By American Cancer Society Chief Medical Officer Otis W. Brawley, MD, FACP and Chief Cancer Control Officer Richard Wender, MD
As leaders of the American Cancer Society, one of our jobs is to look at the big picture; to step back from our day-to-day work and review our nation's collective progress toward ending the cancer problem.
Analyzing the cancer landscape allows us to figure out what's working and what isn't — and to determine what else can be done. Back in the mid-1990s, the American Cancer Society Board of Directors took a hard look at the state of cancer in the United States. Based on what they learned, they challenged the U.S. to cut the cancer mortality rate in half by the year 2015.1 They made the start year 1990.
They knew from the outset that achieving the goal would require the combined efforts of many sectors, and not any one organization.
Today, we are reporting on the nation's progress toward achieving that goal. Here's what we have all accomplished together: The cancer death rate declined 26% over the 25-year period of 1990 to 2015. Though the goal of a 50% reduction was only one-half achieved, we believe this progress should be viewed as a glass half full.
Let's break down this number. From 1990 to 2015, the age-adjusted cancer death rate declined by:
- 32% among men
- 22% among women
- 39% for breast cancer
- 44% for colorectal cancer among women
- 47% for colorectal cancer among men
- 45% for lung cancer among men
- 53% for prostate cancer among men
These findings and more are published early online today in the American Cancer Society journal, CA: A Cancer Journal for Clinicians.
What these numbers tell us is that while the goal of a 50% decrease in cancer mortality overall was not met, more progress is possible given our current state of medical knowledge. Let us explain.
Speeding up progress in cancers already seeing declines in death rates
Progress is especially possible in cancers for which there is prevention, screening, diagnosis and treatment that we know works. The problem is a large number of Americans do not have access to state-of-the-art care, including preventive services. More cancer deaths could have been prevented by getting adequate high-quality care to more Americans. More lives can be saved in the future by getting adequate high-quality care to more Americans.
Breast Cancer: For example, the 39% decrease in breast cancer death rates was achieved nationally. The successes in breast cancer were due to improvements in screening, awareness, diagnosis and treatment. However, previous American Cancer Society studies showed that there is dramatic variation in breast cancer death rates by state. Death rates declined in 36 states and the District of Columbia, but did not decline in 14 states.3 These 14 states are mainly located in the south and west. There is evidence to show the lack of decline was due to differences in the quality of mammography screening, diagnosis and treatment.
Colorectal Cancer: Similar findings have been documented for colorectal cancer. Effective screening, diagnosis and treatment have led to the significant decline in the colorectal cancer death rate. But the fact that Massachusetts and New York can have a greater than 40% decline over 25 years and Mississippi had no decline means we can do better.4
Lung Cancer: The 45% drop in lung cancer deaths among men is due to the decline in tobacco use. Tobacco has been linked to at least 16 different cancers. Tobacco control efforts led to the steep drop in smoking rates in the U.S. These declines in tobacco use drove much, if the not most, of the 26% decline in deaths from all cancers.
Prostate Cancer: As we have shown, oftentimes we know why we are seeing progress against certain cancers. But sometimes the picture isn't so clear. For example, clinicians and researchers continue to study why the prostate cancer death rate is declining. Increases in early detection and improvements in treatment, as well as other factors, have played a role. We go into this in great detail in the full report. We encourage you to read it if you want to know more.
Focusing on cancers with increasing death rates
While death rates have gone down for a number of cancers and especially for the very common cancers, there are some cancers for which death rates have remained stable or increased. For example:
- Liver cancer death rates in the past 25 years have nearly doubled from 3.6 to 6.5 per 100,000.
- There has been a small increase in pancreatic cancer death rates from 10.6 per 100,000 to 11 per 100,000 over the past 25 years.
- And there has been an increase in uterine cancer deaths from 4.3 to 4.6 per 100,000 over the same time period.
Let's take a look at liver cancer. The death rate for liver cancer increased by about 60% from 1990 to 2015 — a greater increase than for any other cancer type. The two reasons for this increase are both preventable. The biggest cause is chronic hepatitis C infection among "baby boomers" (Americans born between 1945 and 1965). While it is recommended that everyone born in that era get screened for hepatitis C, most of the population hasn't been tested. So partly we have an awareness problem. The other issue is the need for a lower cost drug to treat the infection.
Turning around the obesity epidemic will also be key to stopping the increase in liver cancer deaths — and addressing the nation's weight problem will impact other cancers as well.
Making more discoveries to better understand and treat cancer
While better applying what we already know is a big piece of the puzzle, we still need more options — new discoveries, especially in areas where we have not seen much progress. Sometimes, to make the biggest discoveries, we have to go back to basics. We need to support basic research — learning more about why cancer forms and how it spreads. We also need more clinical research in cancer to get better treatment options to patients.
Of course, to do all of this — and do it as fast as possible — funding is necessary. Right now, only about 10% of all of the good cancer research ideas out there are being funded. Major efforts like the vice president's "cancer moonshot" program in combination with other large-scale investments from all corners of the country hold great promise. And we here at the American Cancer Society remain deeply committed to funding cancer research.
Bottom line
The full report reviews what we can do to better control cancer. Many Americans do not get state-of-the-art care, from screening to diagnosis. Fixing that requires new changes in our systems of providing care, not new science.
While we all support and see a need for more scientific research aimed at finding new and better treatments for cancer, it is both an irony and a shame that so many Americans do not enjoy the fruits of completed research. From 1991 through 2015, more than one million cancer deaths were averted in men and more than 500,000 were averted in women. We've proven that dramatic progress is possible.
We have the opportunity and the moral obligation to do everything possible to speed up progress, to ensure that everyone has a chance to benefit from interventions proven to work and to redouble efforts to find new interventions to prevent and treat all cancers.
Working closely with all segments of society, the American Cancer Society can fuel progress to achieve a greater reduction in our nation's cancer burden.
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