The rate of new cancer cases and deaths for all cancers combined as well as for most of the top 10 cancer sites declined between 1990 and 1997 in the United States, according to a new report released today by the National Cancer Institute (NCI), the American Cancer Society (ACS), the North American Association of Central Cancer Registries (NAACCR), and the Centers for Disease Control and Prevention (CDC), including the National Center for Health Statistics (NCHS). A special section of the report focusing on colorectal cancer shows declines in incidence rates despite low use of screening tests for the disease.
The "Annual Report to the Nation on the Status of Cancer, 1973-1997, with a Special Section on Colorectal Cancer" is published in the May 15, 2000 issue of the journal Cancer*.
"These findings underscore the remarkable progress we've made against cancer," said NCI Director Richard D. Klausner, M.D. At a February 2000 hearing before the House Subcommittee on Labor-HHS-Education Appropriations, Klausner noted that "the leveling off of cancer deaths in the population in the past few years despite the increase in the size of the American population is encouraging."
The report shows that the incidence rate -- the number of new cancer cases per 100,000 persons per year -- for all cancers combined declined on average 0.8 percent per year between 1990 and 1997. Using a new statistical technique called joinpoint analysis, researchers described changing trends over successive segments of time, and the amount of increase or decrease within each time period, as opposed to relying on overall trends. Thus, the greatest incidence decrease, at a rate of 1.3 percent per year, occurred after 1992, the year in which incidence rates peaked. This trend reversed a pattern of increasing incidence rates from 1973 to 1992.
"Cancer death rates have been falling since 1991 and since 1995 that decline has been even more rapid," said John R. Seffrin, Ph.D., chief executive officer, American Cancer Society. "This gives us great hope that in the new millennium, our dreams of conquering cancer are closer than ever to becoming a reality." Cancer mortality declined 0.8 percent for the period from 1990 to 1997.
By far, the greatest decline in cancer incidence rates has been among men, who overall have higher rates of cancer than women. The report analyzed data for white, black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic populations and noted large differences in cancer incidence by race and ethnicity, with incidence rates highest for blacks for the top four cancer sites except for breast cancer.
Four cancer sites -- lung, prostate, breast, and colon and rectum -- accounted for slightly over half of all new cancer cases and were also the leading causes of cancer deaths for every racial and ethnic group. Trends for those primary sites show that rates are going down for prostate cancer incidence and mortality.
Breast cancer incidence rates have shown little change in the 1990s, while breast cancer death rates have declined about 2 percent per year since 1990 and have dropped sharply since 1995.
Incidence trends in lung cancer increased from 1973 until 1991, but have since declined. Lung cancer mortality continues to increase for females but has been declining for men since 1990.
Incidence and death rates for non-Hodgkin's lymphoma among women are continuing to increase, while incidence rates for melanoma for both sexes combined have continued to rise about 3 percent annually since 1981, but death rates have been approximately level since 1989.
The report includes a special section on colorectal cancer, which for the first time incorporates data from selected state and regional cancer registries participating in NAACCR's annual Call-For-Data. This annual Call covers 49 percent of the U.S. population. According to Holly L. Howe, Ph.D., executive director of NAACCR, "with the support of its partners, NAACCR has been able to help many cancer registries achieve uniform and high quality standards. These standards make it possible to assemble data from multiple registries, leading to a better understanding of cancer incidence patterns across the United States."
Colorectal cancer has the third highest incidence of any cancer site for U.S. men, ranks second to breast cancer for Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander women, and ranks third for white and black women. The report shows that overall incidence increased until 1985 and then began decreasing steadily at an average rate of 1.6 percent per year. Like incidence, deaths from colorectal cancer rank third after lung and prostate cancer for men and third after lung and breast cancer for women.
The report also examined long-term trends in mortality from 1950 to 1997. For women, mortality rates have been declining since at least 1950 while rates for men remained fairly level from 1950 to 1980, then began declining in the 1980s. The latest five-year relative survival rate for colorectal cancer was 61 percent and varied by stage. When colorectal cancer is detected in the earliest stage of the disease, Stage I, the survival rate was 96 percent rate whereas survival for Stage IV was only 5 percent.
The prevalence of colorectal cancer screening by either fecal occult blood testing (FOBT), sigmoidoscopy, or proctoscopy, was based on data collected through the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS). Based on BRFSS results, the use of FOBT by people age 50 and older was 21.0 percent in women and 18.4 percent in men; 35.2 percent of men had either a sigmoidoscopy or proctoscopy whereas only 26.8 percent of women had either procedure. Although screening rates were low, data from the NHIS showed gradual and modest increases in the use of screening procedures for colorectal cancer from 1987 to 1998. The percentage of people who reported FOBT two years before the interview increased from 30 percent in 1992 to 33 percent in 1998, with rates varying by income and education.
According to James S. Marks, M.D., director, National Center for Chronic Disease Prevention and Health Promotion, CDC, "The findings of this Report underscore the need to improve rates of colorectal cancer screening. This is one cancer where screening clearly has benefits by saving lives. In response to low screening rates, CDC and its federal partners are pleased to join together in the broad-based educational campaign called Screen for Life."
The authors of the report suggest that screening and advances in treatment have helped reduce mortality from the disease. They also found that incidence and mortality varied somewhat from state to state. Incidence and mortality rates among black men and women were higher than among persons of other racial and ethnic groups, a disparity which could be reduced in the future, perhaps through better screening utilization and access to care.
The report is based on incidence data from SEER and NAACCR and mortality data from the NCHS. The special section on colorectal cancer incorporates data from selected state and regional registries participating in NAACCR. The ACS, NCI, NAACCR, CDC, and NCHS expect to continue monitoring the occurrence of cancer in the United States and collaborating in presenting this data to the nation.
For more information, visit the following Web sites:
SEER Homepage: http://www.seer.cancer.gov
(This site contains all data points for graphs in the manuscript as well as supplementary data and charts.)
National Cancer Institute: http://www.cancer.gov
American Cancer Society: http://www.cancer.org
CDC's Division of Cancer Prevention and Control: http://www.cdc.gov/cancer
CDC's National Center for Health Statistics: http://www.cdc.gov/nchs