Cancer death rates in the United States are continuing to decline for most major types of malignancies. The decline is seen in both men and women, across all major racial and ethnic groups, and in the most common types of cancer, including lung, colon, breast, and prostate.
According to the annual report on the status of cancer, published online December 16 in Cancer, death rates from all cancers combined dropped from 2001 to 2010 an average of 1.8% per year in men and 1.4% per year in women. For children, the decline was by 2% per year.
During that same period, the rate of new cancer cases has decreased by an average 0.6% per year in men, has remained the same in women, and increased 0.8% for children 14 years and younger.
There are differences between racial and ethnic groups for certain cancer types, but black men appear to shoulder the biggest burden; they have the highest rates of new cancer cases and cancer-related deaths.
"The continuing decrease in overall cancer death rates is a clear indicator that our societal investments are paying off, in particular for those patients with cancers that have been traditionally most challenging to treat, such as lung cancer," said Clifford A. Hudis, MD, FACP, president of the American Society of Clinical Oncology, in a statement.
Dr. Hudis noted that the improvements in lung cancer survival, specifically, "can be attributed to better supportive care and new drugs, some based on exciting advances in molecular biology made possible by the research infrastructure we have built and supported over the years."
"The successful translation of these findings into clinically relevant treatments has been possible only because of decades of clinical trials that have led to significant advances in targeted therapies in lung and a number of other cancers," said Dr. Hudis. "At the same time, the availability of effective screening options for those at high risk of developing lung cancer may yield even greater reductions in mortality — by finding more patients with early-stage, curable disease — in the coming years."
Some Cancers Going Up
The report points out that some of the news is not good. The rates of new cases of some cancers have been rising. Cancers of the pancreas, kidney, thyroid, liver, melanoma of the skin, myeloma, and non-Hodgkin's lymphoma increased in men from 2001 to 2010.
In women during this period, the rates of new cases of some malignancy types have increased, including those of the thyroid, melanoma of the skin, kidney, pancreas, liver, and uterus.
Death Rates Declining and Rising
From 2001 through 2010, mortality rates declined for 11 of the 17 most common cancers in men (lung, prostate, colon and rectum, leukemia, non-Hodgkin's lymphoma, esophagus, kidney, stomach, myeloma, oral, and larynx) and for 15 of the 18 most common cancers in women (lung, breast, colon and rectum, ovary, leukemia, non-Hodgkin's lymphoma, brain, myeloma, kidney, stomach, cervix, bladder, esophagus, oral, and gallbladder).
At the same time, death from cancers of the pancreas and liver increased in both men and women. In men, mortality related to melanoma and cancer of soft tissue, including heart (primarily sarcomas), increased, as did death from cancer of the uterus in women.
Racial and Ethnic Variations
When divided by racial and ethnic groups, the data showed differences in both mortality and incidence rates.
Black men had the highest overall cancer incidence rate of any racial or ethnic group (593.9 per 100,000), and the highest cancer death rate (276.6 deaths per 100,000).
Prostate and breast cancers were the most common cancers reported in each racial and ethnic group, with incident lung and colorectal cancers coming in second and third, respectively, in men and women in nearly all racial and ethnic groups. For Hispanic men and women and Asian-Pacific Islander women, the rates of colorectal cancer were higher than those of lung cancer. Beyond these common cancers, cancer rankings varied by race and ethnicity.
Lung, prostate, and colorectal cancers were the 3 leading causes of cancer death in men in every racial and ethnic group except Asian-Pacific islanders (liver cancer ranked second). For almost all women, the leading causes of cancer death were lung, breast, and colorectal cancers. Hispanic women were the exception, where breast cancer was the leading cause of cancer death.
Effect of Comorbidities
This year's report includes a section on the impact of comorbidities on lung, colon, breast, and prostate cancer survival, on all cancers combined, and on the noncancer control cohort of Medicare beneficiaries.
The authors found that the prevalence of comorbidities was similar in the control group of Medicare beneficiaries (31.8%), in breast cancer patients (32.2%), and in prostate cancer patients (30.5%). It was highest in those with lung cancer (52.9%), and "intermediate" in those with colorectal cancer (40.7%).
The most common comorbid conditions in cancer patients were diabetes (16.0%), chronic obstructive pulmonary disease (15.5%), congestive heart failure (9.7%), and cerebrovascular disease (6.0%). Women with breast cancer, men with prostate cancer, and cancer-free patients were more likely to be free of any concurrent health conditions than patients with colorectal or lung cancer.
Age and comorbidity had an effect on the probability of dying from causes other than cancer, and subsequently on overall survival. This was particularly noticeable for patients diagnosed with local and regional disease. For those diagnosed with distant disease, the probability of dying from cancer was much higher than from another cause, and age and comorbidity had a smaller effect on their overall survival.
For example, in women diagnosed with regional breast cancer, comorbidity and age were associated with overall survival. But in those with advanced disease, cancer-specific deaths were much higher — at least 69% of these patients died from cancer 5 years after their diagnosis in all age and comorbidity strata.
The probabilities of dying from cancer and noncancer, and survival by stage, age, and comorbidity level for prostate cancer patients, were generally similar to those of breast cancer. From 2% to 14% of men with localized disease died from their cancer in all age and comorbidity strata, but for those diagnosed at the regional stage (especially those 75 to 84 years of age), the impact and level of comorbidity affected both cancer and noncancer deaths. Conversely, men diagnosed with advanced disease had a high (>54%) probability of dying from their cancer, regardless of age or comorbidity level.
This work was supported by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute at the National Institutes of Health, and the North American Association of Central Cancer Registries. The authors have disclosed no relevant financial relationships.
Cancer. Published online December 16, 2013. Abstract
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Cite this: Cancer Death Rates Continue to Decline in the United States - Medscape - Dec 19, 2013.