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As death rates from cancer decline, why are some communities faring worse?

The death rate from cancer in the U.S. fell 27 percent between 1991 and 2016 due to earlier detection and a decline in smoking, according to a new study by the American Cancer Society. But obesity-related cancer deaths are increasing, and the disparity between outcomes in wealthy and poor communities is widening. John Yang talks to Dr. J. Leonard Lichtenfeld, ACS acting chief medical officer.

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  • Judy Woodruff:

    And now a medical milestone.

    The American Cancer Society said today the death rate from cancer fell 27 percent between 1991 and 2016. The Cancer Society says that translates to 2.6 million deaths prevented during that time.

    But, as John Yang reports, not all the news is good.

  • John Yang:

    Judy, the study says the steady decline is largely due to fewer people smoking and advances in early detection and treatment. Death rates from lung, colorectal, prostate and breast cancers have all dropped.

    But obesity-related cancer deaths are on the rise, and the disparity between deaths in rich and poor communities is getting wider.

    Cancer remains the nation's second leading cause of death, behind heart disease, and experts project that more than 600,000 Americans will die from it this year.

    Dr. J. Leonard Lichtenfeld is here to walk us through the report. He's the American Cancer Society's acting chief medical officer.

    Dr. Lichtenfeld, thanks so much for being with us.

    Let's sort of unpack some of these numbers. You talk about — the study says lung cancer rates going down, largely because smoking is going down, but it's going down twice as fast among men as among women. Why is that?

  • Dr. J. Leonard Lichtenfeld:

    John, we need to understand that men have been smoking for a much longer time, and women began to take up the habit in the late '60s, 1970s.

    So it took a while, longer time for the women to understand that smoking is not good for your health than it did for the men. And the death rate decline in men just started more steeply and earlier than it did for women.

    Fortunately, we're seeing decreases in smoking and decreases in lung cancer death rates for both men and women as we provide this report.

  • John Yang:

    And the study also found that there are higher lung cancer rates among women born in the 1960s compared to men of the same age. Any idea why that is?

  • Dr. J. Leonard Lichtenfeld:

    Well, that's correct.

    That was research that was actually recently reported by my colleagues here at the American Cancer Society. And the reality is, we don't really know why that's happening. It's not due to differences in smoking behaviors. So there are other factors that are leading to that increase in lung cancer.

    Having said that, I think it's very, very important for all of us to understand that lung cancer happens in non-smokers too. We have a tendency to sort of overemphasize the smoking aspects, but non-smokers can get lung cancer, and it may be a somewhat different disease. We don't know. And it may respond differently to treatments. And we're learning about that as well.

    But the bottom line is, we're starting to see that occur in younger people, particularly younger women, and we need to learn more about why that is happening.

  • John Yang:

    And, as I said in the introduction, there is also — and the study says that obesity-related cancer deaths are increasing. The rate of death is increasing.

    What types of cancers are we talking about there?

  • Dr. J. Leonard Lichtenfeld:

    Well, there are a number of cancers that are linked to obesity, 13 in all, perhaps more.

    But we certainly know that breast cancer, and particularly cancer of the uterus in women, are related to obesity, liver cancer, colon cancer. There are a number of cancers that are impacted by being overweight.

    And we also know that, in this country, we have an obesity epidemic. And that has not yet completely played out. So, again, we know this is a problem. We don't yet know how much of an impact it's going to have going forward. But it will have an impact.

    And it's something that we need to — we need to take into account. And we need to least alert people that this is a very serious problem.

  • John Yang:

    The study also said that the racial disparity is narrowing, the disparity between cancer deaths among African-Americans and among white people is narrowing, but that it's getting wider, the disparity between bad outcomes in rich communities and poor communities.

    What do you think's behind that?

  • Dr. J. Leonard Lichtenfeld:

    Well, it's not only rich and poor communities. It's also in rural communities and the cities.

    And there are a lot of explanations for it, the most obvious of which is that some of the lifestyle behaviors are different among those who are poor vs. those who are better educated. So, smoking behaviors, alcohol consumption, other lifestyle issues, obesity, might be a factor as well.

    So that's just one part of the explanation. But access to care is a very, very critical matter. And if you don't have funds, if you don't have insurance, then you don't get the type of care that might be the best care for you if you have cancer. And access to care in rural communities is a very serious issue throughout our country.

    There are large parts of the United States where adequate medical care, particularly adequate cancer care, requires people to travel great distances, or even getting screened for cancer. So we need to really take a very careful look at all of these issues.

    And I do think we need to make a national commitment. We all need to make a commitment, personal commitment, whether it be government, other organizations, the American Cancer Society among them. We need to take a careful look at this and figure out what we need to do to make the outcomes equal.

    We know we can do it. We have seen that happen, that equal care can produce equal outcomes. We just need to make certain that everyone has access to that equal care.

  • John Yang:

    Dr. J. Leonard Lichtenfeld of the American Cancer Society, thank you so very much.

  • Dr. J. Leonard Lichtenfeld:

    Thank you.

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