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| CANCER IN RETREAT
NOVEMBER 14, 1996TRANSCRIPT |
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Cancer death rates have dropped three percent since 1990, that's 15,000 fewer Americans succumbing to the disease every year. To discuss what this means and how it happened, Jim Lehrer is joined by the chief medical officer for the American Cancer Society, Dr. Harmon Eyre.
JIM LEHRER: Our cancer update is first tonight. Studies just released, as I just reported, suggest cancer death rates have begun to decline for the first time this century. Here to tell us about it Dr. Harmon Eyre, chief medical officer of the American Cancer Society. Doctor, welcome.
DR. HARMON EYRE, American Cancer Society: Good evening.
JIM LEHRER: And the extent of this decline, would you explain, please, sir.
DR. EYRE: Well, it's very small if one says 3 percent, but when you compare that to 500,000 individuals or more who will die this year, that means that in 1996, nearly 15,000 lives will be saved from premature death of cancer compared to the same rates in 1990, as a significant impact; we think 15,000 lives is a major step forward.
JIM LEHRER: Now, this, this determination of the 3 percent decline from 1991 to ‘95, how was that determined, just by simply counting up the cause of deaths of people in the United States?
DR. EYRE: Since about 1900, the American people have regularly been required to report causes of death, and we have fairly accurate information dating back that far. This is reported through the National Center for Health Statistics. And actually, Dr. Phil Cole, from the University of Alabama, was the first one to identify looking at information through 1994/95 and adding up all the causes of cancer death. And he was the first to identify this trend from the total death cases, dating back to 1990 as a peak year, so ‘91, ‘92, ‘93, ‘94, and now ‘95, the death rate has gone down, and what's even more encouraging is in ‘95, the decrease was almost 2 percent. So depending on how you calculate it, the rate of decrease in deaths is actually accelerating, very good news, indeed.
JIM LEHRER: In other words, it was 3 percent total between ‘91 and ‘95, but 2 percent of that 3 percent came in the last year, is that what you're saying?
DR. EYRE: Exactly. In the first year, it was only about .3 percent down, and then .4, and it's gradually increasing, and the American Cancer Society thinks that we can even do better than 2 percent. We can increase the decline in deaths much beyond that.
JIM LEHRER: Now, Doctor, is this across-the-board in all cancers? Or break it down for us by some of--some the best known--lung cancer, breast cancer, ovarian, prostate, colon, liver, brain, take us through that, please, sir.
DR. EYRE: Well, Jim, there are four major cancers that account for over 50 percent of cancer deaths. Far and away, the most important in both men and women is lung cancer. Second is colorectal cancer affecting both men and women, and then third is breast cancer, and four is prostate cancer. And let me just talk a little bit about each one.
JIM LEHRER: All right.
DR. EYRE: Very clearly, lung cancer has been an epidemic over the last twenty or thirty years. And if you reach back into the 1970's, and look at death rates from all cancers combined, except lung cancer, the death rate from all other cancers began to decline over 20 years ago, but the rise in lung cancer deaths has been so incrementally large that it has overridden that decrease, and, thus, the death rate from all cancers have been increasing. Now along about 1964, when the Surgeon General released the report on the hazards of smoking based in large part on epidemiology studies contributed to by the American Cancer Society, Americans stopped smoking in big numbers. By the mid 1990's, almost 50 million Americans have stopped smoking. That began first in men, and as a result, what we have seen is five years ago a peak in lung cancer deaths in men, and they begin to go down quite rapidly. Women had started smoking more recently and stopped even later, and thereby the lung cancer deaths in women are still going up. But that's the only negative news out of these four major cancers.
JIM LEHRER: So what is the drop in--in the death rate in these last four years in lung cancer?
DR. EYRE: In lung cancer in men the death rate is down almost 6 percent. In African-American men, it's close to 8 percent. In women, as I said, it's still rising--
JIM LEHRER: It's gone up.
DR. EYRE: --but the younger women, the first to see the change, the younger women are actually seeing a drop in death rates. And so we can predict in about the next five years that we'll see the peak of death rates in women and that they will then turn down. And so this 3 percent reduction in overall cancer deaths, about half of it is due to prevention. And far and away the most important preventive activity the country's been doing is smoking cessation; for all of the Americans who stopped smoking, it's beginning to pay off. We're seeing fewer lung cancer deaths.
JIM LEHRER: Now what about treatment, has that improved? Is that also affecting the death rate?
DR. EYRE: Absolutely. Very clearly, in both colon cancer in men and women and breast cancer in women, the decline is occurring for two reasons. One is that we're undergoing regular screening tests and finding the cancers when they're smaller, earlier, and thus capable of being cured.
JIM LEHRER: And that really matters, doesn't it, Doctor? I mean, when you find the cancer, you really affect survival?
DR. EYRE: The survival of a woman with breast cancer with a small breast cancer detected by mammogram before you can feel it or detect it on physical examination can approach 90 or 95 percent. When that woman finds that cancer without having a mammogram, and it's between two or three centimeters in size, her survival drops down to 70 percent.
JIM LEHRER: But doesn't essentially the same basic rule apply to all cancers, including lung cancer, and pancreatic cancer even, the cancer that killed Cardinal Bernardin today?
DR. EYRE: Well, unfortunately, that rule doesn't universally apply. We haven't been able to find tests that will detect lung cancer early with any degree of accuracy, and so the strategy for controlling lung cancer is smoking cessation. The strategy for controlling breast and colon cancer is early detection, and recently--and these figures are very, very exciting in this regard--we're beginning to see a decline in prostate cancer. And that's due to early detection and treatment. Now, in relationship--
JIM LEHRER: Now, excuse me, on that one, Doctor--on that there's been massive public--publicity to men about the easy testing for prostate cancer, correct, and that's paying off, is that what you're saying?
DR. EYRE: Very clearly, we have been seeing dramatic increases in numbers of prostate cancers, but what we're seeing now is instead of 2/3 of them being spread before they could be treated, now only about 1/3 are spread; 2/3 are capable of being treated for cure. We need to learn a lot more about prostate cancer. It's still one of the most complicated oncologic or cancer problem we as a country are facing, but very clearly, we're making progress. Now, you made reference to the Cardinal's cancer.
JIM LEHRER: Right.
DR. EYRE: Pancreas cancer is the most fatal cancer that we deal with. Almost 98 percent of people who get pancreas cancer die from it. It's rare to find a cancer early enough to be able to cure it, and it's because the cancer sits back inside us, and we don't find it early. When we find it, it's already spread, and our treatment for that kind of cancer just doesn't work.
JIM LEHRER: Now, back to the overall picture and finally, Doctor, just to repeat what you said before, say it again, you expect these numbers to continue to go down based on your reading, on the other experts' reading of this data the last four years, correct?
DR. EYRE: The American Cancer Society just recently completed a futuring episode or exercise where we tried to look 20 years in the future, look at the impact of health care changes, economy, and so forth. And what we predict is that it's possible to sustain over a 2 percent reduction each year, and we believe a lot of that's in the bank, because people have stopped smoking. It won't continue unless we find ways to control tobacco consumption in our children, find ways to get health care access to the population. Those individuals who are poor and don't have health insurance have higher rates of death, have higher, larger-stage cancers when they come in, and their treatment is much more difficult. So we've got a long way to go, but the future is really looking much better than it has in the past.
JIM LEHRER: And better than it's ever looked?
DR. EYRE: No question about it. We're very excited about this.
JIM LEHRER: All right. Doctor, thank you very much.
DR. EYRE: You're welcome.
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