US cancer mortality continues to decline at record pace
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Overall cancer mortality in the United States decreased by 31% between 1991 and 2018 amid continued advances in lung cancer treatment, according to American Cancer Society’s 70th annual report on cancer statistics.
The report, released today and published in CA: A Cancer Journal for Clinicians, showed a record 2.4% decline in cancer death rates between 2017 and 2018, following a 2.2% drop between 2016 and 2017.
Still, approximately 1.9 million new cancer cases and 608,570 cancer deaths are projected for this year. These numbers do not account for the impact of COVID-19 on cancer diagnoses or deaths, according to the report.
“This is our 70th anniversary of publishing the estimated numbers of cancer cases and deaths in the current year, which is critical to inform clinicians, researchers, cancer control planners and advocates of the contemporary cancer burden,” Rebecca L. Siegel, MPH, senior scientific director of surveillance research at American Cancer Society, told Healio. “It is also a check on our progress, including the areas we are doing well in and where there are opportunities to do better, such as with cervical cancer and racial disparities.”
Earlier detection and improvements in treatment have led to long-term declines in death rates for lung, breast, colorectal and prostate cancers, with an estimated 3.2 million cancer deaths averted between 1991 and 2018, according to the report.
“Cancer mortality significantly decreased by more than 2% annually for the second year in row, which is largely due to accelerations in declines of lung cancer, from 2.4% annually during 2009 to 2013 to 5% during 2014 to 2018,” Siegel said. “This was due to improvements in treatment at every stage of diagnosis.”
However, lung cancer mortality is still higher than that of breast, prostate and colorectal cancer combined, Siegel added.
“The majority [80% or more] of lung cancers are caused by smoking, which is why continued work to increase cessation and prevent smoking uptake among young adults — including e-cigarettes, which may be a gateway — is so important,” Siegel said.
Cervical cancer, which can be prevented through screening, remains the second leading cause of cancer death among women aged 20 to 39 years, according to the report, which stated that nearly 11 women per day died of the disease in 2018.
“More emphasis on cervical cancer screening and HPV vaccination is needed to avoid these preventable deaths,” Siegel said. “HPV vaccination coverage remains low in the U.S., with only 57% of adolescent females vaccinated compared with more than 90% in the United Kingdom and more than 80% in Australia.”
This year’s report also included the following statistics:
- Cancer is the leading cause of death among Alaska Natives, Asian Americans and Hispanics.
- Five-year OS for all cancer types diagnosed between 2010 and 2016 was 68% among white patients compared with 63% among Black patients.
- The survival rate is highest for prostate cancer (98%), followed by melanoma of the skin (93%) and female breast cancer (90%). Cancers with the lowest survival rates include those of the lung (21%), liver (20%), esophagus (20%) and pancreas (10%).
- Black patients have lower survival rates than white patients for every cancer type, except for pancreatic cancer. However, the disparity in overall cancer mortality between Black patients and white patients declined from 33% in 1993 to 13% in 2018.
- Among men, bronchus, colorectal, lung and prostate cancers accounted for 46% of incident cases, with prostate cancer specifically accounting for 26% of diagnoses. Colorectal cancer was the leading cause of cancer-associated death among men aged 20 to 39 years.
- Among women, breast, colorectal and lung cancers accounted for 50% of all new diagnoses and breast cancer accounted for 30% of all cancers. The increase in female breast cancer incidence rates of about 0.5% per year from 2008 to 2017 may be attributed in part to steady declines in fertility rates and increased body weight.
Moreover, geographic disparities appeared widest for some of the most preventable cancer types, such as lung and cervical cancer, with incidence and mortality rates varying significantly across U.S. states, according to the report.
“I am hopeful that the overall decrease in cancer mortality will continue at a record pace, although disruptions in care — due to the COVID-19 pandemic — will likely hinder future progress to some extent,” Siegel said.
For more information:
Rebecca L. Siegel, MPH, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303; email: rebecca.siegel@cancer.org.
Perspective
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Robert Uzzo , MD, MBA, FACS
Cancer death rates peaked in 1991 and have been slowly declining since. Significant recent advances have led to steady declines in death due to cancer ,with this year’s report recording the largest single-year drop in overall cancer mortality. This translates to a decrease in cancer deaths by more than 3 million had the 1991 rates persisted.
Educational initiatives, screening, early detection and more effective therapies for advanced disease are largely responsible for these findings.
Great progress has been made in many cancer types in the last decade, but this year’s decline appears to be related to improved survival primarily in lung cancer and melanoma.
Importantly, these incremental gains do not fully reflect the results of the most effective immunotherapies, which have only been available since 2015. When combined with surgery, radiation and or other targeted therapies, these next-generation immunotherapies should continue to bend the cancer survival curve for many years to come.
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