More on progress against cancer

Cancer undefeated

BACKGROUND

Despite decades of basic and clinical research and trials of promising new therapies, cancer remains a major cause of morbidity and mortality. We assessed overall progress against cancer in the United States from 1970 through 1994 by analyzing changes in age-adjusted mortality rates.

METHODS

We obtained from the National Center for Health Statistics data on all deaths from cancer and from cancer at specific sites, as well as on deaths due to cancer according to age, race, and sex, for the years 1970 through 1994. We computed age-specific mortality rates and adjusted them to the age distribution of the U.S. population in 1990.

RESULTS

Age-adjusted mortality due to cancer in 1994 (200.9 per 100,000 population) was 6.0 percent higher than the rate in 1970 (189.6 per 100,000). After decades of steady increases, the age-adjusted mortality due to all malignant neoplasms plateaued, then decreased by 1.0 percent from 1991 to 1994. The decline in mortality due to cancer was greatest among black males and among persons under 55 years of age. Mortality among white males 55 or older has also declined recently. These trends reflect a combination of changes in death rates from specific types of cancer, with important declines due to reduced cigarette smoking and improved screening and a mixture of increases and decreases in the incidence of types of cancer not closely related to tobacco use.

CONCLUSIONS

The war against cancer is far from over. Observed changes in mortality due to cancer primarily reflect changing incidence or early detection. The effect of new treatments for cancer on mortality has been largely disappointing. The most promising approach to the control of cancer is a national commitment to prevention, with a concomitant rebalancing of the focus and funding of research.

The survival pattern in male breast cancer. An analysis of 1429 patients from the Nordic countries

A joint Nordic study was conducted to elucidate the survival pattern in male breast cancer by means of regression analysis of annual relative survival rates. A total of 1429 (98.4%) of all patients diagnosed during a 25-year to 30-year period and reported to the Nordic cancer registries were available for follow-up through 1982. The relative survival rate was lower in older patients; the relative excess risk of dying (from breast cancer) during the first 5 years of observation, calculated by multiple regression modelling, increased in a regular fashion more than three-fold from patients younger than 40 years at diagnosis to those aged 80 years or older. Significantly lower rates were found among males in Denmark and Finland, the relative excess risks of dying (compared with Sweden) being 1.39 (1.06-1.80) and 1.73 (1.22-2.45), respectively, during the first 5 years. The authors concluded first that important differences exist between male and female patients with breast cancer in the relation between survival and age at diagnosis, and secondly that a later stage at presentation or national differences in the natural history are the most likely explanations for the worse prognosis in Denmark and Finland.

Have we reduced the risk of getting cancer or of dying from cancer? An update

We have examined trends in cancer mortality, incidence and survival in the United States to update our earlier work and respond to criticisms. [Bailar, J.C., Smith, E.M.: New Engl. J. Med. 314, 1226 (1986).] Here we concentrate on the years 1975-1984, and show that overall cancer mortality has increased, incidence has increased and case survival is virtually unchanged. This generally unfavorable picture is scarcely changed when lung cancer is excluded from the trends. While trends for individual cancers have been mixed, overall progress in both curative treatment and prevention has been minimal. This evaluation does not deny the marked progress in treating some uncommon forms of cancer, improved palliation, reduced extent or severity of treatment, or benefits of cancer research that can be applied in other areas of medicine. While our finding of limited progress is not new, we believe that it requires increased attention in setting the course of future research initiatives, demonstration programs, medical training and clinical practice.