Overall cancer mortality continues to decline, prostate cancer mortality has stabilized
The latest Annual Report to the Nation on the Status of Cancer finds that overall cancer death rates continue to decline in men, women, and children in the United States in all major racial and ethnic groups. Overall cancer incidence, or rates of new cancers, decreased in men and were stable in women from 1999 to 2014. In a companion study, researchers reported that there has been an increase in incidence of late-stage prostate cancer and that after decades of decline, prostate cancer mortality has stabilized.
The annual report is a collaborative effort between the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society; and the North American Association of Central Cancer Registries (NAACCR). The studies appeared online in Cancer on May 22, 2018.
"This year's report is an encouraging indicator of progress we're making in cancer research. As overall death rates continue to decline for all major racial and ethnic groups in the United States, it's clear that interventions are having an impact," said NCI Director Ned Sharpless, M.D. "The report also highlights areas where more work is needed. With steadfast commitment to patients and their families, we will be able to lower the mortality rates faster and improve the lives of those affected by cancer."
The report includes mortality data through 2015. It shows that, from 1999 to 2015, overall cancer death rates decreased by 1.8 percent per year among men and by 1.4 percent per year among women. From 2011 to 2015, death rates decreased for 11 of the 18 most common cancer types in men and for 14 of the 20 most common cancer types in women. Over the same period, death rates for cancers of the liver, pancreas, and brain and other nervous system increased in both men and women; death rates for cancer of the uterus increased in women; and death rates for cancers of the oral cavity and pharynx and soft tissue increased in men. From 2010 to 2014, incidence rates decreased for 7 of the 17 most common cancer types among men and for 7 of the 18 most common cancer types among women.
In the companion study, researchers explored prostate cancer trends in more detail. They found that overall prostate cancer incidence rates declined an average of 6.5 percent each year between 2007 and 2014, from a rate of 163 new cases per 100,000 men in the population in 2007 to 104 new cases per 100,000 in 2014. However, incidence of distant disease—that is, of cancer that has spread from the original tumor to other parts of the body—increased from a low rate of 7.8 new cases per 100,000 in 2010 to 9.2 new cases per 100,000 in 2014. Furthermore, after two decades of decline between 1993 and 2013, prostate cancer mortality leveled off between 2013 and 2015. Although rates of distant disease increased in recent years, there was no increase in the rates of cases with aggressive histologic grade (Gleason score of 9-10).
This study also reports a decline in recent prostate-specific antigen (PSA) screening in the population based on a series of national surveys. The reported decline in screening occurred between the 2010 and 2013 surveys, for men between 50 and 74 years of age, and after the 2008 survey, for men age 75 and older.
"The increase in late-stage disease and the flattening of the mortality trend occurred contemporaneously with the observed decrease in PSA screening in the population," said Serban Negoita, M.D., Dr.P.H., of NCI's Surveillance Research Program and lead author of the prostate cancer report. "Although suggestive, this observation does not demonstrate that one caused the other, as there are many factors that contribute to incidence and mortality such as improvements in staging and treating cancer. Additional research is needed to get a more comprehensive understanding of the recent trends and the possible relationship with PSA screening, as well as the relationship with other factors that may be associated with these trends."
Findings in the first part of the report show that incidence and death rates for all types of cancer combined were higher in men than in women in every racial and ethnic group. For all cancer sites combined, black men and white women had the highest incidence rates compared to other racial groups, and black men and black women had the highest death rates compared to other racial groups. Non-Hispanic men and women had higher incidence and death rates than those of Hispanic ethnicity.
"There continue to be significant declines in the cancer death rate with significant differences in rate by sex, race, and ethnicity," said Otis W. Brawley, M.D., chief medical officer for ACS. "We need to continue working to understand the reasons for the disparities and how to most efficiently continue supporting and, if possible, accelerate these declines."
The report also describes five-year survival during 2007-2013 by cancer stage at diagnosis for four of the most common cancers—female breast cancer, colorectal cancer, lung and bronchus cancer, and melanoma of the skin. While five-year survival is high for early-stage disease for breast cancer, colorectal cancer, and melanoma, survival remains low for all stages of lung cancer, ranging from 55 percent for Stage I to 4 percent for Stage IV.
"This report underscores that if cancer is caught early, when it has the best chance of being treated, patients can live longer," said CDC Director Robert R. Redfield, M.D. "Early detection and timely, quality treatment are keys to saving lives."
Increases in death rates for several cancers continue to cause concern. Researchers suggest that the increase in liver cancer death rates is related to the high prevalence of hepatitis C virus infection among Baby Boomers, as well as to the high prevalence of obesity in the United States. Obesity is also thought to have contributed to the increase in death rates from cancers of the uterus and pancreas. The recent increase in oral cavity and pharynx cancer death rates among white men is thought to be associated with human papillomavirus infection.
"It's encouraging to see progress in decreasing death rates for many types of cancer," said Betsy A. Kohler, executive director, NAACCR. "Yet the fact that death rates from several cancers are still on the rise means we need to keep working to find strategies to encourage prevention and continue to make improvements in screening and treatment."
Serban Negoita et al. Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics, Cancer (2018). DOI: 10.1002/cncr.31549