Cancer Incidence and Death Rates Continue to Decline in the US

The rate of new cancer cases and deaths for all cancers combined as well as for most of the top 10 cancer sites declined between 1990 and 1997 in the United States, according to report published in the May 15, 2000 issue of Cancer. A special section of the report focusing on colorectal cancer shows declines in incidence rates despite low use of screening tests for the disease.

The report shows that the incidence rate -- the number of new cancer cases per 100,000 persons per year -- for all cancers combined declined on average 0.8 % each year between 1990 and 1997.

The greatest decline: 1.3% per year, occurred after 1992, the year in which incidence rates peaked. This trend reversed a pattern of increasing incidence rates from 1973 to 1992.

"Cancer death rates have been falling since 1991, and since 1995 that decline has been even more rapid," said John R. Seffrin, PhD, chief executive officer of the American Cancer Society. "This gives us great hope that in the new millennium, our dreams of conquering cancer are closer than ever to becoming a reality." Cancer mortality declined 0.8% for the period from 1990 to 1997.

The greatest decline in cancer incidence rates has been among men, who overall have higher rates of cancer than women. The report analyzed data for white, black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic populations and noted large differences in cancer incidence by race and ethnicity, with incidence rates highest for blacks for the top four cancer sites except for breast cancer.

Four cancer sites -- lung, prostate, breast, and colon and rectum -- accounted for slightly more than half of all new cancer cases, and they were also the leading causes of cancer deaths for every racial and ethnic group. Trends for those primary sites show that rates are going down for prostate cancer incidence and mortality.

Breast cancer. Breast cancer incidence rates have shown little change in the 1990s, but breast cancer death rates have declined about 2% each year since 1990 and have dropped sharply since 1995.

Lung cancer. Incidence trends in lung cancer increased from 1973 until 1991, but have since declined. Lung cancer mortality continues to increase for females but has been declining for men since 1990.

Non-Hodgkin's lymphoma. Incidence and death rates for non-Hodgkin's lymphoma among women are continuing to increase.

Melanoma. Incidence rates for melanoma for both sexes combined have continued to rise about 3% annually since 1981, but death rates have been approximately level since 1989.

Colorectal cancer. Colorectal cancer has the third highest incidence of any cancer site for US men, ranks second to breast cancer for Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander women, and ranks third for white and black women. The overall incidence increased until 1985 and then began decreasing steadily at an average rate of 1.6% per year. Like incidence, deaths from colorectal cancer rank third after lung and prostate cancer for men and third after lung and breast cancer for women.

The report also examined long-term trends in mortality from colorectal cancer from 1950 to 1997. For women, mortality rates have been declining since at least 1950 while rates for men remained fairly level from 1950 to 1980, then began declining in the 1980s. The latest five-year relative survival rate for colorectal cancer was 61% and varied by stage. When colorectal cancer is detected in the earliest stage of the disease, Stage I, the survival rate was 96% whereas survival for Stage IV was only 5%.

Although screening rates were low, data showed gradual and modest increases in the use of screening procedures for colorectal cancer. The prevalence of colorectal cancer screening by fecal occult blood testing was 21% in women over 50 and 18.4 in men over 50 years old. Thirty-two percent of men had either a sigmoidoscopy or proctoscopy whereas only 27% of women had either procedure.

According to James S. Marks, MD, director, National Center for Chronic Disease Prevention and Health Promotion, "The findings underscore the need to improve rates of colorectal cancer screening. This is one cancer where screening clearly has benefits by saving lives."

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.