U.S. Cancer Death Rates Continue to Fall

28 may 2009-- Some 650,000 people are alive today who wouldn't be were it not for advances in cancer prevention, detection and treatment over the past 15 years, new statistics show.

The American Cancer Society's Cancer Statistics 2009 report finds an encouraging 19.2 percent drop in cancer death rates among men from 1990 to 2005, as well as an 11.4 percent drop in women's cancer death rates during the same time period.

Overall, cancer death rates fell 2 percent per year from 2001 to 2005 in men and 1.6 percent per year from 2002 to 2005 in women. By comparison, between 1993 and 2001, overall death rates in men declined 1.5 percent per year and, between 1994 and 2002, 0.8 percent in women.

"We continue to see a decrease in death rates from cancer in both men and women and this is mainly because of prevention - mostly a reduction in smoking rates; detection which includes screening for colorectal cancer, for breast cancer and for cervical cancer; and also improved treatment," said report author Ahmedin Jemal, strategic director for cancer surveillance at the American Cancer Society.

"To put this in perspective, the number of lives saved is more than the population of Washington, D.C.," said Dr. Louis M. Weiner, director of the Lombardi Comprehensive Cancer Center at Georgetown University. "In my mind, that's a cause for some celebration. However, there are some sobering trends that we have to be aware of. The death rate for cardiovascular disease has dropped much more dramatically over that period than has the death rate from cancer, indicating the difficulty of developing new strategies to reduce the incidence of cancer and also to treat it more effectively. This is a very complex set of diseases. While we have come a long way, we have a lot further to go."

Hopefully, continued reductions in smoking rates, especially among women, should push cancer rates further down in the future, the researchers noted.

Although some 45 million Americans continue to smoke, for a prevalence rate of about 20 percent, "smoking prevalence is going in the right direction," Jemal said. "We're going to see a reduction in lung cancer death rates, although I don't know when it might be. In particular, we will see a reduction in cancer death rates among women that's going to drive [down] the overall cancer death rate."

Better screening could also further fuel the trend. Only 50 percent of Americans over the age of 50 currently get regular screening for colorectal cancer, he said.

Here is a summary of the report's findings:

• In 2009, an estimated 1,479,350 new cases of cancer will be diagnosed in the U.S. (766,130 in men and 713,220 in women) and 562,340 people will die of the disease (292,540 men and 269,800 women). This means 1,500 deaths from cancer every day).
• Between 2001 and 2005, the incidence of cancer in men declined by 1.8 percent per year; from 1998 to 2005 the incidence rate in women dropped 0.6 percent per year. In men, the gains were largely as a result of decreases in the incidence of lung, prostate and colorectal cancer (the three most common cancers). In women, the decline was largely attributable to declines in both breast and colorectal cancer, the two most common tumor types in women.
• Cancer death rates dropped by 11.4 percent for women between 1991 and 2005, with a 37 percent decline in deaths from breast cancer and a 24 percent decrease in deaths from colorectal cancer.
• The three leading cancer killers in men are lung, prostate and colorectal cancer. In women, they are lung (accounting for 26 percent of all cancer deaths), breast and colorectal cancer.
• Men have a 44 percent chance of developing cancer during their lifetime and women a 37 percent chance, although women are more likely to have the disease earlier (before age 60).
• Lung cancer shows the greatest regional variation in cancer incidence, ranging from a low of 39.6 cases per 100,000 in men and 22.4 per 100,000 in women in Utah to 136.2 in men and 76.2 in women in Kentucky. These statistics correlate directly to smoking rates in the two states, with Utah having the lowest prevalence in adult smoking in the country, and Kentucky the highest.
• Blacks still assume a disproportionate share of the cancer burden, with black men being 18 percent more likely to develop cancer and 36 percent more likely to die. Black women have a 6 percent lower incidence rate but this is more than made up for with a death rate, which is 17 percent higher than that seen in white women.
• The five-year survival rate for children with cancer is now 80 percent, up from only 58 percent for those diagnosed in the mid-1970s. But cancer is still the second leading cause of death in youngsters aged 1 to 14 (after accidents), with leukemia being the most common cancer diagnosed.
• And in a special section, the report finds that cancer survivors are about 14 percent more likely to develop a new cancer than individuals who have never had a cancer diagnosis; almost 900,000 cancer survivors have been diagnosed with more than one cancer. Patients diagnosed with tobacco-related cancers, such as cancers of the oral cavity, lung, esophagus, kidney, and urinary bladder, have the highest risk for a second cancer because smoking is a risk factor for at least 15 types of cancer. Breast cancer survivors comprise almost half of women who develop a second cancer.

Unfortunately, cancer remains the leading killer (surpassing heart disease) for persons under 85, and one-quarter of deaths in the United States still come from cancer, the report stated.

"It's good news that the death rates for the most common cancers are on the decline, but there are still too many Americans dying of cancer every year," said Dr. Alan Astrow, director of medical oncology and hematology at Maimonides Cancer Center in New York City. "It's troubling that African-Americans continue to experience higher rates of mortality from cancer than whites. It's also troubling that Americans with less education have higher death rates. There are continued high rates of deaths from lung cancer. It's hard to feel good about 160,000 Americans dying of lung cancer every year. That's a disturbing statistics which we, as a nation, need to address."

The report appears online and in the July/August print issue of CA: A Cancer Journal for Clinicians.

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.”