|Annual Report to the Nation Finds Cancer Death Rates Still
on the Decline:
Progress in Cancer Treatment Varies by Disease
The nation’s leading cancer organizations report that Americans’ risk of dying
from cancer continues to decline and that the rate of new cancers is holding
steady. The “Annual Report to the Nation on the Status of Cancer, 1975-2002,” published
in the Oct. 5, 2005, issue of the Journal of the National Cancer Institute*,
finds observed cancer death rates from all cancers combined dropped 1.1 percent
per year from 1993 to 2002. According to the report’s authors, declines in death
rates reflect progress in prevention, early detection, and treatment; however,
not all segments of the U.S. population benefited equally from advances, a point
outlined in a featured analysis of treatment trends.
First issued in 1998, the “Annual Report to the Nation” is a collaboration among
the National Cancer Institute (NCI), which is part of the National Institutes
of Health (NIH), the Centers for Disease Control and Prevention (CDC), the American
Cancer Society (ACS), and the North American Association of Central Cancer Registries
(NAACCR). It provides updated information on cancer rates and trends in the United
According to NCI Director Andrew C. von Eschenbach, M.D., “These numbers reflect
a trend in reduction of cancer mortality that has now persisted for six years.
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.”
Death rates from all cancers combined declined 1.5 percent per year from 1993
to 2002 in men, compared to a 0.8 percent decline in women from 1992 to 2002
**. Lung cancer is the leading cause of cancer deaths in both men and women.
Death rates decreased for 12 of the top 15 cancers in men, and nine of the top
15 cancers in women.
“Declines in mortality rates from many tobacco-related cancers in men represent
an important, but incomplete, triumph of public health in the 21st century,” said
John R. Seffrin, Ph.D., chief executive officer of the ACS. “These trends reinforce
the importance of tobacco control programs in the U.S., as well as measures to
combat the increase in tobacco use in other parts of the world, particularly
in developing countries."
Overall cancer incidence rates (the rate at which new cancers are diagnosed)
for both sexes have been stable since 1992. Incidence rates were stable in men
from 1995 to 2002 and increased 0.3 percent annually in women since 1987 to 2002.
The persistent increase in overall cancer incidence rates for women can be attributed
to increases in rates for breast and six other cancers: non-Hodgkin lymphoma,
melanoma, leukemia, and thyroid, bladder and kidney cancer. However, according
to more recent data from 1998 to 2002, female lung cancer incidence rates have
begun to stabilize after increasing for many years, which is good news. Changes
in overall incidence may result from changes in the prevalence of risk factors
and from changes in detection practices due to introduction or increased use
of screening and/or diagnostic techniques.
This year’s report highlights patterns of care for cancer patients. The authors
note that one strategy for reducing death and improving cancer survival is to
ensure that evidence-based treatment services are available and accessible. In
performing this analysis, the authors looked at data from NCI’s Patterns of Care
studies (which supplement routine data collection from NCI’s Surveillance, Epidemiology
and End Results, or SEER Program, with more detailed data on treatment patterns)
and SEER-Medicare databases (which link data from SEER registries to Medicare
claims data to assess treatment histories for those over age 65), as well as
other resources. Using these data, they examined whether evidence-based care
was delivered uniformly to diverse populations and how rapidly changes in evidence-based
guidelines resulted in changes in cancer care.
“Day by day we are winning the war against cancer as more people than ever before
are being screened and are receiving treatments necessary for them to lead healthy
and productive lives,” said CDC Director Julie Gerberding, M.D. “However, there
are gaps and missed opportunities so we must continue to pull out all the stops
to ensure proper screening and access to treatment regardless of one’s age, race,
or geographic location.”
For breast cancer, data on trends in the treatment of early-stage disease show
that the proportion of women diagnosed with stage I or II (earlier stage) breast
cancer who received breast-conserving surgery with radiation treatment increased
substantially during the 1990s. This change followed evidence-based guidelines
that breast-conserving surgery followed by radiation therapy may be preferable
to mastectomy because it provides similar survival but preserves the breast.
The authors also report findings of a separate study on use of chemotherapy
and radiation therapy for women with early-stage breast cancer. For women with
lymph node positive disease, multi-agent chemotherapy, along with tamoxifen (a
hormonal therapy) for those with estrogen-receptor positive tumors, has been
recommended since 1985 by the NIH. This study found that, between 1987 and 2000,
the proportion of women who received both chemotherapy and tamoxifen increased
substantially. However, use of concurrent therapy remained relatively low among
women age 65 and older, who were more likely to receive tamoxifen only.
For colorectal cancer, the authors found that use of adjuvant (additional treatment
that follows initial surgery) chemotherapy for stage III colon cancer patients
increased rapidly between 1987 and 1995. However, delivery of this therapy was
uneven across age groups, with much lower rates of treatment among patients age
65 and older. Also noted was the fact that the number of patients who received
treatment decreased with the increasing number of pre-existing medical conditions,
but the likelihood of receiving adjuvant therapy decreased with age even after
taking other medical conditions into account.
For patients with advanced non-small cell lung cancer, evidence-based guidelines
recommend that chemotherapy may be beneficial for patients who are well enough
to withstand the treatment. One analysis found that, among patients age 65 and
older diagnosed with this type of lung cancer between 1991 and 1993, only 22
percent received chemotherapy. A study of patients diagnosed in 1996 found similarly
low levels of treatment among patients age 65 and older. However, more recent
studies have found increasing trends in the late 1990s in the use of chemotherapy
among late-stage non-small cell lung cancer patients.
Unlike breast and lung cancers, treatment for prostate cancer is more controversial.
The most notable trend in prostate cancer treatment from 1986 to 1999 was the
decreasing proportion of cases that received watchful waiting, surgical or chemical
castration, or hormonal deprivation therapy as primary treatment. More aggressive
treatments using newer radiation techniques were found to be on the rise. However,
black men were found to receive substantially less aggressive treatment than
The report concludes that substantial geographical variations in treatment patterns
exist, but that much of contemporary cancer treatment is consistent with evidence-based
NIH Consensus Development Statements (http://consensus.nih.gov/), which are
considered a “gold standard” for care recommendations.
“The value of cancer registries in population research is immeasurable. Through
linkage with other data systems, the information can give us insight into getting
effective treatments to the general population that will have an impact on survival
and mortality," said NAACCR Director Holly L. Howe, Ph.D.
The authors also examined racial and ethnic disparities in cancer. From 1992
to 2002, prostate, lung, colon/rectum cancer in men, and breast, colon/rectum,
and lung cancer in women, continue to be the leading sites for incidence and
mortality for each racial and ethnic population. Rates for lung and prostate
cancer decreased among men in all populations, while colorectal cancer incidence
rates decreased only for white men. Among women, breast cancer incidence rates
increased in Asian Pacific Islander women, decreased among American Indian/Alaska
Native women, and were stable for other women. Colorectal incidence rates decreased
only for white women. Differences in cancer incidence and mortality persist,
especially among black men, who have 25 percent higher incidence rates and 43
percent higher mortality rates than white men for all cancers combined.
The authors emphasize that reaching all segments of the population with high-quality
prevention, early detection, and treatment services could reduce cancer incidence
and mortality even further, and that monitoring the dissemination of cancer treatment
advances is an important aspect of ensuring uniformly high standards of care.
For more information on this report, visit the following Web sites:
To view the full report, go to the Journal of the National Cancer Institute online:
http://jncicancerspectrum.oupjournals.org/. Supplemental information on micromaps,
confidence intervals on rates, and other materials can also be found at http://jncicancerspectrum.oupjournals.org/jnci/content/vol97/issue19.
For a Q&A on this Report, go to http://www.nci.nih.gov/newscenter/pressreleases/ReportNation2005QandA
CDC’s Division of Cancer Prevention and Control: http://www.cdc.gov/cancer
CDC’s National Center for Health Statistics’ mortality report: http://www.cdc.gov/nchs/deaths.htm
NCI: http://www.cancer.gov and the SEER Homepage: http://www.seer.cancer.gov. Click on the icon "1975-2002 Report to the Nation."
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U. S. Department of Health and Human Services. It is the primary Federal
agency for conducting and supporting basic, clinical, and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.