Rate of new cancer cases, deaths falls

The United States has passed an important milestone in the fight against cancer, researchers reported Tuesday: For the first time, the recorded rate of new cancer cases has fallen for both men and women.

At the same time, a 15-year decline in cancer death rates has accelerated, meaning people in whom the disease has been diagnosed are living longer.

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The report, published online Tuesday in the Journal of the National Cancer Institute, found the leading cancer scourges — including lung cancer, colon cancer and breast cancer — are on the wane, prompting experts to conclude that aggressive cancer-prevention and treatment efforts are paying off against the nation’s No. 2 killer.

If the trend holds, people may hear the words “it’s cancer” from their doctors less frequently in the years ahead.

“The drop in incidence seen in this year’s Annual Report is something we’ve been waiting to see for a long time,” Dr. Otis Brawley, chief medical officer of the American Cancer Society, said in a statement.

While heralding the development, Brawley and other cancer experts sounded notes of caution. Fewer men and women are being screened for prostate and breast cancer, they noted, which can mean fewer tumors get identified. And as the population ages and the economy worsens, access to screening and medical treatments may decrease, eroding the gains.

The downward trend in new cancer diagnoses spans several years and was teased out through careful statistical analysis by researchers from the American Cancer Society, the National Cancer Institute, the U.S. Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.

They found that cancer incidence — the rate at which new illnesses are diagnosed — dropped 0.8 percent annually between 1999 and 2006, a small but statistically significant reduction. The declines held for whites, blacks, Asian/Pacific Islanders and Hispanics.

“What we’re seeing is clear evidence that cancer prevention is working,” said Dr. Therese Bevers, medical director of clinical cancer prevention at M.D. Anderson Cancer Center in Houston.

Cancer death rates have been falling since 1993, but the report found that the rate of decline accelerated between 2002 and 2005, approaching nearly 2 percent a year. Experts credit more effective therapies and improved detection.

The positive trends don’t apply to all types of cancer. New cases are up for myeloma, non-Hodgkin lymphoma, melanoma, and cancers of the liver, kidney and esophagus. Death rates have risen for esophageal cancer in men, pancreatic cancer in women, and liver cancer for men and women.

Esophageal and liver cancers appear to be related to obesity, which is on the rise in the U.S., and liver cancers also may be associated with hepatitis C, which thousands of drug users contracted in the 1960s and 1970s.

“We still have a very long way to go,” said Ahmedin Jemal, director of cancer surveillance for the American Cancer Society.

Nonetheless, the latest numbers underscore some important victories in the war against cancer.

New cases of lung cancer, the second-most common cancer diagnosis for men and women, have skidded to their lowest level in more than 30 years for both sexes as increasing numbers of men and women have given up smoking. This month, the CDC reported the number of adults who smoke has dropped below 20 percent.

Meanwhile, new cases of colon cancer fell by more than 2 percent annually for men and women between 1998 and 2005, which experts attribute to more adults getting screened. By 2005, half of all adults 50 and older were being checked for colon cancer, up from 27 percent in 1987.

Why would more colon screenings mean fewer cases of cancer? Screening for this disease often allows pre-cancerous polyps to be detected and removed before colon cancer gets established. Colon cancer is the third-most common cancer diagnosis for men and women.

Less clear is the story surrounding prostate cancer, the No. 1 cancer for men, whose incidence rates plunged 4.4 percent annually between 2001 and 2005 after rising 2.1 percent in each of the previous six years.

Because it’s highly unlikely that risk factors for prostate cancer changed dramatically during that period, the drop-off is “probably due to changes in detection practices,” Jemal said.

Dr. William Catalona, a professor of urology at Northwestern University’s Feinberg School of Medicine, cites data indicating that 52 percent of men 50 or older reported having a test for PSA (prostate-specific antigen) in 2004, down from 58 percent in 2001.

The medical community is deeply divided over PSA testing, with some experts saying it is a valuable technique for detecting cancer early and others arguing that it leads to over-diagnosis and unnecessary medical interventions. Catalona falls in the former camp.

The picture for breast cancer, the No. 1 cancer for women, is similarly mixed.

Two years ago, researchers from M.D. Anderson announced a surprising 7 percent drop in breast cancer cases, which coincided with sharp reductions in women’s use of hormone replacement therapy.

But the new report shows that new breast cancer cases fell 2.2 percent a year between 1999 and 2005, indicating the falloff started several years before hormone replacement therapy became an issue. That suggests other factors are also involved.

Dr. Seema Khan, professor of breast cancer surgery at Northwestern, offers one explanation. As more women began having mammograms in the 1970s and 1980s, new diagnoses rose significantly because more early cases of breast cancer were being found. In previous years, they would have gone unnoticed.

As a result, fewer cases of advanced cancers cropped up in subsequent years, causing incidence rates to begin to fall off in the late 1990s.

In addition, the National Cancer Institute and the CDC last year reported a 4 percent decline in mammography rates between 2000 and 2005; that’s probably another reason fewer cases of breast cancer are being detected, Khan said.

Bevers of M.D. Anderson also thinks therapies such as tamoxifen and raloxifene, which prevent breast cancer in some women, have had an impact, along with the reduced use of hormone replacement therapy.

“The fact that breast cancer death rates are also down suggests that this is a real phenomenon, but we’ll have to watch carefully and see what happens in the years ahead,” she said.