A report Tuesday that takes a 30-year look at cancer rates and deaths in the United States offers a mixed bag of good news, cautious optimism, and worry.

Overall numbers are on the decline for the first time, according to the collaborative Annual Report to the Nation (pdf).

But this year's report - put together by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries - takes a hard look at lung cancer, and calls for states to maintain and strengthen their control programs.

Cancer incidences, death rates, or a combination of the two rose in 18 mostly Midwestern and southern states.

California is the only state where both the incidence and death rates dropped.

In terms of lung cancer, responsible for about 30 percent of all cancer deaths in the U.S, Ohio had the 14th highest mortality rate for men and women. Because of lack of sufficient information, the report did not rank Ohio in cancer incidence.

Ohio's situation disappoints Dr. Derek Raghavan, director of the Cleveland Clinic's Taussig Cancer Center. He cited geographic proximity as one main cause, with Ohio sharing a border with Kentucky, ranked first in cancer incidents and mortality, and West Virginia -- ranked second in incidences and third in mortality.

"There's no question that there's a lot of cross-flow," he said. "The impact of the tobacco belt is there."

Still, the percentage of Ohio adults over age 18 who smoked dropped from 1996 to 2007. In men, the numbers dropped from 26.3 percent to 24.9. Among women, it dropped from 24 percent to 20.1 percent.

And, unlike their male counterparts, national cancer death rates in women age 75 and older have not yet dropped -- in large part because of the huge influx of women who started smoking between 1965-75, at much higher rates than men.

The report's overall message is clear, Raghavan said. "Men stopped smoking and they got less lung cancer," he said. "Women didn't stop smoking and their numbers have plateaued."

Other report findings:

• Black men had the highest cancer incidence rate for 2001-05 among all men. White women had the highest rate among all women.

• Death rates for all cancers combined for 2001-05 were highest for African Americans and lowest for Asian Pacific Islander men and women.

• Kentucky has the highest death rate for lung cancer. Utah is at the opposite end of the spectrum.