The annual report to the nation on the status of cancer in the United States, published Monday in the Journal of the National Cancer Institute (JNCI), shows that overall cancer death rates continue to decline. The number of people who die as a result of their cancer has been steadily declining since the early 1990s for most cancers, including lung, colorectal, breast, and prostate—the four most commonly diagnosed cancers in the United States. Over the 9-year period between 2000 and 2009, the report shows a 1.8% decrease in death rates per year among men and a 1.4% decrease among women.
The report is authored by researchers from the American Cancer Society, the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries.
“The numbers are fantastic, showing a decrease in cancer deaths for both men and women,” said Sandra M. Swain, MD, president of the American Society of Clinical Oncology (ASCO), in a phone interview with Cancer Network. “A lot of this is related to early detection; for colon cancer this is really clear, and a decrease in smoking has led to lower cancer rates.”
Not everything in the report is good news. Death from melanoma among men has been on the rise since the year 2000, and death rates due to liver, pancreatic, and uterine cancers also continue to increase. There has also been an increased incidence of oropharyngeal and anal cancers as a result of human papillomavirus (HPV) infections. Cancer researchers and the director of the CDC, Thomas R. Frieden, MD, highlighted the importance of increasing the rate of HPV vaccination for both boys and girls to prevent these cancers in an NCI press release.
Cancer Survivorship Studies Need a Boost, ASCO Says
On the same day as the JNCI publication of the annual report, ASCO published a statement, “Achieving High-Quality Cancer Survivorship Care” with recommendations to improve the quality of life for cancer survivors. Currently there are more than 13 million cancer survivors in the United States, and it is estimated that the number will increase to 18 million over the next decade.
As more cancer patients are surviving longer with their disease due to earlier diagnosis, and better treatment and follow-up care, the care and monitoring of these patients is becoming critically more important.
“We definitely need to do more research on cancer survivors. The amount of cancer research funding is low, but it is especially low for cancer survivorship studies,” said Swain.
ASCO would like to see a better action plan for the follow-up care of cancer survivors, including improved federal policies on cancer care, improved clinical guidelines, and research to help improve the care of cancer survivors.
Studies show that patients who survive their cancer have various long-term effects as a result of their disease and the intense treatments, both chemotherapy and targeted therapies can result in lasting side effects. “The transition from active treatment to post-treatment care is critical to optimal long-term health,” according to the ASCO press release.
ASCO outlines recommendations for both oncologists, as well as primary care physicians that care for cancer survivors. The recommendations include collaborative care by the patient’s physicians, implementing quality improvement programs that take into account a patient’s quality of life, expanding research on the long-term and latent effects due to cancer treatment, and educating both survivors and their clinicians to tailor follow-up care and monitoring of cancer survivors.
The recommendations also include a call to policymakers to see cancer survivors as a priority as they finalize provisions in the Patient Protection and Affordable Care Act, and to reform Medicare reimbursement to allow for survivor-specific care.
James Watson Not Satisfied With Cancer Research Progress
A day after these reports, James Watson, who helped to solve the structure of the DNA double helix, and chancellor emeritus at Cold Spring Harbor Laboratory in New York, published an open-source paper, “Oxidants, antioxidants and the current incurability of metastatic cancers,” in Open Biology, urging researchers to develop drugs to target p53-mutated cancers and to finally understand how the oncogene MYC functions in cancer, which should still be seen as a major drug target candidate despite the lack of success in targeting this gene, which is frequently mutated in many cancers.
Watson believes that progress in the treatment of cancer has been too slow. “Even though we will soon have comprehensive views of how most cancers arise and function at the genetic and biochemical level, their ‘curing’ seems now to many seasoned scientists an even more daunting objective than when the ‘War on Cancer’ was started by President Nixon in December 1971.” His article lays out other knowledge gaps in the pathways and cellular systems that become deregulated as a result of tumor development.
Watson also questions whether the Cancer Genome Atlas project will result in cancer treatment breakthroughs. “I don’t know if that is correct,” said Swain, responding to Watson's assertion. “I think the more information we have, the better.”
Swain also highlighted the recent progress with immunotherapy, which was not mentioned by Watson. “This has been a big topic in the last few years, especially for melanoma, showing effective benefits in a disease that had no response to any treatment.”
Swain does agree with Watson’s assertion that the cancer research community needs to aim big. “We need to pull together as a research community,” said Swain, noting that there is an increasing amount of collaboration between academia and industry. “The I-SPY trial is an example of the cooperation of different pharmaceutical companies with academia.”