There’s mixed progress on the cancer front: deaths from the four leading cancers continue to decline. However, for several types of cancer, black patients are increasingly less likely to survive than whites. In addition, the incidence of lung cancer among women is on the rise.
Death rates for all cancers had been inching down by about 1.4 percent a year through the mid-1990s. But by 2000 that decline seems to have leveled off.
The leveling off is at least partly due to a statistical quirk — a change in how cancer deaths are recorded that means fewer were being missed in national counts starting in 1999.
'A slowing of the decline'
Still, “we’re seeing perhaps a slowing of the decline,” said Brenda Edwards of the National Cancer Institute, which co-authored the report with the cancer society and Centers for Disease Control and Prevention. “It gives us pause.”
“Death rates in the United States for all cancers combined increased by 0.5 percent per year through 1990, stabilized through 1994 and declined by 1.4 percent per year from 1994 through 1998,” the researchers wrote.
On the positive side, the report finds the death rates from the four most common cancers— lung, breast, prostate and colorectal — still are declining for all but one group, women with lung cancer.
The decline in the four top cancer killers is attributed to advances in better screening, detection and treatment, along with the battle against tobacco use.
The increase in deaths of women with lung cancer follows smoking trends, which began falling in men just as women began to smoke more.
An estimated 556,500 Americans will die of cancer this year, the nation’s second-leading killer after heart disease. Some 1.3 million will be diagnosed with cancer.
Lung cancer is by far the biggest cancer killer, taking 157,000 lives this year. Colon cancer will kill 57,000 people in the United States this year, breast cancer will kill 40,000, and prostate cancer will kill 29,000 men.
Mixed progress
“The progress against cancer continues to be mixed,” said Dr. Michael Thun of the American Cancer Society, who co-authored the report, published Tuesday in the Journal of the National Cancer Institute.
Instead of awaiting the next anticancer discovery, the report shows states how to better target programs proven to save lives that aren’t being offered equally across the country, he said.
Many states are lagging in proven methods to fight the most common tumors, says the nation’s annual report on cancer. Sixteen states spend less than $1 per person on tobacco control — far less than the $5 to $10 per person recommended by the CDC — even though smoking is the leading cause of lung cancer, the No. 1 cancer killer.
“There are substantial opportunities in applying what we already know,” Thun said. Yet “because of the state budget crises, programs like tobacco-control programs are being cut at a critical time, when there’s terrific opportunity for progress.”
Screening for breast and colorectal cancer varies widely, too.
“This report shows that we have made some progress in reducing the burden of cancer in the United States, but much still needs to be done ... including wider application of what science has shown to be effective in preventing, screening, and treating cancer,” said CDC Director Dr. Julie Gerberding.
Blacks more likely to die
Lung cancer deaths are increasing by just under 1 percent a year among both white and black women.
Most striking are the racial disparities. By 2000, death rates for whites were substantially lower than those for blacks — and the gap appears to be widening in breast and colorectal cancer.
Although breast cancer incidence is 16 percent higher in white women, black women are far more likely to die. Indeed, while breast cancer death rates dropped 2.5 percent a year for white women during the 1990s, death rates dropped just 1 percent a year for black women.
Similarly, black men and women are more at risk of getting and dying of colorectal cancer than whites — and through the 1990s, white survival improved more than that of black patients.
That “would suggest perhaps the black population is not receiving the same benefit from early detection and treatment as the white population,” said CDC epidemiologist Hannah Weir.
While socio-economic factors play a role, scientists can’t yet fully explain the gap.
State comparisons
The researchers also examined state spending on tobacco-control programs.
By 2010, the government wants no more than 12 percent of the population to smoke. Utah is closest to that goal, with 13.3 percent of adults who smoke — and the fewest deaths from lung cancer. At the other extreme is Kentucky, where 30.9 percent of adults light up — and the lung cancer death rate is the nation’s highest.
Kentucky spends just 84 cents a person on tobacco-control programs. Utah, where the Mormon church is a strong anti-tobacco influence, spends $2.46 per person on tobacco control.
Cancer screening varies widely, too. Women aged 40 or older are supposed to get mammograms every year or two. In Indiana, just 30 percent of uninsured women do.
The report, which can be found on the Internet at , includes the largest number of Americans yet, from 34 statewide cancer registries. They cover 68 percent of the U.S. population — versus 55 percent in previous years.
The report says death rates could be lowered even further with better screening — for instance, for colon cancer.
The government wants at least half the over-50 population to be getting regular colorectal cancer screening by 2010 — but in many states, well below 40 percent do.
A report earlier this year from the Institute of Medicine said lifestyle changes such as quitting smoking and better diet and better screening could prevent almost 100,000 new cancer cases and 60,000 cancer deaths each year.
About 25 percent of the U.S. population smokes, despite its clear links with lung cancer, heart disease and stroke.
The Associated Press and Reuters contributed to this report.