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The death rate from cancer is slowly but steadily going down in the United States, thanks to better methods of preventing, finding, and treating the disease. That's the conclusion of the "Annual Report to the Nation on the Status of Cancer, 1975-2002," a summary of how cancer affects the country.

The report is a collaboration of leading cancer organizations, including the American Cancer Society, the National Cancer Institute (NCI), the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. It is published in this week's Journal of the National Cancer Institute.

The death rate from all cancers combined dropped 1.1% each year from 1993 to 2002, the report shows. Over the same time period, the rate of new cancers (incidence) held steady.

"This can only be considered good news for the millions of cancer survivors who have benefited from recent research and treatment advances and emphasizes the expectation that we will achieve a time when no one will suffer or die from cancer," said NCI director Andrew von Eschenbach, MD.

But the report also shows that these improvements aren't reaching everyone equally. Gaps exist because of race and ethnicity, where people live, what kind of health insurance they have, and whether they're a man or a woman.

Cancer death rates, for instance, went down slightly more among men (1.5% per year from 1993-2002) than among women (0.8% per year from 1992-2002). Incidence for all cancers combined held steady among men between 1995 and 2002. But among women, it went up by 0.3% per year from 1987-2002, the report says. Increases in 7 types of cancer are responsible for this rise: breast, non-Hodgkin lymphoma, melanoma, thyroid, leukemia, bladder, and kidney.

The most common cancers are still the most deadly, regardless of gender. For men, these are prostate, lung, and colorectal cancer. For women, they are breast, lung, and colorectal cancer.

Lung cancer is still the top cancer killer for both genders. The picture for men, however, is a little better than it used to be: The number of new cases and the death rate have both gone down. But for women, lung cancer deaths rose slightly between 1995 and 2002. The more recent trend, however, is a good one -- the rate of new lung cancers in women stabilized between 1998 and 2002, and that's a figure that had been rising steadily for decades.

"What this information suggests is that women are starting to see the benefit of decreasing their rates of smoking," said Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society. "But it takes time to see those actions result in decreasing rates of disease from smoking."

The report also examined cancer trends in 5 different racial/ethnic groups: whites, blacks, Asian/Pacific Islanders, American Indian/Alaska Natives, and Hispanic/Latinos.

Overall, black men still fare the worst among US ethnic groups in terms of new cancer cases and cancer deaths. For all cancers combined, black men have an incidence rate 25% higher than white men and a death rate that's 43% higher. The rate of myeloma, stomach cancer, and prostate cancer is 50% higher and death rate from these cancers is more than twice as high in black men as in white men.

Black women have lower incidence of all cancers combined than white women, but their death rate is higher.

Incidence and death rates are generally lower in Asian/Pacific Islanders, American Indian/Alaska Natives, and Hispanics/Latinos than in whites and blacks, although they are higher for certain cancers.

The report doesn't examine possible reasons behind these differences; it just sticks strictly to the numbers.

This year's report includes a special section on treatment trends that looks at whether people are getting the recommended care for their type of cancer. The good news is, most people are.

For instance, the rates of breast-conserving surgery plus radiation for women with early-stage breast cancer went up after 1990, when a National Institutes of Health panel said this treatment was just as effective as mastectomy -- and even preferable to it because it saves the breast. Likewise, more women whose breast cancer has spread to the lymph nodes now get chemotherapy plus tamoxifen, rather than tamoxifen alone. However, women over age 65 are less likely than younger women to receive either of these improved therapies.

The report notes a similar age discrepancy in lung cancer and colorectal cancer, with older patients less likely to receive chemotherapy for more advanced disease, even though guidelines recommend it.

"Of course, common sense suggests that the very elderly, or those who are otherwise impaired either by serious medical or other problems, may not be candidates for chemotherapy or other treatments for their cancer," said Lichtenfeld, "but there are many older people who could safely receive current, state-of-the-art, guideline directed cancer treatment."

The report finds evidence that race, geography, and health insurance status may also be factors in whether people receive adequate cancer care. Black men, for instance, are much less likely than white men to receive aggressive prostate cancer treatment with surgery or radiation. People in Seattle and Los Angeles are more likely to get chemotherapy for lung cancer than patients in other parts of the country. And women with ovarian cancer are more likely to get treated according to guidelines if they have private health insurance.

The report doesn't attempt to explain why these differences exist; the authors call for research that looks at things like how the patient decided on a treatment, how qualified his doctors were, and whether he was referred to specialists.

Citation: "Annual Report to the Nation on the Status of Cancer, 1975-2002, Featuring Population-Based Trends in Cancer Treatment." Published in the Journal of the National Cancer Institute (October 5, 2005, Vol. 97, No. 19: 1407-1427). First author: Brenda K. Edwards, PhD, National Cancer Institute.