ACS: Cancer Death Rate Plummets

Originally published on Jan. 8, 2020, this article reviews the “state of the nation” in terms of cancer mortality in 2019. It is anticipated that the American Cancer Society will issue a new report just after the New Year, so, as a service to our users, BreakingMED is republishing this report in the hope that it will add context to the cancer stats for 2020.

The American Cancer Society released its 2020 cancer report with good news — death from cancer continued to show a steady decline. There was a 2.2% drop from 2016-2017, the largest ever recorded in a single year.

From 1991-2017 the cancer mortality rate declined by 29%, which means that roughly 2.9 million fewer people died of cancer. This trend, the society noted, was primarily driven by declines in lung, colorectal, breast, and prostate cancer. But perhaps one of the most promising highlights of the report is the stunning drop in death from melanoma, which the ACS credited to advances in treatment for the disease.

“In 2011, the U.S. Food and Drug Administration approved ipilimumab, the first immune checkpoint inhibitor approved for cancer therapy, and vemurafenib, a BRAF inhibitor, for the treatment of advanced melanoma,” Rebecca L. Siegel, MPH, and her colleagues from Surveillance and Health Services Research at ACS wrote in their report published in CA: A Cancer Journal for Clinicians. “Subsequently, the 1-year relative survival rate for metastatic melanoma escalated from 42% for patients diagnosed during 2008 through 2010 to 55% for those diagnosed during 2013 through 2015. Likewise, the overall melanoma mortality rate dropped by 7% annually during 2013 through 2017 in men and women aged 20 to 64 years compared with declines during 2006 through 2010 of approximately 1% annually among individuals aged 50 to 64 years and 2% to 3% among those aged 20 to 49 years. The impact was even more striking for individuals aged 65 years and older, among whom rates were increasing prior to 2013 but are now declining by 5% to 6% per year.”

Lung, colorectal, breast, and prostate cancer, despite an overall decline in mortality, are still the top causes of cancer deaths, with lung cancer deaths outpacing breast, prostate, and colorectal cancers combined, accounting for about 25% of all cancer deaths.

Lung Cancer

From 1990-2017, lung cancer death rates decreased by 51% for men, and they declined by 26% for women from 2002-2017. The rates of new lung cancer cases over the span of 4 years — from 2013-2017 — was 5% per year for men and 4% per year for women. “The differences reflect historical patterns in tobacco use, where women began smoking in large numbers many years later than men and were slower to quit,” Siegel and colleagues wrote in a brief on the report. “However, smoking patterns do not appear to explain the higher lung cancer rates being reported in women compared with men born around the 1960s.”

In 2020, the society estimates there will be 228,820 cases of lung cancer with approximately 135,720 deaths.

Breast Cancer

From 1989-2017, there was a 40% drop in death from breast cancer. The ACS estimates that the number of new cases of breast cancer in 2020 will be 279,100, overall, with an estimated 42,690 deaths.

Prostate Cancer

There was a 52% drop in prostate cancer death from 1993-2017. It is estimated that in 2020 there will be 191,903 new cases of prostate cancer, with about 33,330 deaths.

Colorectal Cancer

Men saw a decline in death from colorectal cancer of 53% from 1980-2017, compared with a 57% decline from 1969-2017 among women. For 2020, the ACS estimates there will be 104,610 colon cancer cases and 43,340 rectal cancers, with 53,200 total deaths (combined for both, as the ACS notes that often deaths from rectal cancer are misclassified as colon cancer).

New Cases, Estimated Deaths

In total, the ACS estimates that there will be nearly 2 million cases of cancer (1,806,590) in 2020, which translated to about 4,950 cases each day.

“Prostate, lung and bronchus (referred to as lung hereafter), and colorectal cancers (CRCs) account for 43% of all cases in men, with prostate cancer alone accounting for more than 1 in 5 new diagnoses,” Siegel and colleagues wrote. “For women, the 3 most common cancers are breast, lung, and colorectal, accounting for 50% of all new diagnoses; breast cancer alone accounts for 30% of female cancers.”

They added: “The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (40.1%) than for women (38.7%).”

Survival

Siegel and colleagues noted that the 5-year relative survival rate for all cancers combined is 67% (2009-2015) — 68% in white people, 62% in black people.

“For all stages combined, survival is highest for prostate cancer (98%), melanoma of the skin (92%), and female breast cancer (90%) and lowest for cancers of the pancreas (9%), liver (18%), lung (19%), and esophagus (20%),” the report authors wrote. “Survival rates are lower for black patients than for whites for every cancer type… except for cancers of the kidney and pancreas, for which they are the same.”

The low survival rate for lung cancer is likely because 57% of the cases are diagnosed with metastatic disease. Yet, with early screening of those at high risk, there is a 57% 5-year survival rate.

While there has been an improvement in survival for nearly all cancer types, cervical and uterine cancers are not seeing much improvement.

“Stagnant survival rates for these cancers largely reflect a lack of major treatment advances for patients with recurrent and metastatic disease,” Siegel and colleagues wrote. “For cervical cancer, it may also reflect an increasing proportion of adenocarcinoma over time due to the removal of slow-growing squamous lesions through long-term widespread screening.”

But where there have been treatment advances, such as for chronic myeloid leukemia, the treatments are translating into longer survival rates. In the mid-70s the 5-year relative survival rate for the disease was 22%, but for those diagnosed from 2009 through 2015, survival jumped to 70% “and most patients treated with tyrosine kinase inhibitors experience nearly normal life expectancy,” Siegel and colleagues pointed out.

Other highlights of the report include statistics on adolescents and young adults (AYAs) — 15-39 years old. The ACS projects that for this age group there will be 89,500 new cancer cases and 9, 270 deaths.

Of interest:

• “Adolescents (15- to 19-year-olds) have a unique mix of cancer types including childhood cancers (such as acute lymphocytic leukemia), adult cancers (such as thyroid cancer and melanoma skin cancer), and a higher risk of lymphoma. For example, Hodgkin lymphoma accounts for 13% of cancer cases in adolescents compared to 9% in ages 20-29 years and 3% in ages 30-39 years.
• “In 2020, the most commonly diagnosed cancers will be thyroid, testicular, and melanoma skin cancer in ages 20-29 years and breast, thyroid, and melanoma in ages 30-39 years.
• “Leukemia is the leading cause of cancer death in both males and females ages 15-29 years, while brain and breast cancers are the leading causes of death in males and females, respectively, ages 30-39 years. Although cervical cancer is highly preventable through the HPV vaccine and screening, it is the second-leading cause of cancer death among women ages 20-39 years.
• “During 2007-2016, the steepest increases in thyroid cancer incidence rates occurred among adolescents, 4.9% per year among males and 4.1% per year among females.
• “In adults ages 20-39 years, rates increased for cancers of the colorectum (3%-6% per year), endometrium (3%), kidney (3%), and breast (0.2%-2%), with more rapid increases among those in their 20s.”

Candace Hoffmann, Managing Editor, BreakingMED™

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Topic ID: 78,118,730,118,120,22,23,24,25,26,466,467,468,692,835,192,925