Every year the American Cancer Society publishes a detailed analysis on the incidence and deaths from cancer in the United States. This year’s report—released today—is no exception. It shows in clear and graphic detail the impact of cancer in terms of the number of times each cancer is diagnosed, and how many deaths we can expect.
The statistic in this year’s "Cancer Statistics 2009" that I find so compelling is the number of lives that have been saved as a result of improvements in the prevention, early detection and treatment of a number of cancers. My colleagues who prepare this report now say that from the early 1990s until 2005 (which is the latest year for which accurate information is available), about 650,000 cancer deaths have been avoided (481,300 in men and 169,100 in women). And, in more recent years, as the gap between expected and actual deaths has been increasing, about 100,000 people each year have not died from cancer.
Once again, I keep coming back to that figure as a clear and convincing demonstration that we have made real progress against these terrible diseases we collectively refer to as “cancer.”
What has happened?
In short, many of the gains have been in a limited number of cancers. For men, we have had significant decreases in the rate of cancer deaths because of declines in tobacco related cancers (especially lung cancer), colorectal and prostate cancer. For women, the decreases in deaths are due primarily to declines in death rates from breast and colorectal cancer. (Unfortunately for women, since they took up the smoking habit about 20 years later than men, the decline in female death rates has leveled off but not declined since there is a considerable lag time from when a population stops smoking until they see a decline in deaths from cancer.)
When you look at the total numbers of deaths from cancer, you see another remarkable statistic. Despite the fact that we have become much larger and older as a country when comparing 1990 to 2005, the number of cancer deaths has not increased as dramatically as the age and size of the population. In 1990, there were 478,888 deaths from cancer. In 2006, the number was 505,322. When you consider that the most significant risk factor in general for cancer is age, and you consider that there are a lot more of us now than back in 1990, this relative stability in cancer deaths is truly remarkable.
But not all the news is good news. Cancer still remains the leading cause of death in this country for men and women ages 60 to 79 and for women ages 40 to 59. (It is the second leading cause of death—after heart disease—for men and women age 80 and older.)
There are also significant differences in cancer deaths across this country, which is most dramatically underscored by the lung cancer death rate in Utah (39.6/100,000 in men and 22.4/100,000 in women) compared to Kentucky (136.2 in men and 76.2 in women, respectively). The reason is no mystery: Utah ranks the lowest in smoking prevalence and Kentucky is the highest.
And although we have seen a significant decline in some cancers such as those related to tobacco, stomach cancer, cervical cancer and lymphomas among others, we are seeing increases in death rates from other cancers such as esophagus, liver and melanoma in men and lung, pancreas and liver cancer in women.
Education and ethnicity also play a role in your risk of dying from cancer. If you went to college, your chances of dying from cancer have decreased significantly from 1993 to 2001. But if you have a high school education or less, death rates from cancer remained stable or increased. And these patterns persisted no matter your race or your sex. Consider this finding an “educational disparity”, one that cuts across all lines of race and gender.
The impact of this “educational disparity” is striking. According to the report:
“If everyone ages 25 to 64 years experienced the same cancer death rates as the most educated, 17,650 cancer deaths in women and 30,940 cancer deaths in men could have been averted or postponed in 2001, accounting for over 30% of the total number of cancer deaths in this age group.” (emphasis mine)
How does this happen? Probably it is related to a higher prevalence of risk factors among the less educated, according to our American Cancer Society researchers. Smoking, obesity and limited access to medical care are most likely responsible for this striking and significant difference.
We also can’t forget that substantial differences in 5 year cancer survival persist in this country between whites and African Americans. Although both groups have seen improvements in 5 year survivals for a number of cancers between 1975 and 2004, the sad reality is that for many cancers the 5 year survivals for African Americans woefully trails the 5 year cancer survival for white Americans.
Here is another piece of information you may find interesting: if you are a man, your chance of developing an invasive cancer if you live in the United States is now about 1 in 2 (44%). For a woman, it is about 1 in 3 (37%). But women have a slightly higher chance of developing cancer earlier (before 60 years) in large part because of their risk of breast cancer.
So what does it all mean?
If you are a statistics wonk, there is a lot of material for you to review by going to the article and reading it through.
However, I suspect most of you are not. So let me narrow all of this information down into a couple of bite size pieces:
1) We have made a lot of progress in reducing deaths from cancer in this country over the last 15 to 20 years. Much of that improvement is because we have cut down the use of tobacco, improved early detection (especially for breast cancer) and ramped up prevention (primarily colorectal and cervical cancer). We have improved our treatments as well, especially adjuvant therapies for breast and colorectal cancer.
2) Because of this progress, hundreds of thousands of Americans are alive today that would not be with us, if we hadn’t made the improvements in cancer care and cancer treatment since 1990. Who knows how many more will never even hear the words “you have cancer” because they had a Pap smear, or got screened for colorectal cancer before a polyp turned cancerous, or because they didn’t smoke, or because they chose to lead a healthier lifestyle? I suspect that number—although difficult to measure—is much greater.
3) There is so much more we could do to reduce the burden and suffering from cancer if we only did what we already know: don’t smoke, eat a healthy diet, maintain a healthy weight and get screened. And, of course, make certain that you can get to see a health care professional for your medical care, and even more important have access to adequate and appropriate preventive health services.
4) Despite our progress, there still remain too many cancers that we can’t find early and can’t treat effectively, and too many people that we are simply not able to help despite our best efforts.
5) And let’s not forget that we need to address the disparities in this country that are based on race and education, and which clearly impact the quality and quantity of our years.
We have made considerable progress in our efforts to reduce the burden and suffering from cancer. We still have a long way to go. That’s what these numbers tell us.
In releasing this report, Dr. John Seffrin, the Chief Executive Officer of the American Cancer Society, noted:
“Because the rate (of cancer deaths) continues to drop, it means that in recent years, about 100,000 people each year who would have died if cancer death rates had not declined are living to celebrate another birthday. That is undeniable evidence of the lifesaving progress that we as a country must dedicate ourselves to continuing.”
That, my friends, is a thought worth holding on to.
