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ACS: Cancer death rate continues its decline
The cancer death rate declined 20% in the past 2 decades, with the largest improvements seen among middle-aged black men, according to results of the Cancer Statistics 2014 report conducted by the American Cancer Society.
The report predicts that 1.6 million new cancers will be diagnosed in 2014, and that more than 500,000 cancer-related deaths will occur.
Rebecca Siegel, MPH, director of surveillance information at the ACS, and colleagues evaluated National Center for Health Statistics cancer mortality data from 1930 to 2010. They also used the SEER database and CDC’s National Program of Cancer Registries to evaluate population-based cancer incidence.
They found cancer mortality was highest in 1991 with 215.1 deaths per 100,000 people, which declined by 20% to 171.8 deaths per 100,000 people in 2010. As a result, the researchers calculated that 1.3 million deaths from cancer have been averted.
“One of the most important results from this year’s study was the continued progress against cancer, which is indicated by the sustained declines in cancer death rates,” Siegel told HemOnc Today. “Evaluating these data by race, age and sex, we found that black men have experienced the sharpest declines.”
Across age groups, the decline in cancer mortality from 1991 to 2010 was 33% in black men vs. a 16% decline in non-Hispanic white women, 20% decline in black women and 24% decline in non-Hispanic white men.
Black men aged 30 to 59 years experienced the steepest decline in cancer mortality, ranging from 44% to 55%.
John R. Seffrin
“The progress we are seeing is good, even remarkable, but we can and must do even better,” John R. Seffrin, PhD, CEO of the ACS, said in a press release. “The halving of the risk of cancer death among middle-aged black men in just 2 decades is extraordinary, but it is immediately tempered by the knowledge that death rates are still higher among black men than white men for nearly every major cancer and for all cancers combined.”
The cause for this decline among black men can be linked to smoking initiation habits, Siegel said.
“From the late 1970s through the early 1990s, the rates for smoking initiation dramatically declined among black high school students, whereas they declined much slower among white high school students and had leveled off in the 1980s,” Siegel said. “The declines in the overall cancer death rates — particularly among the middle-aged black men — are a reflection of these lower smoking rates, since it takes 30 to 40 years to see the effects of tobacco on cancer rates. It’s really a success story.”
Overall, the death rate for colorectal cancer has declined 46% from peak rates, followed by a 45% reduction in the death rate for prostate cancer, and a 34% decline in the rate for breast cancer.
However, from 2001 to 2010, the death rates for oropharynx, anus, liver, pancreas and soft tissue cancers have increased among men and women, and the death rate for melanoma has increased among men.
Using these data, Siegel and colleagues estimate that 585,720 cancer-related deaths will occur in 2014, equating to 1,600 deaths per day.
They predict lung and bronchus cancer will cause the most cancer-related deaths among men (28%) and women (26%), followed by breast cancer among women (15%), prostate cancer among men (10%) and colorectum cancer among men (8%) and women (9%).
Siegel and colleagues also evaluated cancer incidence rates.
From 2006 to 2010 — the most recent years for which these data are available — the cancer incidence rate decreased 0.6% yearly among men and remained stable among women.
Siegel and colleagues linked the decline observed among men to the 3.3% yearly decline in the incidence of colorectal cancer, 2% yearly decline in prostate cancer and 1.9% yearly decline in lung cancer.
However, the incidence of thyroid cancer increased 5.4% yearly among men and 6.5% among women, and liver cancer increased 3.7% yearly among men and 2.9% among women during this time.
“The increase in thyroid cancer incidence is thought to be partially caused by overdiagnosis, due to increased awareness and use of imaging tests,” Siegel said. “A lot of these cancers are detected incidentally, and the risk for death from thyroid cancer is extremely low, so that’s why it’s not having an effect on the death rate.”
Using these data, Sigel and colleagues estimated there will be 1.6 million new cancers diagnosed in 2014.
Researchers predict the most common newly diagnosed cancers among men will be prostate (27%), lung and bronchus (14%) and colorectum (8%) cancers. Among women, breast (29%), lung and bronchus (13%) and colorectum (8%) cancers are expected to be those most commonly diagnosed.
Although the report indicates significant improvements have been made in the past 2 decades, it also reveals disparities, Siegel said.
“Even though it’s exciting to see these large declines, there are some disenfranchised groups in the US — primarily groups that have lower socioeconomic status — that have twice the cancer death rates of the most affluent groups,” she said “We could be making even more progress against cancer if we could apply what we know in terms of cancer prevention to all segments of the population.”
These prevention methods include abstaining from tobacco use, maintaining a healthy weight, and being physically active, but those in the lower socioeconomic groups tend to smoke and have higher rates of obesity, Siegel said.
“This group has less access to health care and is more likely to engage in high-risk behaviors like smoking because of marketing strategies targeting these populations. As a result, they have higher cancer death rates,” Siegel said. “The implementation of the Affordable Care Act is exciting because we can expect to see diminishing disparities due to the almost-universal access to health care that will result.”
For more information:
Siegel R. CA Cancer J Clin. 2014;doi:10.3322/caac.21208.
Rebecca Siegel, MPH can be reached at Surveillance and Health Services Research, American Cancer Society, 250 Williams St., NW, Atlanta, GA 30303-1002; email: rebecca.siegel@cancer.org.
Disclosure: The researchers report no relevant financial disclosures.
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The reduction in cancer mortality seen among black men and women, and most prominently among black men, is an aspect of the report that is especially interesting. However, we certainly have additional work to do to understand the excess mortality that still remains, especially with regard to the greater mortality rate that exists among blacks compared with non-Hispanic white men and women. The narrowing of the gap in cancer mortality most likely points to cancer prevention efforts, access to health care and improved screening, as well as treatment being more widely utilized across the spectrum of the population with respect to age and socioeconomic status. We need to make sure that these factors continue to reach out to all aspects of society. We also need to continue epidemiological research to identify risk factors that underlie ethnic variation in disease risk and survival. This is going to be a challenge, but it is crucial in order to eliminate health disparities, as well as to reduce the burden of cancer incidence and mortality globally.
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This is tremendous progress and a direct result of our nation’s commitment to cancer research and care. This 20% decline in death rates shows the progress we’ve made using the earlier generations of cancer treatments. Now, based on accelerating understanding of cancer, we are poised to make even greater progress. Frustrating, this potential is limited by decreasing funding for the NIH — funding has fallen steadily for a decade in real terms — and by increasing barriers to clinical research with oncologists nationwide reporting that the cuts are harming their ability to conduct cancer research.
Although the recently passed budget allows for the reversal of some of the most drastic cuts, the truth is that our nation is gradually abandoning its historical commitment to leading cancer research globally. Given what the field of oncology has accomplished despite more limited resources, imagine what we could do with sustained or increased funding. To support accelerating improvements in cancer care and the kinds of statistics released [in the American Cancer Society report], ASCO joins others in the cancer research and care community in calling for a $32 billion budget for NIH to sustain and enhance the search for new cures.