Declines in cancer death rates continue, but not for all common types
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Experts continued to see a decrease in overall cancer mortality among men and women of all races and ethnicities in the United States toward the end of the last decade, according to the Annual Report to the Nation on the Status of Cancer.
The report, which included data from 2001 to 2018, showed accelerated declines in both melanoma and lung cancer deaths during the most recent period, from 2014 to 2018. However, declines observed in death rates for prostate, colorectal and female breast cancers appeared to have slowed or stopped.
“[This report] provides up-to-date information on the status of cancer occurrence, overall and for multiple cancer types, and emerging trends in the United States using high-quality data covering the entire or almost entire U.S. population,” Farhad Islami, MD, PhD, scientific director of cancer disparity research at American Cancer Society, told Healio. “One of the major aims of this report is to inform health care providers, policy makers and other relevant individuals and institutions to take appropriate actions to reduce the burden of cancer — notably cancers with rising trends — and use the information on cancers with declining trends to identify the factors that may have contributed to the declining trends.”
The report — a collaboration among American Cancer Society, CDC, NCI, HHS and North American Association of Central Cancer Registries that was published in Journal of the National Cancer Institute — also showed continued increases in overall cancer incidence rates among women, children and adolescents and young adults.
Incidence rates
Investigators compiled data on incidence rates for all cancer types included in CDC- and NCI-funded population-based cancer registry programs during 2001 and 2017.
Results showed that between 2013 and 2017, overall cancer incidence rates for all age groups were 487.4 per 100,000 population among males and 422.4 per 100,000 population among females.
Rates remained steady among males during the period but increased slightly among females, for an average annual percent change (AAPC) of 0.2% (95% CI, 0.1-0.2).
Moreover, incidence rates among children, adolescents and young adults increased for all races and ethnicities except for American Indian/Alaska Natives, for whom rates were stable.
“We also found, for the first time, that previously increasing incidence rates of liver cancer have stabilized for both males and females, and incidence rates of thyroid cancer are declining among women,” Islami said. “In contrast, previously declining trends have slowed down for colorectal and female breast cancers and leveled off for prostate cancer. Overall cancer incidence rates also continue to increase among women, children, and adolescents and young adults. Both incidence and death rates of colorectal cancer are increasing among young adults; a similar pattern has been observed in other studies for several other cancer types that are associated with excess body weight.”
Mortality rates
Researchers pooled data on cancer death rates between 2001 and 2018 from the National Center for Health Statistics’ National Vital Statistics System.
They found overall cancer death rates from 2014 to 2018 decreased by –2.2% (95% CI, 2.5 to 1.9) per year for males and –1.7% (95% CI, 2.1 to 1.4) for females. Researchers noted acceleration in annual declines from the 2001-2015 period to the 2015-2018 period among both males (–1.8% to –2.3%) and females (–1.4% to –2.1%).
Death rates among males decreased for 11 of the 19 most common cancer types they experience, with AAPCs of 5.2% (95% CI, 5.6 to 4.9) for lung cancer, 0.4% (95% CI, 1.2 to 0.5) for prostate cancer, 1.9% (95% CI, 2.3 to 1.5) for colorectal cancer and 2.1% (95% CI, 3.4 to 0.8) for leukemia. Conversely, death rates increased for cancers of the bones and joints (AAPC = 2.7%; 95% CI, 0.6-0.8), oral cavity and pharynx (AAPC = 0.6; 95% CI, 0.2-1.1), soft tissue (AAPC = 0.5%; 95% CI, 0.3-0.7), brain (AAPC = 0.4%; 95% CI, 0.2-0.7) and pancreas (AAPC = 0.3%; 95% CI, 0.2-0.4).
Among females, death rates decreased for 14 out of the 20 most common cancer types they experience, with AAPCs of 4.3% (95% CI, 4.8 to 3.7) for lung cancer, 1% (95% CI, 1.4 to 0.7) for breast cancer, 2.4% (95% CI, 2.5 to 2.2) for ovarian cancer, 2% (95% CI, 2.4 to 1.6) for colorectal cancer and 1.4% (95% CI, 1.6 to 1.2) for leukemia. Among cancers for which rates increased among females were those of the corpus/uterus (AAPC = 2, 95% CI, 1.6-2.3) and liver/intrahepatic bile duct (AAPC = 1.1, 95% CI, 0.5-1.6).
Two-year relative survival rates among individuals diagnosed with distant-stage skin melanoma during 2001 and 2009 remained stable. However, survival rates increased by 3.1% (95% CI, 2.8-3.5) annually among those diagnosed between 2009 and 2014 and were similar for both males and females.
“Overall cancer death rates and death rates for many cancer types are declining, and declines in overall cancer death rates and lung cancer death rates have accelerated in recent years,” Islami said. “The declines in lung cancer incidence and death rates started from a few decades ago following a reduction in smoking prevalence. The accelerated declines in lung cancer death rates in recent years, however, could largely be attributed to advances in treatment, such as targeted therapy and cancer immunotherapy, and clinical management of the disease. Recent increases in survival for advanced melanoma also coincide with the introduction of targeted therapy and cancer immunotherapy for this type of cancer.”
Survival by race/ethnicity
Overall, cancer mortality rates decreased among people of all races and ethnicities between 2014 and 2018. Black individuals had the highest cancer death rate of 182.5 per 100,000 population (AAPC, 2%), followed by 163.2 per 100,000 population for American Indian/Alaska Natives (AAPC, 0.7%), 160.2 per 100,000 population for whites (AAPC, 1.8%), 110.8 per 100,000 population for Hispanics (AAPC, 1.2%) and 98 per 100,000 population for Asian/Pacific Islanders (AAPC, 2.1%).
“Disparities in cancer death rates still exist, with higher cancer death rates among Blacks compared with whites,” Islami said. “Our results indicate strong associations between patterns of cancer screening utilization and trends in deaths rates for the corresponding cancer types. These findings underscore the importance of cancer prevention and screening according to guidelines. With increases in average cancer survival for many cancer types, the risk for subsequent primary cancers — especially cancers associated with smoking and excess body weight — among cancer survivors increases. Oncologists should inform their patients about harms of smoking and other cancer risk factors and promote adherence to healthy lifestyle recommendations and cancer screening guidelines.”
For more information:
Farhad Islami, MD, PhD, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303; email: farhad.islami@cancer.org.
Perspective
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Adam C. Berger, MD, FACS
The Annual Report to the Nation on the Status of Cancer provides strong evidence for how precision medicine and targeted therapies are changing the trajectory for our patients — but it also holds motivation for the work ahead. The mortality rate for certain cancers is declining and at a more accelerated rate. That signifies important efforts made in therapy, advances in our treatment protocols, and critical gains made through prevention strategies and early detection. The introduction of immunotherapy has extended survival and is curing patients who had been given no viable treatment options in the past.
Although the annual report data suggest that previously declining trends have slowed in respect to female breast cancer in particular, there is still progress. More women are participating in regular screening mammography, and although hormone therapy was routine, it is now prescribed more judiciously. The result is telling — women are being diagnosed with less advanced breast cancer.
Amid the progress and hope, the report makes clear the work still to be done. There is no early detection for many cancers. For example, pancreatic cancer death rates have increased and are already much higher than other common cancer types. These patients can benefit from a dedicated multidisciplinary team with cutting-edge testing at their fingertips and potentially lifesaving clinical trials, such as what we have at Sylvester Comprehensive Cancer Center.
As we eye the future, obesity as a risk factor associated with cancer should be top of mind. Given the incredibly diverse south Florida community, efforts must be made in prevention to include being culturally sensitive in our efforts as we promote increased exercise and healthy eating. The same should be done across the country.
Lung cancer screenings and smoking cessation intervention should also be central in public awareness campaigns and care. If we can detect it early, oftentimes, we can cure it.
Looking ahead, we await a report that will inform us as to how COVID-19 has impacted cancer screenings. The concern is delayed or canceled appointments and an increase in more advanced cancers. In response, Sylvester Comprehensive Cancer Center and its fellow NCI-designated cancer centers are working together to make the public aware of our concerns and get patients screened. Leadership also is in the process of developing new policies and programs that will be implemented in advance of the next set of data.
Perspective
Back to Top
Stephen Nimer, MD
The Annual Report to the Nation on the Status of Cancer provides strong evidence for how precision medicine and targeted therapies are changing the trajectory for our patients — but it also holds motivation for the work ahead. The mortality rate for certain cancers is declining and at a more accelerated rate. That signifies important efforts made in therapy, advances in our treatment protocols, and critical gains made through prevention strategies and early detection. The introduction of immunotherapy has extended survival and is curing patients who had been given no viable treatment options in the past.
Although the annual report data suggest that previously declining trends have slowed in respect to female breast cancer in particular, there is still progress. More women are participating in regular screening mammography, and although hormone therapy was routine, it is now prescribed more judiciously. The result is telling — women are being diagnosed with less advanced breast cancer.
Amid the progress and hope, the report makes clear the work still to be done. There is no early detection for many cancers. For example, pancreatic cancer death rates have increased and are already much higher than other common cancer types. These patients can benefit from a dedicated multidisciplinary team with cutting-edge testing at their fingertips and potentially lifesaving clinical trials, such as what we have at Sylvester Comprehensive Cancer Center.
As we eye the future, obesity as a risk factor associated with cancer should be top of mind. Given the incredibly diverse south Florida community, efforts must be made in prevention to include being culturally sensitive in our efforts as we promote increased exercise and healthy eating. The same should be done across the country.
Lung cancer screenings and smoking cessation intervention should also be central in public awareness campaigns and care. If we can detect it early, oftentimes, we can cure it.
Looking ahead, we await a report that will inform us as to how COVID-19 has impacted cancer screenings. The concern is delayed or canceled appointments and an increase in more advanced cancers. In response, Sylvester Comprehensive Cancer Center and its fellow NCI-designated cancer centers are working together to make the public aware of our concerns and get patients screened. Leadership also is in the process of developing new policies and programs that will be implemented in advance of the next set of data.
at University of Miami Health System
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