Cancer Deaths, Cases Showing Big Rate Declines in US
Despite Surge Worldwide
Annual report by leaders in cancer war shows historic
declines but trends vary in areas of US
Dec. 11, 2008 The bad news this week that cancer
is increasing so rapidly around the world that it will pass heart
disease as the number one killer, drew a lot more attention that a
report published this month that was good news about the battle against
cancer in the U.S. It shows the rates for both cancer deaths and cancer
occurrences have decreased for the first time since the annual report
began in ten years ago.
Death rates for 8 of the 10 leading causes of death
in U.S. all dropped significantly in 2006; Alzheimers passed diabetes
becoming the sixth leading cause of death
Cancer death rates declined for 10 of the 15 most
common causes of cancer deaths among both men and women, but there were
increases for a few individual cancers, such as esophageal and bladder
cancers among men, pancreatic cancers in women, and for cancers of the
liver in both.
According to the report, cancer death rates for
both sexes combined declined about 1.8% per year from 2002 through 2005,
almost double the 1.1% per year decrease seen from 1993 through 2002.
The decline in cancer incidence was largely due to
declines in the most common cancers: lung, colorectal, and prostate
cancer for men and breast and colorectal cancer for women. Incidence
rates for all cancers combined decreased, falling by 0.8% per year from
1999 to 2005.
Lung cancer death rates in women leveled off from
2003 through 2005, but incidence rates are still rising, though more
slowly than they have risen in the past. Lung cancer death rates have
been decreasing in men since the 1990s.
The findings come from the Annual Report to the
Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung
Cancer, Tobacco Use and Tobacco Control. It was published online Nov.
25, 2008, and appears in the Dec. 2, 2008, Journal of the National
Cancer Institute.
The report notes that, although the decreases in
overall cancer incidence and death rates are encouraging, large state
and regional differences in lung cancer trends among women underscore
the need to strengthen many state tobacco control programs.
The report shows significant differences in lung
cancer deaths in different parts of the United States. In California,
for instance, the lung cancer death rate dropped by about 2.8% per year
among men between 1996 and 2005. That decline is more than double that
seen in some Midwestern and Southern states, and may be due in part to
California's strong tobacco control policies.
The Annual Report to the Nation is a joint report
of the American Cancer Society (ACS), the US Centers for Disease Control
and Prevention (CDC), the National Cancer Institute (NCI), and the North
American Association of Central Cancer Registries (NAACR).
Although cancer death rates have been dropping
since the publication of the first Annual Report to the Nation in 1998,
the latest edition marks the first time the report has documented a
simultaneous decline in cancer incidence, the rate at which new cancers
are diagnosed, for both men and women.
Based on the long-term incidence trend, rates for
all cancers combined decreased 0.8 percent per year from 1999 through
2005 for both sexes combined; rates decreased 1.8 percent per year from
2001 through 2005 for men and 0.6 percent per year from 1998 through
2005 for women. The decline in both incidence and death rates for all
cancers combined is due in large part to declines in the three most
common cancers among men (lung, colon/rectum, and prostate) and the two
most common cancers among women (breast and colon/rectum), combined with
a leveling off of lung cancer death rates among women.
"The drop in incidence seen in this year's Annual
Report is something we've been waiting to see for a long time," said
Otis W. Brawley, M.D., chief medical officer of the American Cancer
Society (ACS).
"However, we have to be somewhat cautious about how
we interpret it, because changes in incidence can be caused not only by
reductions in risk factors for cancer, but also by changes in screening
practices. Regardless, the continuing drop in mortality is evidence once
again of real progress made against cancer, reflecting real gains in
prevention, early detection, and treatment."
The new report shows that, from 1996 through 2005,
death rates for all cancers combined decreased for all racial and ethnic
populations and for both men and women, except for American
Indian/Alaska Native men and women, for whom rates were stable.
The drop in death rates has been steeper for men,
who have higher rates, than for women.
Death rates declined for 10 of the top 15 causes of
cancer death among both men and women.
However, death rates for certain individual cancers
are increasing, including esophageal cancer for men, pancreatic cancer
for women, and liver cancer for both men and women.
Overall cancer death rates were highest for
African-Americans and lowest for Asian American/Pacific Islanders.
For Men Only
Among men, incidence rates dropped for cancers of
the lung, colon/rectum, oral cavity, and stomach. Prostate cancer
incidence rates decreased by 4.4 percent per year from 2001 through 2005
after increasing by 2.1 percent per year from 1995 to 2001.
In contrast, incidence rates increased for cancers
of the liver, kidney, and esophagus, as well as for melanoma
(2003-2005), non-Hodgkin lymphoma, and myeloma. Incidence rates were
stable for cancers of the bladder, pancreas, and brain/nervous system,
and for leukemia.
For Women Only
For women, incidence rates dropped for cancers of
the breast, colon/rectum, uterus, ovary, cervix, and oral cavity.
Incidence increased for cancers of the lung,
thyroid, pancreas, brain/nervous system, bladder, and kidney, as well as
for leukemia, non-Hodgkin lymphoma, and melanoma.
Efforts Must Increase
"While we have made progress in reducing the burden
of cancer in this country, we must accelerate our efforts, including
making a special effort to reach underserved cancer patients in the
communities where they live," said National Cancer Institute (NCI)
Director John Niederhuber, M.D.
"This report gives us a better understanding of
where we may need to redouble our efforts and try to find new ways of
preventing or reducing the occurrence of kidney, liver, and other
cancers that continue to show increases in both mortality and/or
incidence."
Special on Smoking and Lung Cancer
The Special Feature section of the Report
highlights wide variations in tobacco smoking patterns across the United
States, which, coupled with differences in smoking behaviors in younger
versus older populations, helps explains the delay in an expected
decrease in lung cancer deaths among women and a slowing of the decrease
in lung cancer deaths among men.
The report finds substantial differences in lung
cancer death rate trends by state and geographic region. For example,
lung cancer death rates dropped an average of 2.8 percent per year among
men in California from 1996 through 2005, more than twice the drop seen
in many states in the Midwest and the South.
The geographic variation is even more extreme among
women, for whom lung cancer death rates increased from 1996 through 2005
in 13 states and decreased only in three. The report also notes that, in
five states (Pennsylvania, Illinois, Minnesota, Nebraska, and Idaho),
lung cancer incidence among women showed an increasing trend, whereas
the mortality trend was level.
"It's very promising to see the progress we are
making in our fight against cancer," said Centers for Disease Control
and Prevention (CDC) Director Julie Gerberding, M.D.
"Unfortunately, tobacco use continues to plague our
country, and it's the primary reason why lung cancer continues to rob
too many people of a long, productive, and healthy life. We must
recommit ourselves to implementing tobacco control programs that we know
work if we are truly going to impact the staggering toll of tobacco on
our society."
Variation in smoking prevalence among the states is
influenced by several factors, including public awareness of the harms
of tobacco use, social acceptance of tobacco use, local tobacco control
activities, and tobacco industry promotional activities targeted in a
geographic area.
The 13 states where lung cancer death rates for
women are on the rise have higher percentages of adult female smokers,
low excise taxes, and local economies that are traditionally dependent
on tobacco farming and production.
In contrast, California, which was the first state
to implement a comprehensive, statewide tobacco control program, was the
only state in the country to show declines in both lung cancer incidence
and deaths in women.
According to a U.S. Surgeon General's report,
cigarette smoking accounts for approximately 30 percent of all cancer
deaths, with lung cancer accounting for 80 percent of the
smoking-attributable cancer deaths. Other cancers caused by smoking
include cancers of the oral cavity, pharynx, larynx, esophagus, stomach,
bladder, pancreas, liver, kidney, and uterine cervix and myeloid
leukemia.
"We can see that, in areas of the country where
smoking and tobacco use are entrenched in daily life, men and women
continue to pay a price with higher incidence and death rates from many
types of cancer. This type of geographic variation in smoking-related
cancers is due to smoking behaviors, not regional environmental
factors," said Betsy A. Kohler, M.P.H., executive director of the North
American Association of Central Cancer Registries (NAACCR).
"The observed decrease in the incidence and death
rates from all cancers combined in men and women overall and in nearly
all racial and ethnic groups is highly encouraging," conclude the
authors. "However, this must be seen as a starting point rather than a
destination." They say a dual effort, combining better application of
existing knowledge with ongoing research to improve prevention, early
detection, and treatment will be needed to sustain and extend this
progress into the future.
The study was conducted by scientists at the ACS,
Centers for Disease Control and Prevention (CDC), NCI, which is part of
the National Institutes of Health, and the North American Association of
Central Cancer Registries (NAACCR).
Publication Source: Jemal A, Thun MJ, Ries LAG,
Howe HL,Weir HK, Center MM, Ward E, Wu X, Eheman C, Anderson R, Ajani U,
Kohler B, Edwards BK. Annual Report to the Nation on the Status of
Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use and
Tobacco Control. Journal of the National Cancer Institute;
Published online Nov. 25, 2008; Print issue Dec. 2, 2008. Vol. 100, No.
23.
Dec. 11, 2008 The bad news this week that cancer
is increasing so rapidly around the world that it will pass heart
disease as the number one killer, drew a lot more attention that a
report published this month that was good news about the battle against
cancer in the U.S. It shows the rates for both cancer deaths and cancer
occurrences have decreased for the first time since the annual report
began in ten years ago.
Two percent lower lung cancer risk with each glass of
red wine consumed per month
For Men Only
The geographic variation is even more extreme among
women, for whom lung cancer death rates increased from 1996 through 2005
in 13 states and decreased only in three. The report also notes that, in
five states (Pennsylvania, Illinois, Minnesota, Nebraska, and Idaho),
lung cancer incidence among women showed an increasing trend, whereas
the mortality trend was level.