An NCI-designated Comprehensive Cancer Center
By Samantha Bonar | January 9, 2020
The cancer death rate in the United States showed its largest single-year drop ever reported, falling 2.2% from 2016 to 2017, according to American Cancer Society data released January 8. Over the last three decades, the rate has dropped 29%, which translates to about 2.9 million fewer cancer deaths than would have occurred if the mortality rate had remained constant.
 
Each year, the American Cancer Society estimates the number of new cancer cases and deaths that will occur in the U.S. and compiles the most recent data. The latest findings were published online in CA: A Cancer Journal for Clinicians.
 
The decline is largely attributed to reduced smoking rates and advances in lung cancer treatment. In addition, new therapies for melanoma have helped extend life for many people, including those with metastatic disease.
 
On the downside, progress has slowed for those cancers that can be found through screening such as colorectal, breast and prostate, according to the report. Experts attribute this to the rising rate of obesity among Americans, as well as significant racial and geographic disparities in access to health care.

Still second leading cause of death

Still, cancer remains the second leading cause of death after heart disease in both men and women. The American Cancer Society predicts that in 2020 there will be about 1,806,590 new cancer cases and 606,520 cancer deaths. Prostate, lung and colorectal cancers are projected to account for 43% of all cases in men, with prostate cancer alone accounting for more than 1 in 5 new diagnoses. For women, the three most common cancers are predicted to be breast, lung and colorectal, accounting for 50% of all new diagnoses; breast cancer alone will account for 30% of female cancers, according to the report. While declining in incidence, lung cancer is still predicted to be the most deadly, killing more people than breast, prostate, colorectal and brain cancers combined.
 
In the last decade, several important advances in diagnosing and treating lung cancer have helped prevent patient deaths, including more accurate imaging technologies, less invasive surgical procedures and novel immunotherapy approaches.
 
Similar treatment breakthroughs have led to a complete reversal of trends in melanoma. Death rates began declining dramatically after the Food and Drug Administration approved two new immunotherapy drugs for metastatic melanoma in 2011.

Immunotherapy a game-changer

“Immunotherapy has been a game-changer for melanoma patients, particularly because chemotherapy is not very effective for skin cancer," said Kim Margolin, M.D., a melonoma expert and clinical professor in the Department of Medical Oncology & Therapeutics Research at City of Hope, who discussed the latest cancer numbers on CBS News. "In the next five years, I predict that we will fine tune immunotherapy for melanoma: More patients will benefit from the innovative treatment and experience fewer risky side effects. We are coming closer to finding a cure for many types of advanced melanoma, and even when not cured, more people are able to live relatively healthy lives as skin cancer survivors in a similar way as people with diabetes are often able to live long lives while taking treatment for their chronic disease.”
 
(An example of this is City of Hope patient Fred Powers, 73, who was diagnosed with Stage 4 [metastatic] melanoma six years ago. He joined a clinical trial of the two new immunotherapy drugs, nivolumab and ipilimumab. Although a doctor had told him he would be dead in three months, six years later, Powers is still alive, healthy and in remission.)
 
However, the report notes that the rate of obesity-related cancers, including malignancies of the liver, kidneys, pancreas and uterus, cancers of the breast in postmenopausal women, and colon and rectal cancers in adults younger than 55, are increasing. Metabolic and hormonal abnormalities and chronic inflammation associated with extra pounds and lack of physical activity could be precipitating factors.
 
"Some epidemiologists hypothesize that rising rates of obesity, decreases in exercise and activity levels, and changes in the diet may be contributing to the well-established increase in the rate of colorectal cancer in patients under the age of 50," said Trilokesh Kidambi, assistant clinical professor in the Department of Medicine, Division of Gastroenterology, and director of the colon cancer screening program at City of Hope."I emphasize the importance of maintaining a healthy body weight to all of my patients interested in cancer prevention, in addition to getting their colon cancer screening done on time. Despite an overall decline in colon cancer mortality rates, the rate is leveling off and even slowing down, which likely reflects lack of screening, which is where we must continue to place an emphasis."

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