BIRMINGHAM, Ala--After 60 years of steadily increasing cancer mortality, the tide appears to have turned. From 1990 to 1995, age-adjusted cancer mortality declined by a total of 3.1%, say Philip Cole, MD, and Brad Rodu, DDS, of the University of Alabama at Birmingham School of Public Health and School of Dentistry.
Mortality from all cancers peaked at 135 deaths/100,000 patient-years in 1990 and declined in each subsequent year to 130.8 in 1995, representing an average reduction of 0.6% per year (see table on page 10). The bulk of this decline (40%, or 1.6 deaths/100,000 person-years) stems from the fall in lung cancer mortality (Cancer 78:2045-2048, 1996).
This is the news we've been waiting for," NCI director Richard Klausner, MD, said of the finding. "We are on the eve of the 25th anniversary of the National Cancer Act, the legislation that made cancer research a high national priority. Now our nation's investment is paying off by saving lives."
The UAB researchers drew on three sources for their analysis: Vital Statistics of the United States for cancer mortality rates for 1970 to 1990; CDC's Monthly Vital Statistics Reports for the 1991 to 1995 mortality figures; and the Current Mortality Sample for 1994 and 1995 statistics. [See page 27 for a report of the NCI's analysis of US cancer mortality rate trends based on SEER data.]
Smoking prevalence began a steady decline in 1965, so "it was inevitable that lung cancer incidence and mortality rates would begin to decline some 20 or so years later," Drs. Cole and Rodu say. They note that reductions in smoking lead to reduced mortality from other cancers as well, such as bladder cancer.
Cancer prevention efforts, other than those aimed at smoking cessation, including cancer prevention programs in the workplace, also have had an impact on cancer mortality, they say, as well as lower case fatality rates due to earlier detection of disease and more effective treatments.
Unless there is a surge in incidence rates, the investigators believe the decline will likely continue for at least 20 years and may accelerate. "It will continue," they say, "because we are just beginning to see the effects of long-term reductions in smoking and of reduced exposure to other lifestyle carcinogens (eg, alcohol(Drug information on alcohol) and solar radiation) and to some industrial agents."