Death rates down, more work awaits
As the ‘official sponsor of birthdays,’ the American Cancer Society (ACS) found a reason to rejoice in their latest report – Cancer Facts & Figures 2015. Since hitting a peak in 1991, cancer deaths have fallen 22 percent over two decades in the United States, which means more than 1.5 million deaths have been avoided … and more birthdays celebrated.
An ACS infographic showed 3.3 million cancer survivors in the United States in 1973. Today, there are more than 14.5 million cancer survivors, and that number is projected to jump to 18.9 million by 2024.
Each year, the ACS compiles the most recent data on cancer incidence, mortality and survival using data from a variety of sources including the National Cancer Institute, National Center for Health Statistics and the Centers for Disease Control and Prevention. The most recent five-year data (2007-2011) showed the overall cancer incidence rate held steady in women and declined by 1.8 percent per year in men. The decrease in men was attributed to rapid declines in colorectal cancer (3.6 percent per year), lung cancer (3 percent per year) and prostate cancer (2.1 percent per year).
During the same time period, the average annual decline in cancer death rates was 1.8 percent in men and 1.4 percent in women. Lung cancer, while still the deadliest form of the disease, has declined 36 percent between 1990 and 2011 among men. Women have also seen double digit declines attributable to reduced tobacco use. On another happy note, breast cancer death rates for women are down more 35 percent from peak rates, and prostate and colorectal cancer deaths are down by nearly half (47 percent).
Despite the good news, though, ACS officials also noted there is much more work to be done. “The continuing drops we’re seeing in cancer mortality are reason to celebrate, but not stop,” stated John R. Seffrin, PhD, chief executive officer for ACS, when the report was released in January. He added cancer was still responsible for nearly one in four deaths in the United States in 2011. Furthermore, Seffrin noted the country’s second leading cause of death overall is actually the top cause of death among adults ages 40 to 79.
Looking to this year, the ACS has projected 1.658 million new cancer cases will be diagnosed in 2015, and 589,430 Americans will lose their battle with the disease. Of the new cases, the estimate is that men will account for about 848,000 diagnoses across all sites and women 810,000. Prostate, lung and colorectal cancers will account for about half of all cases in men with prostate cancer accounting for around 25 percent of all new diagnoses. Among women, it is anticipated the three most common diagnoses in 2015 will be breast, lung and colorectal cancers. Of those, breast cancer is expected to account for 29 percent of all new cancers for women this year.
Of the 589,430 estimated deaths in 2015, the gender breakdown is 312,150 men and 277,280 women. The most common causes of cancer death are lung, prostate, colorectal and breast cancer with these four accounting for almost half of all cancer deaths. More than a quarter of all cancer deaths (27 percent) will be attributable to lung cancer.
While death rates have declined, the report noted mortality improvements aren’t equal from coast-to-coast. In fact, cancer death rates vary by state and region with the Southeast being on the lower end of improvement scale (15 percent decline in overall cancer mortality) and the Northeast on the higher end (between 25-30 percent decline). The variation has been attributed to a number of reasons including risk factor patterns (such as the number of smokers), distribution of poverty, and access to healthcare.
A recent survey by the American Institute for Cancer Research found there is an ‘alarmingly low’ awareness of key cancer risk factors, and many Americans put fear before facts. The Cancer Risk Awareness Survey, released on Feb. 4 in conjunction with World Cancer Day, found Americans worry about factors over which they have little or no control … such as genetic risks or food additives … with less than half recognizing the correlation between an increased risk of cancer and alcohol, obesity, lack of physical activity and poor diet.
The findings of the biennial survey give providers and other health experts an idea of whether or not cancer messaging is being heard by the American public. This year’s results were decidedly mixed.
Only 42 percent surveyed were aware a diet low in vegetables and fruit increases cancer risk. This number has trended downward since 2009, when it stood at 52 percent.
Only 43 percent knew alcohol increases cancer risk, an increase of five percentage points since the 2013 survey.
And only about 1 in 3 Americans (35 percent) realized diets high in red meat have been convincingly linked to colon cancer. This figure has not changed since the survey was last conducted in 2013.
Awareness that carrying excess body fat is a cancer risk factor is rising. In this latest survey, 52 percent realized obesity and overweight impact cancer risk, a rise of 4 percentage points.
Awareness that being inactive increases cancer risk jumped 6 percentage points, from 36 percent in 2013 to 42 percent in 2015.
There was a high recognition of several known risk factors for cancer including 94 percent of those surveyed correctly identifying tobacco use and 84 percent citing excessive sun exposure as risks.
However, a significant number of those surveyed also worried about risks for which research has yet to provide a definitive answer. Pesticide residue on produce (74 percent), food additives (62 percent), genetically modified foods (56 percent), stress (55 percent), and hormones in beef (55 percent) were all cited as concerns.
President Obama’s Precision Medicine Initiative
After first introducing the topic during the State of the Union Address, President Barack Obama held an event at the White House at the end of January to unveil details about the Precision Medicine Initiative, a major research push to pinpoint the best, most precise treatment options for individual patients considering genetic profile, environment and lifestyle.
In a fact sheet created for the program, White House officials stated, “The Precision Medicine Initiative will pioneer a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge and therapies to select which treatments will work best for which patients.”
While the move away from ‘one-size-fits-all’ medicine is not limited to cancer research, oncology is at the centerpiece of the initiative and a recipient of significant funding. If passed, President Obama’s 2016 budget includes a $215 million investment in the program including $130 million to the National Institutes of Health to develop a voluntary national research cohort of a million or more volunteers to propel the science forward and to create a model for responsible data sharing. Additionally, $70 million is specifically earmarked for the National Cancer Institute to scale up efforts to identify genomic drivers to various cancers, and a major objective of the initiative is to create ‘more and better treatments for cancer.’
In response to the Jan. 30 announcement, American Association for Cancer Research CEO Margaret Foti, PD, MD (hc), said, “We live in an extraordinary time when the scientific opportunities and our ability to translate this new knowledge into ways to both save and improve the quality of life of patients are simply astounding. This is why we are so excited about today’s event at the White House and specifically about President Obama’s major investment in the enormous potential of precision medicine, which is in the very early stages of transforming healthcare.”
Similarly, the Pancreatic Cancer Action Network voiced their appreciation and support for the initiative. “The Pancreatic Cancer Action Network applauds President Obama for his new Precision Medicine Initiative and for making an important investment to advance cancer research and arm the scientific and medical community with the cutting edge tools and resources needed to fight cancer,” said Julie Fleshman, president and CEO of PanCAN. “This is especially welcome news for patients fighting pancreatic cancer who face a five-year survival rate of just 7 percent.”
With personalized medicine for pancreatic cancer still in the early stages, she added, “We recognize, as President Obama highlighted, that the “one-size-fits-all” approach does not work for pancreatic cancer and recently launched Know Your Tumor, a personalized medicine service available through our patient services program. In addition to providing molecular profiling that may help a patient’s oncologist determine the best treatment options, we will collect tumor information from thousands of pancreatic cancer patients to assist with future research and development of new therapies and diagnostics for pancreatic cancer.”