The overall cancer death rate in the United States continues to decline while the overall rate of newly diagnosed cases is essentially unchanged, according to the Annual Report to the Nation on the Status of Cancer. The report includes data on cancer mortality and incidence from 1975 through 2002, the most recent year for which statistics are available.

The trend of declining cancer death rates has occurred as physicians in community settings have increasingly adopted treatments recommended by leading cancer organizations and professional societies, according to the study. The researchers used data from NCI's SEER (Surveillance, Epidemiology, and End Results) cancer registries and related resources to track treatments throughout the population over time.

But not all racial and ethnic groups have benefited equally from the progress. The researchers found disparities in the quality of care available in minority and underserved communities as compared with others. They also found different patterns of treatment for cancers, depending on geography.

The study's data "raise substantial concerns" that a patient's treatment may depend on nonclinical factors such as race, socioeconomic status, age, and where the patient lives, the researchers write in the October 5 Journal of the National Cancer Institute.

"We do find that lower income and minority patients and older individuals do not appear to be getting recommended treatments at optimal rates," says co-author Dr. Martin L. Brown of NCI's Division of Cancer Control and Population Sciences (DCCPS). "That sends an important message to the community and reminds people that we should make sure treatment is being delivered appropriately."

Dr. Brown points out that some "patients may not be getting the recommended treatments for appropriate reasons, such as coexisting medical conditions." The data do not indicate why patients were given one treatment over another.

An example of treatment recommendations affecting patients broadly has been the substantial increase of women with early-stage breast cancer receiving breast-conserving surgery with radiation treatment. The increase was triggered by a 1990 National Institutes of Health (NIH) Consensus Development Panel report that this surgery followed by radiation is as effective as mastectomy but preserves the breast.

The researchers note, however, that recommendations are not always followed completely. For instance, there has been a modest but increasing use of breast-conserving surgery without radiation to treat women with early-stage breast cancer.

The report also updates statistics on the nation's cancer burden. A change from last year's report was a small increase in the overall lung cancer death rate among women for the period 1995 to 2002.

"The good news is that the decline in overall cancer death rates is being driven by declines in many cancers," says first author Dr. Brenda K. Edwards, also of NCI's DCCPS. Death rates are down for 12 of the top 15 cancers in men, and 9 of the top 15 cancers in women.

Nevertheless, the absolute total number of cancer deaths has actually increased, which the researchers attribute to the growing number of older Americans.

The incidence rate for all cancers combined among men was stable from 1995 through 2002, but the rate among women increased by 0.3 percent annually from 1987 through 2002. "The lung cancer incidence rate in women is finally stabilizing, suggesting that declines may occur in the future," notes Dr. Edwards.

The annual report, first published in 1998, is a collaborative effort of the American Cancer Society, the Centers for Disease Control and Prevention, NCI, and the North American Association of Central Cancer Registries.

By Edward R. Winstead