U.S. Cancer Death Rates Are Found to Be Falling

By DENISE GRADY
Death rates from cancer have been dropping by an average of 2.1 percent a year recently in the United States, a near doubling of decreases that began in 1993, researchers are reporting.
“Every 1 percent is 5,000 people who aren’t dying,” said Dr. Richard L. Schilsky, a professor of medicine at the University of Chicago and president-elect of the American Society of Clinical Oncology. “That’s a huge sense of progress at this point.”
Much of the progress comes not from miracle cures, but from more mundane improvements in prevention, early detection and treatment of some of the leading causes of cancer death — lung, colorectal, breast and prostate tumors. Years of nagging and pleading by health officials are finally beginning to pay off, experts say, in smoking cessation and increased use of mammograms, colonoscopies and other screening tests for colorectal and prostate cancer.
But the new statistics also contain bad news: American Indians and Alaska Natives in some regions are not benefiting from the same improvements as the rest of the population and have higher rates of preventable cancers and late-stage tumors that would have had a better prognosis had they been detected sooner. Some groups within those populations have high rates of smoking. Researchers attribute the problems to poverty, lower education levels and lack of insurance and access to medical care.
About 1.8 million of the 3.3 million American Indians and Alaska Natives receive their medical care through the Indian Health Service, but its facilities generally do not treat cancer. Outside contractors provide cancer treatment; to get it patients may have to navigate complicated rules and restrictions.
“The concern we have,” said Elizabeth Ward, director of cancer surveillance for the American Cancer Society, “is that much of the progress we’ve attained in reducing death rates comes from tobacco control, screening and access to timely and high-quality treatment, and those positive effects are not being seen in all populations in the U.S.”
The new information, in an annual report from the cancer society, the National Cancer Institute and others, is being published online today (www.interscience.wiley.com/cancer/report2007) and in the Nov. 15 issue of the journal Cancer.
In the United States, cancer remains the second leading cause of death after heart disease, with 559,650 deaths expected this year.
But over all, death rates from cancer have been dropping by an average of 1.1 percent a year since 1993.
The report, using a statistical technique to analyze death rates, finds that the rate of decline deepened recently, averaging 2.1 percent a year from 2002 to 2004, the latest dates for which statistics are available. For men, the average decline during that period was 2.6 percent, and for women 1.8 percent.
“I’m hopeful that these improvements will serve to at least partially satisfy the cynics who have questioned whether the investment in cancer treatment has borne fruit,” said Dr. Neal J. Meropol, director of the gastrointestinal cancer program at Fox Chase Cancer Center in Philadelphia. “In my view these numbers are starting to highlight the advances that have been made.”
But Dr. Meropol added that the figures “also highlight how we are failing large segments of our population in not providing health insurance.”
In men, death rates decreased for most cancers, but went up for esophageal and liver cancer.
In women, death rates also dropped for most common cancers, but increased for liver and lung cancer. Lung cancer rates are still increasing for women because they started smoking, and quit, later than men did. But the death rate in women is increasing more slowly than in the past.
“What we think the statistics show now,” said Dr. Ward of the American Cancer Society, “is that the epidemic of lung cancer in women has peaked, and we hope we’ll start seeing a downturn.”
The report found that the incidence of both breast and ovarian cancer had decreased in the past few years. Researchers think the decline may be due in part to a sharp drop in hormone use after menopause, a response to a landmark study in 2002 that found the drugs increased the risk of breast cancer.
Dr. Ward said the report was the first to analyze American Indians and Alaska Natives region by region, and it found striking differences among the groups.
For instance, lung cancer rates were highest in Alaska and the northern and southern plains, lower on the Pacific Coast and in the East, and lowest in the Southwest. Colorectal cancer incidence was three or more times higher in Alaska and the northern plains than in the Southwest. Alaska also had the highest rates of breast cancer. Smoking explains the lung cancer variations, but the other differences are not fully understood.
The American Cancer Society has said that lack of access to medical care is a major obstacle to reducing death rates. It recently began an advertising campaign to publicize the problem.
“Access to care truly is the message,” said Dr. Patricia Ganz, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles. “When people have equal access to care, they have equal outcomes.”
Dr. Meropol of the Fox Chase Cancer Center said: “What jumps out is that we really still have a long way to go.
“In spite of improvements, it’s still a minority of individuals in our country that undergo screening for colon cancer,” he said. “If everyone were screened appropriately, these incidence numbers would fall even more dramatically annually.”