Cancer is one of the most frightening words that can pass between a provider and a patient. It evokes fear and an immediate sense of futility much of the time. Indeed, it is estimated that in 2020 there will be more than 1.8 million new cancer cases in the US, and over 600,000 people will die of cancer. But there are some very hopeful long term trends in cancer deaths, and opportunities to do even better. Last week the American Cancer Society reported that since 1991 deaths from cancer have decreased by 29%, which translates into 2.9 million fewer deaths than would otherwise have occurred. This has been a consistent trend during the past 30 years and the gains can be attributed to a few important changes in how we live and how we treat cancer:
- First and foremost, much of the improvement is due to decreased deaths from lung cancer and much of that improvement is due to the fact that smoking rates are dramatically lower than they had been prior to 1970. It typically takes decades for a smoking related cancer to develop, and so the improvement from decreasing smoking rates also took decades to have a positive effect, but the trend is clear – lung cancer deaths peaked in 1990 and have been dropping steeply ever since. A caveat, though, is that lung cancer still kills more people than breast, prostate, colon and brain cancers combined.
- Newer treatments which engage the immune system in fighting lung and other cancers appear to be more effective than past treatments.
- Better imaging tests may lead to earlier diagnosis and enhanced survival from cancer, and less invasive surgical techniques may also contribute to improved survival.
- Treatment for melanoma has dramatically improved in the past 10 years and melanoma death rates have been declining by 5% to 7% per year, depending on age groups. This is a reversal of what had been an increasing death rate from melanoma prior to these treatments.
There are some areas where we have important opportunities to improve. Racial disparities are still dramatic. For example, black men are 20% more likely to die from cancer than white men. Poorer, more rural areas often have higher rates of lung cancer (this is true in Maine), and cancer of the cervix is much more prevalent in Arkansas than in Vermont, for example (which is likely related to access to care and screening, and vaccination rates with the HPV vaccine).
Finally, cancer of the pancreas, liver, kidneys breast, uterus and prostate are all adversely impacted by obesity. Obesity, inactivity and unhealthy diets lead to hormone and metabolic abnormalities and to chronic inflammation and as obesity rates have increased, the decline in deaths from these cancers has slowed. Addressing obesity, healthy eating and health lifestyle could improve outcomes with these diseases as well.