New data for 1999 show that death rates
for all cancers continued to decline in the United States. However, the number
of cancer cases is expected to rise in coming years due to the growth and aging
of the population, according to a recent report. The "Annual Report to the
Nation on the Status of Cancer, 1973-1999, Featuring Implications of Age and
Aging on the US Cancer Burden" was published in a recent issue of the
journal Cancer (94:2766-2792, 2002).
The report is produced jointly by the National Cancer Institute
(NCI), the American Cancer Society, the North American Association of Central
Cancer Registries, the National Institute on Aging, and the Centers for Disease
Control and Prevention (CDC), including the National Center for Health
Statistics and the National Center for Chronic Disease Prevention and Health
The initial report, issued 4 years ago, documented the first
sustained decline in cancer death rates. This marked a notable reversal from the
increases that had been seen since the 1930sthe period when death rates for
the entire nation were first reported.
"The continuing decline in the rate of cancer deaths once
again affirms the progress we’ve made against cancer, but the report also
highlights the need for an acceleration of research as the population of the
United States ages," said Andrew C. von Eschenbach, MD, director of the
Lung Cancer Retains Its Title
Lung cancer remains the leading cause of cancer death in the
United States. During the most recent reporting period, it accounted for almost
one-third of all cancer deaths in men and about one-fourth of all cancer deaths
in women. Colorectal cancer is the second leading cause of cancer death,
followed by breast and prostate cancer.
"The good news in this report is the continuing fall in
cancer death rates by slightly more than 1% per year between 1993 and
1999," said John R. Seffrin, PhD, chief executive officer of the American
Cancer Society. "Of special note is the continuing decline in death rates
for the four most common cancers."
According to James S. Marks, MD, director of the CDC’s
National Center for Chronic Disease Prevention and Health Promotion,
"Another important issue in the report is that the incidence rate, or rate
of new cancers, for all cancers combined was stable during most of the 1990s,
after increasing during the 1970s through 1980s. These data highlight the need
for the rapid, full application of all we know about prevention, screening, and
treatment of cancer."
Growing Risk Factor
The single most important risk factor for cancer is age. Because
the population in the United States is both growing and aging, the authors
focused on how the number of people diagnosed with cancer will increase.
The authors projected the cancer burden 50 years into the future
by applying US Census Bureau population projections to current cancer incidence
rates. "If cancer rates follow current patterns, we anticipate a doubling
from 1.3 million people in 2000 to 2.6 million people in 2050 diagnosed
with cancer," said Holly L. Howe, PhD, executive director of the North
American Association of Central Cancer Registries. "The number of cancer
patients age 85 and over is expected to increase fourfold in this same time
period," she said.
Richard J. Hodes, MD, director of the National Institute on
Aging notes that "the data presented in the report underscore a critical
need for expanded and coordinated cancer control efforts to serve an aging
population and reduce the burden of cancer in the elderly."
In addition, the authors posit a number of strategies for
dealing with the future cancer burden. Special considerations in treating cancer
in older people will need to be undertaken due to comorbid conditions and
physical limitations that have not been studied fully in older age groups.
Increasing enrollment of older patients into clinical trials could help answer
questions about how best to treat this population of cancer patients. The
authors also note the growing need for trained cancer care professionals.
Certain changes and limitations in reporting data for this fifth
report preclude comparisons with previous reports. In this report, age
adjustment of statistics used the year 2000 standard populationin contrast to
the year 1970 standard populationwhich makes rates of certain cancers appear
20% to 50% higher. This change conforms to the new federal policy for reporting
disease rates. Also, a change in how cause of death is coded, starting with 1999
deaths, further complicates comparisons with previous years.
Annual population counts at the county level prior to 1990 are
available for blacks and whites only. Therefore, assessment of long-term trends
in other population groups is not possible. The report examined recent patterns
of cancer occurrence in specific racial and ethnic populations such as Asian and
Pacific Islanders, American Indians/Alaska Natives, and Hispanics. For the
latest time period, from 1995 through 1999, cancer rates among these groups were
The report is based on incidence data from the NCI’s
Surveillance, Epidemiology and End Results (SEER) Program, the CDC’s National
Program of Cancer Registries, and the North American Association of Central
Cancer Registries. Mortality data were taken from the CDC’s National Center
for Health Statistics.