Every year the American Cancer Society provides a report that is one of the most widely quoted scientific articles in this country. This year's "Cancer Statistics, 2010" report was released this morning, and provides a considerable amount of information regarding the burden of cancer in the United States, such as the expected number of new cancer cases and number of cancer deaths in the United States in 2010.
As part of the same report, my colleagues at the American Cancer Society also dissect the numbers and provide insight into the trends in cancer incidence and deaths, what is happening and perhaps why it is happening. Statistics--no matter how good you are at writing reports--are always somewhat droll and boring. But there are the occasional pearls that leap out at you from time to time, especially if you are interested in this particular subject (which obviously, I am).
Some good news is that--as we have seen in recent years--the death rates from cancer in this country continue their steady decline since the early 1990's. For men of all races, death rates from cancer have fallen 21% between 1990 and 2006, the latest year for which accurate information is available. Most of that decline can be explained by decreases in deaths from lung, prostate and colorectal cancer which account for 80% of the observed fall in cancer deaths in men. For women, the data show a 12.3% decrease in cancer death rates over the similar period of time with most of the decrease coming from falling breast and colorectal cancer death rates. For women, unfortunately--as has been the case for the past several years--lung cancer deaths have remained steady.
These changes from the early 1990's through 2006 have occurred slowly, year over year over year. But when looked at in total, you begin to understand the impact of this accumulated progress. My colleagues estimate that over this period of time, 767,000 deaths from cancer have been avoided.
Take a moment from your day and think what that means: 767,000 people who would have died from cancer were able to live their lives, love their families, do their jobs. That may have been your mother or your father, your brother, a friend, a co-workers. It may have been someone who never even knew they otherwise would have been destined to get cancer, for example by getting screened for colorectal cancer and having polyps removed before they became cancerous.
Not all of this was due to some remarkable breakthrough in medical treatment, although some of it certainly is due to better cancer care. Much of it has to do with stopping smoking, or not starting for that matter, especially among men. Much of it has to do with better screening and early detection of breast and colorectal cancer, and perhaps prostate cancer (although we are not certain about the latter). Some of it may have to do with lifestyle changes, such as increased awareness of the importance of exercise and diet in reducing cancer risk.
There are some other important points made in the article, far too many to go into here (you can read the entire article online at our CA: A Cancer Journal for Clinicians website. Access is free of charge.) Let me point out a few that I consider interesting:
- Four cancers account for 52% of all newly diagnosed cancers in men. These include prostate cancer (which alone accounts for 28% of newly diagnosed male cancers in 2010), lung cancer and colorectal cancer. For women, 52% of new cancer diagnoses will be in the three most common female cancers, including lung, breast and colorectal cancer.
- What many women don't realize is that the most common cause of cancer death in women is not breast cancer (although breast cancer is the most common cancer diagnosed in women), but lung cancer (26% of cancer deaths in women are from lung cancer).
- The sad reality is that in 2010 in the United States, we will lose approximately 1500 people every day as a result of cancer.
- There has been a dramatic decline in the incidence of breast cancer in this country since 1999. The reason is not clear, although the substantial decrease in the use of hormone therapy in post-menopausal women beginning in 2001 may have played a role. That said, the authors of this report also note that there has been a decline in the use of mammograms as well, which might lead to delayed diagnoses, and that most of the decline (6%) in breast cancer incidence occurred from 2002 to 2003, then the incidence of new cases of breast cancer levelled off. What is really going on here remains uncertain, but the researchers note that the hormones may not have been the actual cause of breast cancer (if that was the case, then the number of new cases would continue to drop) but instead acted as a breast cancer "promoter" (in other words, stimulating the growth of an underlying breast cancer that was already in progress). Time will help us understand this issue better.
- Cancer accounted for 23%--or about 1 in 4--deaths in the United States in 2007. There were 562,875 cancer deaths that year, which were 2987 more than in 2006. However, the cancer death rate continued to decline from 180.7 in 2006 to 178.4 in 2007. The reason for this seeming paradox is that our population is larger and older, meaning a lower rate is spread over more older people, which in turn leads to an increase in the actual number of cancer deaths.
- Cancer continues to be the leading cause of deaths for people in this country between the ages of 40 and 79, while heart disease is far and away the leading cause of death in people age 80 and over.
- Race and ethnicity continue to play a large role in one's risk of getting and dying from cancer. For all cancers, African American men have a 14% higher incidence rate and a 34% higher death rate from cancer, according to the article, compared to white men. African American women, on the other hand, have a lower incidence of cancer when compared to white women (7% lower), but a 17% higher death rate. Death rates for African Americans are higher compared to whites for nearly every stage of cancer and every cancer site.
- For other ethnic groups, the incidence and death rates from cancer in this country are lower than they are for whites and African Americans. However, when it comes to cancers caused by infectious agents such as HPV, heliocobacter pyolorii and hepatitis B and C, minorities have a higher incidence and death rates than whites.
- The probability of developing cancer in your lifetime in the United States is 44% for men and 38% for women. Women are generally diagnosed with cancer at younger ages than men.
So that's a brief summary of what this year's statistical report has to say. In general, the news is encouraging.
However, there are still critical gaps that we must acknowledge and resolve:
We continue to have significant disparities in access to health care in this country, and as a consequence we have many people who cannot get screened for cancer or receive needed high quality care in a timely fashion.
We have many people who aren't listening to the messages about screening for cancer, which for many people accounts for their being alive today.
We have many people who continue to smoke, and
We have many people who don't understand that a healthy lifestyle--which includes not smoking, eating a healthy diet, getting regular exercise, maintaining a healthy body weight and getting screened--can substantially reduce their risk of dying from cancer (and several other major diseases as well).
767,000 people in this country are either alive today or were able to live a fuller measure of their lives because we have been doing something right when it comes to cancer. Yes, we are diagnosing more people today than we would have diagnosed years ago, because of our new awareness, new technologies and new treatments. Yes, we are treating people whose cancers may have never interfered with their lives--and we need to redouble our research efforts to help us identify those people who may have an otherwise "indolent cancer."
But the statistics don't lie, and the statistics tell us that for so many people and for several cancers, we have clearly done something right. And for many more people, we know what we could today and tomorrow to make the outlook even better.
767,000 people is a lot of people. It's also a lot of birthdays that many have been able to celebratewith their friends and families, and I don't know a whole lot of folks who would mind celebrating more birthdays.
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