Cancer deaths drop, but more late-stage prostate cancer diagnoses spark concerns

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• Amna Nawaz:

  Cancer deaths in the United States have dropped 33 percent in the past three decades. That's according to a new report from the American Cancer Society.

  Among the report's highlights, cervical cancer rates dropped 65 percent for women in their early 20s, in part thanks to the HPV vaccine. But there are troubling signs as well. Advanced prostate cancer diagnoses have risen roughly 4.5 percent annually since 2011.

  For a closer look, I'm joined by Karen Knudsen, CEO of the American Cancer Society.

  Karen, thank you so much for joining us.

  Let's just start with that good news, a 33 percent drop in cancer deaths since 1991. That translates to an estimated 3.8 million deaths averted. How did we get there?

• Karen Knudsen, CEO, American Cancer Society:

  That's exactly right.

  So, 1991 was a high watermark in this country, when we peaked of our cancer — for our cancer death rates in the U.S. So, since that time, the investments in cancer research by the American Cancer Society, the government and other entities has really borne fruit in giving us new strategies for cancer prevention, for early detection, which we know is critical for improved outcome, as well as new treatments and, in some cases, cure for the 200 diseases that we call cancer.

• Amna Nawaz:

  So we have better screening now. There's fewer smokers out there as well.

  But I do want to highlight that specific 65 percent drop in cervical cancer rates. That's for women in their early 20s. We know that cancer kills some 4,000 women every year. How much of that decline do you attribute just to that vaccine?

• Karen Knudsen:

  You see a significant relationship between vaccination for HPV and that decline, because it's specific to that group of women, that precipitous decline in cervical cancer incidence.

  So those women ages 20 to 24 would be the first to have received vaccination against the human papilloma virus. So this is the first real-world evidence that we have to show that HPV vaccination does, as predicted, reduce cancer incidence and mortality from cervical cancer.

  We believe this also portends, in outlying years, we will see that same decline in those who were vaccinated against HPV for other HPV-induced cancers, including a suite of head and neck cancers that affect both men and women.

• Amna Nawaz:

  That is just an incredible generational change.

  But, at the same time, there is some worrying news we should highlight, a 4.5 percent increase annually in advanced prostate cancer diagnoses. What should we understand about that?

• Karen Knudsen:

  This is really a call to arms for men and their clinical providers to think differently about prostate cancer.

  So, prostate cancer is the most frequently diagnosed malignancy of men in this country, accounting for almost one-third of all new male cancer deaths and — or cancer incidents anticipated this year. Now, unfortunately, prostate cancer, although highly survivable, if detected early, is clearly being detected too late.

  We can see this in that shift of diagnosis to men with more advanced disease, when prostate cancer is much more difficult to treat, if not impossible, and it is therefore no surprise that prostate cancer is now perched as the second leading cause of cancer death for men in this country, accounting for 34,000 anticipated deaths this year.

  So we are anxious for these cancers to be caught earlier and for men and their clinical providers to determine the best screening plan for them for prostate cancer.

• Amna Nawaz:

  A call, as you say, for earlier screenings, but the highest incidence and mortality, we should point out, is among Black men, when you look at those advanced prostate diagnoses.

  Why the racial disparity and how do we close it?

• Karen Knudsen:

  So much to unpack there.

  So, what we do know is that Black men have a 70 percent increased risk of prostate cancer, as compared to white counterparts, and a two- to four-fold increase increased risk of death from prostate cancer as compared to any other group in the United States.

  Now, when we look at screening rates amongst Black men and white men, they're approximately identical. So we really cannot ascribe this to differences in screening. In fact, screening is low, unfortunately, for all men across this country. That needs to change.

  So then what's causing this disproportionate burden on Black men? Now, we know very little about genetics of risk overall, but especially for Black men, that's an area where research needs to come into play. But, certainly, access to quality cancer care and screening may also come into play.

  And we also know that Black men are vastly underrepresented in clinical trial for prostate cancer, which we know is the most advanced form of care, so many levers that we can potentially pull to bring about more equity and outcomes for prostate cancer.

  But, for men overall, we need to do better.

• Amna Nawaz:

  Karen, when you take a big picture look at this, cancer does remain the second leading cause of death in the United States, behind heart disease, some two million cases, 600,000 deaths expected this year alone.

  It's a mixed picture with these latest numbers, but I'm just curious on your big picture take. Where are we in the fight against cancer?

• Karen Knudsen:

  I would say we are in a period of hope.

  Each of those 200 diseases we call cancer tells a different story. There are areas like cervical cancer where these wins now infuse enthusiasm for additional prevention strategies, and others like prostate, where we need to understand much more, or early onset colorectal cancer, where we truly don't understand why it is that this is on the rise.

  So we simply need to invest more into cancer research. We have shown that gives a precipitous decline in cancer death. We have much more to learn and to implement, so that we can reverse these trends and cancer as we know it for everyone.

• Amna Nawaz:

  Karen Knudsen, CEO of the American Cancer Society, thank you for your time.

• Karen Knudsen:

  Thank you so much for having me.