It’s a milestone in the fight against cancer: U.S. cancer death rates have declined continuously for the last quarter of a century, according to a new report.
From 1991 to 2016, the U.S. cancer death rate dropped steadily by about 1.5 percent per year, resulting in an overall decline of 27 percent during the 25-year-period, according to the report from the American Cancer Society (ACS). That translates to an estimated 2.6 million fewer cancer deaths than would have been expected if death rates had remained at their peak level, the researchers said.
But despite this progress, there are growing disparities in cancer deaths according to socioeconomic status, with people living in poorer communities experiencing an increasingly larger burden of preventable cancers, the report said.
Although the continued decline in overall cancer death rates is good news, the “bad news that this report highlighted [is that] inequalities are widening, particularly among those of low socioeconomic status,” said Dr. Darrell Gray II, deputy director of the Center for Cancer Health Equity at The Ohio State University Comprehensive Cancer Center, who was not involved in the study. “It underscores the importance of health care providers, researchers and lay community members and advocates to continue to push toward health equity,” Gray told Live Science.
Declines in major cancers
The annual report from the ACS, which was recently published in CA: A Cancer Journal for Clinicians, analyzes the most recent data on cancer incidence, deaths and survival rates in the U.S.
In 2016, there were 156 cancer deaths for every 100,000 people, down from a rate of 215 cancer deaths per 100,000 people in 1991.
The two-and-a-half-decade decline is mostly due to reductions in smoking (which increases the risk of a number of cancers, particularly lung cancer), as well as advances in the early detection and treatment of cancer, the report said.
For example, lung cancer death rates have dropped by 48 percent among men from 1990 to 2016; and 23 percent among women from 2002 to 2016. Breast cancer death rates dropped 40 percent among women from 1989 to 2016; prostate cancer death rates dropped by 51 percent among men from 1993 to 2016; and colorectal cancer death rates dropped by 53 percent among both men and women from 1970 to 2016, the report said.
However, rates of several other cancers have been on the rise in recent years, including endometrial cancer (cancer of the lining of the uterus), which increased 2.1 percent per year from 2012 to 2016, and pancreatic cancer, which increased 0.3 percent per year among men during this same time period. Liver cancer death rates also increased by 1.2 percent per year among men and 2.6 percent per year among women, from 2012 to 2016.
Gray noted that while cancers such as breast and colorectal cancer have evidence-based screening guidelines available, there are no such guidelines for pancreatic and uterine cancer.
“We may continue to see a rise in death rates while we are working on getting guideline-based screening available” for these cancers, Gray said. “There’s still a lot of work and a lot of research” that needs to be done in this area, he added.
The report also found that gaps in cancer death rates by race are narrowing, but gaps by socioeconomic status are widening. For example, the cervical cancer death rate among women in poor counties in the U.S. is twice as high as that of women in wealthier counties, the report said. And lung and liver cancer death rates are more than 40 percent higher among men living in poor counties, compared with wealthier counties.
Increased efforts are needed to address this gap. “These [poor] counties are low-hanging fruit for locally-focused cancer control efforts, including increased access to basic health care and interventions for smoking cessation, healthy living, and cancer screening programs,” the report concluded.
Gray agreed, and said that patients of low socioeconomic status face many barriers to cancer prevention — for example, they may be unable to take time off work for medical appointments, or they may not be able to afford healthy foods. “These are competing priorities. These are things we have to help people to nagaivate,” Gray said.