Cancer mortality goes down as diligence pays off

Washington -- Deaths from cancer are continuing a downward trend that began in the early 1990s. However, the rate of new cancers diagnosed is holding steady, according to the "Annual Report to the Nation on the Status of Cancer, 1975-2003." It was released on Sept. 6.

Its take-away message for physicians is this, say experts: Great job, but don't stop yet.

Despite the decreasing mortality rates, cancer continues to take a toll on the nation, with nearly 1.4 million new cases expected this year, based on American Cancer Society statistics. But the report, developed by federal health agencies and leading cancer organizations, shows that screenings that catch cancer at its earliest stage and the wider application of new and more effective treatments are having a favorable impact.

"There are now more than 10 million cancer survivors in this country," noted Martin Abeloff, MD, director of the Johns Hopkins Kimmel Cancer Center in Baltimore. "Progress is being made, and people are living longer even if they are not cured."

Dr. Abeloff looks forward to the day when the incidence rate also starts dropping and to that end urges more effort on anti-smoking initiatives so that tobacco use, a major cause of cancer, can be eliminated completely.

"There is much more work to be done because we still have far too many people dying from cancer," he said.

Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH, also cautioned against complacency.

"We must continue to fight to ensure that resources are available to address the importance of prevention, screening and early detection and promoting healthy behaviors which are proven strategies to reduce the burden of cancer," Dr. Gerberding said in a statement.

A rapidly growing minority

For the first time, the report also includes a special section on the nation's 35 million Hispanics -- a diverse and fast-growing group whose countries of origin include Mexico, Puerto Rico, and several Central and South American nations. It shows that this group had lower incidence rates than did non-Hispanic whites for most cancers, but were less likely to be diagnosed at an early, and therefore more curable, stage.

Information on the nation's Hispanic population is particularly relevant given its recent growth nationally. From 1990 to 2000 their numbers increased by 58% while the total U.S. population increased by only 13%, said Barry Miller, PhD, an epidemiologist with the Surveillance Research Program at the National Cancer Institute and an author of the report. He spoke at a National Institutes of Health briefing marking its release.

NCI Director John Niederhuber, MD, also said in a statement that he was encouraged by the lower cancer rate among Hispanics but the finding that they are diagnosed at a more serious stage underscores the need for education on the importance of screenings as well as other ways to reduce cancer risk, including lifestyle changes.

Hispanics are also more likely to lack health insurance than other groups, according to the report, making them less likely to visit a physician regularly.

Cancer of the lung, colon and rectum, prostate, female breast and cervix were among those detected at later stages among Hispanics, and there are effective screening techniques for several of these cancers.

With that in mind, Elmer Huerta, MD, MPH, director of the Cancer Preventorium at Washington Hospital Center in Washington, D.C., has been working since 1994 to educate the Hispanic community on the value of cancer screening and preventive health in general. To date, he has seen nearly 19,000 patients, he said at the NIH briefing.

They pay $120 for a battery of tests from Pap to PSA to depression screenings at his preventorium, which, he noted, is a word he invented to shift the focus from treatment to disease prevention.

Although the report found lowered incidence rates for most cancers among Hispanics, the infectious agents that cause cancers -- such as human papillomavirus, Helicobacter pylori and hepatitis B and C viruses -- were found to be more common among this population. Additionally, rates for leukemia, retinoblastoma, osteosarcoma and germ cell tumors were found to be higher among Hispanic children.

The new report provides comprehensive data on trends detected over the past several decades for all major cancers. It shows the long-term decline in overall cancer death rates continued through 2003 for all races and both sexes. The declines were greater for men, at 1.6% per year, than for women, at 0.8% per year.

Although the annual rates of decrease may not look high, they do add up to 16% for men and 8% for women over the past decade, said Len Lichtenfeld, MD, the American Cancer Society's deputy chief medical officer.

Death rates decreased for 11 of the 15 most common cancers in men and for 10 of the 15 most common cancers in women. The report's authors attribute this decrease to successful efforts to reduce exposure to tobacco, earlier detection through screening and more effective treatment.

The data also suggest the rate at which lung cancer among women is being diagnosed slowed from 1991 to 2003, perhaps as the anti-smoking message, which seems to have been heard by men, is also taken to heart by women.

"The greater decline in cancer death rate among men is due in large part to their substantial decrease in tobacco use," said Betsy A. Kohler, MPH, president of the North American Assn. of Central Cancer Registries. "We need to enhance efforts to reduce tobacco use in women so that the rate of decline in cancer death rates becomes comparable to that of men."

The report, first issued in 1998, is a collaborative effort by the North American Assn. of Central Cancer Registries, the National Cancer Institute, the American Cancer Society and the Centers for Disease Control and Prevention. It will be published in the Oct. 15 Cancer.