Cancer mortality rate drops 29% between 1991 and 2017
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The rate of cancer mortality dropped by 29% between 1991 and 2017 in the United States, with a 2.2% drop between 2016 and 2017, according to data from Cancer Statistics 2020, American Cancer Society’s annual report on cancer rates and trends.
This progress is led by declining smoking rates and subsequent lung cancer mortality, as well as treatment breakthroughs with checkpoint inhibitors, researchers noted.
“This wasn’t a surprise because we’ve seen a yearly decrease in lung cancer mortality over the past 2 decades,” Ronald B. Natale, MD, professor of medicine and medical director of the clinical lung cancer program at Cedars-Sinai Medical Center, who was not involved with the report, told Healio. “The decrease of cigarette smoking and its subsequent lag effect on the incidence of lung cancer and obviously the death rate is something we have been tracking. It’s exciting to see.”
The decreased mortality rate reflects approximately 2.9 million fewer cancer-related deaths in that time than would have occurred if peak rates had persisted.
“The accelerated drops in lung cancer mortality as well as in melanoma that we’re seeing are likely due at least in part to advances in cancer treatment over the past decade, such as immunotherapy,” William G. Cance, MD, chief medical and scientific officer of American Cancer Society, said in a press release. “They are a profound reminder of how rapidly this area of research is expanding, now leading to real hope for [patients with cancer].”
Declines in cancer mortality
For their 2020 report, researchers analyzed incidence data through 2016 from the SEER database, the National Program of Cancer Registries and the North American Association of Central Cancer Registries. They analyzed mortality data through 2017 using the National Center for Health Statistics.
Results showed an overall decline of 29% in cancer-related deaths between 1991 and 2017, driven by long-term declines in deaths of lung, colorectal, breast and prostate cancers.
Between 2008 and 2017, however, reduction in death rates slowed for female breast and colorectal cancers. Rates for prostate cancer remained steady over that time period.
Declines in lung cancer mortality rates, meanwhile, accelerated between 2008 and 2017, from dropping 3% annually between 2008 and 2013 to 5% annually between 2013 and 2017 among men. Corresponding decreases accelerated from 2% to 4% among women.
Overall, lung cancer death rates dropped by 51% since 1990 among men and by 26% since 2002 among women.
The annual declines in lung cancer mortality led to a 2.2% overall drop in cancer mortality between 2016 and 2017, which researchers noted is the largest single-year decrease of cancer mortality in history.
Despite the decreases, lung cancer still caused more deaths in 2017 than breast, prostate, colorectal and brain cancers combined, researchers noted.
Natale said that there are still major concerns about the increase in e-cigarette use, which could reverse some of these trends.
“The big concern is among high school students in particular,” Natale told Healio. “In some parts of the country, the incidence of vaping is over 60% among high school students. The carcinogenic effect from vapor may be a little better than the inhalation of cigarette smoke, but the big concern is the nicotine addiction. People who get addicted to nicotine before age 18 have a much harder time breaking the addiction than those who got addicted after age 18.”
Results also showed that reductions in rates of melanoma mortality — driven by FDA approval of new treatments for metastatic disease — increased from 1% annually between 2006 and 2010 to 7% annually between 2013 and 2017 among men and women aged 50 to 64 years, and from 2% to 3% among those aged 20 to 49 years. Researchers noted annual declines in melanoma mortality rates of 5% to 6% among individuals aged 65 years and older, compared with increases among this group prior to 2013.
Rates of death related to liver cancer attenuated among women and stabilized among men between 1991 and 2017.
Predictions for 2020
The American Cancer Society estimated that there will be 1,806,590 new cancer cases in the United States in 2020. Additionally, researchers estimated that 606,520 individuals will die of cancer in 2020, corresponding to more than 1,600 deaths per day.
Trends in cancer incidence can fluctuate based on behaviors associated with cancer risk and changes in medical practice, researchers noted. An example is the substantial increase in prostate cancer incidence in the early 1990s due to PSA testing of previously unscreened men.
Estimates of cancer-related deaths for 2020 are based on a model that may be oversensitive to sudden or large changes in data, which serves as a limitation to these data. Additionally, errors in reporting race/ethnicity in medical records and death certificates may result in underestimates of cancer incidence in minority populations.
“The news this year is mixed,” Rebecca Siegel, MPH, cancer epidemiologist and scientific director of surveillance research at American Cancer Society, said in a press release. “The exciting gains in reducing mortality for melanoma and lung cancer are tempered by slowing progress for colorectal, breast and prostate cancers, which are amenable to early detection. It’s a reminder that increasing our investment in the equitable application of existing cancer control interventions, as well as basic and clinical research to further advance treatment, would undoubtedly accelerate progress against cancer."
"As excited as we are about these data, we also recognize the concerns about the racial disparities that some minority groups experience,” Natale told Healio. “It gives us pause because we realize the public health effort that started in 1966 has missed some groups. We are concerned some people in our population with a lower educational level and consequently a lower socioeconomic level, or those without insurance, have rates of cigarette smoking that remain much higher than the national average. This gives us insight on where the public health efforts need to be focused to continue this tremendous achievement and make it better.” – by John DeRosier
Ronald B. Natale, MD, can be reached at Cedars-Sinai Medical Center, 8700 Beverly Blvd. Saperstein Critical Care Tower, Suite MS-33, Los Angeles, CA 90048; phone: 310-423-1101.
Disclosures: The American Cancer Society funded this study. All researchers report employment with American Cancer Society.
Perspective
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Michael B. Steinberg, MD, MPH, FACP
As a tobacco treatment researcher and clinician, I optimistically attribute much of the lung cancer mortality decline over this period to past and continued reductions in the use of combusted tobacco products across the nation. Cigarette smoking rates have dropped from 21% in 2005 to 13.7% in 2018. As a society, we need to continue to recognize the deadly addictive nature of tobacco and the importance of connecting current tobacco users to safe and effective tobacco dependence treatment, including counseling, group treatment, telephone quit lines and FDA-approved pharmacotherapies.
However, lung cancer still caused more deaths in 2017 than breast, colorectal and prostate cancers combined. Therefore, more work is clearly necessary. We must maintain our strongest efforts to reduce tobacco use, offer evidence-based tobacco dependence treatment and strive to keep never smokers from ever falling victim to the most addictive substance in our society. Additionally, we need to increase the utilization of methods for screening/early detection for lung cancer, namely low-dose CT (LDCT) scans. This evidence-based screening test demonstrated a 20% lung cancer mortality reduction in the National Lung Screening Trial and is recommended by the U.S. Preventive Services Task Force. However, utilization of LDCT is still woefully low. It has been reported that less than 4% of those eligible for LDCT actually undergo the scans. This level is far lower than that of cervical cancer screening, mammograms or colonoscopy. Our best medical and public health efforts are required to increase awareness and utilization of this potentially lifesaving screening test.
Only through vigilance in offering effective tobacco treatment, combined with significant increases in lung cancer screening, can we hope to continue to reduce lung cancer and thus overall cancer death rates in the U.S.
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