Cancer death decline hits second year, may mark trend

A second straight year of declining cancer deaths announced Wednesday marks the beginning of what is expected to be a long-term drop as the success of anti-smoking campaigns launched decades ago accelerates progress against the biggest cancer killer of all – lung cancer.

The American Cancer Society reported that cancer deaths in 2004 dropped by 3,014, driven by sharp declines in colon and rectal cancer fatalities, which total about 52,000 per year.

But the biggest declines in the coming years are expected to be in tobacco-driven tumors in women. Lung cancer kills about 160,000 men and women in the U.S. each year.

Previous drops in cancer death rates have been fueled by steep declines in smoking among men, but women have lagged nearly two decades behind them in heeding the call to quit.

Lung cancer rates among women have begun to plateau and are expected to begin falling soon, mirroring the pattern observed in men 15 years ago.

“What we are seeing now is the peak of the lung cancer epidemic in women,” said epidemiologist Elizabeth Ward, one of the authors of the new report. “We would anticipate that deaths would start heading down.”

The improvements in battling this once uniformly lethal disease are expected to be augmented by declines in other cancers as screening and treatment are extended to underserved populations.

But experts cautioned that the growing incidence of obesity and declines in physical activity threaten to reverse many of the hard-won gains.

In addition, doctors warn that access to cancer care also needs to be improved. “For all cancers, African American men have a 38 percent higher death rate than Caucasians and African American women have an 18 percent higher rate,” said Dr. Christy Russell, an oncologist at the University of Southern California/Norris Cancer Hospital. “I find those statistics sobering.”

Next to heart disease, cancer is the second leading cause of death in the U.S. with 553,888 deaths in 2004, according to information from death certificates compiled by the National Center for Health Statistics. An estimated 1,444,000 cancers were diagnosed that year.

Last year, the cancer society announced the first drop in cancer deaths in more than 70 years with results from 2003. But the small size of the decline – 369 deaths – led many to question its significance.

“This second consecutive drop … much steeper than the first, shows last year’s historic drop was no fluke,” said John R. Seffrin, the society’s chief executive.

Cancer death rates actually have been declining for 13 years, but the lowered rate has been overwhelmed by growth of the population, leading to an increase in the absolute number of deaths, he said.

The latest drop in cancer deaths occurred across all four major cancer types – lung, colon and rectal, prostate and breast – although lung cancer deaths in women stayed relatively constant.

The biggest decline was in colorectal cancer, where mortality dropped 5.7 percent from 2003. Ward attributed the decline largely to increased screening for polyps, which are precursors of colorectal tumors, although lowered smoking contributed to it.

The rate of breast cancer, which accounts for one in every four cancer cases in women and killed 40,954 in 2004, has been declining due to increased mammography and more aggressive therapy, said Russell.