番茄社区

Death rates from cancer continue to drop in the U.S., but within this overall picture there are winners and losers, with mortality from certain types of cancer on the rise and certain populations remaining at increased risk of dying from malignancies.

From 1999 to 2015, cancer mortality decreased each year by 1.4% in women and 1.8% in men; and in children, the yearly rate decreased 1.5% from 2011 to 2015, according to the from the National Cancer Institute (NCI) and others.

"This year's report is an encouraging indicator of progress we're making in cancer research," said NCI Director Ned Sharpless, MD, in a . "As overall death rates continue to decline for all major racial and ethnic groups in the United States, it's clear that interventions are having an impact."

In both men and women, the rates of cancer mortality decreased from 2011 to 2015 for those with lung, colorectal, esophageal, kidney, and gastric cancers, and leukemia, melanoma, and non-Hodgkin's lymphoma (NHL).

In men alone, cancer mortality also decreased for laryngeal cancer, multiple myeloma and prostate cancer (though it leveled off from 2013 to 2015, see more below). In women only, cancer mortality also decreased for breast, ovarian, cervical, gallbladder, bladder, and oral cavity and pharyngeal cancers.

"The overall reduction in cancer mortality has been dramatic," said Stephen Edge, MD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, who was not involved with the report. "This welcome news can be attributed to a combination of screening and improved treatment, and is likely to decrease further with broad application of new therapies, including immunotherapy."

The report is a collaboration by the NCI, CDC, American Cancer Society, and North American Association of Central Cancer Registries (NAACCR).

Published in , the report also highlights areas where more work is needed, said Sharpless.

With 5-year death rate trends during this period described by average annual percent change (AAPC), a number of common cancers in men increased from 2011 to 2015:

• Non-melanoma skin cancer (AAPC 2.8%)
• Liver cancer (1.6%)
• Oral cavity and pharyngeal cancer (1.0%)
• Soft-tissue sarcoma (0.8%)
• Brain and central nervous system (CNS) tumors (0.5%)
• Pancreatic cancer (0.2%)

And in women, increased death rates were seen in the following:

• Liver cancer (AAPC 2.7%)
• Uterine cancer (1.9%)
• Brain and CNS tumors (0.5%)
• Pancreatic cancer (0.2%)

"The fact that death rates from several cancers are still on the rise means we need to keep working to find strategies to encourage prevention and continue to make improvements in screening and treatment," said NAACCR Executive Director Betsy A. Kohler, MPH, in a .

And while mortality from cancer continues to decrease overall, "concerning disparities persist relating to people's social and ethnic background," said Edge.

Black men (239.9 per 100,000) and black women (159.0 per 100,000) had the highest rates of cancer mortality, according to the report. Black men also had the highest rates of cancer incidence (558.2 per 100,000), but among women, whites had the highest cancer rates (428.7 per 100,000).

From 2008 to 2014, the incidence rates of cancer in the U.S. dropped by an average of 2.2% each year in men, while no decrease was observed in women. Overall, men had a higher incidence of cancer than women (502.0 versus 420.6 per 100,000). In children, rates of cancer incidence increased by 0.8% each year from 2010 to 2014.

Prostate Cancer Trends

In a study that accompanied the annual report, researchers looked closer at , revealing that from 2013 to 2015, mortality from the disease stopped falling after two decades of decline.

And from 2010 to 2014, the incidence of distant-stage disease increased from 7.8 to 9.2 cases per 100,000 men, reported Serban Negoita, MD, DrPH, of the NCI's Surveillance Research Program, and colleagues.

"We've seen a concerning increase in the rates of men with advanced prostate cancer, a trend that could be related to changes in the use of prostate cancer screening," said Edge.

Notably, new cases of prostate cancer in the U.S. dropped from 163 per 100,000 in 2007 to 104 cases per 100,000 in 2014 (average decrease of 6.5% per year) -- raising questions about whether it's a consequence of the U.S. Preventive Services Task Force's (USPSTF) 2012 guidelines recommending against prostate-specific antigen (PSA) screening for asymptomatic men.

"The increase in late-stage disease and the flattening of the mortality trend occurred contemporaneously with the observed decrease in PSA screening in the population," said Negoita in a . "Although suggestive, this observation does not demonstrate that one caused the other."

However, the report found no increase in Gleason 9-10 disease, suggesting the increase in distant-stage disease could in part be due to better initial work-up of patients. "There are many factors that contribute to incidence and mortality, such as improvements in staging and treating cancer," Negoita said.

Bobby Liaw, MD, of the Icahn School of Medicine at Mount Sinai, who was not involved with the study, said that with the recent change in USPSTF recommendations, there might eventually be a course correction, where again prostate cancers are caught at an earlier stage.

"The pendulum is coming back," Liaw told 番茄社区. "We went from screening everyone to screening no one, now we're coming back to a more middle ground."

The USPSTF recently recommended that PSA screening for men ages 55 to 69 be an individual decision, but data reflecting this change might not be seen for a number of years.

Liaw highlighted that the plateauing of the survival -- even with a slightly higher number of newly diagnosed advanced prostate cancer cases -- speaks to the effectiveness of newer therapies in prostate cancer. "I actually take that as a promising sign that we're still able to keep things steady," he said.