Study Shows Drop in Cancer Deaths for Second Straight Year
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MARGARET WARNER: Not only did the number of Americans who died from cancer fall for the second straight year in 2004, but the decline was far sharper than in 2003.
The most significant drops in 2004 were recorded in three common cancers, colorectal, breast and prostate, and also in lung cancer among men. Cancer remains the second-leading cause of death in the United States. And lung cancer still accounts for the lion’s share of fatal cases.
For more on this development and what’s behind it, I’m joined by Dr. Harmon Eyre, chief medical officer of the American Cancer Society, which issued today’s report.
Dr. Eyre, welcome. Now that this is the second year in a row we’ve seen a drop in cancer deaths, are you comfortable saying this isn’t a fluke but this is a trend?
DR. HARMON EYRE, American Cancer Society: Well, we believe, Margaret, that it does represent the beginning of a trend. And, clearly, in the last few years, we’ve been able to document a declining death rate or incidents of deaths per 100,000 individuals.
But the aging population and the growing population have overcome that, so that the actual number of people dying had been increasing until these last two years. But we’re seeing a much steeper decline in that death rate, and the steepness of that decline has been enough to overcome the aging population.
As you have 78 million baby boomers getting into an age range where cancer is more common, you’ve got to see a pretty substantial decline in death rates to actually reverse the overall trend and see the numbers go down. So we’re very optimistic that this represents the beginning of a much greater decline in death rates and the numbers will continue to go down.
Key factors in the decline
MARGARET WARNER: And so what is driving it? Is it that there are fewer cases in the first place or that detection and treatment are better?
DR. HARMON EYRE: It's all three. Prevention is working in some cancers very well. You mentioned that the death rate in lung cancer in men was dropping substantially. And that's due to a drop in male smoking, going clear back into the mid- to late-1960s, all the way to now, and we know that women have stopped smoking.
And so, even though we don't see the decline in death rates in women, we're going to be able to see that very soon, and we'll predict, within the next one to two years, that that will begin. That's all prevention.
We also know, in colorectal cancer, that if you have colonoscopy and remove colon polyps, that prevents the cancer from occurring. And we know that some population in America is eating better and exercising more, and we know that those two factors will actually reduce the incidence rate in colon cancer.
And just last month, there was a very dramatic report about the possible link by dropping hormone replacement therapy for post-menopausal women, and this dropped the incidence of breast cancer. We'll have to have some more studies to see that come together.
But we also know, in addition to that prevention that's happening, early detection of breast, colon, prostate, and cervix cancer is resulting in continuing declines in death rates, and that's coupled with better treatments.
And so, in the last decade, last two decades, the research effort of this country has begun to pay off, with better agents that are more focused, less toxic, and that's resulting in better survival of individuals, better treatments that actually cure, and so we now have 10 million survivors. So it's all three: It's prevention, it's early detection, and it's improved treatment.
MARGARET WARNER: Well, as you just said, an important corollary of this is the survival rate, and I found stunning in your report today the fact that, in the mid-'70s, if you got cancer, 50 percent of Americans who got cancer died within -- die of it in less than five years. Today, the survival rate, if you get cancer, you have -- two-thirds of Americans will live at least five years.
Now, are these people who are surviving, are they living full lives or is their quality of life severely diminished, and essentially they're going from treatment to treatment?
DR. HARMON EYRE: Very important question, because the goal of cancer management is twofold. It's, number one, to cure the person. But, number two, to maintain high-quality life, and we're just beginning to get the tools to measure the quality of life and, surprisingly, a lot of people have very high quality of life.
I might focus down on those survival numbers just a little bit further. We know that lung cancer, as an example, still has a very high fatality rate. Pancreas cancer has a high fatality rate.
But you look at the other common cancers that you mentioned -- and that is, let's say, breast cancer in women -- when it's found by mammography, the five-year survival rate is over 95 percent. When prostate cancer is found by PSA testing, five-year survival is nearly 100 percent.
And so if a person doesn't smoke and gets screened regularly, their chances of five-year survival are much greater than the two-thirds that you mentioned. And the same is true for many other cancers.
When we get early cancer, good treatment, a lot of these people are living high-quality lives. And the 10 million people who are survivors today, the vast majority of them are living quite normal lives. And they have some side effects from the treatment, but many of them are pretty near normal.
Access to care
MARGARET WARNER: The new head of the National Cancer Institute said today in a meeting with President Bush that access to care can actually be a big, big risk factor, in terms of survival versus death. Would you agree?
DR. HARMON EYRE: Every time we report these numbers, we look at the subpopulations who have less access to care. And when you do that, their death rates are sometimes almost double what the individuals are who have insurance.
And this goes across race and ethnicity, so that individuals in all subpopulations who have access to care do very well.
The American Cancer Society is very concerned about lack of access to care. We have 47 million Americans who don't have good care throughout their health system, and those individuals find cancers like you talked about in the 1950s.
They're more advanced, and we still haven't made huge progress in curing advanced cancers for the common cancers, and so their death rates are much higher. There's also the factor that we need to continue to do the research that has led us down this pathway, and we need to continue to support it, because both those factors are critical in the ultimate control of cancer.
Everybody has to have care. Everybody has to live a lifestyle that helps prevent cancers from occurring, and we have to continue the research that will get us the answers to the issues that are still unknown.
MARGARET WARNER: Dr. Harmon Eyre of the American Cancer Society, thank you so much.
DR. HARMON EYRE: Thank you.