Good news is always welcome, especially when talking about something as serious as cancer. And there is plenty of welcome information in the American Cancer Society’s release of our annual report on “Cancer Statistics, 2019” and its accompanying consumer-oriented version of “Cancer Facts & Figures 2019.”
Among the good news in this report: A significant decline in death rates from cancer — especially among some of the most common cancers, significant improvements in early detection and treatment of cancer, and a decrease in the disparities in death rates between African-Americans and whites.
Despite the good news, unfortunately, there are also pieces of the puzzle that have not been solved. And to ignore that information is a disservice to those who struggle with cancer and those who have passed because of this dread disease. The reality is we can — indeed, we must — do better. And that fact is an equally important part of the information contained in this report.
First, the good news statistics just as they are reported:
- The death rate from all cancers combined has declined 27% since 1991 — that’s over the past 25 years for which we have accurate information–because of increased awareness, decreased smoking and advances in early detection and treatment
- There have been substantial declines in death rates from some of the most common cancers:
- 48% for lung cancer in men from 1990-2016
- 23% for lung cancer in women from 2002-2016
- 40% for female breast cancer from 1989-2016
- 51% for prostate cancer from 1993-2016
- 53% for colorectal cancer from 1970-2016
There are several cancers where early detection and treatment have resulted in significant 5-year survivals:
- 98% in prostate cancer
- 92% in melanoma
- 90% in breast cancer
All these numbers add up to an astounding 2.6 million — yes, MILLION — premature deaths from cancer averted over those 25 years. The impact of that reality is nothing short of remarkable in so many ways.
And then there are other important pieces of this puzzle:
- In 2019 the American Cancer Society estimates there will be 1.762 million new cases of invasive cancer diagnosed in the United States. Stated another way: 4,800 people will be diagnosed with invasive cancer in the United States every day.
- Sadly, in 2019, the Society estimates there will be 606,880 cancer deaths. That translates into 1,660 cancer deaths daily, or 1.2 deaths every minute, every day.
- Your lifetime probability of hearing “you have cancer” (excluding skin cancers and non-invasive cancers) is 39.3% in men and 37.7% in women. That’s close to 4 out of every ten people in this country, over their lives.
Yet, as mentioned, there are serious issues we must recognize and deal with if we are to continue to tilt the odds in favor folks throughout the country:
- We are seeing the racial gap in cancer deaths is narrowing between blacks and whites — but it still exists and needs to be recognized for what it is: an inequality in care and outcomes
- At the same time, another significant inequality is getting worse, and that’s related to socioeconomic status (SES), which includes income, education, insurance status, as well as living in rural, underserved counties throughout the country. What shows up in the statistics is that the difference in outcomes based on SES and location isn’t that great for cancers where we don’t have effective early detection and treatment. In those circumstances, outcomes are pretty much the same. However, for those cancers where those factors are proven to make a difference, there is a substantial gap with those living in cities and those in higher SES brackets doing significantly better (think breast and cervical cancers).
- In the poorest counties in the country death rates from cervical cancer are two times higher than in other parts of the country. There are even differences within states when comparing metropolitan centers to rural communities, with those in the cities having better outcomes. All of this speaks volumes about the need to offer more available medical care and early detection, as well as making HPV vaccination available to all who are eligible nationwide. This alone would result in a rapid decline in cervical cancer deaths, which today account for nine deaths in young women ages 20-39 every week.
- And it’s not just cervical cancer where more deaths occur in rural counties: death rates are 40% higher for lung cancer and liver cancer as well. The incidence of lung cancer in Kentucky is 3.5 times greater in men than that in Utah. For women, the difference in death rates between the two states is 3.3 times greater in Kentucky compared to Utah.
- Then there are the concerns about the rising rates of colorectal cancer in folks younger than 55 at about 2% per year since the mid-1990s. That’s why the American Cancer Society recently recommended that routine screening for CRC in people at average risk be moved forward to 45 instead of the former recommendation to start at age 50.
Lung cancer is not immune to the unfortunate news:
- Notwithstanding the significant declines in cigarette smoking, we are starting to see higher rates of lung cancer in young women compared with men born around the 1960’s — and we don’t know the reason. It does not appear to be related to smoking behaviors, which serves to point out once again that we must view lung cancer as a disease in all its manifestations.
- And even for those we know to be at highest risk of lung cancer, the latest available information (from 2015) shows that only 4% of 6.8 million eligible Americans reported being screened for lung cancer with low-dose computed tomography — a technique that has been proven to reduce (although not eliminate) the probability of death from this disease which remains generally refractory to available treatments (although progress is certainly being made in that regard). Getting more people aware of lung cancer screening–along with educating them about the benefits and risks of the test — remains one of the opportunities and challenges for the year ahead.
So, what is the bottom line of all these numbers?
We are making progress in reducing the burden of cancer in this country. We have made strides; however, we could do far better. It wouldn’t necessarily take some great new breakthrough drug or procedure, although we are making considerable progress on that front as well.
No, for many the answer isn’t necessarily the great breakthrough. It’s the everyday blocking and tackling that will continue to make a real difference: healthy lifestyles, access to accurate information (such as that found on our website at cancer.org) and access to care. It’s about making certain everyone has that access no matter their circumstances, no matter where they live.
If we would do that and continue our research into the causes of cancer and the development of new drugs as well as determining the best ways to use those treatments we already have, then this march towards progress will continue. If we don’t do that, then we have only ourselves and our commitment to hold accountable.
J. Leonard Lichtenfeld is deputy chief medical officer, American Cancer Society. He blogs at Dr. Len’s Cancer Blog.
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