Annual Report to the Nation Finds Cancer Death Rates Still on the Decline: Progress in Cancer Treatment Varies by Disease
The nation's leading cancer organizations report that Americans' risk of dying
from cancer continues to decline and that the rate of new cancers is holding
steady. The "Annual Report to the Nation on the Status of Cancer, 1975-2002,"
published in the Oct. 5, 2005, issue of the Journal of the National Cancer
Institute*, shows observed cancer death rates from all cancers combined dropped
1.1 percent per year from 1993 to 2002. According to the report's authors,
declines in death rates reflect progress in prevention, early detection, and
treatment; however, not all segments of the U.S. population benefited equally
from advances, a point outlined in a featured analysis of treatment trends.
First issued in 1998, the "Annual Report to the Nation" is a collaboration
among the National Cancer Institute (NCI), which is part of the National
Institutes of Health (NIH), the Centers for Disease Control and Prevention
(CDC), the American Cancer Society (ACS), and the North American Association of
Central Cancer Registries (NAACCR). It provides updated information on cancer
rates and trends in the United States.
According to NCI Director Andrew C. von Eschenbach, M.D., "These numbers
reflect a trend in reduction of cancer mortality that has now persisted for
nine years. This can only be considered good news for the millions of cancer
survivors who have benefited from recent research and treatment advances and
emphasizes the expectation that we will achieve a time when no one will suffer
or die from cancer."
Death rates from all cancers combined declined 1.5 percent per year from 1993
to 2002 in men, compared to a 0.8 percent decline in women from 1992 to 2002**.
Lung cancer is the leading cause of cancer deaths in both men and women. Death
rates decreased for 12 of the top 15 cancers in men, and nine of the top 15
cancers in women.
"Declines in mortality rates from many tobacco-related cancers in men represent
an important, but incomplete, triumph of public health in the 21st century,"
said John R. Seffrin, Ph.D., chief executive officer of the ACS. "These trends
reinforce the importance of tobacco control programs in the U.S., as well as
measures to combat the increase in tobacco use in other parts of the world,
particularly in developing countries."
Overall cancer incidence rates (the rate at which new cancers are diagnosed)
for both sexes have been stable since 1992. Incidence rates were stable in men
from 1995 to 2002 and increased 0.3 percent annually in women since 1987 to
2002. The persistent increase in overall cancer incidence rates for women can
be attributed to increases in rates for breast and six other cancers:
non-Hodgkin lymphoma, melanoma, leukemia, and thyroid, bladder and kidney
cancer. However, according to more recent data from 1998 to 2002, female lung
cancer incidence rates have begun to stabilize after increasing for many years,
which is good news. Changes in overall incidence may result from changes in the
prevalence of risk factors and from changes in detection practices due to
introduction or increased use of screening and/or diagnostic techniques.
This year's report highlights patterns of care for cancer patients. The authors
note that one strategy for reducing death and improving cancer survival is to
ensure that evidence-based treatment services are available and accessible. In
performing this analysis, the authors looked at data from NCI's Patterns of
Care studies (which supplement routine data collection from NCI's Surveillance,
Epidemiology and End Results, or SEER Program, with more detailed data on
treatment patterns) and SEER-Medicare databases (which link data from SEER
registries to Medicare claims data to assess treatment histories for those over
age 65), as well as other resources. Using these data, they examined whether
evidence-based care was delivered uniformly to diverse populations and how
rapidly changes in evidence-based guidelines resulted in changes in cancer
care.
"Day by day we are winning the war against cancer as more people than ever
before are being screened and are receiving treatments necessary for them to
lead healthy and productive lives," said CDC Director Julie Gerberding, M.D.
"However, there are gaps and missed opportunities so we must continue to pull
out all the stops to ensure proper screening and access to treatment regardless
of one's age, race, or geographic location."
For breast cancer, data on trends in the treatment of early-stage disease show
that the proportion of women diagnosed with stage I or II (earlier stage)
breast cancer who received breast-conserving surgery with radiation treatment
increased substantially during the 1990s. This change followed evidence-based
guidelines that breast-conserving surgery followed by radiation therapy may be
preferable to mastectomy because it provides similar survival but preserves the
breast.
The authors also report findings of a separate study on use of chemotherapy and
radiation therapy for women with early-stage breast cancer. For women with
lymph node positive disease, multi-agent chemotherapy, along with tamoxifen (a
hormonal therapy) for those with estrogen-receptor positive tumors, has been
recommended since 1985 by the NIH. This study found that, between 1987 and
2000, the proportion of women who received both chemotherapy and tamoxifen
increased substantially. However, use of concurrent therapy remained relatively
low among women age 65 and older, who were more likely to receive tamoxifen
only.
For colorectal cancer, the authors found that use of adjuvant (additional
treatment that follows initial surgery) chemotherapy for stage III colon cancer
patients increased rapidly between 1987 and 1995. However, delivery of this
therapy was uneven across age groups, with much lower rates of treatment among
patients age 65 and older. Also noted was the fact that the number of patients
who received treatment decreased with the increasing number of pre-existing
medical conditions, but the likelihood of receiving adjuvant therapy decreased
with age even after taking other medical conditions into account.
For patients with advanced non-small cell lung cancer, evidence-based
guidelines recommend that chemotherapy may be beneficial for patients who are
well enough to withstand the treatment. One analysis found that, among patients
age 65 and older diagnosed with this type of lung cancer between 1991 and 1993,
only 22 percent received chemotherapy. A study of patients diagnosed in 1996
found similarly low levels of treatment among patients age 65 and older.
However, more recent studies have found increasing trends in the late 1990s in
the use of chemotherapy among late-stage non-small cell lung cancer patients.
Unlike breast and lung cancers, treatment for prostate cancer is more
controversial. The most notable trend in prostate cancer treatment from 1986 to
1999 was the decreasing proportion of cases that received watchful waiting,
surgical or chemical castration, or hormonal deprivation therapy as primary
treatment. More aggressive treatments, including newer radiation techniques,
were found to be on the rise. However, black men were found to receive
substantially less aggressive treatment than white men.
The report concludes that substantial geographical variations in treatment
patterns exist, but that much of contemporary cancer treatment is consistent
with evidence-based NIH Consensus Development Statements
(http://consensus.nih.gov/ ), which are considered a "gold standard" for care
recommendations.
"The value of cancer registries in population research is immeasurable. Through
linkage with other data systems, the information can give us insight into
getting effective treatments to the general population that will have an impact
on survival and mortality," said NAACCR Director Holly L. Howe, Ph.D.
The authors also examined racial and ethnic disparities in cancer. From 1992 to
2002, prostate, lung, colon/rectum cancer in men, and breast, colon/rectum, and
lung cancer in women, continue to be the leading sites for incidence and
mortality for each racial and ethnic population. Rates for lung and prostate
cancer decreased among men in all populations, while colorectal cancer
incidence rates decreased only for white men. Among women, breast cancer
incidence rates increased in Asian/Pacific Islander women, decreased among
American Indian/Alaska Native women, and were stable for other women.
Colorectal incidence rates decreased only for white women. Differences in
cancer incidence and mortality persist, especially among black men, who have 25
percent higher incidence rates and 43 percent higher mortality rates than white
men for all cancers combined.
The authors emphasize that reaching all segments of the population with
high-quality prevention, early detection, and treatment services could reduce
cancer incidence and mortality even further, and that monitoring the
dissemination of cancer treatment advances is an important aspect of ensuring
uniformly high standards of care.
* The report was published on October 5, 2005, in Journal of the National Cancer Institute: "Annual Report to the Nation on the Status of Cancer, 1975-2002, Featuring Population-Based Trends in Cancer Treatment," (Vol. 97, Number 19, pgs. 1407-1427). The authors of this year's report are Brenda K. Edwards, Ph.D. (NCI), Martin Brown, Ph.D. (NCI), Phyllis A. Wingo, Ph.D. (CDC), Holly L. Howe, Ph.D. (NAACCR), Elizabeth Ward, Ph.D. (ACS), Lynn A.G. Ries, M.S. (NCI), Deborah Schrag, M.D., (Memorial Sloan-Kettering), Patricia M. Jamison (CDC), Ahmedin Jemal, Ph.D. (ACS), Xiaocheng Wu, M.D. (NAACCR), Carol Friedman, (CDC), Linda Harlan, Ph.D. (NCI), Joan Warren, Ph.D. (NCI), Robert N. Anderson, Ph.D. (CDC), and Linda Pickle, Ph.D. (NCI).
** Time periods for rates between men and women (and also for racial and ethnic comparisons) are not the same due to statistical methodology. Please see question #16 in Q&A for a detailed explanation.
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For more information on this report, visit the following Web sites:
To view the full report, go to the Journal of the National Cancer Institute
online: http://jncicancerspectrum.oupjournals.org/. Supplemental information on
micromaps, confidence intervals on rates, and other materials can also be found
at http://jncicancerspectrum.oupjournals.org/jnci/content/vol97/issue19.
For a Q&A on this Report, go to
http://www.nci.nih.gov/newscenter/pressreleases/ReportNation2005QandA
ACS: http://www.cancer.org
CDC's Division of Cancer Prevention and Control: http://www.cdc.gov/cancer
CDC's National Center for Health Statistics' mortality report:
http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
NAACCR: http://www.naaccr.org/
NCI: http://www.cancer.gov and the SEER Homepage: http://www.seer.cancer.gov.
Click on the icon "1975-2002 Report to the Nation."
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