The US cancer death rate has fallen 33% since 1991, thanks in part to advances in treatment, early detection and smoking reduction, a new report says
The rate of people dying from cancer in the United States has steadily declined over the past three decades, according to a new report from the American Cancer Society.
The U.S. cancer death rate has fallen 33% since 1991, equivalent to an estimated 3.8 million deaths averted, according to a report published Thursday in CA: Journal of Cancer for Clinicians. The rate of lives lost to cancer continued to decrease in the most recent year for which data is available, between 2019 and 2020, by 1.5%.
The 33 percent drop in cancer deaths is “truly incredible,” said Karen Knudsen, chief executive officer of the American Cancer Society.
The report attributes this steady progress to improvements in cancer treatment, reductions in smoking and increases in early detection.
“New discoveries for prevention, early detection and treatment have resulted in real, significant gains in many of the 200 diseases we call cancer,” Knudsen said.
In their report, researchers from the American Cancer Society also pointed to the association of HPV vaccination with a reduction in cancer deaths. Infections with HPV or human papillomavirus can cause cervical and other cancers, and vaccination is associated with a reduction in new cases of cervical cancer.
Among women in their early 20s, there was a 65% drop in cervical cancer rates from 2012 to 2019, “which completely follows the time when HPV vaccines were introduced,” said Dr. William Dahut, chief scientific director of the company.
“There are other cancers that are associated with HPV — whether it’s head and neck cancer or anal cancer — so there’s optimism that this will have relevance beyond this,” he said.
The lifetime probability of being diagnosed with any invasive cancer is estimated to be 40.9% for men and 39.1% for women in the US, according to a new report.
The report also includes projections for 2023, estimating that there could be nearly 2 million new cancer cases in the United States this year—the equivalent of about 5,000 cases a day—and more than 600,000 cancer deaths.
During the first days of the Covid-19 pandemic, many people skipped regular medical examinations, and some doctors have noticed an increase in advanced cancer cases in the midst of a pandemic of delayed examinations and treatment.
The American Cancer Society researchers were unable to track “that reduction in screening that we know we’ve all seen across the country during the pandemic,” Knudsen said. “I believe that by this time next year, our report will provide an initial insight into what the impact of the pandemic has been on cancer incidence and cancer mortality.”
The new report includes data from national programs and registries, including those at the National Cancer Institute, the US Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.
The data showed that cancer death rates in the US rose for most of the 20th century, largely due to an increase in smoking-related lung cancer deaths. Then, as smoking rates fell and improvements in early detection and treatment of some cancers increased, cancer death rates fell from their peak in 1991.
Since then, the pace of decline has slowly accelerated.
The new report found that the five-year relative survival rate for all cancers combined increased from 49% for diagnoses in the mid-1970s to 68% for diagnoses during 2012-18.
The types of cancer that now have the highest survival rates are thyroid at 98%, prostate at 97%, testicular at 95% and melanoma at 94%, according to the report.
Current survival rates are lowest for pancreatic cancer, at 12%.
The finding of a reduction in cancer death rates shows “continuation of good news,” said Dr. Otis Brawley, a professor of oncology at Johns Hopkins University who was not involved in the research.
“The biggest reason for the decline that began in 1991 was the prevalence of smoking in the United States, which began to decline in 1965,” said Brawley, the former chief medical officer of the American Cancer Society.
“That’s why we started to have a decline in 1991, and that decline continued because the prevalence of smokers in the United States continued to decline,” he said. “Now, in certain diseases, our ability to treat has improved, and there are some people who don’t die from treatment.”
While the cancer death rate has been steadily declining, the new report also highlights that new cases of breast, uterine and prostate cancer are “alarming” and rising in the United States.
Incidence rates of breast cancer in women have been growing at about 0.5% per year since the mid-2000s, according to the report.
The incidence of endometrial cancer has increased by about 1% per year since the mid-2000s among women 50 and older and by nearly 2% per year since the mid-1990s in younger women.
The incidence rate of prostate cancer rose 3% per year from 2014 to 2019, after two decades of decline.
Knudsen called prostate cancer a “decline” as its previous decline in incidence has reversed, and appears to have been driven by diagnoses of advanced disease.
On Thursday, the American Cancer Society announced the launch of the Impact initiative, aimed at improving prostate cancer incidence and mortality rates by funding new research programs and expanding patient support, among other efforts.
“Unfortunately, prostate cancer remains the number one most commonly diagnosed malignancy in men in this country, with nearly 290,000 men being diagnosed with prostate cancer this year,” Knudsen said. Cancer diagnosed when it is confined to the prostate has a five-year survival rate of “more than 99%,” she said, but there is no permanent cure for metastatic prostate cancer.
“Prostate cancer is the second leading cause of cancer death in men in this country,” she said. “What we are reporting is not only an increase in the incidence of prostate cancer across all demographic groups, but also a 5% year-over-year increase in the diagnosis of men with advanced disease. So we’re not catching these cancers early when we have the opportunity to cure men of prostate cancer.”
Breast, uterine, and prostate cancers also have large racial disparities, with communities of color having higher death rates and lower survival rates.
In 2020, the risk of overall cancer death was 12% higher in blacks compared to whites, according to a new report.
“Not every individual or every family is equally affected,” Knudsen said.
For example, “Blacks unfortunately have a 70% increase in prostate cancer incidence compared to whites and a two- to fourfold increase in prostate cancer mortality compared to any other ethnic and racial group in the United States,” she said. He said.
Data in the new report show “important and consistent” progress in the fight against cancer, Dr. Ernest Hawk, vice president for cancer prevention and population sciences at the University of Texas MD Anderson Cancer Center, said in an email.
“Cancer is preventable in many cases and detected at an early stage with a better outcome in many others. When necessary, treatments are improved both in terms of efficacy and safety. It’s all great news,” Hawk wrote.
“However, it is past time to take health inequalities seriously and make them a much bigger national priority. Disparities in cancer risk, cancer treatment and cancer outcomes are unacceptable and we should not be satisfied with these regular reminders of avoidable disparities,” he said. “With deliberate and dedicated effort, I believe we can eliminate these disparities and make even greater progress in eradicating cancer.”