shows the US 2000 standard population and the world standard million population. (Some World Health Organization mortality publications use a different world standard million population.)

      Age-adjusted rate: An age-adjusted incidence or mortality rate is a weighted average of the age-specific incidence or mortality rates, where the weights are the counts of persons in the corresponding age groups of a standard population. The potential confounding effect of age is reduced when comparing age-adjusted rates based on the same standard population. For this report, the 2000 US standard population (or, where appropriate, the world standard million population) is used in computing age-adjusted rates, unless otherwise noted.

      Percent change: The percent change (PC) in a statistic over a given time interval is

      Percent change = (Final value – Initial value) / Initial value * 100.

      A positive PC corresponds to an increasing trend, a negative PC to a decreasing trend.

      Annual percent change: The annual percent change (APC) is calculated by first fitting a regression line to the natural logarithms of the rates (r) using calendar year (x) as a regressor variable. In this report the method of weighted least squares is used to calculate the regression equation. If ln(r) = mx + b is the resulting regression equation (with slope m), then APC = 100 * (em − 1). A positive APC corresponds to an increasing trend, a negative APC to a decreasing trend.

      Because the methods used in their calculation are mathematically different, the signs of the PC and the APC for a given statistic and time interval may differ, as occurs in a few of the tables presented. That is, one of these statistics may show an increasing trend, the other a decreasing trend.

      Testing the hypothesis that the actual mean annual percent change is 0 is equivalent to testing the hypothesis that the theoretical slope estimated by the slope m of the line representing the equation ln(r) = mx + b is 0. The latter hypothesis is tested using the t distribution of m / SEm with n − 2 degrees of freedom. The standard error of m, called SEm, is obtained from the fit of the regression (Kleinbaum et al., 1988). (This calculation assumes that the rates increased or decreased at a constant rate over the entire calendar year interval; the validity of this assumption was not assessed.) In those few instances where at least one of the rates was 0, the linear regression was not calculated.

      Average Annual Percent Change: The average annual percent change (AAPC) is a summary measure of a trend over a pre-specified fixed interval based on an underlying joinpoint model. It allows us to use a single number to describe the average trend over a period of multiple years. It can be estimated even if the joinpoint model indicates that there were changes in trends during those years, since it is estimated as a weighted average of the joinpoint APCs, with the weights equal to the lengths of each subinterval over the pre-specified fixed interval.

      Life table: A table for a given population listing, for each sex and each age from 0 to 120, how many members die at that age and how many survive one more year.

      Observed survival: The observed survival estimate represents the proportion of cancer patients surviving for a specified time interval after diagnosis. Note that some of those not surviving died of the given cancer and some died of other causes.

      Relative survival: The relative survival estimate is calculated using a procedure (Ederer et al., 1961; Ederer and Heise, 1959) whereby the observed survival estimate is adjusted for expected mortality. The relative survival estimate approximates the likelihood that a patient will not die from causes associated specifically with the given cancer before some specified time after diagnosis. It is always larger than the observed survival estimate for the same group of patients.

      Standard error: The standard error of a rate is a measure of the sampling variability of the rate.

      Person-years of life lost: The person-years of life lost (PYLL) is calculated as follows: For each individual who dies of the cancer of interest, the number of years of expected additional life for an average person of that age, race, and sex is obtained from life tables for the US population (available from the NCHS). The PYLL in the general population associated with a particular cancer for a given year is simply the sum of this expectation over all those individuals who died of that cancer in that year.

      Average years of life lost: The average years of life lost (AYLL) associated with a particular cancer for a given year is the PYLL associated with that cancer in the general population divided by the number of deaths from that cancer in the general population in that year.

      Prevalence: Prevalence is defined as the number or percent of people alive on a certain date in a population who previously had a diagnosis of the disease. It includes new (incident) and preexisting cases and is a function of past incidence, past survival, and the size and age structure of the population.Limited-duration prevalence represents the proportion of people alive on a certain day who had a diagnosis of the disease within the past x years (e.g. x = 5, 10, or 20 years). Complete prevalence is an estimate of the number of persons (or the proportion of the population) alive on a specified date who had been diagnosed with the given disease, no matter how long ago that diagnosis was. For more details on cancer prevalence definitions and methods, refer to http://surveillance.cancer.gov/prevalence/.

      Stage of disease at diagnosis: Extent-of-disease information determines stage of disease at diagnosis. The SEER summary stage presented has four levels. An invasive neoplasm confined entirely to the organ of origin is said to be localized. A neoplasm that has extended beyond the limits of the organ of origin, either directly into surrounding organs or tissues or into regional lymph nodes, is said to be regional. A neoplasm that has spread to parts of the body remote from the primary tumor, either by direct extension or by discontinuous metastasis, is said to be distant. When information is not sufficient to assign a stage, a neoplasm is said to be unstaged. In situ tumors (except those of the cervix uteri) are also collected by SEER but generally are not published in this series. For some cancers and diagnosis years, the extent of disease information can also be converted to Stages 0-IV as defined by the American Joint Committee on Cancer (Greene et al, 2002; Edge et al., 2010 ).

      Software used to Generate the Seer Cancer Statistics Review

      The SEER Cancer Statistics Review includes statistics generated by a variety of statistical software including:

      • SEER*Stat, statistical software for the analysis of SEER and other cancer databases, was used to generate incidence, mortality, prevalence, and survival statistics presented in the CSR.
      • Analysis generated by the Joinpoint Regression Program are presented to better describe trends that are not constant over time.
      • The DevCan system generated the probability of developing cancer from twelve SEER areas and the probability of dying from cancer from the total United States.
      • The ComPrev software was used to calculate complete prevalence estimates.

      Additional statistics can be obtained via SEER’s Cancer Query Systems. These data retrieval applications provide access to pre-calculated cancer statistics stored in online databases.

      References

      Table 1.1 Estimated New Cancer Cases and Deaths for 2014 All Races, By Sex

      Table 1.3 62-Year Trends in U.S. Cancer Death Ratesa All Races, Males and Females All Primary Cancer Sites Combined

      Table 1.4 Summary of Changes in Cancer Mortality, 1950-2011 and 5-Year Relative Survival (Percent), 1950-2010 Males and Females, By Primary Cancer Site

      Table 1.5 Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival (Percent) By Primary Cancer Site, Sex and Time Period

      Table 1.6 Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival (Percent) By Primary Cancer Site, Sex and Time Period

      Table 1.7 Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival (Percent) By Primary Cancer Site, Sex and Time Period

      Table 1.8 SEER Incidence and U.S. Mortality Trends by Primary Cancer Site and Sex All Races, 2002-2011

      Table 1.9 SEER Incidence and U.S. Mortality Trends by Primary Cancer Site and Sex Whites, 2002-2011

      Table 1.10 SEER Incidence and U.S. Mortality Trends by Primary Cancer Site and Sex Blacks, 2002-2011

      Table 1.11 Age Distribution (%) of Incidence Cases by Site, 2007-2011 All Races, Both Sexes

      Table 1.12 Median Age of Cancer Patients at Diagnosisa, 2007-2011 By Primary Cancer Site, Race and Sex

      Table 1.13 Age Distribution (%) of Deaths by Site, 2007-2011 All Races, Both Sexes

      Table 1.14 Median Age of Cancer Patients at Deatha, 2007-2011 By Primary Cancer Site, Race and Sex

      Table 1.15 Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site and Race/Ethnicity Both Sexes, 18 SEER Areas, 2009-2011

      Table 1.16 Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site and Race/Ethnicity Males, 18 SEER Areas, 2009-2011

      Table 1.17 Lifetime Risk (Percent) of Being Diagnosed with Cancer by Site and Race/Ethnicity Females, 18 SEER Areas, 2009-2011

      Table 1.18 Lifetime Risk (Percent) of Dying from Cancer by Site and Race/Ethnicity Both Sexes, Total U.S., 2009-2011

      Table 1.19 Lifetime Risk (Percent) of Dying from Cancer by Site and Race/Ethnicity Males, Total U.S., 2009-2011

      Table 1.20 Lifetime Risk (Percent) of Dying from Cancer by Site and Race/Ethnicity Females, Total U.S., 2009-2011

      Table 1.21 U.S.and SEER Death Rates by Primary Cancer Site and Race/Ethnicity, 2007-2011

      Table 1.22 U.S.Prevalence Counts, Invasive Cancers Only, January 1, 2011a Using Different Tumor Inclusion Criteriab

      Table 1.23 U.S.Complete Prevalence Counts, Invasive Cancers Only, January 1, 2011a By Age at Prevalence

      Table 1.24 Age-Adjusted SEER Incidence Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Both Sexes

      Table 1.25 Age-Adjusted SEER Incidence Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Males

      Table 1.26 Age-Adjusted SEER Incidence Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Females

      Table 1.27 Age-Adjusted U.S. Death Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Both Sexes

      Table 1.28 Age-Adjusted U.S. Death Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Males

      Table 1.29 Age-Adjusted U.S. Death Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Females

      Figure 1.1 Surveillance, Epidemiology, and End Results (SEER) Program: SEER 9, 13, & 18 Geographic Areas National Cancer Institute, USA

      Figure 1.2 Leading Causes of Death in US, 1975 vs 2011 Percent of All Causes of Death

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention.

      Figure 1.3 Us Death Rates, 1975-2011 Heart Disease compared to Neoplasms, by age at death

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention.Rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      Figure 1.4 Trends in SEER Incidence and US Death Rates by Primary Cancer Site 2002-2011

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG) and US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention.

      Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

      * The APC is significantly different from zero (p<.05).

      a Ovary excludes borderline cases or histologies 8442, 8451, 8462, 8472, and 8473.

      Figure 1.5 Trends in SEER Incidence Rates by Age Group and Primary Cancer Site 2002-2011

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG).

      Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

      * The APC is significantly different from zero (p<.05).

      a Ovary excludes borderline cases or histologies 8442, 8451, 8462, 8472, and 8473.

      Figure 1.6 Trends in US Death Rates by Age Group and Primary Cancer Site 2002-2011

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention.

      Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

      * The APC is significantly different from zero (p<.05).

      Figure 1.7 Trends in SEER Incidence Rates by Sex and Primary Cancer Site 2002-2011

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG). Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

      * The APC is significantly different from zero (p<.05).

      a Ovary excludes borderline cases or histologies 8442, 8451, 8462, 8472, and 8473.

      Figure 1.8 Trends in US Death Rates by Sex and Primary Cancer Site 2002-2011

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. Underlying rates are per 100,000 and age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). For sex-specific cancer sites, the population was limited to the population of the appropriate sex.

      * The APC is significantly different from zero (p<.05).

      Figure 1.9 SEER Incidencea and US Death Rates,b 2007-2011 5-Year Relative Survival,c 2004-2010 All Cancer Combined, by Race and Sex

      a Incidence rates are from the SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry,Rural Georgia,California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG) and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      b Death rates are from the US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      c Survival rates are from the SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG).

      Table 1.25 Age-Adjusted SEER Incidence Rates and Trends for the Top 15 Cancer Sitesa by Race/Ethnicity Males

      Figure 1.11 5-Year Relative Survival (%) SEER Program, 2004-2010 Both Sexes, by Race and Cancer Site

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG).

      a Ovary excludes borderline cases or histologies 8442, 8451, 8462, 8472, and 8473.

      Figure 1.12 SEER Cancer Incidence and US Death Rates, 2007-2011 By Cancer Site and Race/Ethnicity

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG) and US Mortality Files,

      a National Center for Health Statistics, Centers for Disease Control and Prevention. Rates for American Indian/Alaska Native are based on the CHSDA (Contract Health Service Delivery Area) counties.

      b Hispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics are based on NHIA and exclude cases from the Alaska Native Registry.

      Figure 1.13 SEER Incidence 2002-2011 Males by Race/Ethnicity

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG). Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). Regression lines are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute.

      a Incidence rates for American Indian/Alaska Native (AI/AN) are based on the CHSDA(Contract Health Service Delivery Area) counties.

      b Hispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics are based on NHIA and exclude cases from the Alaska Native Registry.

      Figure 1.14 SEER Incidence 2002-2011 Females by Race/Ethnicity

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG). Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). Regression lines are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute.

      a Incidence rates for American Indian/Alaska Native (AI/AN) are based on the CHSDA(Contract Health Service Delivery Area) counties.

      b Hispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics are based on NHIA and exclude cases from the Alaska Native Registry.

      Figure 1.15 US Mortality 2001-2010 Males by Race/Ethnicity

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      a Regression lines are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute.

      b Mortality rates for American Indian/Alaska Native (AI/AN) are based on the CHSDA(Contract Health Service Delivery Area) counties. Hispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives.

      Figure 1.16 US Mortality 2001-2010 Females by Race/Ethnicity

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      a Regression lines are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute.

      b Mortality rates for American Indian/Alaska Native (AI/AN) are based on the CHSDA(Contract Health Service Delivery Area) counties. Hispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives.

      Figure 1.17 Incidence Percent Change between 2002 and 2011 Numbers (burden) vs Rates (risk) All Races, All Ages, Both Sexes

      Source: SEER 18 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey and Georgia excluding ATL/RG). Burden is the change in the number of incidence cases between 2002 and 2011. Risk is the change in the cancer incidence rates between 2002 and 2011.

      a Ovary excludes borderline cases or histologies 8442, 8451, 8462, 8472, and 8473.

      Figure 1.18 Mortality Percent Change between 2002 and 2011 Numbers (burden) vs Rates (risk) All Races, All Ages, Both Sexes

      US Mortality estimates based on US age-specific rates applied to US population.

      Burden is the change in the number of deaths between 2002 and 2011.

      Risk is the change in the cancer death rates between 2002 and 2011.

      Figure 1.19 Person-Years of Life Lost Due to Cancer All Races, Both Sexes, 2011
      Average Years of Life Lost Per Person Dying of Cancer All Races, Both Sexes, 2011

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention and 2009 Life Tables.

      Figure 1.20 Person-Years of Life Lost Due to Major Causes of Death in US All Races, Both Sexes, 2011
      Average Years of Life Lost Per Person Due to Major Causes of Death in US All Races, Both Sexes, 2011

      Source: US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention and 2009 Life Tables.

      Figure 1.21 SEER Observed Incidence and Delay Adjusted Incidence Ratesa All Cancer Sites, By Sex

      a Source: SEER 9 areas. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). Regression lines and APCs are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute. The APC is the Annual Percent Change for the regression line segments. The APC shown on the graph is for the most recent trend.

      * The APC is significantly different from zero (p < 0.05).

      Figure 1.22 SEER Observed Incidence and Delay Adjusted Incidence Ratesa Both Sexes

      a Source: SEER 9 areas. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103). Regression lines and APCs are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute. The APC is the Annual Percent Change for the regression line segments. The APC shown on the graph is for the most recent trend.

      * The APC is significantly different from zero (p < 0.05).

      Figure 1.23 SEER Observed Incidence and Delay Adjusted Incidence Ratesa Males

      a Source: SEER 9 areas. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      Regression lines and APCs are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute. The APC is the Annual Percent Change for the regression line segments. The APC shown on the graph is for the most recent trend.

      * The APC is significantly different from zero (p < 0.05).

      Figure 1.24 SEER Observed Incidence and Delay Adjusted Incidence Ratesa Females

      a Source: SEER 9 areas. Rates are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1103).

      Regression lines and APCs are calculated using the Joinpoint Regression Program Version 4.1.0, April 2014, National Cancer Institute. The APC is the Annual Percent Change for the regression line segments. The APC shown on the graph is for the most recent trend.

      * The APC is significantly different from zero (p < 0.05).

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