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U.S. Cancer Death Rates Dropping at Faster Rate

October 15, 2007 at 6:05 PM EDT
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JUDY WOODRUFF: Today’s annual report showed declines in the death rates of some of the most commonly diagnosed cancers. Researchers also found that the overall rate of new diagnoses fell slightly, as well.

To walk us through some of these findings is our health correspondent, Susan Dentzer. The Health Unit is a partnership with the Robert Wood Johnson Foundation.

Susan, thank you for being with us again.

SUSAN DENTZER, NewsHour Health Correspondent: My pleasure, Judy.

JUDY WOODRUFF: Tell us exactly what’s happening here.

SUSAN DENTZER: Judy, cancer death rate, overall death rates have been dropping for the past 15 years. If we look at what happened from 1993 to 2002, they were dropping about 1.1 percent a year. That’s the overall rates of death.

Essentially what’s happened here is that that steam has really picked up. And basically, from 2002 to 2004 — these data released today relate to 2004 — that rate almost doubled. The decline in death rates from cancer almost doubled to 2.1 percentage points a year.

JUDY WOODRUFF: And why is it?

SUSAN DENTZER: Mainly because, first of all, we’re seeing drops in mortality in the most common forms of cancer. That’s what’s really driving these rates down. So that, for example, in men, it’s prostate cancer, death rates really dropping, lung cancer death rates really dropping; in women, breast cancer death rates dropping; and in both men and women together, colon cancer rates dropping. And that’s pushing these overall levels down.

JUDY WOODRUFF: But it’s not true across the board, is that right?

SUSAN DENTZER: No, it’s not. As we know, cancer is not one disease. It’s really several hundred different diseases that have very different genetic subtypes to them, essentially. And so what we’re seeing is actually, in some cancers, the rates are going up, death rates.

For example, in men, liver cancer rates continue to go up. In women, liver death rates also going up. In women, for example, ovary cancer death rates aren’t dropping; they’re stabilizing. In men, back to men again, melanoma death rates stabilizing, not dropping. So depending on what you’re looking at, you’re going to see a different story.

Improvements in mortality rates

Susan Dentzer
NewsHour health correspondent
The main reason we're seeing these improvements in overall rates, especially in those big common cancers, is early detection and improvements in treatment.

JUDY WOODRUFF: Is there a common explanation for these improvements in these -- because you've so often, I've heard you say on this program so often, there are so many different kinds of cancer. It's not just one disease. Is there a common cause behind this change?

SUSAN DENTZER: The main reason we're seeing these improvements in overall rates, especially in those big common cancers, is early detection and improvements in treatment. Because we're doing so much mammography, for example, colonoscopy screening, et cetera, we're picking up cancers when they're smaller and sooner in the cancer development process. And they're much easier to treat.

When cancer spreads to other organs in the body outside of the primary tumor site, it's very difficult to treat. So we're detecting them earlier.

We're also seeing some real improvements in treatment. If you just take breast cancer, we can screen that now, we can understand whether a breast cancer is of a type that thrives in the presence of estrogen or progesterone. We treat that differently from cancers that are not so-called hormone receptor positive. We give it different drugs.

So we're much more sophisticated now about distinguishing among types of cancer, even within the same type of cancer, like breast cancer, and treating it in a much more targeted way. And that's really why we're seeing these improvements in mortality.

JUDY WOODRUFF: So, given all that, what is holding back further progress here, do you think?

SUSAN DENTZER: Well, research for one, and the fact that the National Cancer Institute budget is declining, and that the NCI can give out fewer grants proportionally than ever before is a concern for people.

Another large concern, though, is that cancer is a disease of aging. And our population is getting older. We have every expectation that we're going to see cancer death numbers begin to rise. So the rate may continue to decline, but the rate is a function of -- you have a numerator and a denominator. And if the denominator of elderly people continues to rise, as it will, the overall death numbers are going to go up. And we will see that increasingly as the population does get older.

We're still having 1,500 people die every day in this country of cancer. We're still losing $200 billion of resources from a combination of direct medical care costs and also just the lost productivity of people suffering from cancer. Just because you don't die of cancer doesn't mean you don't suffer from cancer. You're still on chemotherapy, et cetera, et cetera.

So what people are very worried about is, are we doing enough, first of all, to detect more cancers across the board? And especially if we detect cancers late and they have spread, we really still don't have particularly good tools, especially in some cancers, like lung cancer, so that if you're diagnosed in stage four metastatic lung cancer, your prognosis is still very, very bad.

JUDY WOODRUFF: So some good news here, but clearly some cause for worry in so many of these areas.

SUSAN DENTZER: And continued vigilance and pushing on research and new breakthroughs.

JUDY WOODRUFF: All right, Susan Dentzer, thank you very much.

SUSAN DENTZER: Thanks, Judy.

Detecting cancer early

Robert Schoen
University of Pittsburgh
[T]he best cancer is the cancer that you don't get. And the fact that we can see a drop in people actually developing colorectal cancer is very, very encouraging.

JUDY WOODRUFF: Well, now we want to take a closer look at the report's findings on two of the biggest cancer killers in the country, colorectal cancer -- you heard Susan mention that -- as well as lung cancer.

And for this, we turn to Dr. Robert Schoen. He's a professor of medicine and epidemiology at the University of Pittsburgh. He's also a practicing gastroenterologist, and he researches colon cancer screening techniques.

Also, Dr. James Mulshine, he's vice president and associate provost for research at Rush University Medical Center in Chicago. He's a practicing oncologist, and he's worked in lung cancer research for 30 years.

Gentlemen, thank you both for being with us.

Dr. Schoen, to you first. Your research interest is in colorectal cancer. We were just listening to Susan Dentzer talk about how so much of this improvement is because of early screening. Help us understand why that has made such a difference?

DR. ROBERT SCHOEN, University of Pittsburgh: Well, I think there are a couple of elements, one Susan stated quite clearly, that if we pick up cancer early, the prognosis is much better. So, in that sense, this report is indicating and shows some evidence that we are picking up cancers earlier.

But there's another element here which is a big homerun for colorectal cancer prevention, and that is we're seeing a drop in the incidents of disease. And what we know from studies is that, if we screen people and find polyps, which are the precursors of colorectal cancer, and we take those polyps out, we can prevent people from developing cancer.

And the best cancer is the cancer that you don't get. And the fact that we can see a drop in people actually developing colorectal cancer is very, very encouraging.

JUDY WOODRUFF: And you're saying there's been a significant drop there in the last two years?

DR. ROBERT SCHOEN: There's been a very significant decline in the last six years in incidents, not just in mortality, in death to the cancer.

JUDY WOODRUFF: And you're making a distinction between the two here?

DR. ROBERT SCHOEN: Yes. I mean, they're linked in the sense that the screening also increases early detection, and therefore you find cancers at earlier stages when they're more treatable. But you also have the element of actually preventing people from getting the cancer, and that's particularly encouraging.

A rise in lung cancer in women

James Mulshine
Rush University Medical Center
Most of cancer, certainly adult cancer -- colon cancer, breast cancer, lung cancer -- is really a chronic disease. It develops over the course of decades.

JUDY WOODRUFF: Dr. Mulshine, your interest is in lung cancer, somewhat different picture there. How much of the change in lung cancer -- and we understand it's gotten somewhat better, the statistics from men, not better for women. Help us understand what's happening there.

DR. JAMES MULSHINE, Rush University Medical Center: Well, there's a lot of trends, but the dominant one for lung cancer relates to the use of tobacco products. And in response to the surgeon general's report several decades ago, men, earlier than women, started decreasing their use of these products.

This was complicated for women with some incredibly effective marketing to people about "personal choice" and "coming a long way." And smoking rates in women came up as they were going down in men, and that persistence really drives the mortality figures that we're talking about today.

JUDY WOODRUFF: You've talked about how there's a very clear, what, 20- to 30-year spread between, what, the onset of smoking, heavy smoking, and lung cancer?

DR. JAMES MULSHINE: Yes, and this is something that people don't understand. Most of cancer, certainly adult cancer -- colon cancer, breast cancer, lung cancer -- is really a chronic disease. It develops over the course of decades. And in lung cancer, 85 percent to 90 percent of it relates to smoking activity decades before the development of symptomatic disease.

JUDY WOODRUFF: I want to come back to you, Dr. Schoen, on the colorectal cancer, the other aspect of what we were talking about. I mean, we were talking about prevention, but we -- we were talking, I should say, about screening, but what about prevention and about treatment? How much difference in the treatment today from what it was five, ten years ago?

DR. ROBERT SCHOEN: Oh, there's been tremendous advances in treatment, with many new drugs, chemotherapeutic drugs, drugs that are targeting growth factors, and that certainly is making a difference in the mortality rates. That is, even though one is found to have advanced cancer, there are things that we can do for you and that can help you.

But this overall picture is a combination of early detection, prevention of getting the disease, improvements in treatment. And then one other factor, which we don't fully understand, really the death rates to colon cancer have been dropping for a number of years, in women back in maybe 50 years, in men since the 1980s, and there are probably a number of etiologic factors that are contributing to that that we still need to understand.

JUDY WOODRUFF: And, quickly, what do you mean by etiologic? What are you referring to?

DR. ROBERT SCHOEN: Well, diet, environmental factors, aspirin, drugs, all kinds of things that may be contributing to cancer as we age.

JUDY WOODRUFF: And, Dr. Mulshine, with regard to lung cancer, you've tied it directly to the use of tobacco. That's the story there, is that what you're saying?

DR. JAMES MULSHINE: Yes. It's an amazing phenomenon that we've known about the danger of tobacco, and yet our impact in terms of helping people to stop smoking is agonizingly slow.

Access to health care

Robert Schoen
University of Pittsburgh
[W]hat's so tremendously optimistic about colorectal cancer is it looks like we have some very effective tools. We need to get people into them...because if they could be screened, these rates could drop even further.

JUDY WOODRUFF: Dr. Mulshine, we know -- there's a lot of talk, especially in this presidential election year, but all the time in this country about health care and about access to health care. How much of what you see and what you're aware of could be improved if there were better access? Or is that part of the picture when it comes to lung cancer?

DR. JAMES MULSHINE: Well, the American Cancer Society has done some studies showing that outcomes across our society are different in terms of how well people do with cancer care. But when they look at it more carefully, they find out that access to care is probably the overall determinant of those outcomes.

And so, for instance, here in Chicago, a working group has found that African-American women in Chicago have 68 percent higher chance of dying of breast cancer than white women. And it turns out there it's very definitely access to care.

And across the board, colon cancer screening, cervical cancer screening, access to care, and education are very important factors and things that we have to do a better job on. And these numbers kind of give ammunition to the people that are very interested in early detection to suggest that it really is having an impact.

And some of the confusion in our society about the benefit of breast cancer screening or some of these other screening measures, the possibility of emergence of successful lung cancer screening, that can be put together as a message to people that essentially is how you started this show: Finding disease when you can remove it before it has spread is associated with much more favorable outcomes across the board for cancer.

JUDY WOODRUFF: So, Dr. Schoen, picking up on this point, to expect any improvement in the future is a combination of research, better access to care, and what else? How would you characterize it?

DR. ROBERT SCHOEN: Oh, well, I mean, what's so tremendously optimistic about colorectal cancer is it looks like we have some very effective tools. We need to get people into them, especially in lower socioeconomic groups, in minority groups, because if they could be screened, these rates could drop even further.

JUDY WOODRUFF: Are we talking about -- colorectal cancer, is it something that you could see completely disappearing one day?

DR. ROBERT SCHOEN: Not completely disappearing, but we -- it looks like we could make a very substantive impact.

JUDY WOODRUFF: And, Dr. Mulshine, with regard to lung cancer, I mean, for those people who dream and would like to think it could drop dramatically, if not go away all together, what do you say?

DR. JAMES MULSHINE: Well, I think that some of the imaging tools that are having a profound impact in colon cancer are also being applied in lung cancer. Now, in lung cancer, we did not have an effective tool like endoscopy, and so the clinical trials are just now being done, so we don't have definitive, randomized trial evidence of mortality benefit.

But the technology keeps getting better and better. We're learning how to use it more efficiently. We're learning how to use it with less invasive procedures. And it is very promising that, in the not-too-distant future, we might have very credible evidence that this is as beneficial in lung cancer as it is in breast or colon.

JUDY WOODRUFF: Well, that's an uplifting note for us to end on. Dr. James Mulshine, joining us tonight from Chicago, and Dr. Robert Schoen, thank you very much, gentlemen. We appreciate it.

DR. ROBERT SCHOEN: Thank you.

DR. JAMES MULSHINE: Thank you very much, Judy.