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The major features of this chapter are the clinical aspects of cancer, including etiology, prevention, staging, diagnosis, and treatment of common cancers, and recognition and management of complications from cancer.


Cancer is the second most common cause of death in the United States. In 2021, an estimated 1,898,160 cases of cancer were diagnosed, and 608,570 persons died of cancer. Table 39–1 lists the 10 leading cancer types in men and women by site. However, death rates from cancers are declining. Compared with the 1991 overall cancer death rate of 215 per 100,000 population, the 2018 rate of 149 per 100,000 represents a 31% reduction in the overall cancer death rate. Importantly, death rates have declined in all four of the most common cancer types (prostate, breast, lung, and colorectum). Reductions in cancer mortality reflect successful implementation of a broad strategy of prevention, detection, and treatment. Due to these improvements, the number of cancer survivors is increasing. In 2019, an estimated 16.9 million people were alive in whom cancer had been previously diagnosed; that number is projected to grow to 18.9 million in 2024.

Table 39–1.Estimated 10 most common cancer cases in the United States in men and women (all races).


Tobacco use is the most common preventable cause of cancer death; at least 30% of all cancer deaths in the United States are directly linked to tobacco use. In 2014, an estimated 167,133 cancer deaths in the United States could be directly attributed to tobacco. Clear evidence links tobacco use to at least 15 cancers. The most dramatic link is with lung cancer; 81% of lung cancer deaths are attributable to smoking. Remarkably, almost 10% of long-term survivors of a tobacco-related cancer continue to use tobacco products, increasing their risk of yet another cancer.

The prevalence of smoking for US adults based on the 2019 National Health Interview Survey is 14% for adults aged 18 years or older, which is a remarkable reduction from the 1955 peak of ...

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