More Americans are surviving cancer, but the disease is striking young and middle-aged adults and women more frequently, the American Cancer Society reported on Thursday.
And despite overall improvements in survival, Black and Native Americans are dying of some cancers at rates two to three times higher than those among white Americans.
These trends represent a marked change for an illness that has long been considered a disease of aging, and which used to affect far more men than women.
The shifts reflect declines in smoking-related cancers and prostate cancer among older men and a disconcerting rise in cancer in people born since the 1950s.
Cancer is the second leading cause of death in the United States, but the leading cause among Americans under 85. The new report projects that some 2,041,910 new cases will occur this year and that 618,120 Americans will die of the disease.
Six of the 10 most common cancers are on the rise, including cancers of the breast and the uterus. Also increasing are colorectal cancers among people under 65, as well as prostate cancer, melanoma and pancreatic cancer.
“These unfavorable trends are tipped toward women,” said Rebecca L. Siegel, an epidemiologist with the American Cancer Society and the report’s first author.
“Of all the cancers that are increasing, some are increasing in men, but it’s lopsided — more of this increase is happening in women.”
Women are also being diagnosed at younger ages. Cancer rates are rising among women under 50 (so-called early-onset cancer), as well as among women 50 to 64.
Despite increases in some early-onset cancers, like colorectal cancer and testicular cancer, “overall rates are flat in men under 50 and decreasing in those 50 to 64,” Ms. Siegel said.
Several other troubling trends are outlined in the report. One is an increase in new cases of cervical cancer — a disease widely viewed as preventable in the United States — among women 30 to 44.
The incidence of cervical cancer has plummeted since the mid-1970s, when Pap smear screening to detect precancerous changes became widely available. But recent surveys have found many women are postponing visits to their gynecologists.
A Harris Poll survey of over 1,100 U.S. women conducted last year for BD, a medical technology company, found that 72 percent said they had put off a visit with their doctor that would have included screening; half said they didn’t know how frequently they should be screened for cervical cancer.
(The current recommendation, not yet official, is a bit complicated. Get a Pap smear every three years from ages 21 to 29. Then, from ages 30 to 65, continue with a Pap smear every three years; or get a Pap smear plus a test for human papillomavirus, which can cause cervical cancer, every five years; or alternatively, get tested for the virus every five years.)
Another disturbing trend started in 2021 when, for the first time, lung cancer incidence in women under 65 surpassed the incidence in men: 15.7 cases per 100,000 women under 65, compared with 15.4 per 100,000 in men.
Lung cancer has been declining over the past decade, but it has decreased more rapidly in men. Women took up smoking later than men and took longer to quit.
There have also been upticks in smoking in people who were born after 1965, the year after the surgeon general first warned that cigarettes cause cancer.
Smoking continues to be the leading cause of preventable death in the United States, and will account for almost 500 cancer deaths daily in 2025, mostly from lung cancer, the American Cancer Society said.
“There is growing concern that e-cigarettes and vaping may contribute to this burden in the future, given their carcinogenic potential and wide popularity,” the report said.
Breast cancer rates have also been inching up for many years, increasing by about 1 percent a year between 2012 and 2021. The sharpest rise has been seen in women under 50, and there have been steep increases among Hispanic American, Asian American and Pacific Islander women.
The increases are driven by detection of localized tumors and certain cancers fueled by hormones.
Some of the rise results from changing fertility patterns. Childbearing and breastfeeding protect against breast cancer, but more American women are postponing childbirth — or are choosing not to bear children at all.
Other risk factors include genetics, family history and heavy drinking — a habit that has increased in women under 50. In older women, excess body weight may play a role in cancer risk.
Uterine cancer is the only cancer for which survival has actually decreased over the past 40 years, the A.C.S. said.
Death rates are also rising for liver cancer among women, and for cancers of the oral cavity for both sexes.
Pancreatic cancer has been increasing in incidence among both men and women for decades. It is now the third leading cause of cancer death. As with many other cancers, obesity is believed to contribute.
Little progress has been made in the understanding and treatment of pancreatic cancer. Death rates have been rising since record-keeping started, rising to 13 per 100,000 in men and 10 per 100,000 in women today, up from about five per 100,000 in both men and women in the 1930s.
The lack of progress has frustrated many scientists and physicians. The cancer is often fairly advanced when diagnosed, and the five-year survival rate is only 13 percent.
“We need to make progress in specifically understanding what’s driving pancreatic cancers to grow, what treatment will then stave off these cancers, what can prevent it in the first place, and how we can screen for it early,” said Dr. Amy Abernethy, an oncologist who co-founded Highlander Health, which focuses on accelerating clinical research.
Some experts are beginning to acknowledge that environmental exposures may be contributing to early-onset cancer, in addition to the usual suspects: lifestyle, genetics and family history.
“I think that the rise in not just one but a variety of cancers in younger people, particularly in young women, suggests there is something broader going on than variations in individual genetics or population genetics,” said Neil Iyengar, an oncologist at Memorial Sloan Kettering Cancer Center.
“It strongly points to the possibility that environmental exposures and our lifestyles in the U.S. are contributing to the rise of cancers in younger people.”
Public health efforts aimed at reducing risky lifestyle behaviors have focused on people at higher risk and at older Americans, who still bear the brunt of cancer’s burden, he noted.
But the risk factors in young people may be different.
Emerging research hints that maintaining regular sleeping patterns, for example, may also help to prevent cancer, he said.
Lifestyle and behavioral changes can reduce the risk for many cancers, Ms. Siegel said.
“I don’t think people realize how much control they have over their cancer risk,” she said. “There’s so much we can all do. Don’t smoke is the most important.”
Among the others: Maintaining a healthy body weight; not consuming alcohol or consuming in moderation; eating a diet high in fruits and vegetables, and low in red and processed meat; physical activity; and regular cancer screenings.
“There are all these things you can do, but they’re individual choices, so just pick one that you can focus on,” she said. “Small changes can make a difference.”