Annual Cancer Report: Overall Incidence, Death Rates Decline for Men, Women

For the first time since the inaugural annual report on cancer was published in 1998, both incidence and death rates for all cancers combined are decreasing for both American men and women. That's according to the most recent annual report from the American Cancer Society, or ACS; the CDC; the National Cancer Institute, or NCI; and the North American Association of Central Cancer Registries.

"The drop in incidence seen in this year's annual report is something we've been waiting to see for a long time," said Otis Brawley, M.D., chief medical officer for ACS, in a Nov. 25 news release about the report.

Brawley said he was cautious about interpreting the study's results because changes in incidence can be caused not only by reductions in risk factors for cancer, but also by changes in screening practices. For example, a decline in breast cancer incidence might be related to diminishing use of some hormone replacement therapies that are known to increase breast cancer risk, but it also could be a result of fewer women getting regular screening mammograms.

"Regardless, the continuing drop in mortality is evidence once again of real progress made against cancer, reflecting real gains in prevention, early detection and treatment," Brawley said.

The report said the decline in both incidence and death rates for all cancers is due, in large part, to declines in incidence and death rates for the three most common cancers among men (lung, colorectal and prostate) and the two most common cancers among women (breast and colorectal).

Incidence rates among men also dropped for cancers of the oral cavity and stomach, and incidence rates for women dropped for cancers of the uterus, ovary, cervix and oral cavity.

Although incidence and death rates declined overall for both men and women, rates for American Indian/Alaska Native men and women were stable. Overall cancer death rates were highest among blacks.

FP Richard Wender, M.D., chair of the department of family and community medicine at Thomas Jefferson University Hospital in Philadelphia, told AAFP News Now that family physicians have "played a vital role" in the declining incidence of and death rates from cancer. They have helped patients stop smoking and either provided screening or encouraged patients to get screened for certain types of cancers, including breast, colon and prostate, said Wender, who is a past president of the ACS.

"It's the family physician who makes a difference as to whether or not (screening) gets done," said Wender. "Numerous studies have shown that."

According to Wender, the nation has made progress in fighting cancers that are amenable to prevention and early detection but not as much progress in terms of other types of cancer.

Among men, incidence rates increased for cancers of the liver, kidney and esophagus, as well as for melanoma, non-Hodgkin's lymphoma and myeloma, according to the report. Among women, incidence rates increased for cancers of the lung, thyroid, pancreas, brain/nervous system, bladder and kidney, as well as for leukemia, non-Hodgkin's lymphoma and melanoma.

According to Wender, immigration and its effect on the nation's overall demographic breakdown can play a role in increased incidence rates for some types of cancer. For example, he said, Asians, who had one of the lowest overall cancer death rates, are more prone to liver cancer than some other ethnic groups.

In addition, one of the biggest obstacles to reducing cancer incidence is the nation's obesity epidemic, said Wender.

"The American public doesn't yet understand the link between unhealthy food, unhealthy portion sizes, inadequate exercise and cancer," he said. "Part of the reason they don't understand it is family physicians haven't helped them make that link."

"(Although) we have made progress in reducing the burden of cancer in this country, we must accelerate our efforts, including making a special effort to reach underserved cancer patients in the communities where they live," said NCI Director John Niederhuber, M.D., in the Nov. 25 news release. "This report gives us a better understanding of where we may need to redouble our efforts and try to find new ways of preventing or reducing the occurrence of kidney, liver and other cancers that continue to show increases in both mortality and/or incidence."

The annual report also found differences in lung cancer death rates by state. Lung cancer death rates for women increased from 1996 through 2005 in 13 states. The report said that those 13 states have higher percentages of adult female smokers, lower tobacco taxes and local economies that are dependent on tobacco farming and production.

Cancer is the nation's second-leading cause of death, and cigarette smoking accounts for 30 percent of all cancer deaths in the United States, according to the U.S. Surgeon General. However, only three states -- Delaware, Colorado and Maine -- meet the CDC's minimum spending guidelines for tobacco prevention programs. Thirty states failed to meet at least half of the agency's guidelines.

According to a study published in the Journal of the National Cancer Institute, cancer deaths cost the United States $115.8 billion in lost productivity in 2000, and researchers estimate that figure will increase to $147.6 billion by 2020.

Meanwhile, the International Agency for Research on Cancer said in its World Cancer Report 2008 that there were 12 million new cancer diagnoses worldwide this year. According to a Dec. 9 ACS press release, of those 12 million new cases, more than 7 million will die from their disease. The report projects that cancer will be the leading cause of death worldwide by 2010 and, by 2030, will account for an estimated 20-26 million new diagnoses and 13-17 million deaths each year.

The report said incidence and death rates are increasing globally, in part, because of the adoption of Western habits, including tobacco use and consumption of high-fat diets.