Encouraging Signs and Trends in the National Status of Cancer
By Dr Zafar M. Iqbal
The National Cancer Institute (NCI), established 75 years ago, is the largest of the 27 Institutes and Centers that form the National Institutes of Health (NIH; Bethesda, MD), a part of the US Department of Health and Human Services. Under the National Cancer Act of 1971, with substantially increased government funding, NCI was further charged with coordinating the efforts in our fight against cancer with, both in-house biomedical research and clinical trials, and through grants and contracts to researchers in universities and other institutions. The budget request for 2013, after some leveling off in recent years, is for nearly $ 6 billion.
A collaborative report, sponsored by the American Cancer Society (ACS), the Centers of Disease and Prevention , NCI and the North American Association of Central Cancer Registries has just been published in Journal of the National Cancer Institute (7 January, 2013; see DOI: 10.1093/jnci/djs491 ).
This report, designed for scientists, patients and public at large , summarizes the current status of cancer, with progress and problems/concerns in different areas, along with such factors as the overall rates of new cancer diagnoses (or cancer incidence) and deaths in the US due to specific cancer-types. This information is further broken down according to gender, age, and other factors such as race, ethnicity, region of the country, and lifestyle choices (smoking, drinking, and diet-related weight problems). The report also highlights new areas the scientists found most promising but need additional support.
There are some encouraging signs and trends in the national status of cancer. Perhaps the most hopeful, as shown in Figure 1, is that in the US, overall cancer death rates for most of the common cancer sites in both men and women of major racial and ethnic groups continued to decrease in 2012. This decrease is consistent with a steady, unmistakable trend in recent years, notably since early 1990s. During 2000-2009, the decrease in death rates per year amounted to 1.8% in men, 1.4% in women, and 1.8% in children (14-year old and younger). In the same 10-year period, the death rates decreased in men with 10 out 17 common cancers (including lung, prostate, leukemia, non-Hodgkin lymphoma, kidney and others), but increased both in men for six other cancer-types (including melanoma of the skin, and cancers of the pancreas, thyroid, and liver and myeloma) and in women with the cancer of the uterus.
Cancer incidence rates during the same 10-year period decreased in men by 0.6% per year, but remained stable in women and increased by 0.6% per year in children under 14. In men, the incidence rates decreased for five cancer-sites (prostate, lung, colon, stomach and larynx) and increased for six others (kidney, pancreas, liver, thyroid, melanoma and myeloma) of 17 most common cancers. Among women, the incidence rates decreased for these seven (lung, colon, bladder, cervix, oral cavity/pharynx, ovary and stomach) and increased in cases of seven cancer-sites (thyroid, melanoma. kidney, pancreas, leukemia, liver and uterus) out of the 17-18 most common cancers. Besides this, the incidence rates remained stable for other main sites, including breast cancer in women and non-Hodgkin lymphoma in both men and women.
In his testimony before the Congress, the NCI Director, Dr. Harold Varmus, also emphasized the beneficial effects of cancer preventive, health-conscious, life-style trends:
1. Length of survival in all cancer patients after diagnosis has increased by about 67% since 2003.
2. Cigarette smoking in adults, the main possible cause of lung cancer, has slowly declined since 1991, even though one in five is still a smoker. Exposure to side-stream smoke has also declined since 1990s, thanks to indoor air legislations by the states and cities.
3. Sun protective behaviors have increased since 2005, although not as much in young adults. Indoor tanning has also generally declined in the last eight years.
He also stressed on some problem areas that demand more attention, for instance:
1. Although among the smokers, those who are trying to kick the habit have increased to 50%, the successful quitting has been low, despite slight improvement recently. Initiation rates among 18-25 year olds have risen. In children and young non-smoking adults living with smokers, exposure to side-stream (or ‘second hand’) tobacco smoke has been on the rise.
2. Since the mid-1990s, though alcohol consumption has risen slightly, the intake of fruit and vegetables has not. Nor has there been a decline in the consumption of red meat and fat. More people are now overweight or obese.
3. Among young females, one in five used indoor tanning last year, which puts them at increased risk of skin cancer. This use has been lower in Hispanic males and females, and lowest in non-Hispanic blacks. Despite an increase in sun-protective behavior in adults, there have been more sunburn incidences in them since 2005.
4. Disparities remain in cancer statistics among population subgroups: rates of both cancer incidence and deaths are higher in blacks than any other population subgroup.
5. Among women, rates of Pap tests and mammography (2008-2010) were stable at 67% (down from 81% and 69%, respectively, in 2000). By comparison, screening rates for colorectal cancer, despite its proven effectiveness, are lower.
6. Expenditure for cancer treatment continues to increase, as does the overall healthcare.
On cancers associated with human papilloma virus (HPV), which received special emphasis in this annual report, the incidence rates for HPV-associated oropharyngeal cancer were found to be on the increase in white men and women. Since the national three-dose-vaccination coverage for 2008-2010 in the adolescent girls remained low in the US during 2008-2010, particularly in the lower socioeconomic groups, the incidence of some HPV-associated cancers may increase.
More information for public, patients, and those in science or healthcare interested in specific cancer-sites and trends, including concise scientific reports, preventive measures and interactive resources on cancer, can be found in this comprehensive JNCI link : http://www.cancer.gov/statistics/find#report and NCI Press release: http://www.cancer.gov/newscenter/newsfromnci/2013/ReportNation .
For the latest topical reports, interactive maps and graphs, and cancer statistics by cancer type, geographic area, and demographic subgroups, see these links: http://www.cancer.gov/statistics/find#report ; http://progressreport.cancer.gov/ .
Besides NCI, other private agencies (e.g., ACS) and foundations (e.g., Howard Hughes Biomedical), also provide helpful information.
Further help for those interested in various cancer-related issues, including scientific progress on specific cancer site and clinical trials, is also available via telephone: 1-800-4-CANCER. (The author joined the National Cancer Institute in 1970, about a year before the National Cancer Program Act (1971) and worked there through 1974. Since then and for the next two decades, he has been an NCI / NIH grantee and served on its various advisory groups.)