• 2/1/2004
  • By Sid Kirchheimer , Reviewed By Michael Smith, MD
  • WebMD Medical News (see below)

But More Work Is Needed as 1,500 Americans Will Die Each Day.

Although more people are being diagnosed, death rates for most major cancers continue to fall, the American Cancer Society says. Since 1930, overall cancer deaths have declined 11% among men and 14% among women. The biggest decrease has been in stomach cancers, which have dropped 86% in men and 91% in women — largely because of improved hygiene and food storage and a lower rate of infection of the H pylori bacteria among Americans. “Cancer is not an inescapable fact of life,” says Michael J. Thun, MD, an author of the report. “There are things that we do, in our culture and with social policies and practices, that make a difference in cancer occurrence.”

While news is good regarding deaths from cancer, there is still much work to do. The ACS estimates that cancer will kill more than 1,500 Americans each day this year — more than 560,000 in all — and account for one of every four deaths in the U.S. Cancer will continue to be the No. 2 killer behind heart disease. About one-third of these deaths will result from lifestyle factors such as poor diet, obesity or lack of exercise, while smoking will claim about 180,000 lives.

In its new report, Cancer Facts & Figures 2004, the American Cancer Society projects that some 1.4 million Americans will be diagnosed with cancer this year — up from the 1.3 million cases predicted for 2003. This largely results from a growing and aging population.

Early screening has led to more diagnoses — particularly of breast and prostate cancers — but has resulted in quicker and more effective treatment. For instance, breast cancer diagnoses are estimated to represent about one in three new cancers in women during 2004. But because of mammography and other preventative measures, breast cancer will claim 15% of all female cancer deaths — a 20% drop since 1930. “But for breast cancer, we have a very long way to go in many respects,” he says. “A lot of progress can be made in how to prevent breast cancer entirely.” Screening has also played a huge role in reducing cancers of the uterus and cervix. “They were the leading sites in death rates in women in 1930, but the introduction of Pap testing and adequate treatment prevents both the development of invasive cervical cancer by treating and removing the premalignant lesions, and if already been malignant transformation, it treats it early, when it’s highly curable.”

Melanoma skin cancers have been on the upswing since 1975, but death rates have not risen as much, says Thun. “They have been flat since the 1980s because of earlier detection and removal of melanoma before it spreads. It’s another clear case in which early detection saves lives.” Perhaps most significantly, public awareness of the dangers of smoking have had a big impact on lung and the 10 other cancers to which tobacco use contributes or causes. Because of these antismoking measures, lung cancer deaths have declined 15% in men in recent decades, although women’s death rates have held steady.

Lung Cancer Tops the List
This year, lung cancer — the top cancer killer of both sexes — is expected to comprise 13% of all new cancer diagnoses in men, and cause one in three cancer deaths. Among women, lung cancer will comprise 12% of new cancer cases and cause one in four cancer deaths. Because of these antismoking measures, “in my view, the cancers we’re making most progress against are lung cancer and other tobacco-related cancers — especially in men,” says Thun.

The top three cancer killers among men will be lung, prostate, and colorectal cancer; in women, lung, breast, and colorectal cancers make the top three. Similar efforts are now needed to get the message of the dangers of obesity and a sedentary lifestyle.

“In the last five years, there has been widespread recognition of the importance of obesity and physical inactivity to cancer,” he tells WebMD. “It’s become increasingly clear that obesity is a factor in approximately a dozen different types of cancer — especially postmenopausal breast cancer in women and colorectal cancer in men.”

Colon cancer awareness, in itself, also has a long way to go. There are five tests to detect premalignant lesions or polyps, but Thun says that only about half of people who should be getting at least one of these screenings are getting them.

On the treatment front, Thun says that “some of the most remarkable steps forward” have been in developing more specific and less toxic treatments for fairly uncommon cancers. The next step is to develop these treatments for more common cancers.

Other highlights of the new report:
* Survival rates continue to improve. Overall, two in three of all cancer patients survive at least five years, but this five-year relative survival rate is 84% among those with early detection.
* The outlook has significantly improved for many childhood cancers. Their five-year survival rate was 56% in the 1970s, but has jumped to 78% for cancers diagnosed in the 1990s.
* There are still huge disparities in death rates by race and social status. Overall, the death rate in 2004 is estimated to be 40% higher among black men and 20% higher in black women this year compared with whites. Other minorities and those who are less affluent also have higher rates of cancer death than whites.

SOURCES: Thun, M. Cancer Facts & Figures 2004. Michael J. Thun, MD, vice president, epidemiology and surveillance research, American Cancer Society, Atlanta.

OCF note: Please note that the ealy detection points made in this article are the same ones that OCF continues to push to reduce the death rate from oral cancers. Further, that head and neck cancers, of which oral and throat cancers make up the majority, were not mentioned in this article as there has been no significant improvement in decades related to the death rate from them. LIke cervical and prostate cancer, oral cancer’s numbers will begin to decline when public awareness and early detection become as commonplace as they are for these other cancers.