Cancer Death Rate Declines In U.S. First Drop In Rate Since We Began Keeping Records

Sparked by major improvements in prevention and treatment, the death rate from cancer in the United States has shown a sustained fall for the first time since scientists began keeping records, according to new research to be published Friday.

Since 1990, the ageadjusted death rate from cancer - the second-leading cause of death in this country after heart disease - has declined by about 3.1 percent. That translates to as many as 16,000 lives saved this year that would have been lost at the 1990 rate.

“The 1990s will be remembered as the decade when we measurably turned the tide against cancer,” said Dr. Richard Klausner, director of the National Cancer Institute. “This is the news we have been waiting for.”

Although the decline is relatively small, researchers believe it is a harbinger of further decreases in cancer deaths “because we are just beginning to see the effects of long-term reductions in smoking and of reduced exposure to other lifestyle carcinogens, such as alcohol and solar radiation,” said Dr. Philip Cole and Dr. Brad Rodu of the University of Alabama at Birmingham. The pair were co-authors of the report, which will appear in the journal Cancer.

“If the current momentum continues, it is likely that there will be a 25 percent decrease in the overall death rate from cancer, and possibly as much as a 50 percent decrease, in the next 20 years,” said John R. Seffrin, chief executive officer of the American Cancer Society.

The one caveat in the data is that the overall death rate, as compared to the age-adjusted death rate, continues to rise because the population is aging and cancer is a disease of aging. Virtually all health statistics in this country are statistically adjusted to combine the rates from individual age groups so that values are not biased by, for example, the elderly or by teenagers.

As the population ages, “the number of persons diagnosed with cancer and dying from it actually will increase rather than decrease,” noted epidemiologist Curtis J. Mettlin of the Roswell Park Cancer Institute.

“We think it will be possible to turn around the (overall death rate), but that is going to take several more years,” said Dr. Harmon Eyer, chief medical officer of the American Cancer Society.

The incidence of some types of cancer also continues to increase for reasons that are not clear. Mortality from non-Hodgkin’s lymphoma, multiple myeoloma and related cancers continues to rise, for example, as does the incidence of brain tumors.

The death rate from cancer has been growing consistently throughout the century. In 1900, the first year for which a meaningful estimate is possible, about 4 percent of all deaths in the United States were caused by cancer.

By 1970, cancer caused 17 percent of all deaths and the age-adjusted mortality rate was 129.9 deaths per 100,000 people. Both indicators peaked in 1990: the proportion of deaths at 24 percent and the mortality rate at 135.0 per 100,000.

Since then, the proportion of deaths caused by cancer has stabilized at 23 percent, while the mortality rate has fallen to 129.8 per 100,000, slightly lower than in 1970.

“The decline is accelerating and is now continuing at about 2 percent per year,” Cole said.

According to the National Cancer Institute, most of the overall drop in the death rate is due to declines in lung, colorectal and prostate cancer deaths in men and breast, colorectal and gynecologic cancer deaths in women. While the drop in lung cancer in men is caused by decreased smoking, the declines in the other types are attributable largely to improved detection, especially early detection by mammography and Pap screening in women.

Men are faring better than women. From 1991 to 1995, the mortality rate declined 4.3 percent in men, compared to a fall of only 1.1 percent in women. This is primarily because the death rate from lung cancer has continued to rise in women because of increased smoking, while it has fallen in men. Lung cancer mortality dropped 6.7 percent in men during this decade, but rose 6.4 percent in women.