It seems like we're finally making significant progress in preventing cancer deaths. The rate of deaths from the disease dropped 27 percent between 1991 and 2016, according to a new report from the American Cancer Society. That translates to about 2.6 million fewer deaths during that time, thanks primarily to a reduction in deaths due to smoking-related cancers and breast cancer. However, the report also revealed the gaps in care that we still need to address.
For the report, published Tuesday in CA: A Cancer Journal for Clinicians, researchers analyzed cancer incidence, mortality, and survival data from the National Center for Health Statistics; the Surveillance, Epidemiology, and End Rules Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries.
Those data showed that the nationwide cancer death rate hit its peak of 215.1 deaths per 100,000 people in 1991 and dropped by 1.5 percent each year to 156 per 100,000 people in 2016. Still, the report estimates that in 2019, there will be 1,762,450 new cancer cases diagnosed in the U.S. and 606,880 cancer deaths.
Although lung cancer and breast cancer deaths decreased significantly over the past few decades, deaths related to other types of cancer did not show the same pattern.
The mortality rate for lung cancer dropped by 48 percent from 1990 to 2016 among men and by 23 percent from 2002 to 2016 among women. Plus, the rate for female breast cancer also dropped by 40 percent from 1989 to 2016, prostate cancer deaths dropped by 51 percent from 1993 to 2016, and colorectal cancer mortality also dropped by 53 percent from 1970 to 2016.
It wasn’t all good news, though. Liver cancer death rates rose for both men (1.2 percent) and women (2.6 percent) between 2012 and 2016, pancreatic cancer deaths rose by 0.3 percent for men per year, and endometrial cancer deaths rose by 2.1 percent per year. Cancers of the brain and other nervous system, soft tissue, and oropharyngeal cancers linked to human papillomavirus (HPV) also increased.
Experts say the decrease in the overall cancer death rate is probably due to a combination of several factors.
One big factor is the decrease in cigarette smoking in the U.S., Matthew Schabath, Ph.D., a cancer epidemiologist at Moffitt Cancer Center, tells SELF. “Over time as fewer people are smoking, the incidence of tobacco-related cancers has been on the decline,” he says. That includes lung cancer as well as leukemia, stomach cancer, and bladder cancer, among others, Alyssa Rieber, M.D., chair of the department of general oncology at the University of Texas MD Anderson Cancer Center, tells SELF.
The decrease may also be driven by people pursuing healthier lifestyles, including eating better, exercising regularly, and cutting back the amount of alcohol they consume, J. Leonard Lichtenfeld, M.D., interim chief medical officer of the American Cancer Society, tells SELF.
And finally, there have been advancements in early detection techniques with several forms of cancer that are being used more widely, Dr. Lichtenfeld says. In particular, breast cancer and cervical cancer screening techniques and guidelines have changed pretty dramatically over the past few decades.
Although cancer deaths in the U.S. fell overall, there are still significant racial and economic gaps in mortality rates.
The racial gap in cancer mortality is narrowing—the mortality rate was 33 percent higher for black Americans than white Americans in the mid-1990s, and the gap is now 14 percent—but it still exists. Schabath calls the narrowing racial gap “encouraging” and says it’s likely attributed to years of concerted efforts at the local, state, and national level to reduce racial and ethnic cancer disparities. But, he adds, “much more work is still needed.”
There is also a growing gap in mortality rates based on socioeconomic status. Between 2012 and 2016, the overall cancer death rate was about 20 percent higher for people who live in the poorest counties in the U.S. compared with those who live in the most affluent counties. The gap was even wider for some types of cancer: The mortality rate for cervical cancer in the poorest areas is twice that of the most affluent areas, for instance. However, there were little to no differences in mortality rates between socioeconomic groups for cancers that are generally more difficult to screen for and treat (such as pancreatic and ovarian cancers).
“We can do better,” Dr. Lichtenfeld says. “Unfortunately, not everyone has equal access to care." If someone is concerned about putting food on the table, for instance, it's obviously going to be hard to justify taking the time to go for a cancer screening. "And, if they’re diagnosed, [they] may not have insurance or adequate insurance, delaying their care,” he says.
But overall, experts still feel positive about the new numbers. “This is fantastic news,” Dr. Rieber says. “It’s great for people to know that when we do catch cancer early and get the appropriate therapy, people can live longer.” However, she says, the pressure is on for physicians and researchers to extend quality care to everyone: “We should continue to put pressure on ourselves to make sure that everyone has good access and opportunity for treatment.”