Abstract
Death rates from cancer dropped by 25% from 1991 to 2014, driven by declines in smoking and improvements in detection and treatment methods, according to a new report from the American Cancer Society. However, significant gender and racial disparities remain for incidence and death rates for many cancers.
Death rates from cancer dropped by 25% from 1991 to 2014, according to the American Cancer Society's (ACS) most recent annual report on cancer incidence, mortality, and survival. Driven by steady reductions in smoking and advances in early detection and treatment, the overall death rate has declined by 1.5% annually since 2001, although significant gender and racial disparities persisted.
The positive trend was due in part to declines in death rates for four major cancers—lung, breast, prostate, and colorectal—according to “Cancer Statistics, 2017,” published in CA: A Cancer Journal for Clinicians. Tobacco control efforts since the 1960s have led to 8 million fewer premature smoking-related deaths, one third of which are due to cancer, the report states. However, in the southern United States, smoking still caused 40% of cancer deaths in men in 2014.
Although racial disparities improved over the past few decades, the cancer death rate in 2014 remained 15% higher for blacks than whites, the report's authors found. The Affordable Care Act (ACA) of 2010 has the potential to help narrow that gap by providing access to insurance coverage and high-quality care, they note: The number of blacks without insurance dropped from 21% to 11% between 2010 and 2015, but President Donald Trump has vowed to repeal the ACA.
“The ACA hasn't been around long enough to have a major impact on death rates but it is already having a major effect on access to care,” says the report's lead author Rebecca Siegel, MPH, strategic director for surveillance information services for the ACS. “For the proportion of blacks who are uninsured to be cut in half in just the last 5 years is tremendous progress, and it's concerning to see that progress threatened.”
The report also highlights a wide gender gap, with men having a 20% higher incidence rate and a 40% higher death rate from all cancers compared with women. The disparity reflects the different cancer risk factors and diagnoses that tend to disproportionately affect men, says Siegel. For example, liver cancer is three times more common in men, who are more likely than women to have risk factors such as hepatitis C infection, tobacco use, and excess alcohol consumption.
Men also have a 60% higher incidence of melanoma than women—and double the death rate, says Siegel. That disparity persists even when controlling for variables such as tumor characteristics and stage of disease.
“We may see overall improvements in the gender disparity in the future due to smoking reductions,” says Siegel. “However, we need continued clinical and basic research to better understand certain cancers and to improve treatment and detection methods.” –Janet Colwell
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