New Cancers and Cancer Death Down

The overall rate of new cancer cases (incidence) and deaths from all cancers (mortality) decreased in the United States between 1992 and 1998, according to a special article appearing in the June 6 issue of the Journal of the National Cancer Institute.

Each year the American Cancer Society (ACS), the National Cancer Institute (NCI), the North American Association of Central Cancer Registries (NAACCR), and the National Center for Disease Control and Prevention (CDC) issue a collaborative report on the current burden of cancer in the nation.

The authors’ goal through this collaboration “is to use surveillance data in targeting and prioritizing populations so that prevention initiatives, early-detection programs, and research can be effectively focused and so that access to state-of-the-art treatment, quality of life, and palliative care for cancer patients can be improved.”

In this year’s report, Holly Howe, Ph.D., of NAACCR and colleagues from all the participating agencies examined trends from 1973 through 1998 in the incidence and mortality rates for all cancer, as well as for the four most common cancer types (breast, prostate, lung, and colorectal). The report also identifies cancers with increasing incidence or death rates between 1992 and 1998.

A review of national statistics showed that between 1992 and 1998 the rate of new cancers in the U.S. decreased by an average of 1.1 percent each year. This decline reversed the pattern of increasing rates between 1973 and 1992. This improvement is largely due to a 2.9 percent yearly decline among white men and a 3.1 percent yearly decline among black men. Women showed a 0.3 percent increase per year in cancer incidence.

Overall cancer mortality rates decreased for both men and women, 1.6 percent and 0.8 percent respectively, per year.

Lung cancer caused 29 percent of cancer deaths and represented 13.2 percent of cancer cases in 1998. Its incidence decreased 1.6 percent per year between 1992 and 1998. The authors credit this improvement to reductions in tobacco smoking since the 1960s. Lung cancer incidence dropped 2.7 percent for in men, but rose 0.8 percent in women. Lung cancer mortality decreased among men from 1992 until 1998 by an average of 1.9 percent each year, but it increased 0.8 percent per year among women.

Breast cancer accounted for 7.8 percent of cancer deaths and 16.3 percent of cancer cases in 1998. Breast cancer incidence increased by 1.2 percent per year from 1992 to 1998. This increase was most pronounced in white women between the ages of 50 and 64. The authors attribute the higher rates in this population to its increased use of mammography. 1989 to 1995 saw breast cancer mortality rates decrease 1.6 percent per year, followed by a further 3.4 percent annual drop from 1995 to 1998.

The increased incidence of breast cancer and lung cancer in women accounts for their increased overall incidence of cancer.

Prostate cancer was responsible for 5.9 percent of cancer deaths and 14.8 percent of cancer incidence in 1998. Prostate cancer incidence rates increased dramatically from 1973 until 1992 because of the introduction of screening for prostate-specific antigen (PSA), thus increasing detection of prostate cancers. The incidence rate then dropped from 1992 through 1998– 5.7 percent annually for white men and 4.0 percent for black men. Mortality rates from prostate cancer also declined in recent years, but the authors note this decline varied widely by race, region, and year.

Colorectal cancer claimed 10.5 percent of cancer deaths and represented 11.6 percent of cancer cases in 1998. The incidence of colorectal cancer varied across races ranging from 10.2 per 100,000 Hispanics to 22.8 per 100,000 blacks. The mortality rates from colorectal cancer dropped variably from 1992 to 1998 among all males, and white women. Death rates for black women were stable.

Gilbert Ross, M.D., of the American Council on Science and Health says, “it is unfortunate that lung cancer rates among women are still rising. Hopefully, as fewer women take up smoking and more quit, their lung cancer rates will follow men’s downward.”

He continued, “Colorectal cancer rates could be markedly reduced as well, if more Americans had appropriate screening procedures.”

The authors also identified ten less common sites for which incidence or mortality rates increased in one or more population subgroups between 1992 and 1998. These include non-Hodgkin’s lymphoma, melanoma, acute myeloid leukemia, and cancer of the liver- intrahepatic bile duct, esophagus, soft tissue, thyroid, small intestine, vulva, and peritoneum-omentum-mesentery.

The authors suggest a number of strategies for reducing future cancer burden in the U.S. They stress that “the single most critical determinant of future cancer incidence and mortality will be the ability to reduce tobacco use in all segments of the population.” They add, “tobacco smoking causes an estimated 30 percent of cancer deaths. Both the avoidance and cessation of smoking effectively reduce the risk of many cancers.”

Other strategies mentioned to reduce cancers impact include using popular role models to demonstrate protective behavior, increasing use of available screening technologies, continuing to develop state-of-the-art procedures and treatment, and reducing disparities in cancer care across population subgroups.

The authors conclude, “although it is encouraging that overall cancer incidence and death rates continue to decline in the United States, measures to sustain this progress must address the entire spectrum of prevention, early detection, and improved treatment and quality of life and must be aimed at reducing mortality among all populations.”

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