Keeping Recent Mortality Figures in Perspective
The headlines varied, but when the Cancer Facts & Figures 2008 data were released late last month, the dominant message that many TV, print, and electronic news stories carried was that the decline in the number of actual cancer deaths had come to an end.
After back-to-back drops in the number of actual cancer deaths, the most recent data show an increase of more than 5,400 deaths from 2004 to 2005. But the larger story - a true success story - is that cancer mortality rates are continuing to decline. From the time the decline began in the early 1990s, in fact, cancer death rates for men have decreased more than 18 percent, while the rate for women has seen a more modest 10.5 percent decrease.
According to American Cancer Society estimates, that's more than half a million lives saved from death due to cancer - nearly equivalent to the population of Portland, Oregon.
The increase in the number of cancer deaths was no surprise. Not only has the U.S. population continued to swell, but it's also aging: More than 20 percent of the population is 55 or older, an age group that represents more than three of every four cancer diagnoses. So, even though fewer people as a proportion of the whole population are dying from cancer, the actual number of deaths still increased.
The new report also provides some important insights into the cancers and populations where some of our most significant challenges lie.
Estimates are that lung cancer, for example, will account for more than a quarter of all cancer deaths among women in 2008. Clearly this is an area where we must do better. Disparities in care and outcomes persist. The cancer death rate among African American men, for example, is 37 percent higher than it is among white men.
Hopefully the cancer and public health communities can work with policymakers to develop and implement the necessary changes to address these disparities - something NCI is already spearheading with important initiatives like the NCI Community Cancer Centers Program and the Community Networks Program.
Looking to the future, recent advances and promising research suggest that we can maintain the cancer death rate decline, and perhaps even accelerate it.
Last year, for instance, we saw significant advances in the treatment of some of the most difficult-to-treat cancers, including small-cell lung cancer, liver cancer, and kidney cancer. And while the introduction of HPV vaccines stands to greatly reduce cervical cancer incidence in the future, recent evidence demonstrating an association between HPV and head and neck cancers also suggests widespread vaccination could have unforeseen benefits.
We are also pursuing new avenues of cancer prevention research, including identifying biomarkers of cancer risk, such as hypermethylation patterns, while continuing to pursue promising new chemoprevention agents, such as DFMO for the prevention of colon polyps, which are often precursors to colon cancer.
And as we continue to learn more about cancer stem cells, also known as tumor-initiating cells, we are gaining a better understanding of their resistance to treatment and how to target these cells. We are also learning to effectively mine molecular clues from patients' tumors to guide treatment. One such example is the NCI-funded TAILORx trial, which is testing whether a 21-gene assay can guide the use of adjuvant chemotherapy for certain breast cancer patients.
Collectively, these examples represent an extensive investment in our attack on the collection of malignancies we call cancer. Progress will be swift in some areas, slower in others, and of course will be heavily reliant on the budgets under which NCI operates.
But, as the continued decline in death rates demonstrates, the foundation for progress has been laid. NCI is committed to finding ways to strengthen that foundation through judicious management, strategic collaboration, and wise investment in the best science possible.
Dr. John E. Niederhuber