Cancer deaths in the United States are falling, but if current trends continue, they will fail to reach to the milestone outlined in President Joe Biden’s Cancer Moonshot Initiative.
One of the Moonshot goals is a 50% reduction in overall age-standardized cancer mortality in the United States by 2047.
If the most recent trend in deaths from all cancers combined continues, the overall age-adjusted cancer death rate is estimated to decrease 44% by 2047, falling short of this goal.
Cancer death rates would need to decline more rapidly — by an average of 2.7% per year vs the current rate of 2.3% per year — to achieve a 50% reduction by 2047, say researchers from the National Cancer Institute, led by Meredith Shiels, PhD.
In their paper, published online in Cancer Discovery on April 17, they also outline how this could be achieved by improving on current approaches to cancer prevention, detection, and treatment.
Cancer prevention involves making lifestyle changes, such as having a healthy diet and exercise routine, maintaining a healthy weight, avoiding tobacco products, and getting vaccinated against certain viruses that increase the risk of developing cancer, the authors point out.
Policy changes from regulatory agencies like the Food and Drug Administration (FDA) play an important role in prevention efforts, they comment. Tobacco control policies have led to declines in lung cancer incidence and mortality, but there is still much work to be done, as lung cancer remains the most common cause of cancer mortality in men and women in the United States.
"The prevalence of smoking remains unacceptably high, and there are considerable disparities," Shiels and colleagues write. "Increased adoption of population-level policies, such as tobacco product price increases and comprehensive smoke-free policies, together with enhanced access to evidence-based smoking cessation treatment, could accelerate cessation rates."
Early detection and prompt treatment can improve outcomes for many types of cancer. Regular screening tests such as mammograms, ultrasounds, and other imaging tests and biopsies can help detect cancer at an early stage when it is more treatable. In some cases, early detection of cancer can even prevent it from developing in the first place, the authors point out.
There needs to be an increase in these early cancer screenings, write National Cancer Institute Director Monica Bertagnolli, MD, and colleagues in an accompanying editorial.
"In early detection, there is much to be gained by improving the uptake of breast, cervical, colorectal, and lung cancer screening according to current guidelines from the US Preventive Services Task Force," they write. "We must also pursue new early detection tools, especially for those cancers like pancreatic and ovarian that are often diagnosed in advanced stages with poor outcomes."
Bertagnolli et al. emphasize that improving cancer treatments across the board will have to begin with healthcare equity.
"Achieving a 50% reduction in cancer mortality in 25 years will be impossible without addressing cancer health equity," they write. "Many populations experience health inequities, including people from some racial and ethnic minority groups, people with disabilities, women, people who are LGBTQ+, people with limited English proficiency, and people living in rural locations."
Making cancer treatment more equitable begins with addressing implicit bias, financial barriers, and access to care. A recent study published in the Journal of the National Comprehensive Cancer Network suggested that the shift starts with more diverse clinical trials. The study notes that only about 10% of clinical trial participants are from groups other than non-Hispanic Whites.
"Low recruitment of underrepresented populations in cancer research may limit the generalizability of findings and perpetuate these inequities," the authors comment. "Multicomponent, multilevel interventions to improve access to care have the potential to address these inequities and improve care, but only if they reach the intended populations."
Cancer Discovery. Published online April 17, 2023. Abstract.
JNCCN. Published online April 11, 2023. Full text.
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Cite this: Improvements Needed to Reach Cancer Moonshot Goals - Medscape - Apr 25, 2023.