Cancer Now on Decline in the U.S., Study Shows

WASHINGTON —  For the first time in nearly 20 years, the incidence of all cancers combined--and most of the leading types of cancer--declined from 1990 to 1995 in the United States, health officials announced Thursday. Death rates from the disease also decreased.

The drop in the rate of new cases represents a reversal of a discouraging trend of escalating cancer incidence over nearly two decades, while the decline in the death rate sustains a turnaround noted for the first time last year.

Moreover, preliminary findings from 1996 show that declines in both incidence and death rates are continuing, officials said.

“The chances of getting cancer are declining, and the chances of dying from cancer are declining even faster,” said Dr. James S. Marks, an official at the Centers for Disease Control and Prevention.

Describing cancer as “one of the most feared diseases, and rightfully so,” Marks said that with the new statistics, “the burden of fear should begin to lift.”

Stressing that “behind the numbers are people’s lives,” Dr. Richard Klausner, director of the National Cancer Institute, said that in 1995 alone, the trends translate into 25,000 to 30,000 fewer cancer deaths and 70,000 fewer new cancer cases.

Klausner added: “These numbers do not reveal real improvements in the quality of life for cancer survivors [who number about 8.5 million Americans]. We did not trade improved survival for a worsened quality of life.”

Officials attributed the declines to numerous factors, chief among them earlier detection through screening, improvements in cancer treatments and such lifestyle changes as quitting smoking and healthier diets.

The officials added that Americans still need to be more vigilant in undergoing screenings, particularly for colon-rectum and breast cancer. “One-third of American women have never had a mammogram, and 20% don’t have them regularly,” Marks said.

The new report, to be published in the March 15 issue of the journal Cancer, shows that after increasing an average of 1.2% per year from 1973 to 1990, the incidence for all cancers declined an average 0.7% annually over the next five years, said officials from the NCI, CDC and American Cancer Society.

Overall death rates dropped an average of 0.5% each year starting in 1990, after having increased annually by 0.4% from 1973 to 1990.

The decline in deaths in recent years was seen more in men than in women. It also was reflected in almost all racial and ethnic groups, except for Asian and Pacific Islander women, the officials said.

Also, African Americans still are more likely to develop cancer than whites and are about 30% more likely to die of cancer than whites.

The report looked at 23 types or “sites” of cancer and focused heavily on the four cancers that accounted for the leading incidence and deaths for the five-year period beginning in 1990: lung, prostate, breast and colon-rectum.

These cancers account for more than half of all newly diagnosed cases.

The incidence of breast cancer, the most commonly occurring cancer in women, remained level in 1990-95 after having increased rapidly in 1973-90; death rates in 1990-95 decreased but only for white women and Latinas. The breast cancer death rates remained level for black women and appear to be on the rise for Asian and Pacific Islander women, the report says.

The incidence and mortality rates of prostate cancer both declined. Incidence declined for both white men and, more recently, for African Americans, the report says. Death rates from prostate cancer have dropped for all except Latinos, officials said.

The report is tempered, however, by data showing a rise among women both in the rate of new lung cancers and in lung cancer deaths, in contrast with a drop in both measures among men. This is likely explained by the surge in the smoking rate among women in past years, officials said.

For cancer of the colon and rectum, incidence and mortality have declined for both men and women, the report says.

The news about some other cancers was less encouraging. Both incidence and mortality from non-Hodgkin’s lymphoma and melanoma, a deadly form of skin cancer, are increasing; also, the decline in the incidence of uterine cancer has leveled off.

Health officials warned that the large number of children who are still taking up smoking--estimated at 3,000 every day--could reverse the statistics unless efforts to curb tobacco use are stepped up.

“We must protect our children,” said John R. Seffrin, chief executive officer of the Cancer Society, “If we, or Congress, allow [a reversal in the statistics] to happen, shame on us.”

Health officials also acknowledged that major inequities in access to care, particularly among poor people and minorities, likely explains some of the disparities in the new statistics.

“We realize that the declines in cancer incidence and deaths have not been seen for all Americans and that our collective efforts must be directed at reaching populations with a disproportionate cancer burden,” Marks said.

Cancer incidence differs significantly between the United States and other countries, but once immigrants move here and embrace U.S. habits, they begin to experience the same cancer patterns as Americans.

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Cancer Rates Dropping

Cancer cases have declined an average of 0.7% a year since 1993, after increasing 1.2% a year from 1973 to 1992. Cancer death rates declined an average of 0.5% a year from 1990 to 1995.

Reported Incidents (Rate per 100,000 for all races and both sexes.)

‘92: 426.2

‘93: 412.5

‘95: 392

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Study Findings

These cancers accounted for more than half of the newly diagnosed cases from 1990 to 1995.

* Lung: More men quitting smoking.

* Breast: More women getting mammograms and better treatment.

* Prostate: After a surge in cancer screening tests, a decrease in screening may be occurring.

* Colon-rectal: More people getting precancerous polyps removed.

Source: National Cancer Institute

researched by JULIE SHEER / Los Angeles Times