|
E-mail this page to a friend!
Cancer Death Rates Continue to Decline in U.S.
Progress in Cancer Treatment Varies by Disease
Oct. 5, 2005 – The risk of dying from cancer
continues to decline and the rate of new cancers is holding steady, says
a report by America’s leading cancer organizations. (See chart below)
The “Annual Report to the Nation on the Status of
Cancer, 1975-2002,” published in the Oct. 5, 2005, issue of the Journal
of the National Cancer Institute, finds observed cancer death rates from
all cancers combined dropped 1.1 percent per year from 1993 to 2002.
According to the report’s authors, declines in death rates reflect
progress in prevention, early detection, and treatment; however, not all
segments of the U.S. population benefited equally from advances, a point
outlined in a featured analysis of treatment trends.
First issued in 1998, the “Annual Report to the
Nation” is a collaboration among the National Cancer Institute (NCI),
which is part of the National Institutes of Health (NIH), the Centers
for Disease Control and Prevention (CDC), the American Cancer Society
(ACS), and the North American Association of Central Cancer Registries (NAACCR).
It provides updated information on cancer rates and trends in the United
States.
According to NCI Director Andrew C. von Eschenbach,
M.D., “These numbers reflect a trend in reduction of cancer mortality
that has now persisted for six years. This can only be considered good
news for the millions of cancer survivors who have benefited from recent
research and treatment advances and emphasizes the expectation that we
will achieve a time when no one will suffer or die from cancer.”
Death rates from all cancers combined declined 1.5
percent per year from 1993 to 2002 in men, compared to a 0.8 percent
decline in women from 1992 to 2002
**. Lung cancer is the leading cause of cancer deaths in both men
and women. Death rates decreased for 12 of the top 15 cancers in men,
and nine of the top 15 cancers in women.
| |
SEER
incidence rates and trends for the 15 most common cancers by sex
and race/ethnicity for 1992 through 2002 |
|
| |
 |
|
| |
Sources of data are the Surveillance,
Epidemiology, and End Results (SEER) Program registries that
include Connecticut, Hawaii, Iowa, Utah, and New Mexico; the
metropolitan areas of San Francisco, Detroit, Atlanta,
Seattle-Puget Sound, San Jose-Monterey, and Los Angeles; rural
Georgia and Alaska Natives in Alaska (i.e., SEER13).
Cancers are sorted in descending order according
to sex-specific rates for all races. More than 15 cancers may
appear for males and females to include the 15 most common
cancers in every racial and ethnic group.
APC = annual percent change; AC = absolute
change; API = Asian/Pacific Islander; AI/AN = American
Indian/Alaska Native; NOS = not otherwise specified.
† Data for Hispanics/Latinos excludes cases
diagnosed in Detroit, Hawaii, Alaska Natives, and rural Georgia.
‡ Rates are per 100 000 persons and are
age-adjusted to the 2000 U.S. Standard Population (using 19 age
groups, with data provided from U.S. Bureau of the Census,
Current Population Reports, Series P25-1130.
§ APC is based on rates that were age-adjusted to
the 2000 U.S. Standard Population (using 19 age groups, with
data provided from U.S. Bureau of the Census, Current Population
Reports, Series P25-1130) (39)
.
|| AC was calculated as the difference in the
age-adjusted rate for 2002 minus age-adjusted rate for 1992.
¶ All sites excludes myelodysplastic syndromes
and borderline tumors; ovary excludes borderline tumors.
# APC is statistically significantly different
from zero (two-sided P
<.05).
** Statistic could not be calculated. APC based
on fewer than 10 cases for at least 1 year during the time
interval.
† † Excludes borderline tumors. |
|
“Declines in mortality rates from many
tobacco-related cancers in men represent an important, but incomplete,
triumph of public health in the 21st century,” said John R. Seffrin,
Ph.D., chief executive officer of the ACS. “These trends reinforce the
importance of tobacco control programs in the U.S., as well as measures
to combat the increase in tobacco use in other parts of the world,
particularly in developing countries."
Overall cancer incidence rates (the rate at which
new cancers are diagnosed) for both sexes have been stable since 1992.
Incidence rates were stable in men from 1995 to 2002 and increased 0.3
percent annually in women since 1987 to 2002. The persistent increase in
overall cancer incidence rates for women can be attributed to increases
in rates for breast and six other cancers: non-Hodgkin lymphoma,
melanoma, leukemia, and thyroid, bladder and kidney cancer. However,
according to more recent data from 1998 to 2002, female lung cancer
incidence rates have begun to stabilize after increasing for many years,
which is good news. Changes in overall incidence may result from changes
in the prevalence of risk factors and from changes in detection
practices due to introduction or increased use of screening and/or
diagnostic techniques.
This year’s report highlights patterns of care for
cancer patients. The authors note that one strategy for reducing death
and improving cancer survival is to ensure that evidence-based treatment
services are available and accessible. In performing this analysis, the
authors looked at data from NCI’s Patterns of Care studies (which
supplement routine data collection from NCI’s Surveillance, Epidemiology
and End Results, or SEER Program, with more detailed data on treatment
patterns) and SEER-Medicare databases (which link data from SEER
registries to Medicare claims data to assess treatment histories for
those over age 65), as well as other resources. Using these data, they
examined whether evidence-based care was delivered uniformly to diverse
populations and how rapidly changes in evidence-based guidelines
resulted in changes in cancer care.
“Day by day we are winning the war against cancer
as more people than ever before are being screened and are receiving
treatments necessary for them to lead healthy and productive lives,”
said CDC Director Julie Gerberding, M.D. “However, there are gaps and
missed opportunities so we must continue to pull out all the stops to
ensure proper screening and access to treatment regardless of one’s age,
race, or geographic location.”
For breast cancer, data on trends in the treatment
of early-stage disease show that the proportion of women diagnosed with
stage I or II (earlier stage) breast cancer who received
breast-conserving surgery with radiation treatment increased
substantially during the 1990s. This change followed evidence-based
guidelines that breast-conserving surgery followed by radiation therapy
may be preferable to mastectomy because it provides similar survival but
preserves the breast.
The authors also report findings of a separate
study on use of chemotherapy and radiation therapy for women with
early-stage breast cancer. For women with lymph node positive disease,
multi-agent chemotherapy, along with tamoxifen (a hormonal therapy) for
those with estrogen-receptor positive tumors, has been recommended since
1985 by the NIH. This study found that, between 1987 and 2000, the
proportion of women who received both chemotherapy and tamoxifen
increased substantially. However, use of concurrent therapy remained
relatively low among women age 65 and older, who were more likely to
receive tamoxifen only.
For colorectal cancer, the authors found that use
of adjuvant (additional treatment that follows initial surgery)
chemotherapy for stage III colon cancer patients increased rapidly
between 1987 and 1995. However, delivery of this therapy was uneven
across age groups, with much lower rates of treatment among patients age
65 and older. Also noted was the fact that the number of patients who
received treatment decreased with the increasing number of pre-existing
medical conditions, but the likelihood of receiving adjuvant therapy
decreased with age even after taking other medical conditions into
account.
For patients with advanced non-small cell lung
cancer, evidence-based guidelines recommend that chemotherapy may be
beneficial for patients who are well enough to withstand the treatment.
One analysis found that, among patients age 65 and older diagnosed with
this type of lung cancer between 1991 and 1993, only 22 percent received
chemotherapy. A study of patients diagnosed in 1996 found similarly low
levels of treatment among patients age 65 and older. However, more
recent studies have found increasing trends in the late 1990s in the use
of chemotherapy among late-stage non-small cell lung cancer patients.
Unlike breast and lung cancers, treatment for
prostate cancer is more controversial. The most notable trend in
prostate cancer treatment from 1986 to 1999 was the decreasing
proportion of cases that received watchful waiting, surgical or chemical
castration, or hormonal deprivation therapy as primary treatment. More
aggressive treatments using newer radiation techniques were found to be
on the rise. However, black men were found to receive substantially less
aggressive treatment than white men.
The report concludes that substantial geographical
variations in treatment patterns exist, but that much of contemporary
cancer treatment is consistent with evidence-based NIH Consensus
Development Statements (http://consensus.nih.gov/),
which are considered a “gold standard” for care recommendations.
“The value of cancer registries in population
research is immeasurable. Through linkage with other data systems, the
information can give us insight into getting effective treatments to the
general population that will have an impact on survival and mortality,"
said NAACCR Director Holly L. Howe, Ph.D.
The authors also examined racial and ethnic
disparities in cancer. From 1992 to 2002, prostate, lung, colon/rectum
cancer in men, and breast, colon/rectum, and lung cancer in women,
continue to be the leading sites for incidence and mortality for each
racial and ethnic population. Rates for lung and prostate cancer
decreased among men in all populations, while colorectal cancer
incidence rates decreased only for white men. Among women, breast cancer
incidence rates increased in Asian Pacific Islander women, decreased
among American Indian/Alaska Native women, and were stable for other
women. Colorectal incidence rates decreased only for white women.
Differences in cancer incidence and mortality persist, especially among
black men, who have 25 percent higher incidence rates and 43 percent
higher mortality rates than white men for all cancers combined.
The authors 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, and that monitoring the dissemination of cancer treatment
advances is an important aspect of ensuring uniformly high standards of
care.
For more information on this report, visit the
following Web sites:
To view the full report, go to the Journal of the
National Cancer Institute online:
http://jncicancerspectrum.oupjournals.org/. Supplemental information
on micromaps, confidence intervals on rates, and other materials can
also be found at
http://jncicancerspectrum.oupjournals.org/jnci/content/vol97/issue19.
For a Q&A on this Report, go to
http://www.nci.nih.gov/newscenter/pressreleases/ReportNation2005QandA
ACS:
http://www.cancer.org
CDC’s Division of Cancer Prevention and Control:
http://www.cdc.gov/cancer
CDC’s National Center for Health Statistics’
mortality report:
http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
NAACCR:
http://www.naaccr.org/
NCI:
http://www.cancer.gov and the SEER Homepage:
http://www.seer.cancer.gov. Click on the icon "1975-2002 Report to
the Nation."
The National Institutes of Health (NIH) — The
Nation's Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U. S. Department of Health and Human Services.
It is the primary Federal agency for conducting and supporting basic,
clinical, and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
http://www.nih.gov.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
