Study: Death rate from cancer drops 27 percent over last 25 years

January 14, 2019 | by Samantha Bonar

James Lacey, Jr. James Lacey, Ph.D., M.P.H.
The overall cancer death rate has dropped by 27 percent over the last 25 years, according to data released last week by the American Cancer Society. That translates to about 2.6 million fewer cancer deaths than would have been expected if death rates had stayed at their peak, seen in 1991, according to the study, published Jan. 8 in CA: A Cancer Journal for Clinicians.
However, although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers, according to the latest numbers. For example, compared with the most affluent counties, mortality rates in the poorest counties in the United States were twofold higher for cervical cancer and 40 percent higher for male lung and liver cancers from 2012 to 2016.
Overall, men fared slightly better than women: Over the last decade of data, the cancer incidence rate (2006‐2015) was stable in women and declined by approximately 2 percent per year in men, whereas the cancer death rate (2007‐2016) declined annually by 1.4 percent and 1.8 percent, respectively. 
According to the American Cancer Society, cancer is the second-leading cause of death in the United States, accounting for about one-quarter of deaths annually. (Heart disease takes the top spot.) The data show that the nationwide cancer death rate climbed during most of the 20th century, largely driven by jumps in lung cancer deaths due to smoking and tobacco use.
But since its peak of 215.1 deaths per 100,000 people in 1991, the cancer death rate has dropped steadily by about 1.5 percent per year to 156 per 100,000 people in 2016, an overall decline of 27 percent.
The decline in cancer mortality over the last two decades is primarily the result of steady reductions in smoking and advances in early detection and treatment, which are reflected in the rapid declines for the four major cancers (lung, breast, prostate and colorectum), according to the study. Specifically, the death rate for lung cancer dropped by 48 percent from 1990 to 2016 among males and by 23 percent from 2002 to 2016 among females, whereas the death rate for breast cancer dropped by 40 percent from 1989 to 2016, that for prostate cancer dropped by 51percent from 1993 to 2016, and that for colorectal cancer dropped by 53 percent from 1970 to 2016.
In different ways, these declines affirm important messages: prevention and screening save lives,” said James Lacey, Ph.D., M.P.H., director of the Division of Health Analytics within the Department of Computational and Quantitative Medicine at Beckman Research Institute of City of Hope. “For smoking, the year-over-year data are fascinating. In the last 50 years, the percentage of adults who smoke has gone down by about 50 percent. And now we see that lung cancer death rates are 50 percent lower than they were at their peak, in the early 1990s. That’s great news, and it should motivate everyone to keep pushing for more smoking prevention and cessation.”
The data also show that a disparity in death rates between black and white cancer patients appears to be closing. In the mid-1990s, the cancer death rate in blacks was 33 percent higher than in whites. The current data now indicate it's 14 percent higher. But the data show a growing gap in death rates based on wealth. Wealth causes differences in exposure to risk factors (key are higher levels of obesity, smoking and alcohol use in poorer regions) and also access to cancer screening, prevention and treatment.
For example, between 2012 and 2016, the overall cancer death rate was about 20 percent higher among people living in the poorest counties in the United States compared with those in the most affluent counties. Socioeconomic inequalities in cancer mortality widened over the last three decades overall, the study found. The study states that “approximately one‐third (34 percent) of cancer deaths in Americans aged 25 to 74 years could be averted with the elimination of socioeconomic disparities.”
“These numbers show we as a society need to find ways to reduce these disparities,” Lacey said. “For a number of cancers — breast, colorectal, ovarian, prostate and bladder — the worsening disparities are because rates did not fall as much among the poor as they did among the more affluent. Those numbers make a pretty compelling case for more outreach.
“For other cancers, it’s more worrisome because the numbers show rates are going up, and going up more among the poor than among the affluent. In recent years, funding agencies have begun to require us researchers to directly address disparities by sex and race/ethnicity. I wonder if it’s time to start requiring research to address the poverty disparities, too.”
Each year, the American Cancer Society also estimates the numbers of new cancer cases and deaths that may occur nationwide, based on the most recent data. This year, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. That corresponds to more than 4,800 new cases and almost 1,700 deaths per day, according to the study. For 2019, the greatest number of deaths are projected to be from cancers of the lung, prostate and colorectum in men and the lung, breast and colorectum in women. One‐quarter of all cancer deaths are expected to be due to lung cancer.
Prostate, lung and colorectal cancers account for 42 percent of all new cases in men, with prostate cancer alone accounting for nearly 1 in 5 new diagnoses. For women, the three most common cancers are breast, lung and colorectum, which collectively represent one‐half of all new diagnoses; breast cancer alone accounts for 30 percent of all new cancer diagnoses in women.
“These numbers are exactly what is expected, based on the last few years,” Lacey said. “However, the stage distribution at diagnosis shows how much of an impact better early detection could have. Lung cancer and colorectal cancer are two of the top three most common cancers among both men and women.  For both of those tumors, the majority of new patients are diagnosed with advanced disease. Finding ways to shift more of those diagnoses to localized disease could improve survival and further reduce mortality.”
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