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Cancer cases, deaths go down

 
Published March 13, 1998|Updated Sept. 12, 2005

For the first time since the 1930s, the number of new cancer cases in the United States is declining, federal officials said, announcing a sharp reversal in the incidence of diseases that kill more than 1,500 Americans each day.

Deaths from cancer are also dropping, continuing a trend that was first reported in November 1996. Together, the two developments offer experts new hope that 27 years after President Richard Nixon declared "war on cancer," the nation may have reached a turning point.

"The burden of fear the public has been feeling should begin to lift," said Dr. James Marks of the Centers for Disease Control and Prevention, in releasing a national report card on cancer at a news conference here. "Cancer is conquerable and progress is being made."

Experts attribute the decline in new cases to changes in behavior, most notably a drop in smoking, and the decline in deaths to increased screening and better therapies. But the positive trends are not benefiting all Americans; minorities and women remain particularly at risk.

From 1990 to 1995, the study found, cancer rates for men and women of every race dropped, with one notable exception: black men. They have the highest cancer rates of any group in the nation, mainly because of a sharp rise in new cases of prostate cancer.

In the same period, new cases of breast cancer increased for black women. And new cases of lung cancer, while dropping sharply among men, rose among women who were white, Asian and Pacific Islander.

"The gaps between what we know and what we do are greater for racial and ethnic minorities," said Marks, director of the National Center for Chronic Disease Prevention and Health Promotion.

Minorities, he added, are "less likely to be screened, less likely to have cancer detected early and less likely to get the best therapy."

The incidence of cancer in the United States has been rising since the 1930s, although the government has been keeping detailed annual statistics only since 1973. The rate of all new cancers combined dropped an average of 0.7 percent per year from 1990 to 1995, according to Thursday's report, which was jointly released by the disease control centers in Atlanta, the National Cancer Institute in Bethesda, Md., and the American Cancer Society in New York.

That drop is in contrast to a steady climb from 1973 to 1990, when incidence increased an average of 1.2 percent annually. The sharpest drop occurred after 1992, when new cases of cancer appeared to have peaked. That year, cancer was diagnosed in 426 of every 100,000 Americans; by 1995, the figure had dropped to 392.

Death rates, meanwhile, declined 0.5 percent per year from 1990 to 1995; from 1973 to 1990, death rates increased 0.4 percent each year. Preliminary data from 1996 indicate that the recent downward trend is continuing. But men benefited more from the recent declines than did women. And among Asian and Pacific Islander women, death rates are up.

According to the cancer society, cancer accounts for 1 of every 4 deaths in this country; an estimated 564,800 Americans are expected to die of cancer this year. In the United States, men have a risk of 1 in 2 for developing cancer; for women, it is 1 in 3.

At the same time, there are more cancer survivors than ever. Dr. Richard Klausner, director of the National Cancer Institute, said that on Thursday 8.5-million Americans were living with a history of cancer, but not all are considered cured.

Since 1971, when Nixon announced a national crusade to cure cancer, to be fashioned in the mold of efforts that "split the atom and took man to the moon," the United States has spent more than $30-billion on cancer research. Dr. John Seffrin, chief executive of the cancer society, said today's report card proved that investment had paid off.

"This is about results," Seffrin told reporters, "very positive results. It is about transforming hope into progress through science."

But because cancer is really a variety of different diseases lumped together under one umbrella, there are many subplots to the overall story, some of them more dismaying than hopeful.

The numbers "are just a snapshot of where we are and where we have been," said Klausner, the cancer institute director. Beneath them, he said, "are complexities and many questions."

Lung cancer, prostate cancer, breast cancer and cancer of the colon and rectum are the four most common types; together they account for about 54 percent of all newly diagnosed cancers. With the exception of breast cancer, the study found, African-Americans had higher rates of each of these diseases than Americans who are white, Asian, Pacific Islander and Hispanic, who can be of any race.

For example, while the rate of prostate cancer among white men for the 1990-95 period was 24 per 100,000 people, the corresponding rate for black men was 55 per 100,000. For breast cancer, there were 26 cases per 100,000 white women and 31.5 cases for black women. Among whites of both sexes, there were 49 cases of lung cancer per 100,000 individuals and 60 cases per 100,000 among blacks.

The research, being published in Sunday's issue of the journal Cancer, analyzed death statistics kept by the disease control centers, as well as figures from the Surveillance, Epidemiology and End Results program, a national registry of 23 cancers. The registry has been maintained by the cancer institute since 1973.

Some of the trends identified by the study are difficult to explain. For instance, regions of the country that have reported the greatest decline in deaths from prostate cancer are those where men are screened less frequently. And while recent studies have shown that black women are catching up to white women in their use of mammography, death rates from breast cancer remain much higher among black women than among whites.

The trends in lung cancer are directly linked to cigarette smoking. The percentage of Americans who smoke has been cut roughly in half since 1964, when the surgeon general's office issued its first report warning of the dangers of smoking. That accounts for the overall declines in new cases and deaths due to lung cancer.