Cancer Survival Rates Up
By Amanda Gardner, HealthDay Reporter
THURSDAY, June 3 (HealthDayNews) -- For the first time ever, lung cancer rates have begun to drop among American women.
And survival rates for many other types of cancer are improving for both men and women.
That's the encouraging news from the Annual Report to the Nation on the Status of Cancer. The report, which covers the period from 1975 to 2001, appears in the June 3 issue of Cancer.
Not all the news is positive, however. The decline in death rates was more dramatic in men than in women from 1992 to 2001. And all ethnic and racial groups -- except Asian/Pacific Islander women -- had a higher risk of dying from cancer than whites.
But health experts are encouraged by the increase in survival rates for many cancers and the decline in lung cancer rates among women.
Rates of lung cancer -- the number one cancer killer -- have declined approximately 2 percent a year among women since 1998. Men experienced a similar drop in lung-cancer diagnoses years ago -- reflecting the fact that many American women started smoking decades after men did and many men began kicking the habit years before women tried to do so.
Also, death rates from lung cancer have begun to plateau among women, remaining constant since 1995, according to the report.
"We're seeing the impact of quitting smoking among the early [women] smokers," said Brenda K. Edwards, director of the National Cancer Institute's Surveillance Research Program.
Edwards is one of several authors of the annual report, a collaboration between several different health organizations that include the National Cancer Institute (NCI) and the American Cancer Society.
While previous reports only looked at the four most common cancers, this one examines the top 15 and includes a racial/ethnic breakdown.
Overall, cancer incidence rates dropped 0.5 percent between 1991 and 2001 for men and women, while death rates declined 1.1 percent between 1993 and 2001. A higher percentage of patients are also surviving five years after their initial diagnosis, according to the study. The five-year survival rate is a significant milestone for cancer patients.
When it comes to other types of tumors, colorectal cancer rates decreased while prostate cancer rates increased, perhaps reflecting better detection methods.
"It's probably a function of the sensitivity of the PSA [prostate-specific antigen] test and picking up cancers much earlier than we were able to do in the past," said Dr. Louis Harrison, chairman of radiation oncology at Beth Israel Medical Center and St. Luke's Roosevelt Hospital Center in New York City.
Improvements in cancer rates, however, were not equally distributed. The decline in death rates was more dramatic in men (1.5 percent a year between 1993 and 2001) than in women (0.8 percent annually from 1992 to 2001).
And, all ethnic and racial groups (except Asian/Pacific Islander women) had a higher risk of dying from cancer than whites.
"The issue of differences in outcome based upon socioeconomic class is not surprising to anyone in the field," Harrison said. "It just highlights the need to better serve the underprivileged population."
In addition to lung cancer, the incidence of five cancers among women -- colon, cervix, pancreas, ovary and oral cavity -- dropped. But rates for breast, thyroid, bladder, kidney cancer and melanoma rose. Women with colon, kidney and breast cancers, as well as non-Hodgkin's lymphoma, are surviving longer than ever, according to the report.
Breast cancer rates increased 0.4 percent per year from 1987-2001, a slower rate of increase than before 1987. Death rates from breast cancer decreased beginning in the early 1990s, with steeper declines among white women than black women. Rising breast cancer incidence rates during the 1990s have been attributed, in part, to increased mammography screening.
For men, incidence rates decreased for seven of the top 15 cancers -- lung, colon, oral cavity, leukemia, stomach, pancreas and larynx. On the other hand, the rates increased for melanoma as well as prostate, kidney and esophageal cancer. Men with prostate, colon and kidney cancers, as well as non-Hodgkin's lymphoma, melanoma and leukemia, saw their survival rates boosted more than 10 percent.
Survival rates increased dramatically for childhood cancers during the past 20 years: 20 percent in boys and 13 percent in girls. Right now, 75 percent of children with cancer can expect to live five years or longer, a huge advance from 40 years ago, when most childhood cancers were fatal, the researchers said.
The report also uncovered racial disparities.
Black men had the highest incidence of cancer and the highest death rates for all cancers combined. The incidence of prostate cancer for black men was 62 percent higher and the death rate twice as high, compared to white men.
Black women had the highest deaths rates for all cancer sites combined, the report found. Death rates from breast cancer were almost 30 percent higher than for white women, despite a lower incidence of the disease.
Hispanic/Latino women had higher cervical and gallbladder cancer incidence rates and gallbladder cancer death rates than other racial/ethnic populations.
The big-picture improvements are most likely due to a combination of factors, Harrison said.
"Early detection is important," he said. "I also think there is no question that therapies for cancer have improved. Surgery is better. Radiation therapy is better. There are new drugs."
"One of the things that isn't obvious from the report is that in addition to a lower mortality rate and a lower incidence of certain cancers, what has also happened is that cancer treatment has become less toxic," Harrison added. "Treatments are very focused on quality of life and trying to minimize the damage that's done to people in the pursuit of treating cancer. People are not only living longer, they're living better."
More information
The National Cancer Institute has questions and answers (www.cancer.gov) about the report. 
SOURCES: Brenda K. Edwards, Ph.D., associate director, Surveillance Research Program, National Cancer Institute, Bethesda, Md.; Louis Harrison, M.D., clinical director, Continuum Cancer Centers of New York, and chairman, radiation oncology, Beth Israel Medical Center and St. Luke's Roosevelt Hospital Center, New York City; June 3, 2004, Cancer
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