How often do we get to report good news in the war on cancer? Not often, but today, there's cause for celebration.
There has been a 23% drop in the cancer death rate since its peak in 1991, according to a new report from the American Cancer Society. That drop translates into more than 1.7 million cancer deaths averted through 2012, the latest year for which comprehensive data is available.
"Part of the decline in cancer mortality rates is because of smoking cessation and some of our successes in battling tobacco," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "Part of the decline is because of improvements in our ability to treat many of these cancers. And part of the decline is from the success of what I'll call 'wise screening.'"
Overall, cancer incidence is stable in women and declining by 3.1% per year in men (from 2009 to 2012). The report attributes the significant drop in men to recent rapid declines in prostate cancer diagnoses, as prostate-specific antigen, or PSA, testing decreases. PSA testing is no longer recommended due to concerns of over-diagnosis. Cancer mortality rates have declined steadily over the last decade in both sexes. On average, the rate dropped by 1.8% per year in men and 1.4% per year in women.
According to the American Cancer Society, the decline is driven by continued decreases in death rates for the four major cancer sites: lung, breast, prostate and colon/rectum. Death rates for female breast cancer have declined 36% from peak rates in 1989, while deaths from prostate and colorectal cancers have each dropped about 50% from their peak, a result of improvements in early detection and treatment. Lung cancer death rates declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females, due to reduced tobacco use.
"We have a large number of people who, even though they get health care, they get inadequate health care -- or, less than high quality health care," said Brawley. "If we could improve those logistics, we could decrease the death rate from cancer even more."
"We need to also focus on the fact that there are some good screening tests that actually clearly save lives, that we are not using enough," Brawley said. "I would point out that 55% to 60% of Americans over the age of 50 are up do date on colorectal cancer screening. We could save a lot of lives if we could just get to 80% by 2018. We could help to decrease the cancer death rate that way. I would point out that there is no debate that mammography saves lives -- and if you look at women over the age of 45, about a third to 40% are not up to date on mammography. Many have never actually even had a mammogram, and we need to work on that."
Even as cancer remains the second leading cause of death nationwide, steep drops in deaths from heart disease have made cancer the leading cause of death in 21 states. Additionally, cancer is the leading cause of death among adults ages 40 to 79, and among both Hispanics and Asian/Pacific Islanders, who together make up one-quarter of the U.S. population. Heart disease remains the top cause of death overall in the United States. In 2012, there were 599,711 (24%) deaths from heart disease, compared to 582,623 (23%) of deaths from cancer, according to the report.
"I don't think the two diseases ought to be competing against each other," said Brawley. "I think we need to realize that some of the causes of heart diseases are major causes of cancer. We talk a lot about high caloric intake, obesity and lack of physical activity. Those are risk factors for heart disease, as well as cancer. We talk a great deal about tobacco use. That's a risk factor for heart disease as well as cancer. We need to double down and work on all of those things."
The report estimates there will be 1,685,210 new cancer cases and 595,690 cancer deaths in the United States in 2016.