Progress Shown in Death Rates from Four Leading Cancers
Decline in Overall Mortality Has Slowed
Death rates from the four most common cancers – lung, breast, prostate, and colorectal – continued to decline in the late 1990s according to new data from the "Annual Report to the Nation on the Status of Cancer, 1975-2000." For all cancers combined, the death rate began to stabilize in the late 1990s, showing neither an increase nor a decrease, while the incidence rate (newly diagnosed cases) began to stabilize in the middle of the decade.
The report concludes that further reductions in cancer can be achieved but will require strong federal, state, local, and private partnerships to apply evidence-based cancer control measures – such as screening for colorectal cancer – that reach all segments of the population. Analyses of the findings, including new data from the states, also highlight the need for improved delivery of quality cancer care, as well as the development of more effective treatment and screening strategies.
Cancer incidence rates for all types of cancers combined increased from the mid-1970s through 1992, declined from 1992 to 1995, and then stabilized from 1995 to 2000 (there was a slight increase from 1995 to 2000, but it was not statistically significant*). In this most recent time period, an increase in breast cancer in women and prostate cancer in men was offset by a long-term decrease in lung cancer in men.
Overall death rates increased through 1990, stabilized through 1994, and declined from 1994 through 1998 before becoming stable from 1998 through 2000. There were continuing small declines in death rates for men, but death rates for women have been stable through the late 1990s.
"This report shows that we have made some progress in reducing the burden of cancer in the United States, but much still needs to be done to reach the Healthy People 2010 goals -- including wider application of what science has shown to be effective in preventing, screening, and treating cancer," said Centers for Disease Control and Prevention (CDC) Director Julie L. Gerberding, M.D. “The state-specific information featured in this year’s report will help states understand and address the cancer burden in their communities.”
The death rate from lung cancer, the leading cancer killer, continues to decrease among white and black men, while the rate of increase has slowed among women, reflecting reductions in tobacco smoking.
"The steep decline in lung cancer rates in men and the recent slowing of an increase in rates in women demonstrate that we can move the trend in the number one cancer killer in the right direction," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society (ACS). "Further progress will require rigorous application of strategies that we know are effective in reducing tobacco use."
Death rates from breast cancer continue to fall despite a gradual, long-term increase in the rate of new diagnoses. Declining breast cancer death rates and rising breast cancer incidence rates during the 1990s have been attributed, in part, to increased use of mammography screening. This report notes that higher rates of late-stage disease in some population groups and geographic areas may reflect delayed access to care, often among women who lacked health insurance and among recent immigrants.
Prostate cancer death rates have been declining since 1994, while incidence rates have been rising since 1995, with a 3.0 percent per year increase in white men and a 2.3 percent per year increase in black men. Clarification of the risks and benefits of prostate specific antigen (PSA) screening, including potential impact on mortality, awaits the conclusion of two randomized clinical trials now in progress.
Colorectal cancer death rates have also been declining for both whites and blacks. Rates began declining in the 1970s, with steeper declines beginning in the mid-1980s. Meanwhile, colorectal cancer incidence rates stabilized beginning in 1996 for all men and women.
The authors of the report are encouraged by the recent continuing declines in death rates from the four leading cancers – lung, breast, prostate, and colorectal – declines that were observed nationally and in most states. "Biomedical research has dramatically enhanced our understanding of cancer and given us more effective strategies for cancer control," said Andrew C. von Eschenbach, M.D, Director of the National Cancer Institute (NCI), which is part of the National Institutes of Health. "These declines in death rates from four leading cancers are the dividends of those advances. During this period of unprecedented growth in cancer knowledge, technology, and resources, the NCI is committed to accelerating these trends, and extending them to other cancers, through the discovery, development and delivery of effective interventions."
The report examined recent patterns of cancer among whites, African Americans, Asian and Pacific Islanders, American Indians/Alaska Natives, and Hispanics. From 1992 through 2000, the most recent time period for which data are available, cancer rates among each of these groups differed considerably, but showed encouraging declines in some of the most prevalent cancers.
This year’s report includes incidence data from 34 statewide cancer registries that cover 68 percent of the U.S. population. This marks an increase from previous years when data covered only 55 percent of the U.S. population. Holly L. Howe, Ph.D., executive director of National American Association of Central Cancer (NAACCR), noted, "The larger number of states in this year's report, with registries that are providing high quality data to produce meaningful incidence rates, is very encouraging. High quality at the state level is crucial because cancer control planning takes place first and foremost at the local and state levels."
The "Annual Report to the Nation on the Status of Cancer, 1975-2000, Featuring the Uses of Surveillance Data for Cancer Prevention and Control" is published in the Sept. 3, 2003 (Vol. 95, No. 17, pages 1276-1299), issue of the Journal of the National Cancer Institute**. The report is by the CDC, the ACS, the NCI, and the NAACCR.
Additional background on this report† can be found at: http://newscenter.cancer.gov/pressreleases/2003ReportQandA and http://newscenter.cancer.gov/pressreleases/2003ReportFactSheet.
† Please note that there is an erratum for the Report, which can be found
* For an explanation of how this non-significant increase was derived, please see question 17 in the Q&A on this report, which can be found at http://newscenter.cancer.gov/pressreleases/2003ReportQandA.
** The authors of this year's report are Hannah K. Weir, Ph.D. (CDC), Michael J. Thun, M.D. (ACS), Benjamin F. Hankey, Ph.D. (NCI), Lynn A.G. Ries, M.S. (NCI), Holly L. Howe, Ph.D. (NAACCR), Phyllis A. Wingo, Ph.D. (CDC), Ahmedin Jemal, Ph.D. (ACS), Elizabeth Ward, Ph.D.(ACS), Robert N. Anderson, Ph.D., (NCHS), and Brenda K. Edwards, Ph.D. (NCI).
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