Cancer Case Rates Increase, But Deaths Fall

"The U.S. is getting better at treating cancer. We're falling behind on preventing it.

Cancer rates are rising for many common cancers, including breast cancer, prostate cancer and melanoma, a new report found. Colorectal cancer is increasing for patients under age 55, part of a demographic cancer shift that is skewing younger for reasons that aren't completely clear.

These increases, along with persistent disparities, threaten the progress made over the past three decades in reducing cancer deaths.

"We're encouraged by the steady drop in cancer mortality," Rebecca Siegel, a senior scientific director at the American Cancer Society and lead author of the report published on Wednesday, said in a statement. "But as a nation, we've dropped the ball on cancer prevention."

Cancer death rates in the U.S. have dropped by a third from a peak in 1991 to 2021, thanks to declines in smoking, earlier detection and better treatments. Lung cancer is the greatest driver of the trend, with deaths dropping sharply even as the disease remains the biggest cancer killer in the U.S. by far.

The researchers looked at federal death data through 2021, the report said. Case trends were analyzed through the end of 2019. Missed screenings and diagnoses during the pandemic contributed to a 9% drop in case rates in 2020, but that is expected to rebound, the researchers said.

Through the end of 2019, incidence rates were increasing for some of the most common cancers, including breast, pancreatic, uterine, renal and HPV-related oral cancers, as well as melanoma. For breast cancer, the changes are connected in part to declining fertility rates and increasing obesity, while screening rates have held relatively steady, the report said.

The report found that the demographics of cancer patients are increasingly shifting from older to more middle-age adults. The changes are due to both sharp decreases in prostate and smoking-related cancers in older adults, and rising cancer risks for people born since the 1950s.

Colorectal cancer case rates, for example, are declining for those over 65. But there has been a steady increase for adults under 55 since the mid-1990s. For people under 50, colorectal cancer is now the leading cause of cancer-related death for men and second for women, behind breast cancer.

"We're seeing an increase in colorectal cancer in that group, and we're seeing it present as a more advanced disease," said Dr. William Dahut, chief scientific officer at the American Cancer Society. "This is likely to continue until we have mitigation strategies."

The rise in people under 50 with cancer diagnoses has alarmed doctors and researchers, spurring new screening guidelines and research into potential causes, including changes in diet, exercise and environmental factors. The change is linked to some known risks, including higher obesity rates, but hasn't been fully explained.

"It has been hard because the idea is that it has to do with early-age exposures, and now the world is very different than it was 40 years ago," said Brenda Diergaarde, a molecular epidemiologist at the UPMC Hillman Cancer Center in Pittsburgh.

Disparities based on race, wealth and geography also hold back progress. Black women have 41% higher breast cancer mortality compared with white women, even though their incidence is 4% lower, a gap that is stagnant since the mid-2000s.

Screening and other routine healthcare that was suspended during the Covid-19 pandemic has been slower to bounce back among people of color, the report said.

Cervical cancer incidence varies, with rates in states including West Virginia and Kentucky double those of Massachusetts, Vermont and Minnesota. That is due in part to differences in uptake of the HPV vaccine, which can help prevent the disease." [1]

1. U.S. News: Cancer Case Rates Increase, But Deaths Fall. Abbott, Brianna.  Wall Street Journal, Eastern edition; New York, N.Y.. 18 Jan 2024: A.3.