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US cancer death rate has dropped 25% since 1991
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A steady decline in smoking and advances in early detection and treatment have contributed to a 25% reduction in cancer death rates in the United States since 1991, according to Cancer Statistics 2017, the American Cancer Society’s comprehensive annual report on cancer incidence, mortality and survival.
The report — published in CA: A Cancer Journal for Clinicians — indicates this reduction in cancer death rate equates to 2.1 million fewer deaths between 1991 and 2014. Data also show a 1.5% annual decline from 2004 to 2014.
“The continuing drops in the cancer death rate are a powerful sign of the potential we have to reduce cancer’s deadly toll,” Otis W. Brawley, MD, FACP, chief medical officer of the American Cancer Society, as well as a HemOnc Today Editorial Board member, said in a press release. “Continuing that success will require more clinical and basic research to improve early detection and treatment, as well as creative new strategies to increase healthy behaviors nationwide.
“Finally, we need to consistently apply existing knowledge in cancer control across all segments of the population, particularly to disadvantaged groups,” he added.
According to the annual report, first published by the American Cancer Society in 1967, the cancer death rate dropped from its peak of 215.1 per 100,000 Americans in 1991 to 161.2 per 100,000 in 2014, the latest year for which mortality data were available for analysis.
Researchers attributed the decrease primarily to the steady decline in the death rate of the four major cancer sites. Death of lung cancer decreased 43% between 1990 and 2014 in males and 17% between 2002 and 2014 in females; breast cancer death rates fell 38% from 1989 to 2014; prostate cancer death rates declined by 51% from 1993 to 2014; and colorectal cancer death rates fell by 51% from 1976 to 2014.
Gender-specific cancers
The report reveals significant disparities in incidence and mortality among men and women. For all cancer sites combined, men have a 20% higher incidence rate and 40% higher death rate. However, from 2004 to 2013, incidence of all cancer sites in men has declined 2%, whereas rates have remained stable in women.
One reason for the disparities is the rise in prostate cancer diagnoses, which spiked in the late 1980s and early 1990s due to a surge in PSA screenings and the detection of asymptomatic disease. However, they have since dropped more than 10% annually from 2010 to 2013 following a U.S. Preventive Services Task Force recommendation against routine screening.
Lung cancer incidence, although still the most common among all cancers, continues to decline about twice as fast among men, which could be reflective of a decrease in tobacco use among men.
Colorectal cancers in men and women fell by about 3% per year from 2004 through 2013. Researchers attribute the decline to the increase of colonoscopies used among adults aged 50 years and older, from 21% in 2000 to 60% in 2015.
However, incidence rates of liver cancer continue to increase rapidly, by about 4% per year in men and 3% in women. Rates of liver cancer are three times higher in men than women.
“This is because of the combination of increased prevalence of risk factors such as hepatitis C and obesity/diabetes/metabolic syndrome, and a lack of effective screening and therapy,” Paolo Boffetta, MD, MPH, professor of medicine at Icahn School of Medicine at Mount Sinai and associate director for cancer prevention at Tisch Cancer Institute at Mount Sinai, who was not involved with the report, told HemOnc Today. “With the recent development of drugs for hepatitis C, the trend might change in the future.
The report indicates men are four times more likely to be diagnosed with cancers of the esophagus, larynx and bladder. Women are more likely to be diagnosed with cancers of the anus, gallbladder and thyroid, and thyroid diagnosis occur at a rate three times higher in women than men.
Melanoma incidence rates are 60% higher in men than women, whereas death rates are more than double. Researchers noted that women are more likely to be diagnosed with melanoma at an earlier stage than men and, therefore, have better survival rates.
Racial, socioeconomic disparities
Cancer incidence and death rates vary considerably between racial and ethnic groups, with rates generally highest among black individuals and lowest among Asian individuals and Pacific Islanders, according to the report.
In 2014, the cancer death rate was 15% higher in blacks than in whites. Black men had an excess cancer risk of 21% in 2014, compared with 47% in 1990. Researchers attribute the decline in cancer deaths among black men to rapid declines in smoking-related cancers.
In 1998, black women had a 20% greater incidence of cancer than white women, but that rate decreased to 13% in 2014. The disparities are linked to unequal access to and use of high quality health care, including cancer prevention, timely diagnosis and optimal treatment, the researchers wrote. For similar reasons, black individuals also are more likely than whites to be diagnosed with cancer at an advanced stage.
The gap is narrowing rapidly, researchers report, after the Affordable Care Act of 2010, which has contributed to a reduction in the proportion of uninsured black individuals from 21% in 2010 to 11% in 2015, and of uninsured Hispanic individuals from 31% in 2010 to 16% in 2015.
The incidence of cancer within the four major cancer sites — lung, breast, prostate and colorectal — was lower among Hispanics, American Indians and Alaska natives than Non-Hispanic whites, but higher for cancers of the stomach and liver.
Geographically, lung cancer rates in Kentucky (118 per 100,000 men; 80 per 100,000 women) — which historically has had the highest smoking prevalence — were more than three times greater than in Utah (34 per 100,000 men; 24 per 100,000 women). The incidence of prostate cancer in the District of Columbia (169 per 100,000) more than doubled that of Arizona (84 per 100,000), most likely because of PSA testing and racial composition.
Cancer in children
Behind only accidents, cancer is the second most common cause of death among children aged 1 to 14 years in the United States, with an estimated 10,270 children expected to be diagnosed with cancer in 2017 and an estimated 1,190 children expected to die of cancer. Leukemias — 76% of which are lymphoid leukemia — account for 29% of all childhood cancers.
Cancers of the brain and other nervous system tumors are the second most common type (26%), followed by lymphomas and reticuloendothelial neoplasms (11%), soft-tissue sarcomas, neuroblastoma (6%) and renal tumors (5%).
The most common cancer types in adolescents aged 15 to 19 years are lymphoma (21%), cancers of the brain and other nervous system tumors (17%), leukemia (14%), germ cell and gonadal tumors (12%), thyroid carcinoma (11%) and melanoma (5%).
Death rates among those aged birth to 19 years have declined continuously in recent years, from 6.6 per 100,000 in 1970 to 2.2 per 100,000 in 2014, an overall reduction of 66%. Five-year survival rates for all cancers improved among children from 58% in the mid-1970s to 83% from 2006 to 2012; 5-years survival rates in adolescents increased from 68% to 84%.
Predicting 2017
Looking ahead, the researchers estimate that in 2017 there will be nearly 1.7 million new cancer diagnoses (averaging more than 4,600 per day) and more than 600,000 cancer deaths (averaging 1,650 per day) in the United States. Of those, about 63,410 diagnoses of female breast carcinoma in situ and 74,680 diagnoses of melanoma are expected in 2017.
The most common cancer diagnosis for men in 2017 is projected to be prostate cancer (19%), followed by lung and bronchus (14%), colon and rectum (9%) and urinary bladder (7%). However, the cancers most likely to result in death among men are lung and bronchus (27%), colon and rectum (9%), prostate (8%) and pancreas (7%).
Among women, breast cancer is projected as the most common 2017 cancer diagnosis (30%), followed by lung and bronchus (12%), colon and rectum (8%) and uterine corpus (7%). The cancers with the highest projected rate of mortality among women include lung and bronchus (25%), breast (14%), colon and rectum (8%) and pancreas (7%).
Researchers note that their estimated numbers of new cancer cases and cancer deaths in 2017 are based on projections from 2013 and 2014 and could be affected by changes in methodology. Researchers also noted that despite an overall decrease in cancer deaths since 1991, death rates are rapidly rising among patients with cancers of the liver and uterine corpus, both of which are strongly associated with obesity.
“Advancing the fight against cancer requires continued clinical and basic research to improve detection practices, as well as treatment,” researchers wrote. “In addition, creative new strategies are also needed to increase healthy behaviors nationwide and to more broadly apply existing cancer control knowledge across all segments of the population, with an emphasis on disadvantaged groups.” – by Chuck Gormley
Disclosures: The authors report no relevant financial disclosures.
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