[ RadSafe ] ANNUAL REPORT TO THE NATION FINDS CANCER DEATH RATES STILL ON THE DECLINE

Tue Oct 4 15:48:43 CDT 2005

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Subject: ANNUAL REPORT TO THE NATION FINDS CANCER
DEATH RATES STILL ON THE DECLINE

U.S. Department of Health and Human Services 
NATIONAL INSTITUTES OF HEALTH NIH News 
National Cancer Institute (NCI)
http://www.cancer.gov/

EMBARGOED FOR RELEASE: Tuesday, October 4, 2005; 4:00
p.m. ET 

CONTACT: NCI Press Office 301-496-6641 (NCI Press
Officers), CDC Press Office 770-488-5131 (Anita
Blankenship), ACS Press Office 213-368-8523 (David
Sampson), NAACCR 217-698-0800, ext. 2 (Holly Howe) 

ANNUAL REPORT TO THE NATION FINDS CANCER DEATH RATES
STILL ON THE DECLINE: 
Progress in Cancer Treatment Varies by Disease

The nation's leading cancer organizations report that
Americans' risk of dying from cancer continues to
decline and that the rate of new cancers is holding
steady. The "Annual Report to the Nation on the Status
of Cancer, 1975-2002," published in the Oct. 5, 2005,
issue of the "Journal of the National Cancer
Institute" *, finds observed cancer death rates from
all cancers combined dropped 1.1 percent per year from
1993 to 2002. According to the report's authors,
declines in death rates reflect progress in
prevention, early detection, and treatment; however,
not all segments of the U.S. population benefited
equally from advances, a point outlined in a featured
analysis of treatment trends. 

First issued in 1998, the "Annual Report to the
Nation" is a collaboration among the National Cancer
Institute (NCI), which is part of the National
Institutes of Health (NIH), the Centers for Disease
Control and Prevention (CDC), the American Cancer
Society (ACS), and the North American Association of
Central Cancer Registries (NAACCR). It provides
updated information on cancer rates and trends in the
United States. 

According to NCI Director Andrew C. von Eschenbach,
M.D., "These numbers reflect a trend in reduction of
cancer mortality that has now persisted for six years.
This can only be considered good news for the millions
of cancer survivors who have benefited from recent
research and treatment advances and emphasizes the
expectation that we will achieve a time when no one
will suffer or die from cancer." 

Death rates from all cancers combined declined 1.5
percent per year from 1993 to 2002 in men, compared to
a 0.8 percent decline in women from 1992 to 2002 **.
Lung cancer is the leading cause of cancer deaths in
both men and women. Death rates decreased for 12 of
the top 15 cancers in men, and nine of the top 15
cancers in women. 

"Declines in mortality rates from many tobacco-related
cancers in men represent an important, but incomplete,
triumph of public health in the 21st century," said
John R. Seffrin, Ph.D., chief executive officer of the
ACS. "These trends reinforce the importance of tobacco
control programs in the U.S., as well as measures to
combat the increase in tobacco use in other parts of
the world, particularly in developing countries." 

Overall cancer incidence rates (the rate at which new
cancers are diagnosed) for both sexes have been stable
since 1992. Incidence rates were stable in men from
1995 to 2002 and increased 0.3 percent annually in
women since 1987 to 2002. The persistent increase in
overall cancer incidence rates for women can be
attributed to increases in rates for breast and six
other cancers:  non-Hodgkin lymphoma, melanoma,
leukemia, and thyroid, bladder and kidney cancer.
However, according to more recent data from 1998 to
2002, female lung cancer incidence rates have begun to
stabilize after increasing for many years, which is
good news. Changes in overall incidence may result
from changes in the prevalence of risk factors and
from changes in detection practices due to
introduction or increased use of screening and/or
diagnostic techniques. 

This year's report highlights patterns of care for
cancer patients. The authors note that one strategy
for reducing death and improving cancer survival is to
ensure that evidence-based treatment services are
available and accessible. In performing this analysis,
the authors looked at data from NCI's Patterns of Care
studies (which supplement routine data collection from
NCI's Surveillance, Epidemiology and End Results, or
SEER Program, with more detailed data on treatment
patterns) and SEER-Medicare databases (which link data
from SEER registries to Medicare claims data to assess
treatment histories for those over age 65), as well as
other resources. Using these data, they examined
whether evidence-based care was delivered uniformly to
diverse populations and how rapidly changes in
evidence-based guidelines resulted in changes in
cancer care. 

"Day by day we are winning the war against cancer as
more people than ever before are being screened and
are receiving treatments necessary for them to lead
healthy and productive lives," said CDC Director Julie
Gerberding, M.D. "However, there are gaps and missed
opportunities so we must continue to pull out all the
stops to ensure proper screening and access to
treatment regardless of one's age, race, or geographic
location." 

For breast cancer, data on trends in the treatment of
early-stage disease show that the proportion of women
diagnosed with stage I or II (earlier stage) breast
cancer who received breast-conserving surgery with
radiation treatment increased substantially during the
1990s. This change followed evidence-based guidelines
that breast-conserving surgery followed by radiation
therapy may be preferable to mastectomy because it
provides similar survival but preserves the breast. 

The authors also report findings of a separate study
on use of chemotherapy and radiation therapy for women
with early-stage breast cancer. For women with lymph
node positive disease, multi-agent chemotherapy, along
with tamoxifen (a hormonal therapy) for those with
estrogen-receptor positive tumors, has been
recommended since 1985 by the NIH. This study found 
that, between 1987 and 2000, the proportion of women
who received both chemotherapy and tamoxifen increased
substantially. However, use of concurrent therapy
remained relatively low among women age 65 and older,
who were more likely to receive tamoxifen only. 

For colorectal cancer, the authors found that use of
adjuvant (additional treatment that follows initial
surgery) chemotherapy for stage III colon cancer
patients increased rapidly between 1987 and 1995.
However, delivery of this therapy was uneven across
age groups, with much lower rates of treatment among
patients age 65 and older. Also noted was the fact
that the number of patients who received treatment
decreased with the increasing number of pre-existing
medical conditions, but the likelihood of receiving
adjuvant therapy decreased with age even after taking
other medical conditions into account. 

For patients with advanced non-small cell lung cancer,
evidence-based guidelines recommend that chemotherapy
may be beneficial for patients who are well enough to
withstand the treatment. One analysis found that,
among patients age 65 and older diagnosed with this
type of lung cancer between 1991 and 1993, only 22
percent received chemotherapy. A study of patients
diagnosed in 1996 found similarly low levels of
treatment among patients age 65 and older. However,
more recent studies have found increasing trends in
the late 1990s in the use of chemotherapy among
late-stage non-small cell lung cancer patients. 

Unlike breast and lung cancers, treatment for prostate
cancer is more controversial. The most notable trend
in prostate cancer treatment from 1986 to 1999 was the
decreasing proportion of cases that received watchful
waiting, surgical or chemical castration, or hormonal
deprivation therapy as primary treatment. More
aggressive treatments using newer radiation techniques
were found to be on the rise. However, black men were
found to receive substantially less aggressive
treatment than white men.  

The report concludes that substantial geographical
variations in treatment patterns exist, but that much
of contemporary cancer treatment is consistent with
evidence-based NIH Consensus Development Statements
(http://consensus.nih.gov/), which are considered a
"gold standard" for care recommendations. 

"The value of cancer registries in population research
is immeasurable. Through linkage with other data
systems, the information can give us insight into
getting effective treatments to the general population
that will have an impact on survival and mortality,"
said NAACCR Director Holly L. Howe, Ph.D. 

The authors also examined racial and ethnic
disparities in cancer. From 1992 to 2002, prostate,
lung, colon/rectum cancer in men, and breast,
colon/rectum, and lung cancer in women, continue to be
the leading sites for incidence and mortality for each
racial and ethnic population. Rates for lung and
prostate cancer decreased among men in all
populations, while colorectal cancer incidence rates
decreased only for white men. Among women, breast
cancer incidence rates increased in Asian Pacific
Islander women, decreased among American Indian/Alaska
Native women, and were stable for other women.
Colorectal incidence rates decreased only for white
women.

Differences in cancer incidence and mortality persist,
especially among black men, who have 25 percent higher
incidence rates and 43 percent higher mortality rates
than white men for all cancers combined. 

The authors emphasize that reaching all segments of
the population with high-quality prevention, early
detection, and treatment services could reduce cancer
incidence and mortality even further, and that
monitoring the dissemination of cancer treatment
advances is an important aspect of ensuring uniformly
high standards of care. 

For more information on this report, visit the
following Web sites: 

To view the full report, go to the Journal of the
National Cancer Institute
online: http://jncicancerspectrum.oupjournals.org/.
Supplemental information on micromaps, confidence
intervals on rates, and other materials can also be
found at
http://jncicancerspectrum.oupjournals.org/jnci/content/vol97/issue19.

For a Q&A on this Report, go to
http://www.nci.nih.gov/newscenter/pressreleases/ReportNation2005QandA

ACS: http://www.cancer.org 

CDC's Division of Cancer Prevention and Control:
http://www.cdc.gov/cancer

CDC's National Center for Health Statistics' mortality
report:
http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm

NAACCR: http://www.naaccr.org/ 

NCI: http://www.cancer.gov and the SEER Homepage:
http://www.seer.cancer.gov. Click on the icon
"1975-2002 Report to the Nation."

The National Institutes of Health (NIH) -- "The
Nation's Medical Research Agency" -- includes 27
Institutes and Centers and is a component of the U.
S. Department of Health and Human Services. It is the
primary Federal agency for conducting and supporting
basic, clinical, and translational medical
research, and it investigates the causes, treatments,
and cures for both common and rare diseases. For more
information about NIH and its programs, visit
http://www.nih.gov.

--------------------------------------------------------------------------------
* The report was published on October 5, 2005, in
"Journal of the National
Cancer Institute": "Annual Report to the Nation on the
Status of Cancer, 1975-2002, Featuring
Population-Based Trends in Cancer Treatment," (Vol.
97, Number 19, pgs. 1407-1427). The authors of this
year's report are Brenda K. Edwards, Ph.D. (NCI),
Martin Brown, Ph.D. (NCI), Phyllis A. Wingo, Ph.D.
(CDC), Holly L. Howe, Ph.D. (NAACCR), Elizabeth Ward,
Ph.D. (ACS), Lynn A.G. Ries, M.S. (NCI), Deborah
Schrag, M.D., (Memorial Sloan-Kettering), Patricia M.
Jamison (CDC), Ahmedin Jemal, Ph.D. (ACS), Xiaocheng
Wu, M.D. (NAACCR), Carol Friedman, (CDC), Linda
Harlan, Ph.D. (NCI), Joan Warren, Ph.D. (NCI), Robert
N. Anderson, Ph.D. (CDC), and Linda Pickle, Ph.D.
(NCI). 

** Time periods for rates between men and women (and
also for racial and ethnic comparisons) are not the
same due to statistical methodology. Please
see question #16 in Q&A for a detailed explanation. 
-------------------------------------------------------
##

This NIH News Release is available online at:
http://www.nih.gov/news/pr/oct2005/nci-04.htm.

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John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com

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