Cancer rates falling in the US

The nation's leading cancer organizations report that Americans' risk of getting and dying from cancer continues to decline and survival rates for many cancers continue to improve. The "Annual Report to the Nation on the Status of Cancer, 1975-2001*" finds overall observed cancer incidence rates dropped 0.5 percent per year from 1991 to 2001, while death rates from all cancers combined dropped 1.1 percent per year from 1993 to 2001. According to the report's authors, the new data reflect progress in prevention, early detection, and treatment; however, not all segments of the U.S. population have benefited equally from the advances.

First issued in 1998, the "Annual Report to the Nation" is a collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). It provides updated information on cancer rates and trends in the United States.

"This new report clearly shows we've made considerable gains in reducing the burden of cancer in the United States," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. "The first ever drop in lung cancer incidence rates in women is remarkable proof that we are making a difference in the number one cancer killer, and is powerful evidence that our successful efforts must continue."

The percentage of patients who have survived more than five years after being diagnosed with cancer has increased over the past two decades. According to NCI Director Andrew C. von Eschenbach, M.D., "these survival statistics are a reason for optimism, as they show us that we are on the right track to reaching the NCI Challenge Goal to eliminate the suffering and death due to cancer. We are committed to even greater advances in survivorship research at NCI. We are directing and conducting research on long-term follow-up of childhood cancer survivors, healthy behaviors for all survivors, and unique issues faced by cancer survivors from underserved populations."

Death rates from all cancers combined have been decreasing since the early 1990s. Death rates decreased for 11 of the top 15 cancers in men, and eight of the top 15 cancers in women. Lung cancer deaths rates among women leveled off for the first time between 1995 and 2001, after continuously increasing for many decades.

Among men, cancer incidence rates have recently declined for seven of the top 15 cancer sites: lung, colon, oral cavity, leukemia, stomach, pancreas, and larynx. Incidence rates increased only for melanoma and cancers of the prostate, kidney, and esophagus. When a process known as delay adjustment is taken into account, some of these trends change (please refer to the Report to the Nation Q&A**, question #14, for an explanation of delay adjustment).

For the first time, lung cancer incidence rates among women are on the decline. Incidence rates decreased for five additional cancers out of the top 15 in women (colon, cervix, pancreas, ovary, and oral cavity). Only breast, thyroid, bladder, and kidney cancer and melanoma rates are rising among women.

This year's report highlights trends in cancer survival by comparing five-year survival rates of cancer patients diagnosed in two time periods: 1975-1979 and 1995-2000. Between those time periods, survival substantially improved for most of the top 15 cancers in both men and women, and the top ten sites in children.

For men, large gains in cancer survival rates (more than 10 percent) were seen in cancers of the prostate, colon and kidney, and non-Hodgkin lymphoma, melanoma, and leukemia. Modest gains (5 percent to 10 percent) were found for cancers of the bladder, stomach, liver, brain, and esophagus.

For women, large gains in cancer survival rates were seen for colon, kidney, and breast cancers and non-Hodgkin lymphoma. Modest gains were found for bladder, oral cavity, stomach, brain, esophageal, and ovarian cancers and melanoma and leukemia.

Limited survival improvement was noted for the most fatal forms of cancer in adults including cancers of the lung, pancreas, and liver, which are characterized by late stage at diagnosis and relatively poor survival rates even when these cancers are diagnosed at a localized stage. There was also little or no gain in several cancers that already have high survival rates, including larynx, thyroid, and uterine cancers.

Childhood cancers showed some of the largest improvements in cancer survival during the past 20 years, with an absolute survival rate increase of 20 percent in boys and 13 percent in girls. The current five-year survival rate of over 75 percent confirms substantial progress made since the early 1960s, when childhood cancers were nearly always fatal.

"Cancer is a devastating disease that impacts so many people. But the good news is there is hope and these data show we are winning the battle as people with cancer are living longer and more healthier lives than ever before," said CDC Director Julie Gerberding, M.D. "But we can't become complacent. We must renew our efforts to make sure people make healthy choices to prevent cancer, that they are properly screened for cancer, and that they receive the appropriate treatment when they have cancer."

The report identifies wide variations in survival associated with race and ethnicity. In every racial and ethnic population, with the exception of Asian/Pacific Islander (API) women, the risk of cancer death from all cancer sites combined was higher than the risk of death for non-Hispanic white patients. Black men were at higher risk of dying of 12 cancers compared to white men, with the increased risk ranging from 9 percent (lung cancer) to a high of 67 percent (oral cavity). Black women experienced higher risks of death from 12 cancers, with the increase ranging from 7 percent (lung cancer) to 82 percent (corpus uterus and melanoma). Additionally, non-Hispanic white and API patients tended to have higher survival rates than other racial and ethnic groups except for patients with brain cancer and leukemia.

"Increased efforts by NAACCR and its partners will continue to expand information for a broader spectrum of underserved populations, including not only racial groups other than white and black, but also U.S. Latinos, rural populations, and areas defined by socioeconomic indicators," said NAACCR Director Holly L. Howe, Ph.D. "With this information, we will be able to more accurately address the cancer burden and disparities in these populations."

The authors of the report emphasize that reaching all segments of the population with high-quality prevention, early detection, and treatment services could reduce cancer incidence and mortality even further. In addition, they point out that "leaders in the scientific community forecast an era of unprecedented progress in cancer research." For these research advances to impact cancer incidence and death rates, it will be critical that all partners with a stake in impacting cancer control help to expedite the translation of these research discoveries to widespread and equitable delivery of preventive and clinical services.

For more information, visit the following Web sites:

Cancer online: http://interscience.wiley.com/cancer/report2004