Posted: Jan 7, 2013 9:17 PM
Fewer Americans are dying from cancer.
This is one main take-away from the latest report on cancer death rates and new diagnoses of cancer in the U.S. This decline is seen among men and women across all major racial and ethnic groups, and for 17 of the most common types of cancer including lung, colon, breast, and prostate cancers.
Still, not all of the news from the new report is positive.
Rates of death are on the rise from the potentially fatal form of skin cancer, melanoma, in men; uterine cancer in women; and liver and pancreatic cancer in both sexes. What's more, the data show a rise in cancers related to human papillomavirus (HPV) infection, and that too few at-risk people are getting the vaccine that can help prevent these cancers.
"There is substantial good news in this report," says researcher Edgar P. Simard, PhD, MPH. He is a senior epidemiologist in the Surveillance Research Program at the American Cancer Society (ACS) in Atlanta.
The ACS, CDC, National Cancer Institute, and the North American Association of Central Cancer Registries (NAACCR) all contributed to the new report.
Overall, cancer death rates decreased by 1.8% per year among men and by 1.4% per year among women from 2000 to 2009. Death rates among children up to 14 years of age decreased by 1.8% per year.
The reasons that fewer people are dying from cancer are likely earlier detection plus better treatments, Simard says. "With the exception of lung cancer, there are screening tests that can detect precancerous lesions or early cancer for the common types of cancer." And "in the past 10 years, targeted therapies that take into account the genes and molecular characteristics of individuals and tumors have shown promise."
Some of this decline may also be related to healthier lifestyle choices such as not smoking.
But many outside experts say that we can't rest on our laurels just yet.
"It is encouraging that the rates are going down, but we would like to see the curves dropping faster and death rates from all cancers declining," says Leonard B. Saltz, MD. He is the chief of the gastrointestinal medical oncology service at Memorial Sloan-Kettering Cancer Center in New York City. "We would like to have as few people as possible get cancer in the first place and the highest number of people survive if they do develop cancer."
The report does find that between 2000 and 2009, overall rates of new diagnoses of cancer decreased by 0.6% per year among men, remained stable among women, and increased by 0.6% per year in children up to 14 years of age.
Cy Aaron Stein, MD, PhD, is worried that budget cutbacks will erode some of the gains seen in the new report. He is the chair of the Department of Medical Oncology and Therapeutics Research at City of Hope Cancer Center in Duarte, Calf.
"I am delighted, but it is not enough," he says. "The real question is: Will these decreases continue in today's financial climate? We know that as go the finances, so goes the [death] rate. There is no question that we have to cut back, because we are going to break the bank if we don't."
"We need to build on the progress and need a better understanding of why certain cancer death rates are dropping, and a better understanding about those that aren't," Saltz says. These include cancers related to HPV, a sexually transmitted disease that may increase risk of cervical, oral, anal, and other cancers.
From 2000 to 2009, rates of HPV-related oral cancer increased among white men and women. In addition, rates for anal cancer among white and African-American men and women continued to rise. In 2010, fewer than half of girls aged 13 to 16 got at least one dose of the HPV vaccine, and just 32% got all three doses.
Two vaccines (Cervarix and Gardasil) are approved to help prevent most cervical cancers in women. Gardasil may protect against genital warts and cancers of the anus, vagina, and vulva. Both vaccines are available for females. Only Gardasil can be used by males. The CDC recommends that all 11- or 12-year-old girls get the three shots of either vaccine. The CDC recommends Gardasil for all boys aged 11 or 12.
"HPV is an anti-cancer vaccine. If only we had vaccines to prevent other cancers as well," Simard says.
"We can always do better," says Richard Smith, MD. He is a head and neck cancer specialist at Montefiore Einstein Center for Cancer Care in New York City. He says that the rise in HPV-related cancers has only just begun. "This epidemic will become more prevalent over the next number of years."
Julian Sanchez, MD, explains the risk. He is an expert in anal cancer at the City of Hope Cancer Center. He has seen a huge increase in anal cancer in recent years. "Anal cancer is becoming a real public health problem, and we have a way to prevent it," he says. "We need to increase awareness for the vaccine against HPV in girls and boys before they become sexually active."
The full report appears online in the Journal of the National Cancer Institute.