Welcome to the New Year!
And as has been the case for many years in the past, the American Cancer Society takes the New Year opportunity of providing the nation with the latest estimates of cancer incidence and deaths, along with a measure of how well we are doing in reducing the burden of cancer in the United States.
The data is contained in two reports released today by the Society: the consumer oriented Cancer Facts and Figures 2012 and the more scientifically directed Cancer Statistics 2012. Both are available online.
It is never "good news" to realize that the burden of cancer in this country is immense. And with the country gaining in population and age, the extent of that burden is inevitably going to increase. But this year's report does contain some welcome information, namely that cancer death rates have declined in men and women of every racial/ethnic group over the past 10 years, with the sole (and unfortunate) exception of American Indians/Alaska Natives. In addition, the Society now estimates that a bit more than one million cancer deaths (1,024,400 to be exact) have been avoided since 1991-1992.
That one million number is actually more significant than it seems. Many of the people in that 1 million never heard the words "you have cancer." Maybe they had a colon polyp removed before it became cancerous, maybe they stopped-or never started-smoking. Maybe they had a pap smear that found a pre-cancerous lesion. And then there are the patients who have benefitted from the advances in cancer treatment that have occurred over the past number of decades.
But the 1 million number also means that these are people who have hopefully remained active and engaged in life, loved by their families, productive in their communities. In economic terms, the return on investment on avoiding those one million deaths may likely be incalculable. In human terms, it is an amazing accomplishment.
However, the burdens of cancer remain significant. Excluding common skin cancers and non-invasive, very early stage cancers, the American Cancer Society estimates there will be 1,638,910 new cases of invasive cancer diagnosed in the United States in 2012. The Society also estimates that 577,190 cancer deaths will occur this year.
We continue to see decreasing death rates in more common cancers, including lung, colon, breast and prostate. For men, 40% of the decline in cancer deaths is due to the decline in lung cancer. For women, 34% of the decline is due to decreases in deaths from breast cancer.
Compared to white men and women, African American men and women still suffer disproportionately from the impact of cancer. In almost all types of cancer, 5 year survival is lower for African Americans than whites with comparable stages of cancer at diagnosis. African American men have a 15% higher incidence rate of cancer compared to white men, and a 33% higher death rate. African American women actually have a 6% lower incidence rate, but a 10% higher death rate when compared to white women. However, it is important to note that despite the grim comparisons, the most rapid decline in death rates year over year have been in African American men, at 2.4% per year. (Hispanic men have also had a rapid decline in cancer death rates of 2.3% per year.)
In addition, minorities in general tend to have higher cancer death rates from cancers linked to infectious agents-such as cervical cancer (HPV), stomach cancer (bacteria called H. Pylori), and liver cancer (hepatitis B and C virus)--compared to whites.
As has been recent custom, the reports also review a particular cancer topic of interest. This year, the special section focuses on cancers where there has an increase in incidence. These cancers include cancer of the pancreas, liver, thyroid, kidney, melanoma (the most serious form of skin cancer), cancer of the oropharynx related to HPV infection, and adenocarcinoma of the esophagus (swallowing tube).
The reasons for the increases in each of these cancers-to the degree we can understand the cause of the increase--are different, and are reviewed in detail in the online reports. For example in thyroid cancer it may be that we are better able to detect smaller cancers with ultrasound and that there is increased awareness of the disease. On the other hand, according to the authors, other studies suggest that the increase is real, and due to factors other than improved diagnosis.
Obesity may also play a role in the increased incidence of some of these cancers, particularly adenocarcinoma of the esophagus and cancers of the pancreas, liver and kidney. That explains why many experts in the field are concerned that the rising rates of obesity in our country may supplant some of the gains we have made in prevention, diagnosis and treatment of cancer over the past two decades.
One particularly interesting observation is the rising incidence of oral cancers related to HPV infection, especially in white men and to a lesser degree in white women. In fact, from 1999-2008 (the last year for which reliable data is available), HPV-related oral cancers have increased 4.4% per year in white men and 1.9% per year in white women. In an interesting contrast, rates for this type of cancer have not increased in other ethnic groups. Many experts are now focused on sexual practices as the explanation for this increase, which is caused in 90% of the cases by a single subtype of the HPV virus (16). This raises the interesting question whether the relatively recently introduced HPV vaccine-which is effective in decreasing the incidence of HPV 16 infection in women if given before the onset of sexual activity-would also reduce the frequency of these oral cancers. But the jury remains "out" on that particular question.
So, as is frequently the case, Cancer Facts and Figures offers some hopeful news and some questions. We have certainly made progress, although there is much further to go. And for some cancers and for some groups among us, there remains the sad reality that there is much more we could do. Whether it is access to improved preventive, early detection and treatment options, or whether it is a better understanding of how we can effectively prevent or treat some cancers which we are seeing more frequently, it remains a fact that we cannot look back at the million deaths averted and rest on our laurels.
Yes, we have made considerable progress. But as these reports demonstrate so clearly, we still have a long way to go.