Cancer Death Rates Decline, But Disparities Remain

The National Prevention, Health Promotion, and Public Health Council recently announced the release of the National Prevention Strategy, a comprehensive plan that will help increase the number of Americans who are healthy at every stage of life. The National Prevention Strategy (pdf 1.8MB) recognizes that good health comes not just from receiving quality medical care, but also from clean air and water, safe outdoor spaces for physical activity, safe worksites, healthy foods, violence-free environments and healthy homes. Prevention should be woven into all aspects of our lives, including where and how we live, learn, work and play.

Finding strategies to help prevent cancer is a big part of improving the health and wellness of Americans. Cancer is a major public health problem in the United States and many other parts of the world. Currently, one in 4 deaths in the United States is due to cancer. Newly published statistics from the American Cancer Society show that cancer death rates in the U.S. continue to decrease, but that cancer death rates for the least educated segment of the population are 2 ½ times higher than for the most educated.

The annual report, "Cancer Statistics, 2011," published in the American Cancer Society’s journal, and its companion piece "Cancer Facts & Figures 2011," estimates the numbers of new cancer cases and deaths expected in the U.S. this year.


Dr. Otis W. Brawley, MD, chief medical officer of the American Cancer Society, talks about the significance of the new statistics.

As Dr. Leonard Lichtenfeld, Deputy Chief Medical Officer for the national office of the American Cancer Society, said on his blog:

"We have been hearing for the past several weeks about the things that could cause cancer. We have been inundated with media reports telling us what is bad for us and perhaps not so good for us. We have started a national conversation about cell phones, airport scanners and now Styrofoam and formaldehyde.
But sitting right in front of our noses is the fact that if we did what we already know, at least 37% of cancer deaths in people between the ages of 27 and 64 could be avoided right now."

He quotes Dr. Samuel Broder, former director of the National Cancer Institute -

POVERTY IS A CARCINOGEN

Some highlights of the report "Cancer Facts & Figures 2011":

• Death rates among African Americans for all cancers combined have been decreasing since the early 1990s. The decline has been larger in men (2.5% per year since 1995) than in women (1.5% per year since 1999). A similar decline in death rates has been observed among whites since the early 1990s, with a greater reduction in the rate among men than women.
• Despite these declines, the death rates for all cancers combined continues to be substantially higher among African Americans than whites, although the gap is much smaller among women.
• The racial difference in overall cancer death rates is due largely to breast and colorectal cancers in women and prostate, lung, and colorectal cancers in men.
• In recent years, death rates for lung and other smoking-related cancers and for prostate cancer have decreased faster in African American men than white men, contributing to the recent narrowing of the racial disparity in overall cancer death rates. Notably, lung cancer death rates for young African Americans and whites have converged in both men and women.
• In contrast to the trends for prostate and smoking-related cancers, the racial disparity has widened for colorectal cancer in both men and women and for breast cancer in women.
• The causes of these inequalities are complex and are thought to reflect social and economic disparities more than biologic differences associated with race. These include inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection, and treatment services.

A total of 1,596,670 new cancer cases and 571,950 deaths from cancer are projected to occur in the U.S. in 2011. Between 1990 and 2007, the most recent year for which data is available, overall death rates decreased by about 22% in men and 14% in women. This translates to about 898,000 deaths from cancer that were avoided. The American Cancer Society credits improvements in cancer prevention, early detection, and treatment.

"The nearly 900,000 cancer deaths avoided over a 17-year period stand in stark contrast to the repeated claim that cancer death rates have not budged," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. "Nonetheless, we refuse to be satisfied, and are committed to doing whatever it takes, not only to ensure cancer death rates continue to drop, but to accelerate the decline."

Highlights of the "Cancer Statistics, 2011" report include:

• Among men, cancers of the prostate, lung and bronchus, and colorectum account for more than half (about 52%) of all newly diagnosed cancers. Prostate cancer alone accounts for 29% (240,890) of incident cases in
• The three most commonly diagnosed types of cancer among women in 2011 are breast, lung and bronchus, and colorectum, accounting for about 53% of estimated cancer cases in women. Breast cancer alone is expected to account for 30% (230,480) of all new cancer cases among
• The lifetime probability of being diagnosed with an invasive cancer is higher for men (44%) than women (
• It is estimated that about 571,950 Americans will die from cancer, corresponding to over 1,500 deaths per
• Cancers of the lung and bronchus, prostate, and colorectum in men, and cancers of the lung and bronchus, breast, and colorectum in women continue to be the most common causes of cancer death. These four cancers account for almost half of the total cancer deaths among men and
• Lung cancer is expected to account for 26% of all cancer deaths among women in
• The lung cancer mortality rate in women has finally begun to decline, more than a decade later than the decline began in men. The lag in lung cancer trends in women compared with men reflects a later uptake of cigarette smoking in women, among whom smoking peaked about 20 years later than in
• Recent rapid declines in colorectal cancer incidence rates largely reflect increases in screening that can detect and remove precancerous
• The overall cancer death rate decreased by 1.9% per year from 2001-2007 in males and by 1.5% in females from 2002-2007, compared to smaller declines of 1.5% per year in males from 1993-2001 and 0.8% per year in females from 1994-
• Between 1990/1991 and 2007, cancer death rates decreased by 22.2% in men and by 13.9% in
• Mortality rates have continued to decrease for colorectum, female breast, and prostate
• Among men, the reduction in death rates for lung, prostate, and colorectal cancers account for nearly 80% of the total decrease in the cancer death rate, while among women, a reduction in death rates for breast and colorectal cancers account for almost 60% of the decrease.

The reports feature a Special Section on the impact of eliminating disparities on cancer deaths. Level of education is often used as a marker of socioeconomic status. In 2007, cancer death rates in the least educated segment of the population were 2.6 times higher than those in the most educated. This disparity was largest for lung cancer, for which the death rate was five times higher in the least educated than for the most educated. Differences in lung cancer death rates reflect the striking gradient in smoking prevalence by level of education; 31% of men with 12 or fewer years of education are current smokers, compared to 12% of college graduates and 5% of men with graduate degrees.

The special section also estimated the numbers of potential premature cancer deaths that could be avoided in the absence of socioeconomic and/or racial disparities. If all adults ages 25 to 64 in the United States in 2007 had the cancer death rate of the most educated non-Hispanic whites, 37% --or 60,370 out of 164,190—premature cancer deaths could potentially have been avoided. For African Americans, closing the gap between death rates among the most and least educated could potentially avert twice as many premature cancer deaths as eliminating racial disparities between blacks and whites, underscoring the preponderance of poverty in cancer disparities across all segments of the population.

Reducing cancer disparities will require breaking down barriers to health promotion and wellness care. As these reports have shown, there are thousands of cancer deaths that could be avoided by eliminating economic and racial disparities. Socio-economic status is the primary driver to the high death rate among different races. Poverty and low levels of education are prime factors in higher death rates from cancer. This years reports reinforce the truth:

POVERTY IS A CARCINOGEN

...