714 Special Article | JNCI Vol. 103, Issue 9 | May 4, 2011
DOI: 10.1093/jnci/djr077 Published by Oxford University Press 2011.
Advance Access publication on March 31, 2011. This is an Open Access article distributed under the terms of the Creative Com mons Attribution
Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Since our first Report to the Nation, published in 1998, docu-
mented the first sustained decrease in cancer death rates since
the 1930s (1), the American Cancer Society, the Centers for
Disease Control and Prevention (CDC), the National Cancer
Institute (NCI), and the North American Association of Central
Cancer Registries (NAACCR) have collaborated annually to
produce a report on the status of cancer in the United States.
Each subsequent year, reports have updated information on
trends in incidence and death rates and featured in-depth
analyses of selected topics (2–12). The current report provides
the latest information on trends for all cancers combined, childhood
cancers, and for the top 15 cancers for each of the five major
racial and ethnic groups by sex. Furthermore, this article pre-
sents a comprehensive assessment of the incidence of malignant
and nonmalignant brain tumors in children and adults by race,
sex, age group, and tumor histological type. National collection
of nonmalignant brain tumors began in 2004 following the pas-
sage of Public Law 107-260, the Benign Brain Tumor Cancer
Registries Amendment Act. The historical incidence, mortality,
and survival by histological type, age, and era of diagnosis for
malignant brain and other nervous system (ONS) tumors are
presented.
SPECIAL ARTICLE
Annual Report to the Nation on the Status of Cancer,
1975–2007, Featuring Tumors of the Brain and Other
Nervous System
Betsy A. Kohler, Elizabeth Ward, Bridget J. McCarthy, Maria J. Schymura, Lynn A. G. Ries, Christie Eheman, Ahmedin Jemal,
Robert N. Anderson, Umed A. Ajani, Brenda K. Edwards
Manuscript received November 12, 2010; revised February 16, 2011; accepted February 17, 2011.
Correspondence to: Betsy A. Kohler, MPH, CTR, North American Association of Central Cancer Registries, 2121 West White Oaks Dr, Ste B, Springfield,
IL 62404 (e-mail: bkohler@naaccr.org).
Background The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer
Institute, and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to
provide updated information on cancer occurrence and trends in the United States. This year’s report highlights
brain and other nervous system (ONS) tumors, including nonmalignant brain tumors, which became reportable
on a national level in 2004.
Methods Cancer incidence data were obtained from the National Cancer Institute, CDC, and NAACCR, and information on
deaths was obtained from the CDC’s National Center for Health Statistics. The annual percentage changes in
age-standardized incidence and death rates (2000 US population standard) for all cancers combined and for the
top 15 cancers for men and for women were estimated by joinpoint analysis of long-term (1992–2007 for inci-
dence; 1975–2007 for mortality) trends and short-term fixed interval (1998–2007) trends. Analyses of malignant
neuroepithelial brain and ONS tumors were based on data from 1980–2007; data on nonmalignant tumors were
available for 2004–2007. All statistical tests were two-sided.
Results Overall cancer incidence rates decreased by approximately 1% per year; the decrease was statistically signifi-
cant (P < .05) in women, but not in men, because of a recent increase in prostate cancer incidence. The death
rates continued to decrease for both sexes. Childhood cancer incidence rates continued to increase, whereas
death rates continued to decrease. Lung cancer death rates decreased in women for the first time during 2003–
2007, more than a decade after decreasing in men. During 2004–2007, more than 213 500 primary brain and
ONS tumors were diagnosed, and 35.8% were malignant. From 1987–2007, the incidence of neuroepithelial
malignant brain and ONS tumors decreased by 0.4% per year in men and women combined.
Conclusions The decrease in cancer incidence and mortality reflects progress in cancer prevention, early detection, and treat-
ment. However, major challenges remain, including increasing incidence rates and continued low survival for some
cancers. Malignant and nonmalignant brain tumors demonstrate differing patterns of occurrence by sex, age, and
race, and exhibit considerable biologic diversity. Inclusion of nonmalignant brain tumors in cancer registries pro-
vides a fuller assessment of disease burden and medical resource needs associated with these unique tumors.
J Natl Cancer Inst 2011;103:714–736

jnci.oxfordjournals.org JNCI | Special Article 715
Subjects and Methods
Cancers, Cancer Deaths, and Population Estimates
Population-based cancer registries that are NAACCR members
and participate in the NCI’s Surveillance, Epidemiology, and
End Results (SEER) Program, and/or the CDC’s National
Program of Cancer Registries were used to obtain information
on newly diagnosed invasive cancers and benign and borderline
brain tumors. Incident cases were classified by site and histology
according to the International Classification of Diseases for Oncology
(ICD-O) edition in use at the time of diagnosis, converted to the
Third Edition coding (13) and categorized according to SEER
site groups (14).
Incidence data were not available uniformly for every period,
geographic area, and racial and ethnic group in the United States
(Supplementary Table 1, available online). The longest continuous
incidence data were available from the nine original SEER regis-
tries (SEER 9) covering about 10% of the US population. Long-
term (1975–2007) trends based on data from the SEER 9 registries
are included in Supplementary Table 2 (available online). Data
providing better coverage of the US population (about 14%) were
available from the SEER 13 registries and form the basis of our
long-term incidence trend (1992–2007) analysis for all races and
ethnicities combined (15). Beginning in 1995, following the advent
of the National Program of Cancer Registries, coverage of the US
population increased dramatically. Data from NAACCR covering
40 population-based cancer registries were used to assess short-term
(1998–2007) trends. Data from 46 NAACCR population-based
cancer registries were used to estimate 5-year (2003–2007) average
annual age-standardized incidence rates for all races and ethnicities
combined and for each of the five major racial and ethnic popula-
tions (white, black, Asian and Pacific Islander [API], American
Indian/Alaska Native [AI/AN] who reside in counties covered by
the Indian Health Service [IHS] Contract Health Service Delivery
Area [CHSDA], and Hispanic). The 40 and 46 registries met
NAACCR’s data quality criteria for every year included in the
analysis; these registries covered 83.6% and 93% of the US popu-
lation, respectively.
All primary brain and ONS tumors (ICD-O-3 codes C70.0–72.9
and C75.1–75.3, respectively), including malignant, borderline,
and benign behaviors diagnosed in 2004–2007 were identified
from 46 states in the NAACCR dataset. A neuropathologist
reviewed the brain and ONS site and histology combinations and
recommended excluding 1771 cases (0.8%) from analysis because
of unlikely combinations. Consistent with the SEER site re-code
convention, tumors coded to the nasal and nasopharyngeal regions
also were excluded.
Data on approximately 76 000 malignant and 137 000 non-
malignant brain and ONS tumors were analyzed. Within the brain
and ONS, seven major histological groups were used in analyses
(16,17). Tumors of neuroepithelial tissue were divided into eight
specific histological subgroups (16). Tumors of neuroepithelial
tissue coded as nonmalignant by registries, but for which only a
malignant behavior code existed in ICD-O-3, were considered
malignant. Consistent with previous practice, pilocytic astrocy-
tomas were considered malignant. Malignant and papillary menin-
gioma and meningeal sarcomatosis were categorized as malignant,
whereas all other benign and uncertain or atypical meningioma
histologies were categorized as nonmalignant, according to the
ICD-O-3 behavior codes. Childhood brain and ONS tumors also
were grouped using International Classification of Childhood
Cancers (ICCC) definitions (18).
Cause of death is based on death certificate information
reported to state vital statistics offices and compiled into a national
file through the CDC National Center for Health Statistics
National Vital Statistics System (19) and categorized according to
SEER anatomic site groups (14) to maximize comparability among
ICD and ICD-O versions. The underlying causes of death were
selected according to the version of the ICD codes and selection
rules in use at the time of death (ICD-6 to ICD-10) (20–24). We
examined long-term (1975–2007) mortality trends for all races and
ethnicities combined. Short-term (1998–2007) trends and 5-year
(2003–2007) average annual age-standardized death rates were
calculated for all cancer sites combined and for the top 15 cancer
sites for men and women in each of the five major racial and ethnic
populations. Death rates for the AI/AN population were based on
deaths in counties served by IHS CHSDA because estimated rates
based on CHSDA counties have been reported to be more accu-
rate for this group (10,25).
County-level population estimates, summed to the state and
national level, were used as denominators in calculations of inci-
dence rates (26). The National Center for Health Statistics and
the Census Bureau collaborate to provide NCI with bridged
single-race annual population estimates, with annual reestimates
calculated back to the most recent decennial census to accommo-
date multiracial data (27). The NCI makes slight modifications to
the Hawaii population estimates based on additional local infor-
mation (26).
For most states, population estimates as of July 1 of each year
were used to calculate annual incidence and death rates. For
Louisiana, Alabama, Mississippi, and Texas, where residents were
displaced by Hurricanes Katrina and Rita, NCI made adjustments
to the 2005 incidence data and underlying population data. The
national total population estimates are not affected by these adjust-
ments (further details are available at http://seer.cancer.gov/popdata/
methods.html).
Statistical Analysis
Age-specific and age-standardized rates were expressed per 100 000
persons (or per 1 000 000 children), based on 2000 US standard
population, and generated using SEER*Stat Software, Version
6.6.2 (http://www.seer.cancer.gov/seerstat) (28). Rates were
suppressed if the numerator was less than 16 observations, consis-
tent with our previous work (1–12).
Trends in age-standardized cancer incidence and US death
rates were analyzed using joinpoint regression, which involves
fitting a series of joined straight lines on a logarithmic scale to the
trends in the annual age-standardized rates (http://www.srab.
cancer.gov/joinpoint). We allowed a maximum of three joinpoints
in models for the period 1992–2007 (Table 1), four joinpoints in
models for the period 1975–2007 (Table 2 and Supplementary
Table 2, available online), and up to two joinpoints for the period
1998–2007 for short-term fixed interval incidence (Table 3) and
mortality analyses (Table 4). The joinpoint method is described in