In 1991, the Dead Sea Scrolls were first unveiled, Apartheid was dismantled in South Africa and the Dow Jones average for the first time surpassed 3,000. Unfortunately, that was also the year American deaths from cancer reached an historic peak, claiming the lives of 215 out of 100,000 citizens.
In the two decades since that all-time high, U.S. cancer deaths have fallen 22 percent, according to the American Cancer Society’s recently issued “Cancer Facts & Figures 2015.” This drop in mortality rate is equivalent to upwards of 1.5 million lives spared – representing more people than the populations of Seattle and Portland combined.
Overall, cancer deaths have declined in every state, with variations ranging from drops of 9 percent in Oklahoma to 33 percent in the District of Columbia. In general, the declines were greatest in Northeast states, while Southern states showed the slowest declines as well as the highest numbers of current cancer deaths.
Western states had the lowest cancer death rates compared to other parts of the country; for example, mortality ranged from approximately 125 cancer deaths in a population of 100,000 in Utah compared to 200 in Kentucky. Washington saw a relative decline of 19 percent in cancer deaths from 1990 to 2011, resulting in 3,192 fewer deaths from cancer in 2011.
“These significant declines in cancer mortality certainly reflect advances in prevention, and basic and clinical research,” said Dr. Polly Newcomb, head of the Fred Hutchinson Cancer Research Center Prevention Program. “Policy changes have also been essential in realizing these advancements. For example, tobacco-control legislation, restrictions on [carcinogenic] exposures in the workplace, and reimbursement for screening [have all contributed to these declines].”
Lung cancer incidence began dropping in the mid-1980s in men and the late 1990s in women due to reductions in tobacco use that started many years before. The ACS report indicates that between 1990 and 2011, lung cancer deaths in men declined 36 percent; between 2002 and 2011, lung cancer mortality for women dropped by 11 percent. The lag time and differences are related to the facts that smoking became a trend among women decades later than it did for men and that women were slower to quit.
According to the American Cancer Society report, these overall declines reflect the ongoing decreases in mortality from the four major cancers (lung, breast, prostate, and colorectal). The lives saved can be credited to reduced tobacco use, improvements in early detection and treatment, better screening, and new insights regarding cancer prevention.
Survival rates of most cancers have also made marked improvements. The five-year relative survival rate for all cancers combined has grown by 19 percentage points among whites and 23 percentage points among blacks, according to the ACS.
Survival rates have increased most in blood cancers such as leukemia and lymphoma; for example, the five-year survival for acute lymphocytic leukemia increased from 41 percent during the mid-1970s to 70 percent from 2004 to 2010. Researchers credit improvements in treatment protocols and the use of targeted therapies for these more optimistic outcomes.
“Fred Hutch has been at the forefront of the development of stem cell transplants and other treatments for blood cancers,” Newcomb said. “This [kind of research] has dramatically increased survival from these cancers.”
The data provide hope for continued reductions in U.S. cancer incidence and mortality rates, but also estimate what we can expect in the year ahead:
Although rates of major cancers may be declining, the ACS data indicates that mortality rates are rising for both men and women related to cancers of the oropharynx, anus, liver, pancreas and soft tissue. In men, the report showed that incidence rates have increased for non-Hodgkin lymphoma and human papillomavirus-positive oropharyngeal cancers. In women, rates of esophageal adenocarcinoma and uterine cancer also are increasing.
“Eliminating cancer has turned out to be much more complicated than the research and public community imagined 40 years ago with the National Cancer Act,” Newcomb said. “The research community recognizes that cancer control requires a multidisciplinary approach, including scientists in the lab, clinic, community – and certainly at the computer. Applying the information we have right now to a larger population, such as through behavior change (increased physical activity, smoking cessation, and increased screening), will help decrease incidence.”
Newcomb’s work at Fred Hutch highlights how genetics, epigenetics, and personal characteristics (such as body size) may all play a role in cancer incidence and mortality. “Although some might consider these characteristics destiny,” she said, “they can help individuals and their clinicians direct interventions to reduce risk.”
“For example, in research here at Fred Hutch, investigators are using a risk score based upon a genetic score to identify the appropriate age to begin screening for colon cancer. Personal characteristics may also help direct whether some drugs will be effective in treating specific cancers. We have every reason to be hopeful,” she said.
In an ACS news release, Dr. John R. Seffrin, the organization’s chief executive officer, was cautiously optimistic about this year’s report.
“The continuing drops we’re seeing in cancer mortality are reason to celebrate, but not to stop,” he said. “Cancer was responsible for nearly one in four deaths in the United States in 2011, making it the second leading cause of death overall. It is already the leading cause of death among adults aged 40 to 70, and is expected to overtake heart disease as the leading cause of death among all Americans within the next several years.
”The change may be inevitable, be we can still lessen cancer’s deadly impact by making sure as many Americans as possible have access to the best tools to prevent, detect and treat cancer.”
Research, much of it happening at Fred Hutch, shows that many cases of cancer may be preventable through basic lifestyle changes, and many potentially deadly cancers can be stopped in their tracks through regular screening and early detection.
Newcomb recommends the following simple steps to reduce cancer risk and mortality and improve one’s quality of life:
Immunize against cancer-causing viruses. Cancer vaccines boost the body’s immune system defense against abnormal cells. The U.S. Food and Drug Administration has approved two types of cancer vaccines: One protects against the hepatitis B virus, which can cause liver cancer. Another targets human papillomavirus types 16 and 18, which are associated with approximately 70 percent of cervical cancer cases. According to the National Cancer Institute, additional vaccines are currently in development for many other types of cancers.
Get regular exercise. Literally dozens of studies, including those conducted at Fred Hutch, indicate that exercise reduces the risk of breast and colon cancer, two of the most common malignancies. Regular physical activity and maintaining a healthy weight can prevent the growth of cancer cells by controlling insulin levels.
Eat green (and red, orange and yellow). Eating more vegetables of any kind will decrease cancer risk, but cruciferous varieties are especially potent protectors. Broccoli, cauliflower, Brussels sprouts, cabbage and other crucifers contain high amounts of phytochemicals that increase enzyme activity against cancer-promoting compounds in the body. Make it a habit to add extra vegetables to soup, salads and other dishes. Fruits, such as berries and vitamin-C-rich oranges, grapefruit and kiwi, contain important phytonutrients as well.
Be serious about not smoking. Tobacco use increases your risk for more than just lung cancer. A Fred Hutch study showed that heavy smokers are at double the risk for aggressive prostate cancer as compared to men who have never smoked. Smoking can also increase breast cancer risk by up to 40 percent. Bottom line, when it comes to cancer, there is no safe amount of smoking. Quit now; you won’t regret it.
Find cancer early. Detecting cancer in its earliest stages can mean the difference between life and death. Mammograms, Pap and HPV tests, colonoscopy and low-dose spiral CT scans are ways to spot the most common cancers at their most treatable stages.
Joely Johnson Mork is a Seattle-based freelance health and science writer/editor whose work has appeared in numerous consumer health books, as well as in Prevention and TIME. Her personal essays have been heard on NPR. Mork has a master’s degree in community health education and is a certified yoga instructor. Reach her at firstname.lastname@example.org.