Indicator Definitions – Cancer

Family Group

Cancer is the second-leading cause of death among Americans, causing one in every six deaths in the United States. In 2019, more than 1.7 million new cases of invasive cancer were diagnosed in Americans and more than 599,500 Americans died from this disease. In 2019, the direct medical costs for cancer, including all health care expenditures, were $140.7 billion and an estimated 12.8 million Americans were living with a history of invasive cancer diagnosed in the past 18 years.

Several effective primary and secondary prevention measures could substantially reduce the number of new cancer cases and prevent many cancer-related deaths. These measures include reducing behavioral and environmental factors that increase cancer risk, ensuring high-quality screening services and evidence-based treatments are available and accessible to everyone, supporting medically underserved populations, and improving the quality of life for people who have survived cancer. CDC’s Division of Cancer Prevention and Control has supported all 50 states, the District of Columbia, tribes and tribal organizations, Pacific Island Jurisdictions, and Puerto Rico in developing, implementing, and promoting proven strategies and planned actions to prevent cancer in their geographic regions.

Definition Details

Colon and rectum (colorectal) cancer mortality among all people, underlying cause
Population: All people
Numerator: Deaths with International Classification of Diseases (ICD)-10 codes C18–C20 as the underlying cause of death among residents during a calendar year
Denominator: Midyear resident population for the same calendar year.
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every six deaths in the United States was due to cancer.1 Colorectal cancer is a leading cause of cancer death and, in 2021, more than 52,000 people died from the disease.1 Declines in colorectal cancer death trends have slowed in more recent years. During 2001–2019, the average declines accelerated from 3.1% per year during 2001–2009 to 2.1% per year during 2009–2019 among males and from 3.0% per year during 2001–2010 to 2.0% per year during 2010–2019 among females.2 Screening can prevent colorectal cancer by detecting and removing precancerous polyps and can detect cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that adults age 45 to 75 be screened for colorectal cancer.3
Notes: Because colorectal cancer can have a long latency period, years might pass before changes in behavior or clinical practice patterns affect population mortality.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: Healthy People 2030 objective: C-06. Reduce the colorectal cancer death rate
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479
Reference 3: US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965–1977. doi:10.1001/jama.2021.6238

Breast cancer mortality among all females, underlying cause
Population: All people
Numerator: Deaths with International Classification of Diseases (ICD)-10 code C50 as the underlying cause of death among female residents during a calendar year
Denominator: Midyear resident female population for the same calendar year.
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every six deaths in the United States was due to cancer.1 Female breast cancer is a leading cause of cancer death and in 2021, nearly  43,000 females died from the disease.1 Trends in breast cancer death rates during 2001–2019 varied in declines over the time period (1.6% per year during 2001–2003; 2.3% per year during 2003–2007; 1.6% per year during 2007–2013; 1.2% per year during 2013–2019).2 Screening can detect breast cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years. Women who are 40 to 49 years old should talk to their doctor or other health care provider about when to start and how often to get a mammogram.3
Notes: Because breast cancer can have a long latency period, years might pass before changes in behavior or clinical practice patterns affect population mortality.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: Healthy People 2030 objective: C-04. Reduce the female breast cancer death rate
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479
Reference 3: Siu AL, US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016. doi:10.7326/M15-2886

Cervical cancer mortality among all females, underlying cause
Population: All females
Numerator: Deaths with International Classification of Diseases (ICD)-10 code C53 as the underlying cause of death among female residents during a calendar year
Denominator: Midyear resident female population for the same calendar year
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every six deaths in the United States was due to cancer.1 In 2021, more than 4,300 females died from cervical cancer.1 Trends in cervical cancer death rates during 2001–2019 were stable during 2001–2003 and decreased 0.8% per year during 2003–2019.2 Screening can help prevent cervical cancer or find it early, when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).3
Notes: Because cervical cancer can have a long latency period, years might pass before changes in behavior or clinical practice patterns affect population mortality.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: None
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479
Reference 3: US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686. doi:10.1001/jama.2018.10897

Lung and bronchial cancer mortality among all people, underlying cause
Population: All people
Numerator: Deaths with International Classification of Diseases (ICD)-10 code C34 as the underlying cause of death among residents during a calendar year
Denominator: Midyear resident population for the same calendar year
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every six deaths in the United States was due to cancer.1 Lung cancer is the leading cause of cancer death and in 2021, more than 134,000 people died from the disease.1 Declines in lung cancer death trends continued over time. During 2001–2019, the average declines accelerated for males (2.0% per year during 2001–2005; 2.9% per year during 2005–2012; 4.1% per year during 2012–2015; and 5.4% per year during 2015–2019) and females (0.6% per year during 2001–2007; 2.0% per year during 2007–2014; and 4.2% per year from 2014–2019).2 The U.S. Preventive Services Task Force recommends yearly lung cancer screening with low-dose computed tomography for people who: (1) have a 20 pack-year or more smoking history; (2) smoke now or have quit within the past 15 years; (3) and are between 50 and 80 years old.3 Lung cancer screening is not a substitute for quitting smoking.3
Notes: Because lung cancer can have a long latency period, years might pass before changes in behavior or clinical practice patterns affect population mortality.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: Healthy People 2030 objective: C-02. Reduce the lung cancer death rate
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479
Reference 3: US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962–970. doi:10.1001/jama.2021.1117

Prostate cancer mortality among all males, underlying cause
Population: All males
Numerator: Deaths with International Classification of Diseases (ICD)-10 code C61 as the underlying cause of death among male residents during a calendar year
Denominator: Midyear resident male population for the same calendar year
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every six deaths in the United States was due to cancer.1 Prostate cancer is a leading cause of cancer death and, in 2021, more than 32,000 males died from the disease.1 Trends in prostate cancer death rates during 2001–2019 declined 3.4% per year during 2001–2013 and were level during 2013–2019.2 In 2018, the U.S. Preventive Services Task Force (USPSTF) stated that men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test. Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment. Men who are 70 years old and older should not be screened for prostate cancer routinely.3
Notes: Because prostate cancer can have a long latency period, years might pass before changes in behavior or clinical practice patterns affect population mortality.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: Healthy People 2030 objective: C-08. Reduce the prostate cancer death rate
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479
Reference 3: US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901–1913. doi:10.1001/jama.2018.3710

Colorectal cancer screening among adults aged 45-75 years
Population: Population: Adults aged 45-75
Numerator: Adults aged 45–75 years who report having had a fecal occult blood test (FOBT) within the previous year; a FIT-DNA test within the previous 3 years; a sigmoidoscopy within the previous 5 years; a sigmoidoscopy within the previous 10 years with a FIT in the past year; a colonoscopy within the previous 10 years; or a CT colonography (virtual colonoscopy) within the previous 5 years.
Denominator: Adults aged 45–75 years who report having had or never having a fecal occult blood test (FOBT); a FIT-DNA test; a sigmoidoscopy; a colonoscopy; or a CT colonography (virtual colonoscopy).
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Previous year for FOBT alone; previous 3 years for FIT-DNA test alone; previous 5 years for sigmoidoscopy alone; 10 years for a sigmoidoscopy combined with a FIT in the past year; 10 years for a colonoscopy alone; every 5 years for CT colonography (virtual colonoscopy) alone.
Summary: Colorectal cancer is a leading cause of cancer incidence and death.1 In 2021, more than 142,000 people were diagnosed with and 52,000 people died from the disease.1 Screening can prevent colorectal cancer by detecting and removing precancerous polyps and can detect cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that adults age 45 to 75 be screened for colorectal cancer.2 There are different time intervals and several types of tests for colorectal cancer screening, including stool tests (including one that detect altered DNA in the stool), flexible sigmoidoscopy, colonoscopy, and computed tomography (CT) colonoscopy (or virtual colonoscopy).2
Notes: In May 2021, the U.S. Preventive Services Task Force changed its colorectal cancer screening recommendation. The age at which adults at average risk of getting colorectal cancer were recommended to begin screening was lowered from 50 to 45. The BRFSS 2020 colorectal cancer screening questions changed to include five test types (FIT, sigmoidoscopy, colonoscopy, FIT-DNA, and CT colonography) compared to three types (FIT, sigmoidoscopy, and colonoscopy) included previously. Estimates of people getting colorectal cancer screening are not comparable to previous years. Recommendations for colorectal cancer screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: Healthy People 2030 objective: C-07. Increase the proportion of adults who get screened for colorectal cancer
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965–1977. doi:10.1001/jama.2021.6238

Invasive cancer (all sites combined), incidence
Population: All people
Numerator: Incident cases of cancer with an International Classification of Diseases for Oncology Second Edition (ICD-O-2) or Third Edition (ICD-O-3) (for cases diagnosed after January 1, 2001) code C00 – C80 and behavior = 3 (malignant, primary site) or C67.0 – C67.9 (bladder cancer) and behavior = 2 or 3 (in situ or malignant, primary site) among residents during a calendar year (certain histologic types are excluded).
Denominator: Midyear resident population for the same calendar year
Measure: Annual incidence number and rate (crude and age-adjusted) [cases per 100,000] from a 5-year cycle
Time Period of Case Definition: Five years
Summary: In 2019, more than 1.7 million new cases of cancer were diagnosed.1 Approximately one in two males and one in three females will have a diagnosis of cancer over their lifetime.2 Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions.3 Information on all cancer sites combined provides a measure of, and means of tracking, the burden from cancer. Trends in cancer incidence rates varied by sex. Among males, incidence rates were stable during 2001–2007, decreased an average of 2.1% per year during 2007–2013, and became stable again during 2013–2018. Among females, incidence rates were stable during 2001–2003 and increased an average of 0.2% per year during 2003–2018.4
Notes: Interpretation of trends or patterns in cancer incidence can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect the incidence of new cancer cases. In addition, certain cancers are not amenable to primary prevention or screening.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: None
Related CDI Topic Area: None
Reference 1: US Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, Based on 2021 Submission Data (1999-2019). National Cancer Institute, Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2022. https://www.cdc.gov/cancer/dataviz
Reference 2: Hayat, M.J., Howlader, N., Reichman, M.E. and Edwards, B.K. (2007), Cancer Statistics, Trends, and Multiple Primary Cancer Analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. The Oncologist. 2007; 12: 20-37. doi:10.1634/theoncologist.12-1-20
Reference 3: National Cancer Institute, PDQ Screening and Prevention Editorial Board. Cancer Prevention Overview (PDQ®)–Patient Version. National Institutes of Health; Accessed November 3, 2022. https://www.cancer.gov/about-cancer/causes-prevention/patient-prevention-overview-pdq
Reference 4: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479

Invasive cancer (all sites combined) mortality among all people, underlying cause
Population: All people
Numerator: Incident cases of cancer with an International Classification of Diseases (ICD)-10 codes C00–C97 as the underlying cause of death among residents during a calendar year
Denominator: Midyear resident population for the same calendar year.
Measure: Mortality rate (crude and age-adjusted); number [cases per 100,000]—from a 5-year cycle
Time Period of Case Definition: Calendar year
Summary: In 2021, one out of every five deaths in the United States was due to cancer.1 In 2021, more than 605,000 people died from the disease.1 Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions.2 Information on all cancer sites combined provides a measure of, and means of tracking, the burden from cancer. Trends in cancer death rates varied by sex. During 2001–2019, trends among males showed that average declines accelerated from 1.8% per year during 2001–2015 to 2.3% per year during 2015–2019. Among females, trends declined from 1.4% per year during 2001–2016 to 2.1% per year during 2016–2019.3
Notes: Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions. Interpretation of trends or patterns in cancer mortality can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect cancer mortality. In addition, certain cancers are not amenable to primary prevention or screening.
Data Source: U.S. Cancer Statistics Data Visualizations Tool (US Cancer DVT)
Related Objectives or Recommendations: Healthy People 2030 objective: C-01. Reduce the overall cancer death rate
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: National Cancer Institute, PDQ Screening and Prevention Editorial Board. Cancer Prevention Overview (PDQ®)–Patient Version. National Institutes of Health; Accessed November 3, 2022. https://www.cancer.gov/about-cancer/causes-prevention/patient-prevention-overview-pdq
Reference 3: Cronin KA, Scott S, Firth AU, et al. Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251–4284. doi:10.1002/cncr.34479

Mammography use among women aged 50–74 years
Population: Females aged 50–74 years
Numerator: Females aged 50–74 years who report having had a mammogram within the previous 2 years
Denominator: Female respondents aged 50–74 years who report ever having or never having had a mammogram (excluding unknowns and refusals)
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: Previous 2 years
Summary: Female breast cancer is a leading cause of cancer death and in 2021, nearly 43,000 females died from the disease.1 Screening can detect breast cancer early when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years. Women who are 40 to 49 years old should talk to their doctor or other health care provider about when to start and how often to get a mammogram.2
Notes: Recommendations for mammography screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: Healthy People 2030 objective: C-05. Increase the proportion of females who get screened for breast cancer
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: Siu AL, US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016. doi:10.7326/M15-2886

Cervical cancer screening among women aged 21–65 Years
Population: Females aged 50–74 years
Numerator: Female respondents aged 21–65 years who do not report having had a hysterectomy and who report having had a Papanicolaou (Pap) test within the previous 3 years AND, female respondents 30–65, who do not report having had a human papilloma virus (HPV) test alone or in combination with a HPV test (also known as a co-test) within the previous 5 years.
Denominator: All female respondents aged 21–65 years.
Measure: Prevalence (crude and age-adjusted)
Time Period of Case Definition: For age 21–65: Previous 3 years for Pap test alone
For age 30–65 only: Previous 5 years for HPV test alone or combination of Pap test (co-test).
Summary: In 2021, more than 4,300 females died from cervical cancer.1 Screening can help prevent cervical cancer or find it early, when treatment is more likely to be effective. The U.S. Preventive Services Task Force recommends for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).2
Notes: In August 2018, the U.S. Preventive Services Task Force changed its cervical cancer screening recommendation to include another type of screening (hrHPV testing alone every 5 years). Estimates of people getting cervical cancer screening are not comprable to previous years. Recommendations for cervical cancer screening are not always consistent among national groups. The questions are part of the BRFSS Rotating Core (even years).
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Related Objectives or Recommendations: Healthy People 2030 objective: C-09. Increase the proportion of females who get screened for cervical cancer
Related CDI Topic Area: None
Reference 1: Centers for Disease Control and Prevention. CDC WONDER. Underlying Cause of Death, 2018-2021, Single Race. https://wonder.cdc.gov/ucd-icd10-expanded.html
Reference 2: US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686. doi:10.1001/jama.2018.10897

Additional Data Sources