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Annual report: Overall cancer death rates continue to decline, but problem areas persist
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Overall cancer death rates continued to decrease in men, women and children among all racial and ethnic groups, according to the Annual Report to the Nation on the Status of Cancer.
However, progress in reducing mortality and improving survival is still limited in several cancer types, including liver, pancreas, brain and uterine cancers.
The report — a collaboration between the American Cancer Society, CDC, NCI, HHS and the North American Association of Central Cancer Registries (NAACCR) — has provided updates on cancer incidence and mortality patterns in the United States since 1998.
This year’s report focused on survival by stage, race/ethnicity and state for common cancers to interpret survival statistics in conjunction with changes in screening, early detection and treatment.
“Although trends in death rates are the most commonly used measure to assess progress against cancer, survival trends are also an important measure to evaluate progress in improvement of cancer outcomes,” report researcher Ahmedin Jemal, DVM, PhD, from the ACS Surveillance and Health Services Research program, said in a press release. “We last included a special section on cancer survival in 2004 and, as we found then, survival improved over time for almost all cancers at every stage of diagnosis. But, survival remains very low for some types of cancer and for most types of cancers diagnosed at an advanced stage.”
Incidence rates
Researchers evaluated temporal trends in age-standardized, delay-adjusted cancer incidence from 1999 to 2013.
Incidence rates for men decreased throughout the study period, with the largest yearly decline observed in prostate cancer (–7.9%; 95% CI, –12.2 to –3.3).
Overall, incidence rates among men significantly decreased for seven of the 17 most common cancers, including prostate (P = .003), lung (P < .001), colorectal (P < .001), bladder (P < .001), esophagus (P < .001), brain (P = .005) and larynx cancers (P < .001).
In contrast, cancer rates in men increased for melanoma, leukemia, pancreatic cancer, liver cancer, myeloma and thyroid cancer (P < .001 for all), and stabilized for non-Hodgkin lymphoma, kidney cancer and stomach cancer.
Among women, 1999 to 2013 incidence rates decreased for seven of the 18 most common cancers, including lung (P < .001), colorectal (P < .001), ovary (P < .001), bladder (P < .001), cervix (P = .001) and stomach cancer (P < .001), and non-Hodgkin lymphoma (P = .003).
However, incidence rates increased significantly for breast cancer (P < .03), uterine cancer (P < .001), thyroid cancer (P < .001), melanoma (P < .01), leukemia (P < .001), myeloma (P < .001), pancreatic cancer (P < .001), oral cavity cancer (P = .001) and liver cancer (P < .001). Rates remained unchanged for kidney and brain cancer.
Incidence rate trends in both men and women from 2009 to 2014 appeared consistent with previous trends.
Mortality rates
Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% CI, –1.8 to –1.8) per year in men, by 1.4% (95% CI, –1.4 to –1.3) per year in women and by 1.6% (95% CI, –2 to –1.3) per year in children.
Death rates decreased for 11 of the 16 cancers in men, including lung cancer by 3.5% (95% CI, –3.9 to –3.2) per year, prostate cancer by 3.4% (95% CI, –3.6 to –3.2), and colorectal cancer by 2.5% (95% CI, –2.7 to –2.4).
However, rates increased for cancers of the liver by 2.6% (95% CI, 2.4-2.8) per year, pancreas by 0.3% (95% CI, 0.1-0.4), and brain by 0.5% (95% CI, 0-1). Bladder and oral cavity cancer rates stabilized.
Death rates among women decreased for 13 of the 18 most common cancer types, including lung by 2% (95% CI, –2.2 to –1.8) per year, breast by 1.6% (95% CI, –1.8 to –1.4), and colorectal by 2.8% (95% CI, –3 to –2.7).
However, death rates increased for cancers of the uterus by 2% (95% CI, 1.4-2.6) per year and liver cancer by 3% (95% CI, 2.6-3.4) per year. Pancreas cancer, brain cancer and myeloma rates remained stable.
Death rate trends in both men and women from 2009 to 2014 appeared consistent with previous trends.
Five-year survival for cancers diagnosed in 2006 to 2012 increased significantly for all cancer types, except for cervix and uterus cancers, compared with cases diagnosed in 1975 to 1977. The greatest absolute increases in survival seen in prostate and kidney cancers, non-Hodgkin lymphoma, myeloma and leukemia.
In the same period, cancers with the lowest 5-year survival included cancers of the pancreas (8.5%), liver (18.1%), lung (18.7%), esophagus (20.5%), stomach (31.1%) and brain (35%). Those with the highest 5-year survival rates were prostate (99.3%), thyroid (98.3%), melanoma (93.2%) and female breast cancer (90.8%).
“This report found that tobacco-related cancers have low survival rates, which underscores the importance of continuing to do what we know works to significantly reduce tobacco use,” Lisa C. Richardson, MD, MPH, director of the CDC’s Division of Cancer Prevention and Control, said in the press release. “In addition, every state in the nation has an adult obesity prevalence of 20% or more. With obesity as a risk factor for cancer, we need to continue to support communities and families in prevention approaches that can help reverse the nation’s obesity epidemic. We need to come together to create interventions aimed at increasing the uptake of recommended, effective cancer screening tests, and access to timely cancer care.”
Survival by race/ethnicity
Survival varied by race/ethnicity and state. For example, the adjusted relative risk for death for all cancers combined was 33% higher in non-Hispanic blacks (HR = 1.33; 95% CI, 1.32-1.34) and 51% higher in non-Hispanic American Indians/Alaska Natives (HR = 1.51, 95% CI, 1.46-1.56) compared with non-Hispanic whites.
“While this report found that 5-year survival for most types of cancer improved among both blacks and whites over the past several decades, racial disparities for many common cancers have persisted, and they may have increased for prostate cancer and female breast cancer,” Lynne T. Penberthy, MD, MPH, associate director of NCI’s surveillance research program, said in the press release. “We still have a lot of work to do to understand the causes of these differences, but certainly differences in the kinds and timing of recommended treatments are likely to play a role.”
The researchers noted the importance of increasing efforts to discover new strategies for prevention, early detection and treatment while applying already proven interventions.
“The continued drops in overall cancer death rates in the United States are welcome news, reflecting improvements in prevention, early detection and treatment,” Betsy A. Kohler, MPH, CTR, executive director of NAACCR, said in the press release. “But this report also shows us that progress has been limited for several cancers, which should compel us to renew our commitment to efforts to discover new strategies for prevention, early detection, and treatment, and to apply proven interventions broadly and equitably.” – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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