Cancer deaths in the US: good news and bad
The latest Annual Report to the Nation on the Status of Cancer, 1975–2009 has found that overall cancer death rates have continued to decline in the United States; however, the death rate for some cancers are on the increase.
The report has been produced since 1998; it is co-authored by researchers from the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). It is now available online in the Journal of the National Cancer Institute and will be published in print issue 3, volume 105.
In regard to the good news, the overall cancer death rate has dropped among both men and women, among all major racial and ethnic groups, and for all of the most common cancer sites, including lung, colon and rectum, female breast, and prostate. However, death rates have continued to rise during the latest time period (2000 through 2009) for melanoma of the skin (among men only) and for cancers of the liver, pancreas, and uterus. Another disturbing finding of the report is that human papillomavirus (HPV)-associated cancers have increased for HPV-associated oropharyngeal and anal cancers; in addition, the vaccination coverage levels in the U.S. during 2008 and 2010 remained low among adolescent girls.
The authors note that in the early 1990s a decline in overall cancer death rates began in the United States and that trend is continuing. From 2000 through 2009, cancer death rates decreased by 1.8% per year among men and by 1.4% per year among women. Death rates among children up to 14 years of age also continued to decrease by 1.8% per year. During 2000 through 2009, death rates among men decreased for 10 of the 17 most common cancers; lung, prostate, colon and rectum, leukemia, non-Hodgkin lymphoma, kidney, stomach, myeloma, oral cavity and pharynx, and larynx. However, they increased for melanoma of the skin and cancers of the pancreas and liver.
During the same 10-year period, death rates among women decreased for 15 of the 18 most common cancers: lung, breast, colon and rectum, ovary, leukemia, non-Hodgkin lymphoma, brain and other nervous system, myeloma, kidney, stomach, cervix, bladder, esophagus, oral cavity and pharynx, and gallbladder. However, they increased for cancers of the pancreas, liver, and uterus.
In addition to tracking cancer deaths, the investigators evaluated cancer incidence and found an overall decrease. The report notes that between 2000 and 2009, overall cancer incidence rates decreased by 0.6% per year among men, were stable among women, and increased by 0.6% per year among children (ages 0 to 14 years). During that time period, incidence rates among men decreased for five of the 17 most common cancers: prostate, lung, colon and rectum, stomach, and larynx. However, they increased for six others: kidney, pancreas, liver, thyroid, melanoma of the skin,and myeloma).
Among women, incidence rates decreased for seven of the 18 most common cancers: lung, colon and rectum, bladder, cervix, oral cavity and pharynx, ovary, and stomach). However, they increased for seven others: thyroid, melanoma of the skin, kidney, pancreas, leukemia, liver, and uterus. Incidence rates were stable for the other 17 most common cancers, including breast cancer in women and non-Hodgkin lymphoma in men and women.
The most disturbing finding of the researchers was the rise in HPV-associated cancers because HPV infections can be prevented with the vaccine. From 2000 through 2009, incidence rates for HPV-associated oropharyngeal (mouth and throat) cancer increased among white men and women; in addition, rates for anal cancer among white and black men and women increased. Incidence rates for cancer of the vulva increased among white and black women. Rates of cervical cancer declined among all women except American Indian/Alaska Natives.
Furthermore, cervical cancer incidence rates were higher among women living in low versus high socioeconomic areas. Among men, rates for penile cancer were stable.
The report revealed that in 2010, less than half (48.75) of girls ages 13 through 17 had received at least one dose of the HPV vaccine, and only 32% had received all three recommended doses. In general, vaccination series completion rates were generally lower among some population groups such as girls living in the South, those living below the poverty level, and among Hispanics. In 2010, the national three-dose coverage estimate among girls ages 13 through17 fell far short of the 80% goal established by the US Government’s Healthy People 2020.
The US rate is significantly lower than vaccination rates reported in Canada (50-85%) and the United Kingdom and Australia combined (greater than 70%). The authors note that low overall vaccine uptake in the United States is likely due to a number of issues, including inadequate provider recommendations, provider reimbursement concerns, infrequent use of reminder/recall systems that would promote completion of the three-dose series, and other factors.
Take home message:
The HPV vaccine for girls would lower the rate of HPV infections and subsequent cancers; however, vaccinating boys would also have an impact HPV infections could be reduced in all age groups, from teens to seniors, could be reduced by practicing safe sex. The use of condoms if any possibility of infection existed would markedly reduce the risk of infection.
Reference: Journal of the National Cancer Institute