Cancer Deaths, Rates Continue Decline in U.S.

This article published with permission from The Burrill Report.

The number of cancer cases continues to drop for most American men and women, according to an annual update of cancer incidence, mortality, and trends in the United States.

The Annual Report to the Nation on the Status of Cancer, 1975—2009, was prepared by the American Cancer Society with the Centers for Disease Control, the National Cancer Institute, and the North American Association of Central Cancer Registries.

Death rates for all cancers in men and women combined continued to decline, a trend first observed in 1990. From 2000 through 2009, overall cancer mortality fell by 1.5% annually combined for both men and woman, and 1.8% per year among children under 14.

During that decade, death rates among men fell for 10 of the 17 most common cancers — lung, prostate, colorectal, leukemia, non-Hodgkin lymphoma, kidney, stomach, myeloma, oral cavity and pharynx, and larynx. At the same time, mortality among women declined for 15 of the 18 most common cancers — lung, breast, colorectal, ovary, leukemia, NHL, brain/nervous system, myeloma, kidney, stomach, cervix, bladder, esophagus, oral cavity and pharynx, and gallbladder.

Death rates increased for a limited number of cancers, including melanoma, pancreas, liver, thyroid, kidney, uterus and two human papillomavirus-associated (HPV) cancers — oropharynx and anus.

Reasons for the increasing death rates for pancreatic and liver cancers in men and women, melanoma in men, and uterine cancer in women are unclear, but, according to the report, may reflect a high prevalence of chronic hepatitis C virus infection due to injection drug use for liver cancer; increased obesity prevalence for liver, pancreatic and uterine cancers; and increased harmful ultraviolent radiation exposure for melanoma. The report also suggests that increases in thyroid and kidney cancer rates may be in part due to enhanced and wider application of imaging techniques, in part to unidentified risk factors, and, in part, to increased obesity, in particular for kidney cancer.

In addition to providing updates on incidence and mortality patterns, each report features a topic of special interest, with this year’s report featuring information on HPV-associated cancers in patients aged 15 years or older and HPV vaccination coverage levels among adolescents aged 13 to 17 years.

In examining HPV-associated cancers the report illuminates disparities across socioeconomic classes and racial and ethnic groups. Examples of HPV-related cancers in both genders include oropharyngeal and anorectal tumors, and in women include cervical and vaginal. From 2000 to 2009 cervical cancer incidence fell for women in all racial and ethnic groups except American Indians and Alaskan natives, but was elevated among women living in poor areas, compared with those in better-off neighborhoods. Similar disparities were seen for men with HPV-associated anal cancers, indicating the importance of early detection and screening programs. Notably, HPV-associated cancers occur in excess among people with HIV and AIDS relative to the general population, warranting additional monitoring and prevention activities in this high-risk population.

For those newly diagnosed in 2009, HPV-associated cancers accounted for only 2% of all cancer cases among men and 3.3% among women, with oropharyngeal cancer accounting for the majority of cases among men and cervical cancer the majority among women. The study comments that the increasing trend for HPV-associated oropharyngeal cancer rates is in stark contrast with the overall decreasing trend for tobacco-related oropharyngeal cancers, largely because of declines in cigarette smoking, and that increases in rates of HPV-associated oropharyngeal cancers have also been reported in Canada, Denmark and Sweden.

The number of HPV-associated cancers attributed to HPV infection should be “cautiously interpreted,” according to the study authors, because specific information about the presence of HPV DNA in tumors was unavailable for some of the analysis.

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