Cancer Continues to Decline
in U.S. Says Annual Report to the Nation: Down 1.6%
There could be an overall colorectal cancer mortality
reduction of 50 percent by 2020; rates declined most among senior
citizens over 65 and increased most in people under age 50
Dec.
8, 2009 - New diagnoses for all types of cancer combined in the United
States decreased, on average, almost 1 percent per year from 1999 to
2006 and cancer deaths decreased 1.6 percent per year from 2001 to 2006,
according to a report from leading health and cancer organizations.
Rates of new diagnoses and rates of death from all
cancers combined declined significantly in the most recent time period
for men and women overall and for most racial and ethnic populations in
the United States, says a news release from the National Cancer
Institute.
The drops are driven largely by declines in rates
of new cases and rates of death for the three most common cancers in men
(lung, prostate, and colorectal cancers) and for two of the three
leading cancers in women (breast and colorectal cancer).
These findings are from a report authored by
researchers from the National Cancer Institute (NCI), part of the
National Institutes of Health, the Centers for Disease Control and
Prevention (CDC), the American Cancer Society (ACS), and the North
American Association of Central Cancer Registries (NAACCR). The report
was published early online Dec. 7, 2009, in the journal Cancer.
Overall cancer rates continue to be higher for men
than for women, but men experienced the greatest declines in incidence
(new cases) and mortality (death) rates.
For colorectal cancer, the third most frequently
diagnosed cancer in both men and women, and the second leading cause of
cancer deaths in the United States, overall rates are declining, but
increasing incidence in men and women under 50 years of age is of
concern, the report said.
Top 15 Cancer Sites for
Men and Women
Cancer Type
Men:
New Cases
Men:
Deaths
Women:
New Cases
Women:
Deaths
Bladder
_
_
+0.2%
+0.4%
Brain
+0.5%
-1.0%
_
-1.1%
Breast
-2.0%
-1.9%
Cervix
-3.5%
_
Colon/rectum
-3.0%
-3.9%
-2.2%
-3.4%
Esophagus
+0.7%
+0.4%
Kidney
+1.8%
-1.5%
+2.4%
-0.6%
Leukemia
+0.1%
-0.8%
+0.3%
-1.6%
Liver
+3.6%
+2.4%
+1.8%
Lung
-1.8%
-2.0%
+0.4%
_
Melanoma
+3.1%
+2.0%
+3.0%
Myeloma
+0.7%
-1.1%
-2.4%
Non-Hodgkin Lymphoma
_
-3.0%
+1.1%
-3.7%
Oral
-1.2%
-2.2%
-0.9%
Ovary
-2.1%
-1.4%
Pancreas
_
_
+1.7%
+0.1%
Prostate
-2.4%
-4.1%
Stomach
-2.0%
-3.7%
-2.7%
Thyroid
+6.3%
Uterus
-0.5%
_
Trends data are
based on the most recent trends in rates and variable time
periods. The symbol indicates neither a statistically
significant rise nor fall in the rates during the time period
studies. Blank spaces indicate cancers that were not in the top
15 for that gender/category.
In the Special Feature section, the authors used
modeling projections of colorectal cancer rates to find that, with
accelerated cancer control efforts to get more Americans to adopt more
favorable health behaviors (such as quitting smoking) and higher use of
screening (such as colonoscopy), as well as optimal treatment outcomes
for colorectal cancer (such as more effective chemotherapy), there could
be an overall colorectal cancer mortality reduction of 50 percent by
2020.
Other highlights from the report show that in
men, incidence rates have declined for cancers of the prostate,
lung, oral cavity, stomach, brain, colon and rectum, but continue to
rise for kidney/renal, liver, and esophageal cancer, as well as for
leukemia, myeloma and melanoma.
In women, incidence rates decreased for
breast, colorectal, uterine, ovarian, cervical and oral cavity cancers,
but increased for lung, thyroid, pancreatic, bladder, and kidney
cancers, as well as for non-Hodgkin lymphoma, melanoma and leukemia.
"The continued decline in overall cancer rates
documents the success we have had with our aggressive efforts to reduce
risk in large populations, to provide for early detection, and to
develop new therapies that have been successfully applied in this past
decade," said NCI Director John E. Niederhuber, M.D.
"Yet we cannot be content with this steady
reduction in incidence and mortality. We must, in fact, accelerate our
efforts to get individualized diagnoses and treatments to all Americans
and our belief is that our research efforts and our vision are moving us
rapidly in that direction."
Among racial/ethnic groups, cancer death rates were
highest in black men and women and lowest in Asian/Pacific Islander men
and women.
Although trends in death rates by race/ ethnicity
were similar for most cancer sites, death rates from pancreatic cancer,
the fourth most common cause of cancer death in the United States,
increased among white men and women but decreased among black men and
women.
The three leading causes of cancer death for all
men, with the exception of Asian/Pacific Islanders, were lung, prostate
and colorectal cancer.
Lung, liver and colorectal cancers were the top
three causes of cancer death in Asian/Pacific Islander men.
For women, the three leading causes of cancer death
were lung, breast and colorectal cancer for all racial/ethnic groups
except Hispanic women, for whom breast cancer ranked first.
The differences and fluctuations in death rates by
racial/ethnic group, sex, and cancer site may reflect differences in
risk behaviors, socioeconomic status, and access to and use of screening
and treatment.
"The continued decline in incidence and death rates
for all cancers combined is extremely encouraging, but progress has been
more limited for certain types of cancer, including many cancers that
are currently less amenable to screening, such as cancer of esophagus,
liver and pancreas," said Betsy Kohler, executive director of NAACCR.
Special section on colorectal cancer
The special section on colorectal cancer rates says
that long-term incidence trends for colorectal cancer have been fairly
consistent for men and women, with major declines from 1985 to1995,
minor increases from 1995 to1998, and significant declines from 1998 to
2006.
Since 1984, death rates have also declined for men
and women with accelerated rates of decline since 2002 for men and 2001
for women.
In the most recent decade for which there are data
(1997-2006), rates of newly diagnosed colorectal cancer have decreased
for men and women in all racial/ethnic groups examined except American
Indian/Alaskan Native (AI/AN) women. Incidence rates declined most
rapidly among men and women over 65 years of age and increased most
rapidly in people under age 50 in most population groups.
"This report shows that we have begun to make
progress reducing colorectal cancer. Yet, colorectal cancer still kills
more people than any other cancer except lung cancer," said CDC Director
Thomas Frieden, M.D.
"Reducing smoking further can bring lung and other
cancer rates down, and improved colorectal cancer screening can prevent
colorectal cancer. Through CDC's Colorectal Cancer Control Program, we
have tremendous potential to reduce the disparities that exist in
colorectal cancer screening and to save lives."
The CDC program supports population-based screening
efforts and provides colorectal cancer screening services to low-income
men and women ages 50 to 64 years who are underinsured or uninsured for
screening, when no other insurance is available.
Researchers used microsimulation modeling to
analyze the historical impact of changes in risk factors, screening and
treatment practices, and to project future mortality trends for
colorectal cancer. The model, named MISCAN-Colon, which was developed by
NCI's Cancer Intervention and Surveillance Modeling Network (CISNET)
consortium, simulates the U.S. population from 1975 through 2020.
The model includes factors that could increase risk
for colorectal cancer (i.e., smoking, obesity, and red meat
consumption), as well as factors that could decrease colorectal cancer
risk (i.e., aspirin use, consumption of supplements such as folate and
calcium, and physical activity).
To calculate screening use, researchers used
national data on the use of fecal occult blood testing (which looks for
blood in stool samples), and endoscopy (including flexible sigmoidoscopy
and colonoscopy, which allows doctors to examine the lower part of the
colon or the entire large intestine, respectively).
To assess the effects of treatment, researchers
assessed data on use of, and disease-free survival rates associated
with, four chemotherapy regimens used for advanced colorectal cancer
during different historical time periods.
Using the model, the researchers were able to
estimate the impact of historical changes in risk factors, screening
practices, and treatment advances on past changes in incidence and
mortality, as well as predict future trends through 2020.
From
1975 to 2000, colorectal cancer incidence fell 22 percent, half of which
was most likely due to changes in risk factors, and half due to
screening.
Similarly, colorectal cancer deaths fell by 26
percent during that time period, with a 9 percent drop resulting from a
change in risk factors, a 14 percent drop from screening, and a 3
percent drop from improved treatment.
The researchers created projections to look at how
colorectal cancer mortality trends could change with varying levels of
cancer control interventions.
If there were no changes in risk factors, screening
or treatment (stable since 2000), Americans could expect a 17 percent
decline in colorectal cancer mortality from 2000 to 2020. However, if
current trends persist, Americans could see a 36 percent decline in
colorectal cancer mortality. With accelerated cancer control efforts,
there could be an overall colorectal cancer mortality reduction of 50
percent by 2020.
"The extraordinary progress on colorectal cancer
shows what can be achieved by coordinated and targeted efforts to apply
existing knowledge to cancer control at the state and federal level,"
said John R. Seffrin, Ph.D., chief executive officer of the American
Cancer Society.
"Increases in colorectal cancer screening have been
achieved through a variety of efforts, including education of the public
and medical community and advocacy for health insurance coverage of the
full range of colorectal cancer screening tests. The American Cancer
Society is committed to continuing these efforts to get as close as we
can to the potential 50 percent colorectal cancer mortality reduction
that this report says is possible."
Reference:
Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson R, Jemal A,
Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede
SL, Ries LAG. Annual Report to the Nation on the Status of Cancer,
1975-2006, Featuring Colorectal Cancer Trends and Impact of
Interventions (Risk Factors, Screening, and Treatment) to Reduce Future
Rates. Cancer; Published online Dec. 7, 2009; DOI:
10.1002/cncr.24760.
Dec.
8, 2009 - New diagnoses for all types of cancer combined in the United
States decreased, on average, almost 1 percent per year from 1999 to
2006 and cancer deaths decreased 1.6 percent per year from 2001 to 2006,
according to a report from leading health and cancer organizations.
