Cancer death rates continued to decline in the United States for cancer of all sites combined, and this trend was seen in all major racial and ethnic groups as well as in men and women and in all age groups, note the authors of the Annual Report to the Nation on the Status of Cancer.
The 2020 targets were met for reductions in mortality from lung, prostate, breast, and colorectal cancer, according to the companion report, Progress Toward Healthy People 2020 Objectives for 4 Common Cancers.
Both reports were published online March 12 in Cancer.
Overall, cancer death rates decreased an average of 1.5% per year from 2001 through 2017, with more rapid declines seen among males, at 1.8% a year, than among females, at 1.4% a year, note the authors, headed by Jane Henley, MPH, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia.
"The largest declines in death rates were observed for melanoma of the skin and lung cancer," they add.
In addition, cancer deaths decreased in every racial and ethnic group from 2013 through 2017.
"In the field of cancer, good news is always precious and should be cherished. This year's update of cancer death rates and progress in achieving health goals is one of those times," Robert Ferris, MD, PhD, University of Pittsburgh, in Pennsylvania, writes in an accompanying editorial.
"These welcome trends reflect population science success in reducing cancer risk factors while increasing screening test use," he continues.
"Coupled with breakthrough treatment advances such as cancer immunotherapy and genome-targeted treatments, these 2 reports bode well for continued improvements," he adds.
The Annual Report to the Nation on the Status of Cancer is a collaborative effort by the CDC, the National Cancer Institute, the American Cancer Society, and the North American Association of Central Cancer Registries.
Cancer Incidence Findings
The annual report includes data on cancer incidence and cancer deaths.
During the most recent 5-year period, from 2012 to 2016, the incidence of cancer overall decreased by 0.6% on average per year, but trends differed by sex. Incidence remained stable among males and increased slightly among females.
Among males, cancer incidence remained stable among whites but decreased among blacks, Asian Pacific Islanders, American Indian/Alaska Native, and Hispanic males.
In contrast, the incidence of cancer overall increased among females in every racial and ethnic group during the study interval, the researchers point out.
"The stable trend in overall cancer incidence among males was largely driven by stable trends for 7 of the 17 most common cancers," the authors explain.
The slight increase in overall incidence among females was in part due to an increase in incidence rates for eight of the 18 most common cancers, including uterine, liver, brain, and pancreatic cancer
Childhood/Adolescent Cancers
For the first time, the annual report provides incidence and mortality rates for the most common cancers among children and adolescents as well as adults to the age of 39 years.
Small increases in incidence rates for cancer overall and for the most common types of cancer were observed in each of these age groups, but overall, death rates among children aged 0 to 14 years decreased an average of 1.4% per year.
Among adolescents and adults aged 15 to 39 years, death rates from cancer decreased on average by 1.0% per year.
The most common cancers among younger children were leukemia, lymphoma, and brain and other nervous system cancers. The most common cancer among adolescents and young adults was female breast cancer; incidence rates were highest among young black women.
Healthy People 2020
In the companion article to the annual report, researchers examined progress in four of the most common cancers: lung, prostate, female breast, and colorectal cancer.
Target death rates for all cancers combined as well as target death rates for the four most common cancers were all met, Henley and colleagues report.
However, several lifestyle targets were not met, including those regarding smoking, excessive alcohol use, and obesity.
The target of having smoking rates drop to 12% was not met, either overall or in most groups.
In addition, "most groups did not yet meet the target for reducing excessive alcohol use," the researchers add.
One target was to reduce the proportion of obese adults to 30.5%.
"However, the prevalence of obesity increased among all groups between the periods 2005 to 2008 and 2013 to 2016," they state. From 2013 to 2016, 39% of all adults were obese, according to the report.
Many groups did achieve physical activity targets from 2008 to 2017. The exceptions were people of Hispanic descent, those living in rural areas, and those with less education (high school or less).
The target of having over 80% of women undergo breast cancer screening was not met in any group except women with advanced educational degrees.
Similarly, there was some improvement in colorectal cancer screening rates, but rates did not reach the target of more than 70%, except among adults with advanced educational degrees.
None of the authors of the reports have disclosed any relevant financial relationships. Editorialist Ferris has consulted for Aduro Biotech, Bain Capital Life Sciences, Iovance Biotherapeutics, Nanobiotix, Ono Pharmaceutical, Torque Therapeutics, and TTMS. He has also served on advisory boards for Amgen, AstraZeneca/MedImmune, Bristol-Myers Squibb, EMD Serono, GlaxoSmithKline, Lilly, MacroGenics, Merck, Numab Therapeutics AG, Oncorus, Pfizer, PPD, Regeneron Pharmaceuticals, and Tesaro and has worked on clinical trials for AstraZeneca/MedImmune, Bristol-Myers Squibb, and Merck and has received research funding from AstraZeneca/MedImmune, Bristol-Myers Squibb, Tesaro, TTMS, and VentiRx Pharmaceuticals.
Cancer. Published online March 12, 2020. Annual Report, part I, full text; Annual Report, part II, full text; Editorial
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Cancer survivors diagnosed as teens or young adults are living longer now than young people diagnosed decades ago, largely because of advances in treatment, a U.S. study suggests.
Overall, among people diagnosed between ages 15 and 39, deaths from all causes from five through 10 years after diagnosis dropped to 5.4% among those diagnosed with cancer in 2005-2011, from 8.3% among young people diagnosed in 1975-1984.
The patterns were similar for survival up to 15 years after diagnosis, researchers report in the Journal of the National Cancer Institute.
Chelsea Anderson, a postdoctoral fellow at the American Cancer Society at Atlanta, and colleagues analyzed data from a U.S. population-based cancer registry, focusing on 282,969 people diagnosed with cancer at ages 15 to 39 between 1975 and 2011, who survived at least five years after diagnosis.
The authors followed patients from five years after cancer diagnosis until death or the end of 2016.
Most survivors were white women, 30 to 39 years old when diagnosed with cancer. The most common cancer was breast cancer, for which mortality rates dropped from 15.9% of patients diagnosed in 1975-1984 to 10.1% in 2005-2011.
The most significant drops in death rates between the earliest and most recent diagnosis periods was seen in patients with leukemia (28.6% to 6.6%), non-Hodgkin lymphoma (13.0% to 3.6%), central nervous system tumors (25.0% to 17.2%) and kidney cancer (10.7% to 4.4%).
This was driven mainly by fewer deaths caused by the primary cancer between these periods - down to 4.2% from 6.8%.
Not all cancers have seen the same level of improvement, however. There was little improvement in mortality over the same period for patients with colorectal, bone, cervical/uterine, bladder cancers and sarcomas.
The cancers that showed little improvement were ones that typically affected adults, said Dr. Kara Kelly, chief of Roswell Park Oishei Children's Cancer and Blood Disorders program and professor of pediatrics at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences in New York.
"This may, in part, be related to how there aren't as many clinical trials for these cancers," Kelly, who was not involved in the study, told Reuters Health by phone.
"The greatest improvements were seen in patients with cancers that are also more prevalent in children - and these improvements in childhood cancer have resulted from clinical trials," she said.
While the study affirms improvements in preventing deaths from primary cancers, Kelly said it didn't provide details about how other races and ethnicities fared.
The data set the researchers used also doesn't detail types of treatments or how well patients were managed if they relapsed, she said.
As young adult patients are transitioning to independence and many are uninsured or under-insured, it is critical to understand the access they have to treatment, Kelly said.
Kelly also pointed out the need for less toxic treatments to reduce mortality rates.
Overall, the findings demonstrate the progress made over the past few decades in improving outcomes among long-term survivors of adolescent and young adult cancers, Anderson said by email.
"Some cancer types have not shared in these improvements, and these survivors may be priority groups for efforts to improve long-term surveillance and reduce late mortality from cancer among adolescents and young adults," she said.
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