An article appearing on January 8, 2019 in the medical journal CA: A Cancer Journal for Clinicians reported that the overall cancer death rate in the United States dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak.
The authors of the article reported that the cancer incidence rate from 2006 to 2015 was stable in women, and declined by approximately 2% per year in men, whereas the cancer death rate from 2007 to 2016 declined annually by 1.4% and 1.8%, respectively. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States: there will be approximately 62,930 new cases of female breast carcinoma in situ and 95,830 new cases of melanoma in situ of the skin.
The Most Common Cancers Expected To Be Diagnosed In Men And Women
Prostate, lung and bronchus, and colorectal cancers (CRCs) account for 42% of all cases in men, with prostate cancer alone accounting for nearly 1 in 5 new diagnoses. For women, the 3 most common cancers are breast, lung, and colorectum, which collectively represent one‐half of all new diagnoses. Breast cancer alone accounts for 30% of all new cancer diagnoses in women.
The lifetime probability of being diagnosed with invasive cancer is slightly higher for men (39.3%) than for women (37.7%). The reasons for the excess risk in men are not fully understood, but partly reflect differences in environmental exposures, endogenous hormones, and probably complex interactions between these influences. Recent research suggests that sex differences in immune function and response may also play a role. Adult height, which is determined by genetics and childhood nutrition, is positively associated with cancer incidence and mortality in both men and women, and has been estimated to account for one‐third of the sex disparity.
Over the past decade of data, the overall cancer incidence rate in men declined by approximately 2% per year, reflecting accelerated declines during the past 5 data years (2011‐2015) of approximately 3% per year for cancers of the lung and colorectum, and 7% per year for prostate cancer.
The overall cancer incidence rate in women has remained generally stable over the past few decades. Declines have continued for lung cancer, but tapered in recent years for CRC, whereas rates for other common cancers are increasing or stable. Breast cancer incidence rates increased from 2006 to 2015 by approximately 0.3% to 0.4% per year among non‐Hispanic white (NHW) and Hispanic women, by 0.7% to 0.8% per year among black (non‐Hispanic) and American Indian/Alaska Native women, and by 1.8% per year among Asian/Pacific Islander women. This trend may in part be a consequence of the obesity epidemic, as well as declining parity.
Lung cancer incidence continues to decline twice as fast in men as in women, reflecting historical differences in tobacco uptake and cessation, as well as upturns in female smoking prevalence in some birth cohorts.
CRC incidence patterns are generally similar in men and women, although in the past 5 data years rates have continued to decline by approximately 3% per year in men, but appear to have stabilized in women. Reductions in CRC incidence prior to 2000 are attributed equally to changes in risk factors and the use of screening, which allows for the removal of pre-malignant lesions. However, more recent rapid declines are thought to primarily reflect the increased uptake of colonoscopy, which now is the predominant screening test: colonoscopy use among U.S. adults aged 50 years and older tripled from 21% in 2000 to 60% in 2015. The rapid declines in overall CRC incidence rates mask an increase in adults aged younger than 55 years of almost 2% per year since the mid‐1990s.
Incidence rates continue to increase for melanoma and cancers of the liver, thyroid, uterine corpus, and pancreas. Liver cancer incidence is rising faster than that for any other cancer in both men and women. Notably, however, the majority (71%) of cases in the United States are potentially preventable because most risk factors are modifiable (e.g., obesity, excess alcohol consumption, cigarette smoking, and hepatitis B and C viruses). Approximately 24% of cases are caused by chronic hepatitis C virus (HCV) infection, which confers the largest relative risk and is also the most common chronic blood‐borne infection in the United States.
Cancer Survival Rates
The 5‐year relative survival rate for all cancers combined diagnosed during 2008 through 2014 was 67% in whites and 62% in blacks. For all stages combined, survival is highest for prostate cancer (98%), melanoma of the skin (92%), and female breast cancer (90%) and lowest for cancers of the pancreas (9%), liver (18%), esophagus (19%), and lung (19%). However, blacks also have lower stage‐specific survival for most cancer types: after adjusting for sex, age, and stage at diagnosis, the relative risk of death after a cancer diagnosis is 33% higher in black patients than in white patients.
Cancer survival has improved since the mid‐1970s for all of the most common cancers except those of the uterine cervix and uterine corpus. In contrast to the steady increase in survival for most cancer types, advances have been slow for lung and pancreatic cancers, partly because greater than one‐half of cases are diagnosed at a distant stage.
Cancer Mortality Rates
The cancer death rate rose during most of the 20th century, largely driven by rapid increases in lung cancer deaths among men as a consequence of the tobacco epidemic. However, since its peak of 215.1 deaths (per 100,000 population) in 1991, the cancer death rate has dropped steadily by approximately 1.5% per year, resulting in an overall decline of 27% as of 2016 (156.0 per 100,000 population). The number of averted deaths is larger for men than for women because the total decline in cancer mortality has been steeper for men (34% vs 24%).
Cancer is the second most common cause of death among children aged 1 to 14 years in the United States, surpassed only by accidents. In 2019, an estimated 11,060 children (birth to 14 years) will be diagnosed with cancer and 1,190 will die from the disease. Leukemia is the most common childhood cancer, accounting for 28% of cases (including benign and borderline malignant brain tumors). There has been a dramatic 78% decline in leukemia mortality, from 2.7 per 100,000 children and adolescents in 1970 to 0.6 in 2016.
The decline in cancer mortality over the past 2 decades is primarily the result of steady reductions in smoking and advances in early detection and treatment, which are reflected in the rapid declines for the 4 major cancers (lung, breast, prostate, and colorectum). Death rates rose from 2012 through 2016 for cancers of the liver, pancreas, and uterine corpus, as well as for cancers of the brain and other nervous system, soft tissue (including heart), and sites within the oral cavity and pharynx associated with the human papillomavirus (HPV).
A total of 2,744,248 deaths were recorded in the United States in 2016, 22% of which were from cancer. Cancer is the second leading cause of death after heart disease in both men and women nationally, but is the leading cause of death in many states, in Hispanic and Asian Americans, and in people younger than 80 years. Brain and other nervous system tumors are the leading cause of cancer death among men aged younger than 40 years and women aged younger than 20 years, whereas breast cancer leads among women aged 20 to 59 years. Lung cancer leads in cancer deaths among men aged 40 years and older and women aged 60 years and older, causing more deaths in 2016 than breast cancer, prostate cancer, CRC, and leukemia combined.
The authors found that although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. A recent study estimated that approximately one‐third (34%) of cancer deaths in Americans aged 25 to 74 years could be averted with the elimination of socioeconomic disparities. In men and women combined, the black‐white disparity in overall cancer mortality has declined from a peak of 33% in 1993 (279.0 vs 210.5 per 100,000 population) to 14% in 2016 (183.6 vs 160.7 per 100,000 population). This progress is largely due to the steep drop in smoking prevalence unique among black teens from the late 1970s through the early 1990s.
If you or a family member may be the victim of cancer misdiagnosis in the United States, you should promptly consult with a medical malpractice lawyer in your state who may investigate your cancer malpractice claim for you and represent you or your family member in a cancer medical malpractice case, if appropriate.
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