This cross-sectional study examines trends in colorectal cancer mortality rates among individuals aged 25 to 49 years by educational attainment, as a marker of socioeconomic status.

Abstract Introduction: The incidence of second primary cancer (SPC) is on the rise. In the United States, about 20% of all new cancers diagnosed annually are estimated to be SPC. Prior studies of the SEER registries suggested that survival was inferior in SPC compared with that in the first primary cancer (FPC) of the same type. However, these studies did not account for prognostic factors such as comorbidity, obesity, smoking, and insurance status. We examined survival after breast cancer diagnosis as a SPC vs. as a FPC in a large integrated health care delivery system. Methods: We identified female members of Kaiser Permanente Southern California (KPSC) aged 18-84 years diagnosed with an invasive breast cancer as a FPC (for the FPC cohort) or SPC (for the SPC cohort) between 2000-2022 using KPSC’s cancer registry. Women were followed until the earliest occurrence of death, diagnosis of a subsequent primary cancer, KPSC disenrollment, or 12/31/2023. All-cause and breast cancer-specific mortality were ascertained. Fine and Gray subdistribution hazard regression was used to estimate survival differences in the SPC and the FPC cohort accounting for competing risks. Multivariable models adjusted for age at diagnosis, stage, breast cancer subtype (luminal A, luminal B, HER2-enriched, and triple negative), race/ethnicity, year of diagnosis, Charlson’s comorbidity index, body mass index, and smoking. Stratified analyses were performed by age at diagnosis (<50 yrs and ≥50 yrs), stage, and subtype. Results: A total of 42,972 and 6,363 women were included in the breast FPC and SPC cohort (the mean age at diagnosis: 59.8 yr vs. 66.0 yr), respectively. About half of participants in both cohorts were racial/ethnic minorities. Sixty-five percent of the FPC cohort and 71% of the SPC cohort were diagnosed at localized stage. During a mean follow-up of 7 years, a total of 7,148 (17%) and 1,647 (26%) deaths were observed, including 4,035 (9%) and 838 (13%) breast cancer-specific deaths in the FPC and SPC cohort, respectively. In multivariable-adjusted models, there was an elevated overall mortality in the SPC cohort compared with the FPC [adjusted hazard ratio (aHR) = 1.35 (1.27-1.43)]. Elevated breast cancer-specific mortality was also noted in the SPC cohort: aHR=1.27 (1.17-1.38). Similar findings were observed when stratified by age, stage, or subtype (aHRs range between 1.33-1.40), with the exception that breast cancer-specific mortality was not elevated in SPC for triple-negative breast cancer [aHR=1.04 (0.85-1.27)]. Conclusion: Overall and breast cancer-specific mortality were higher after a breast SPC diagnosis compared to that after a breast FPC diagnosis among an insured population adjusting for prognostic factors. Further research is needed to shed light on the reasons underly the survival difference to inform management for the breast SPC. Citation Format: Chun R. Chao, Hui Zhou, Cody Ramin, Lanfang Xu, Kimberly Cannavale, Hyuna Sung. Survival differences after diagnosis of breast cancer as second primary cancer vs as first primary cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3563.

Abstract Background: Chordoma is a rare malignant bone tumor arising from notochordal remnants, with largely unknown etiology and limited descriptive characterization. Methods: Data from the North American Association of Central Cancer Registries, covering 93% of the U.S. population, were used to estimate age-standardized incidence rates and trends from 2003-2022 by demographic and clinical factors. Period trends were quantified using Joinpoint regression, and birth-cohort trends were assessed using age-period-cohort modeling. Data from 21 Surveillance, Epidemiology, and End Results (SEER) registries were used to estimate relative survival for cases diagnosed from 2003-2021. Results: A total of 6,260 chordoma cases were diagnosed during 2003-2022. Cranial tumors were most frequent (38.7%), followed by sacral (32.7%) and spinal (25.4%) sites. The age-standardized incidence rate was 0.097 per 100,000, increasing with age and peaking at 80-84 years. Males had higher incidence than females after age 35. Incidence was lowest among Black individuals and highest in the Northeast and metropolitan areas. From 2003-2022, incidence rose 1.47% annually (95% CI = 0.61-2.39), with steeper increases among younger individuals, women, and localized and cranial tumors. Successive birth cohorts showed increasing risk, with those born near 1998 having approximately twice the rate of those born near 1958 (95% CI = 1.28-3.16). Among 2,181 SEER cases, 5-year relative survival was 83.4%, varying by race/ethnicity and region, and for distant-stage disease ranged from 68.6% (cranial) to 38.3% (sacral). Conclusions: Chordoma incidence and survival vary by demographic and clinical factors, suggesting potential differences in detection, healthcare access, and underlying etiology. Citation Format: Hyuna Sung, Chenxi Jiang, Hela Koka, Jiwei Bai, Alisa Goldstein, Xiaohong Yang. Incidence patterns and temporal trends of chordoma: A population-based analysis of over 6000 cases in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(8_Suppl):Abstract nr LB382.

Previous cervical cancer incidence trend analyses primarily used period-based approaches, limiting assessment of generational risk shifts against the backdrop of human papillomavirus (HPV) vaccination. Using US Cancer Statistics data and age-period-cohort modeling, we estimated fitted incidence rates at ages 30-31 across birth cohorts (1917-1919 to 1999-2001), adjusted for period deviation. Incidence rates decreased by 1.9% per birth year (95% confidence interval [CI] = -2.1% to -1.8%) up to 1951-1953 cohorts, then decelerated to 0.3% annually (95% CI = -0.4% to -0.2%). Starting with 1987-1989 cohorts, incidence rates dropped sharply by 10.5% annually (95% CI = -12.7% to -8.4%). Compared with 1970-1979 cohorts, 1990-1999 cohorts had a 54% lower incidence rate (10.2 vs. 4.7 per 100 000; rate ratio = 0.46; 95% CI = 0.42 to 0.50). The markedly lower risk among post-1987-1989 cohorts suggests a future reduction in population-level burden as these cohorts age. The finding also has implications for reinforcing HPV vaccination efforts and informing discussions on raising the screening initiation age.

This article provides updated global cancer statistics for the year 2024 based on the GLOBOCAN estimates of the International Agency for Research on Cancer. The authors describe national cancer incidence and mortality by world region and the Human Development Index and predict the burden in 2050 based on demographic trends. In 2024, an estimated 20.6 million new cancer cases (19.5 million excluding nonmelanoma skin cancer) and 9.8 million deaths (9.7 million excluding nonmelanoma skin cancer) occurred worldwide, equivalent to one in five people developing cancer during their lifetime and one in nine men and one in 13 women dying from the disease. Lung cancer is the most frequently diagnosed cancer, responsible for almost 2.6 million new cases (12.8%), followed by female breast (11.8%), colorectal (9.9%), prostate (7.5%), and stomach (4.7%) cancer. Lung cancer is also the leading cause of cancer death, with an estimated 1.9 million deaths (19.1%), followed by colorectal (9.4%), liver (7.5%), female breast (7.1%), and stomach (6.6%) cancer. Incidence rates vary four- to five-fold across regions, with the highest rates found in Australia/New Zealand (men, 477 per 100,000; women, 396 per 100,000), whereas mortality rates differ two-fold, with elevated rates in Eastern Europe for men (158 per 100,000) and Melanesia for women (108 per 100,000). The incidence burden is predicted to reach 34.4 million by 2050, up 67% from 2024, with the largest proportional increases in lower Human Development Index countries. Although global variation in cancer profiles demands a nuanced approach to cancer control at national and regional levels, primary prevention must be at the forefront, including intensified efforts to reduce tobacco use, prevent infections, lower alcohol consumption and excess body weight, and increase physical activity.

The purpose of this study is to describe the 2022 cancer burden by sex and age group globally, as well as by world region. We utilized GLOBOCAN 2022 estimates to quantify overall and cancer-specific incidence and mortality using counts and age-standardized rates (ASRs; per 100,000) simultaneously stratified by sex and age bands (0–14, 15–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80 + years), globally and by world region. In 2022, an estimated 18.7 million cases (excluding nonmelanoma skin cancer) and 9.7 million cancer-related deaths occurred globally, of which 51 and 56

BACKGROUND:Cancer statistics for Asian American and Native Hawaiian and Pacific Islander (NHPI) people are usually aggregated, masking substantial variation within this heterogeneous population. Herein, the American Cancer Society reports cancer incidence and survival for 8 Asian American and 3 NHPI ethnic groups. METHODS:The authors used population-based cancer registry data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, for Asian American and NHPI ethnic groups from 2000 through 2022. RESULTS:During 2018-2022, overall cancer incidence ranged from 218.3 per 100,000 Kampuchean people to 474.5 per 100,000 Native Hawaiian people, which was 1.5 times higher than the rate for the aggregated Asian American and NHPI population (307.3 per 100,000). High incidence among Native Hawaiian people is largely driven by the highest rates of female breast, colorectal, and prostate cancers, whereas infection-related cancers were highest among Asian American ethnic groups. For example, liver and stomach cancer incidence is highest among Vietnamese (22.2 per 100,000) and Korean people (17.8 per 100,000), respectively, both of which were nearly twice that in Native Hawaiian people (12.9 and 9.6 per 100,000, respectively). Native Hawaiian and Samoan women are twice and 3 times as likely, respectively, to be diagnosed with uterine corpus cancer as aggregated Asian American and NHPI women or White women. Five-year relative survival ranges from 42% in Laotians to 74% in Asian Indians/Pakistanis, with largest differences for colorectal (43% in Laotians to 72% in Asian Indians/Pakistanis) and prostate (63% in Kampucheans to 97% in Japanese) cancers. CONCLUSIONS:Wide variation in cancer risk within the Asian American and NHPI population highlights the critical need for disaggregated data to effectively target cancer prevention and control interventions.

BACKGROUND:Despite well-documented national declines in cervical cancer incidence among young women following human papillomavirus (HPV) vaccine implementation, state-level data remain limited. METHODS:Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System. RESULTS:Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95% CI = 0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100 000. Reductions exceeded 50% in DC (RR = 0.48, 95% CI = 0.15 to 0.81), Rhode Island (RR = 0.48, 95% CI = 0.21 to 0.76), Michigan (RR = 0.48, 95% CI = 0.38 to 0.57), and Hawaii (RR = 0.49, 95% CI = 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15%-50%. Ten states showed slower decreases (<15%). Notably, progress was lacking in Vermont (RR = 1.11, 95% CI = 0.21 to 2.00), West Virginia (RR = 1.09, 95% CI = 0.63 to 1.56), Idaho (RR = 0.97, 95% CI = 0.42 to 1.52), Arkansas (RR = 0.96, 95% CI = 0.64 to 1.29), and Alabama (RR = 0.96, 95% CI = 0.71 to 1.21). Across states, higher vaccination rates were correlated with lower RRs (ie, faster decline) (rho=-0.42, P = .0027). Every 10% increase in vaccination rates was associated with an 11.5% (95% CI = -17.2% to -5.4%) reduction in RRs, adjusted for screening rates. CONCLUSION:Declines in cervical cancer incidence in young women during the HPV vaccination era varied substantially by state, aligning with HPV vaccination rates.

Associations between smoking and smoking-associated second primary cancers (SSPC) have been documented predominantly among survivors of smoking-associated first primary cancers (FPC), with limited evidence among survivors of non-smoking-associated FPCs. We examined survivors of FPCs diagnosed from 1992 to 2015 in the Cancer Prevention Study II Nutrition Cohort, followed through June 30, 2017. Self-reported smoking status, intensity, and years since quitting were collected a mean of 1.6 years before FPC diagnosis. Among 28,272 survivors (58.8%, male; mean age at FPC diagnosis, 72.2 years [SD=7.08]), the most common FPCs were prostate (32.8%), breast (18.5%), colorectum (9.0%), and non-Hodgkin lymphoma (8.3%). Over a median follow-up of 7.0 years, 1926 survivors developed SSPCs. Based on Cox proportional hazards models, adjusted for key confounders, SSPC risk was higher among current (HRadjusted=3.78; 95%CI=3.22-4.44) and former (HRadjusted=1.63, 95%CI=1.46-1.81) smokers compared with never smokers, with similar associations for survivors of smoking-associated (HRadjusted=4.08; 95%CI=2.90-5.74 for current smokers) and non-smoking-associated (HRadjusted=3.74; 95%CI=3.11-4.51 for current smokers) FPCs. Among former smokers, risk decreased with increased years since quitting, approaching never-smoker levels after > 30 years of cessation. Post-diagnosis cessation (599 of 1518 current smokers) was associated with a 25% lower SSPC incidence versus continued smoking (HRadjusted=0.75; 95%CI=0.54-1.03). In conclusion, pre-diagnostic smoking was strongly associated with higher risk of SSPCs among survivors of both smoking- and non-smoking-associated FPCs. Longer duration since quitting and cessation after diagnosis reduced the elevated risk, highlighting smoking cessation at any time can help reduce the burden of SPCs among the growing population of cancer survivors.

Introduction:Chordoma is a rare malignant bone tumor arising from notochordal remnants, with unknown etiology and limited descriptive characterization. Methods:Data from the North American Association of Central Cancer Registries, covering 93% of the U.S. population, were used to estimate age-standardized incidence rates and trends from 2003 to 2022 by demographic and clinical factors. Trends were quantified using Joinpoint regression. Data from 21 Surveillance, Epidemiology, and End Results (SEER) registries were used to estimate relative survival for cases diagnosed from 2003 to 2021. Results:A total of 6260 chordoma cases were diagnosed during 2003-2022. Cranial tumors were most frequent (38.7%), followed by sacral (32.7%) and spinal (25.4%) sites. The age-standardized incidence rate was 0.097 per 100,000, increasing with age and peaking at 80-84 years. Overall, incidence rates were higher in males than females (0.1173 versus 0.0800), with the divergence emerging after age 35. Incidence rates were comparable across racial and ethnic populations, except among non-Hispanic Black individuals, whose rates were 56% lower than those of non-Hispanic White individuals (95% CI = 0.39 to 0.49). Incidence rates were highest in the Northeast and metropolitan areas. From 2003 to 2022, incidence rose 1.47% annually (95% CI = 0.61-2.39), with steeper increases among younger individuals, women, and localized/cranial tumors. Among 2170 SEER cases, 5-year relative survival was 83.3%, varying by race/ethnicity and region. For distant-stage disease, survival ranged from 68.6% for cranial tumors to 38.3% for sacral tumors. Conclusion:Chordoma incidence and survival vary by demographic and clinical factors, suggesting differences in detection, healthcare access, and underlying etiology.

ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the https://www.asco.org/practice-patients/guidelines/guideline-methodology . ASCO Guidelines follow the https://www.asco.org/about-asco/legal/conflict-interest-coi . Clinical Practice Guidelines and other guidance (“Guidance”) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and Appendix 2 (online only) for more . PURPOSE To offer clinicians recommendations concerning breast cancer follow-up and surveillance after primary treatment. METHODS ASCO convened an Expert Panel to develop recommendations based on a systematic review and a formal consensus process. RESULTS One randomized controlled trial (RCT) was identified and formed the evidentiary basis for the surveillance mammography guideline recommendation. No RCTs were identified that evaluated different follow-up approaches by risk of relapse in patients treated for early-stage breast cancer. Given the dearth of evidence identified in the systematic review of the literature, formal modified Delphi consensus-based recommendations were generated. RECOMMENDATIONS The guideline offers recommendations on the role of a risk-based approach to the frequency and intensity of follow-up among patients with breast cancer in the adjuvant setting. Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Either virtual or in-person visits can be offered. Certain patients at a high risk of cancer recurrence warrant closer surveillance, such as those patients with locally advanced disease or residual disease following neoadjuvant chemotherapy. Recommendations on the use of blood-based biomarkers and supplemental imaging are provided. Guideline recommendations will be updated once additional evidence-based tools become available to better individualize surveillance. Additional information is available at www.ascopubs.org/topics/asco-guidelines/breast-cancer .

Importance:Mortality disparity in cancer between Black individuals and White individuals in the US has been declining since its peak in the early 1990s, but a comprehensive analysis of cancer type-specific contributions to this reduction is lacking. Objective:To examine cancer type-specific contributions to the reduction in the all-cancer excess mortality rate among Black individuals compared with White individuals between the peak period (1991-1995) and a contemporary period (2019-2023) in the US. Design, Setting, and Participants:A cross-sectional temporal analysis was conducted between March 2025 and October 2025. Non-Hispanic Black individuals and White individuals who died of cancer between 1991 and 2023 were included in the analysis. The data were compiled by the National Center for Health Statistics. Exposure:Race as recorded on death certificates. Main Outcomes and Measures:All-cancer and cancer type-specific excess mortality rates per 100 000 for Black individuals compared with White individuals were calculated by sex. Changes in excess mortality rates were estimated by subtracting the current excess mortality rate for 2019 to 2023 from the peak excess mortality rate for 1991 to 1995. Cancer type-specific contributions to all-cancer excess mortality rate reduction were expressed as percentages. Results:The analysis included 2 461 715 cancer deaths in 1991 to 1995 (11.8% non-Hispanic Black individuals; 47.4% were female) and 2 674 385 cancer deaths in 2019 to 2023 (13.2% non-Hispanic Black individuals; 47.2% were female). Between 1991 to 1995 and 2019 to 2023, the all-cancer excess mortality rate decreased by 98.4 (95% CI, 96.1-100.7) per 100 000 in Black males and by 21.7 (95% CI, 20.3-23.1) per 100 000 in Black females. Among males, lung (31.1% [95% CI, 29.9%-32.4%]), prostate (25.8% [95% CI, 24.7%-27.0%]), and esophageal (12.1% [95% CI, 11.7%-12.5%]) cancer accounted for the largest share of reductions in the all-cancer excess mortality rate. Among females, colorectal (18.8% [95% CI, 16.6%-20.9%]), cervical (16.9% [95% CI, 15.8%-18.0%]), and lung (15.1% [95% CI, 12.3%-17.9%]) cancer accounted for the largest share of reductions in the all-cancer excess mortality rate. Despite these gains in excess mortality rate reduction, prostate, lung, and stomach cancer remained among the top 5 cancer types with the largest contemporary excess mortality rate among males, whereas colorectal cancer increased in rank (from fifth to second) as well as liver cancer (from tenth to fifth), reflecting comparatively smaller or stalled progress. Breast cancer and uterine corpus cancer ranked highest during the contemporary period in excess mortality rate among Black females compared with White females (7.2 per 100 000 and 4.9 per 100 000, respectively), followed by myeloma, colorectal, and pancreatic cancer. Conclusions and Relevance:In this cross-sectional temporal analysis, the marked reductions in excess mortality indicate meaningful progress achieved for several major cancer types through population-wide cancer control efforts. Persistent or worsening disparities in breast cancer and uterine corpus cancer and substantial residual disparities in prostate cancer highlight priorities for equitable interventions. These findings may guide more targeted and efficient cancer prevention and control strategies to further accelerate progress.

Understanding long-term trends in cancer mortality in rural and urban areas can provide additional insight into factors contributing to rural-urban disparities in cancer mortality and inform public policies. We examined trends in age-standardized cancer mortality rates (overall, lung, colorectal, female breast, and prostate cancers) by urbanicity of county of residence using National Center for Health Statistics data. During 1969-2023, the highest all-cancer mortality rates shifted from large metropolitan areas to nonmetropolitan areas with the smallest urban population. The crossover occurred in the 1990s in males and early 2000s in females, with the rural-urban mortality gap widening in subsequent years. A similar pattern was observed for lung, colorectal, and breast cancer mortality. The shift in the high cancer burden from urban to rural areas likely reflects geographic redistribution of social determinants of health, which underpins the cancer continuum from exposure to risk factors and prevention to access to high-quality diagnosis and treatment.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using data collected by central cancer registries (incidence, through 2022) and the National Center for Health Statistics (mortality, through 2023). In 2026, approximately 2,114,850 new cancer cases and 626,140 cancer deaths are projected to occur in the United States. The cancer mortality rate continued to decline through 2023, averting 4.8 million deaths since 1991, largely because of smoking reductions, earlier detection, and improved treatment. These interventions are also evident in rising 5-year relative survival, which reached a milestone 70% for diagnoses during 2015-2021 overall, 69% for regional-stage disease, and 35% for distant-stage (metastatic) disease, up from 63%, 54%, and 17%, respectively, in the mid-1990s. People with high-mortality cancers and advanced diagnoses had the largest gains, including increases from 32% to 62% for myeloma, 7% to 22% for liver cancer, 16% to 35% for metastatic melanoma, 8% to 18% for metastatic rectal cancer, 20% to 37% for regional lung cancer, and 2% to 10% for metastatic lung cancer. Nevertheless, lung cancer will cause more deaths in 2026 than second-ranking colorectal cancer and third-ranking pancreatic cancer combined. In summary, decades of scientific investment have translated to longer lives for people with even the most fatal cancers. However, continued progress is threatened by proposed federal cuts to cancer research and health insurance, which provides access to life-saving cancer treatment.

Increases in colorectal cancer (CRC) incidence among young adults were reported in 27 countries/territories worldwide, yet information on mortality trends is limited. Using the WHO Mortality database (1990 to 2023), we found CRC mortality rates among younger adults (25 to 49 years) increased in 18 of 49 countries (0.7-4.3%/year) during the most recent decade, decreased in 15, and were otherwise stable. Trends ranged from decreases of > 2%/year in Singapore, Belgium, and Denmark to increases of > 3%/year in Paraguay, Uruguay, Chile, and the UK. In half of the countries with increasing trends, rates in older adults (50 to 79 years) were stable (Colombia, Philippines, Croatia [women only]) or decreasing (Uruguay, the U.K., Australia, Canada, the U.S., Argentina). In the remainders-primarily in Latin America/the Caribbean-mortality rose in both groups. Increasing CRC mortality among younger adults may signal a growing future burden, reinforcing the need for etiologic investigation and heightened awareness to avert deaths through earlier detection.

ABSTRACT Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2021) and mortality data collected by the National Center for Health Statistics (through 2022). In 2025, 2,041,910 new cancer cases and 618,120 cancer deaths are projected to occur in the United States. The cancer mortality rate continued to decline through 2022, averting nearly 4.5 million deaths since 1991 because of smoking reductions, earlier detection for some cancers, and improved treatment. Yet alarming disparities persist; Native American people bear the highest cancer mortality, including rates that are two to three times those in White people for kidney, liver, stomach, and cervical cancers. Similarly, Black people have two‐fold higher mortality than White people for prostate, stomach, and uterine corpus cancers. Overall cancer incidence has generally declined in men but has risen in women, narrowing the male‐to‐female rate ratio (RR) from a peak of 1.6 (95% confidence interval, 1.57–1.61) in 1992 to 1.1 (95% confidence interval, 1.12–1.12) in 2021. However, rates in women aged 50–64 years have already surpassed those in men (832.5 vs. 830.6 per 100,000), and younger women (younger than 50 years) have an 82% higher incidence rate than their male counterparts (141.1 vs. 77.4 per 100,000), up from 51% in 2002. Notably, lung cancer incidence in women surpassed that in men among people younger than 65 years in 2021 (15.7 vs. 15.4 per 100,000; RR, 0.98, p = 0.03). In summary, cancer mortality continues to decline, but future gains are threatened by rampant racial inequalities and a growing burden of disease in middle‐aged and young adults, especially women. Continued progress will require investment in cancer prevention and access to equitable treatment, especially for Native American and Black individuals.

The COVID-19 pandemic has impacted cancer outcomes, but research on its impact on survival outcomes, especially cause-specific death across different cancer types and socioeconomic factors, is limited. Individuals diagnosed in 2019 and 2020 with one of 14 types of cancer at ages 20-89 in 17 Surveillance, Epidemiology, and End Results registries were included. We used Cox proportional hazards model to compare the risk of death from all causes, cancer, and COVID-19 within the first year of diagnosis between cases from 2020 vs 2019, adjusting for demographic factors and socioeconomic status. Additionally, for 2020 cases, Cox models were used to identify risk factors for COVID-19, cancer, and all causes death. Compared to 2019 cases (N=274,605), 2020 cases (N=248,840) had a higher risk of death from all causes and COVID-19 for each of the 14 types of cancer, while increased risks of cancer-specific death were limited to cases with 8 of 14 cancer types. Highest hazard ratios (HRs) were estimated among those with cancers of the thyroid (HR=1.57, 95%CI: 1.42-1.72) and prostate (HR=1.51, 95% CI:1.44-1.58) for all-cause death; among those with leukemia (HR=11.42, 95%CI: 6.31-20.64) and lung (HR=6.58, 95%CI:5.02-8.62) cancers for COVID-19 death; and among those with colorectal (HR=1.15, 95%CI:1.10-1.20) and breast (HR=1.12, 95%CI:1.04-1.21) cancers for cancer-specific death. Among 2020 cases, cancer-specific death and Covid-19 death showed distinct patterns in racial/ethnic and urban/rural disparities (Table 1 Table 1: Association of patients characteristics with the risk of death from all-cause, cancer-speci Risk factors (reference group) All-cause Adjusted HR (95% CI) cancer-specific Adjusted HR (95% CI) covid-related Adjusted HR (95% CI) Age (ref: 20-39 y) 40-49 y 1.35 (1.25-1.45) 1.71 (1.50-1.96) 1.51 (0.74-3.09) 50-59 y 1.42 (1.33-1.52) 2.36 (2.10-2.66) 2.65 (1.42-4.97) 60-69 y 1.60 (1.50-1.71) 3.07 (2.73-3.45) 4.79 (2.61-8.79) 70+ y 2.23 (2.10-2.38) 4.49 (4.00-5.04) 8.26 (4.52-15.11) Race (ref: Non-Hispanic White) Hispanic 1.42 (1.38-1.46) 1.00 (0.96-1.05) 1.91 (1.62-2.25) Non-Hispanic American Indian/Alaska Native 1.13 (1.00-1.27) 1.03 (0.88-1.20) 1.36 (0.64-2.86) Non-Hispanic Asian or Pacific Islander 1.20 (1.16-1.25) 1.02 (0.97-1.07) 1.16 (0.90-1.49) Non-Hispanic Black 1.12 (1.08-1.16) 1.08 (1.04-1.13) 1.73 (1.44-2.07) Urban/Rural (ref: Nonmetropolitan) Counties in metropolitan areas with >1 million population 1.02 (0.98-1.06) 0.89 (0.85-0.94) 1.30 (1.02-1.66) Counties in metropolitan areas with less than 1 million population 0.98 (0.95-1.02) 0.94 (0.90-0.98) 1.21 (0.96-1.52) Sex (ref: Female) Male 1.04 (1.02-1.06) 1.04 (1.01-1.07) 1.16 (1.00-1.34) Income (ref: Upper income level) Low 1.28 (1.23-1.33) 1.27 (1.21-1.34) 1.80 (1.40-2.31) Middle 1.13 (1.10-1.15) 1.13 (1.09-1.16) 1.57 (1.34-1.84) Stage (Ref: Stage 1) Stage 2 1.41 (1.35-1.46) 2.13 (1.98-2.28) 1.44 (1.15-1.81) Stage 3 2.22 (2.13-2.31) 4.22 (3.96-4.50) 1.95 (1.55-2.46) Stage 4 3.22 (3.10-3.35) 6.84 (6.45-7.26) 1.82 (1.44-2.31) ). Specifically, individuals living in large metropolitan areas and those identifying as Hispanic were found to be at higher risk of death from COVID-19, but not from cancer. The Covid-19 pandemic’s impact on survival of individuals with cancer varied by cause of death, cancer type, and socioeconomic factors, highlighting the need for targeted healthcare interventions to ensure equitable care and reduced mortality. Chenxi Jiang, Xuesong Han, Ahmedin Jemal, Hyuna Sung. Survival among individuals diagnosed with cancer during the COVID-19 pandemic in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3590.