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In 1996, the ACS challenged the nation to reduce cancer mortality by 50% between 1990 and 2015. Despite steady progress in many areas of cancer control, an interim report shows the United States is unlikely to meet that goal if current trends continue.

In fact, it could take until the year 2040 or longer, the report by members of the ACS's Ends Committee on Incidence and Mortality says.

However, applying knowledge and strategies about cancer prevention, early detection, and treatments that already exist could push the country closer, said lead author Tim Byers, MD, MPH, Professor of Preventive Medicine at the University of Colorado School of Medicine and a member of the ACS Board of Directors.

Byers and his coauthors used data on cancer risk factors from national health surveys (including the Behavioral Risk Factor Surveillance System) and cancer mortality data from the National Center for Health Statistics to make their projections. The findings appear in the ACS journal CANCER (2006;107,2:online June 12, 2006).

They determined that between 1990 and 2002, cancer mortality declined by about 1% per year for all sites combined, with steeper declines in certain cancers (breast and colorectal cancer in women and prostate, colorectal, and lung cancer in men). Those drops coincided with important trends in prevalence of risk factors and in use of cancer screening tests. Most of these changes were favorable, most notably the declines in smoking and use of hormone replacement therapy, and increased use of mammography and endoscopic screening for colorectal cancer. On the other hand, the prevalence of obesity increased substantially during the same period.

Declining cancer death rates have already prevented or delayed more than 315,000 deaths from cancer, the report says.

“This progress deserves celebration as a tangible and hard-won achievement in this nation's 35-year-long war on cancer,” notes an accompanying editorial by James S. Marks, MD, MPH, Senior Vice President and Director, Health Group, the Robert Wood Johnson Foundation, along with C. Tracy Orleans, PhD, and Karen K. Gerlach, PhD, MPH, also of the Robert Wood Johnson Foundation. However, “We must greatly accelerate our current rate of progress,” they add.

Indeed, if the current trends continue unchanged, the Byers report states about 1.8 million cancer deaths will have been prevented by 2015. But if the ACS goal is met, more than 2.3 million cancer deaths could be prevented.

Tobacco control holds the biggest promise for moving the country closer to the 2015 goals, Byers said. Smoking alone is responsible for some 30% of cancer deaths and 87% of deaths from lung cancer, the biggest cancer killer among both men and women.

“If smoking rates nationally were what they are in Utah or California, things would be a lot better,” he noted. These 2 states have the lowest prevalence of current cigarette smokers in the nation, 10.4 and 14.7%, respectively, of adults in 2004 (Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System [BRFSS] Prevalence Data, http://apps.nccd.cdc.gov/brfss/index.asp). (The nationwide prevalence was 20.4%.)

Reversing the obesity trend is also critical to success. Excess weight raises the incidence rates and decreases the survival rates for certain cancers. This is why obesity has an even greater impact on death rates than it does on incidence rates.

“During the same era we've had all these substantial improvements in cancer mortality, we've also had this increase in obesity,” Byers said. “I think that without the obesity epidemic we'd be in a better situation in many of these cancers.”

Byers also sees promise in targeted therapies. “Lots of these drugs are having really remarkable effects. They seem to have very specific effects for specific cancers, but if we get some surprises about agents that have more effects in more cancers, then that could make a big difference.”

But the challenges to progress are formidable. The US health care system is under strain from rising costs; economic disparities still prevent many people from accessing prevention services and cancer care; resources are tight across the board.

Marks and colleagues emphasize that it will take a concerted societal effort to overcome these obstacles.

“As a nation, we all recognize that understanding basic mechanisms of disease causation—the genetics, the bio-molecular mechanisms—are important for curing cancer and other diseases. Many of us have not been nearly as aware of and, accordingly, not as committed to, the understanding that how our society is organized, what our policies foster or inhibit, what our communities encourage and our health care institutions support are equally fundamental causes of good or ill health,” they say in their editorial.

Dan Smith, ACS National Vice President, Government Relations, sees a particular threat in proposed budget cuts for the National Cancer Institute and cancer-related programs provided by the Centers for Disease Control and Prevention (CDC).

“The investment we've made since 1971 [when the National Cancer Act was passed] has paid off in numerous ways,” Smith said. “It's ironic that at that very moment, we're pulling back on the things that have made this possible.”

Cancer costs the United States approximately $210 billion in direct and indirect costs each year, Smith said. Investing money and other resources in strategies that are known to work—like tobacco control and screening—could help reduce those costs and save lives.

“The biggest cancer control problem we're facing in the country is the idea that we can't afford to do this right now,” said Wendy Selig, ACS Vice President of Legislative Affairs. “But our answer is, we can't afford not to.”

ACS strategies for legislative advocacy include grassroots efforts like Relay for Life and Celebration on the Hill, an event that will bring thousands of cancer survivors to Washington to lobby their lawmakers for increased research funding and support of cancer control programs.

“We're poised to do great things,” Smith added, “but we need state, local, and federal governments—as well as private citizens—to get there.”

Byers points out another key partner in the effort: the nation's primary care clinicians. They must continue addressing smoking, obesity, and screening with their patients.

“Study after study shows that doctors do have influence and they need to remain engaged,” said Byers, himself a primary care physician. “In lots of ways, these downturns in cancer mortality are a success of primary care—getting people to stop smoking, to get mammograms, to get specialty care when they do get cancer.”

Such efforts on the part of doctors and others with an interest in public health must continue and grow, Marks and colleagues say.

“What we have learned in the past two decades about effective population-based risk reduction and health care quality improvement has driven unprecedented change,” they write. “But realizing the promise depends enormously on how we apply the fruits of scientific inquiry to close the gaps between ‘what we know’ and ‘what we do’ to eliminate preventable cancer deaths.” 

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Figure  . Despite recent progress against cancer, an interim report says the nation is unlikely to meet the American Cancer Society goal of reducing cancer mortality by 50% by the year 2015.

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