Total U.S. Cancer Rates Down for the First Time

Nov. 25, 2008— -- Since 1998, the American Cancer Society, along with the National Cancer Institute, the Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries have provided an Annual Report to the Nation on the Status of Cancer. This year's report has just been released in the current issue of the Journal of the National Cancer Institute.

For the first time in the history of these reports, the researchers have found that both the incidence rates and deaths from cancer in both men and women are declining.

But before you become too excited, you need to remember that we still have a long way to go in our efforts to reduce the burden and suffering from the diseases we commonly call cancer.

First, some good news:

From 1999 through 2005, the rate of cancers diagnosed in the United States has declined 0.8 percent each year for men and women combined. From 2002 to 2005, the rate of death from cancer has also declined 1.8 percent a year. In 2005; 106,000 deaths from cancer were averted as a result of our progress.

For men, lung cancer incidence and deaths have been declining since the early 1990s at a rate of 1.8 percent per year for incidence and 1.9 percent each year for deaths. That's because men decreased their cigarette consumption years ago. Over that time, hundreds of thousands of lives have been saved.

Now, some not so good news:

For women, the incidence rates for lung cancer have been increasing year over year since 1975, and they continue to grow even now. And although death rates from lung cancer in women may not be climbing any longer, they aren't declining either. This is a direct result of the "You've come a long way, baby" advertising theme that was prominent in the 1970s that helped hook women born between 1950 and 1960 on cigarettes.

Much of the improvement in incidence and deaths in men is due -- as noted -- to the decline in cigarette consumption, as well as a decline in colorectal cancer and prostate cancer incidence and deaths.

For women, the decrease in incidence and deaths is due primarily to the changes in rates for breast cancer and colorectal cancer, in part because of a decrease in the use of hormonal replacement therapy and more women getting screened for colorectal cancer.

When you look at the trends for individual cancers, you find some interesting information.

For example, among men, the incidence rate for prostate cancer dropped 4.4 percent per year from 2001 to 2005. This may be due to a "leveling off" for PSA testing, meaning that fewer prostate cancers are being diagnosed in the first place. Incidence rates for some other cancers in men have been increasing, including a 7.7 percent increase year-over-year for melanoma and 2.4 percent per year increase for liver cancer in men.

For women, incidence rates for breast cancer went down 2.4 percent a year from 1999-2005, and colorectal cancer is declining 2.2 percent per year. Melanoma rose 2.3 percent per year, and thyroid cancer continued its rapid increase at 6.9 percent per year from 1997-2005.

When examining death rates in men for common cancers, we find that colorectal cancer is decreased 4.3 percent per year from 2002-2005, and stomach cancer deaths declined 3.7 percent per year.

For women, colorectal cancer deaths declined by an annual rate of 4.3 percent per year from 2002-2005, and cervical cancer continued to fall at a rate of 3.4 percent per year from 1995-2005.

We hope that the decline in cancer incidence is due to better health and nutrition, higher rates of screening, and better treatment among other factors. But, when you consider that this reflects the numbers of cancers that are actually diagnosed, it may be problematic since it is possible that fewer cancers are being diagnosed because people aren't getting screened or can't afford to go to the doctor.

Deaths from cancer, on the other hand, tend to a more reliable measure of the impact of our efforts. In a sense, they represent the sum of our efforts when it comes to lifestyle, prevention and early detection and appropriate treatment. There is no question that the rate of death from cancer has been declining for many years, which means we are clearly doing something right.

The report also provides considerable detail on our efforts to curb cigarette smoking and its inevitable impact on cancer deaths.

In those states where they take the prevention of deaths from lung cancer seriously, there are fewer smokers and fewer lung cancer deaths. And, in those states where they snub their noses at the issue, there are more smokers and more deaths.

Consider Utah, Kentucky and California.

Lung cancer incidence for men in Utah is 39.6 newly-diagnosed lung cancers per 100,000 men per year. In Kentucky, the number is 136.2, or more than three times greater. For women, the incidence numbers are 22.4 in Utah and 76.2 in Kentucky, respectively. Lung cancer death rates for men are 33.7 per 100,000 men per year in Utah, and 111.5 in Kentucky. For women, the corresponding numbers are 16.9 in Utah and 111.5 in Kentucky.

California is cited in the report for having the greatest changes in lung cancer death rates over time. In California, the death rates for lung cancer in men are now approaching the death rate in Utah.

Utah has a culture that does not encourage smoking. But how did California accomplish its remarkable results? From 1996 through 2005, the decline in lung cancer deaths in men was 2.8 percent each year. This was more than twice the decline seen in many states in the Midwest and South, according to the report.

California accomplished this goal by being the first state in the U.S. to implement a comprehensive statewide tobacco control program, as noted by the report's authors. As a result, they have made the greatest progress in reducing tobacco use. Clean indoor air laws, high tobacco taxes, and advertising and education worked to get the job done. The citizens of California are being rewarded with better health and fewer lung cancer and tobacco-related deaths because California cared enough to do something bold.

States that don't embrace these proposals see their citizens needlessly die prematurely every day. That -- to me and many others -- is simply not acceptable.

What does the future hold?

We have the power within ourselves to reduce the burden and suffering from cancer right now. We can pay more attention to what we can do to keep ourselves healthy. It isn't a guarantee, but it does improve the odds. Exercising, eating a healthy diet, maintaining a healthy body weight, not smoking and getting screened for breast, cervical and colorectal cancers among others are all part of a healthy lifestyle.

Access to affordable, quality health care is another necessary step forward in moving us to our goal of reducing the risk and burden of cancer. Too many people in this country don't have that access, and the American Cancer Society recognizes that we need to make access to health care a nationwide priority if we are going to be successful in our journey.

We need to continue and expand our investment in cancer research, to continue our efforts to understand how cancer cells work and what we can do to exploit their weaknesses and improve our treatments.

And, lest we forget, we have a lot to do to improve the support we provide our patients throughout the cancer experience, especially for those who need comfort and care as they approach the end of their personal journeys.

At this time of the year, as we celebrate Thanksgiving, there is one overarching thought that I believe summarizes the successes reflected in this report and the successes we hope to achieve in the future:

This Thursday, hundreds of thousands of people will be sitting down with their families and friends to enjoy a wonderful Thanksgiving dinner. They are fathers, mothers, brothers, sisters, sons, daughters, friends and colleagues who would not have been with us for the celebration were it not for the progress we have made in the fight against cancer. Some of them may not even be aware how special they are, and that is the greatest blessing of all.

It doesn't get much better than that.

Happy Thanksgiving to all!!!

Len Lichtenfeld is deputy chief medical officer of the American Cancer Society. You can view the full blog by clicking here.