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Guest column

National cancer report shows decrease in death rates

By V. UPENDER RAO
Published January 9, 2006

The National Cancer Institute has issued the annual report to the nation on the status of cancer. It shows that the cancer death rates for all racial and ethnic populations combined had decreased by 1.1 percent per year from 1993 to 2002.

This period was chosen because it gave the best long term perspective on the cancer incidence and death rates among all races combined. The decline was greater in men (1.5 percent) than in women (0.8 percent). Death rates decreased for 12 of the 15 top cancers in men and nine of the top 15 cancers for women. Death rates are the best indicator for progress against cancer.

While the death rates have decreased for men and women, the incidence has risen at an annual rate of 0.3 percent for women since 1987. This increase is attributable to the increase in breast, thyroid, bladder, kidney cancers and lymphoma, melanoma and leukemia.

Data from 1998 to 2002 reveal that the incidence of female lung cancer has stabilized after an increasing trend for many years. Some of the increase in incidence can be accounted for by the introduction of screening programs and installation of newer, more sensitive diagnostic equipment, which tends to detect more cancers from the same existing pool and at an earlier stage and time.

The authors of this report found that the contemporary cancer treatment was in accordance with the "gold standards of care," as outlined in the National Institutes of Health Consensus Development Statements.

For early stage breast cancer there was an increasing trend toward breast conserving surgery and radiation as compared with modified radical mastectomy, a greater use of chemotherapy and hormone therapy for younger patients, and predominantly hormonal therapy for older receptor positive patients.

For stage III colorectal cancer, adjuvant chemotherapy increased rapidly between 1987 and 1992. The benefit of chemotherapy did not reach all age groups, however. The older and those with other medical conditions were less likely to be offered chemotherapy. For lung cancer there was an increasing trend for chemotherapy for late-stage disease, especially since 1990. For ovarian cancer, the older drug cyclophosphamide was replaced by Taxol.

Unlike most other cancers, prostate cancer treatment trends were more controversial. The report indicated that the usage of watchful waiting and chemical or surgical castration decreased and more aggressive surgical and radiation techniques were on the rise.

The overall cancer incidence and death rates were higher for black men than for whites. Black men were also less likely to receive aggressive treatments than white men.

In general, cancer rates for Asian/Pacific Islander, American Indian/Alaska Native and Hispanic/ Latino populations were lower than those for whites. These populations, however, had a greater burden of stomach and liver cancers as compared with the white population.

The purpose of this report is to provide the trends in incidence and death rates and changing patterns in care. The Centers for Disease Control and Prevention, the American Cancer Society, the National Cancer Institute and the North American Association of Central Cancer Registries collaborated in creating this report.

--V. Upender Rao, MD, FACP practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified January 9, 2006, 00:56:11]