In the Journals Plus

US cancer deaths continue to decline, but racial disparities persist

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January 4, 2018

Otis W. Brawley

The cancer mortality rate dropped 1.7% from 2014 to 2015, continuing a decades-long decline reaching 26% since 1991, according to Cancer Statistics 2018, the American Cancer Society’s comprehensive annual report on cancer incidence, mortality and survival.

The report — published in CA: A Cancer Journal for Clinicians — indicated this reduction has resulted in 2.4 million fewer cancer deaths since 1991. Researchers attributed the overall declines to reductions in smoking and advances in early detection and treatment.


Racial, state disparities

The report also found that the racial gap in cancer deaths continued to narrow, driven primarily by progress among older Americans; however, disparities persisted among those aged younger than 65 years.

Among all ages, cancer mortality rates in 2015 appeared 14% (death RR [DRR] = 1.14; 95% CI, 1.13-1.15) higher among blacks than whites, which represented a decrease from the 33% peak in 1993.

However, among adults aged 65 years or older, the mortality rate was only 7% greater among blacks, likely due to access to health care through Medicare.

Still, mortality rates appeared 31% (DRR] 1.31; 95% CI, 1.29-1.32) higher among non-Hispanic blacks aged younger than 65 years than their white counterparts.

The disparities varied significantly between states.

In 13 states, researchers reported death rates did not statistically significantly differ between blacks and whites; however this may due to the makeup of the population rather than progress. Kentucky and West Virginia — two states with no significant differences in mortality between races — also have the highest proportion of whites compared with other states.

“High cancer mortality in Kentucky and West Virginia, irrespective of race, highlights the strong influence of socioeconomic and health policy factors on the cancer burden,” Rebecca L. Siegel, MPH, strategic director of surveillance and health services research at the American Cancer Society, and colleagues wrote. “Nevertheless, the elimination of racial disparities in many states, let alone lower cancer mortality in blacks in Massachusetts and New York, demonstrates the potential for the nation.”


Declines in cancer incidence

Over the past decade, the overall cancer incidence rate declined among men by about 2% per year and remained stable among women. The report also found men were more likely than women to be diagnosed with cancer during their lifetime (39.7% vs. 37.6%).

The report estimated 1.7 million new cancer cases in the United States this year and about 600,000 cancer-related deaths. Of the 10 leading causes of death, only cancer declined from 2014 to 2015.

Lung cancer rates declined 45% among men from 1990 to 2015 and 19% among women from 2002 to 2015. Female breast cancer mortality rates decreased 39% from 1989 to 2015.

Deaths from prostate cancer and colorectal cancer both decreased 52% from 1993 to 2015 and from 1970 to 2015.

Researchers also noted the following trends in cancer incidence:

  • Liver cancer incidence increased rapidly among women, but plateaued among men;
  • The long-term increase in melanoma incidence has slowed, particularly among younger age groups; and
  • Thyroid cancer incidence has begun to stabilize, particularly among whites, following changes in clinical practice guidelines.

“This new report reiterates where cancer control efforts have worked, particularly the impact of tobacco control,” Otis W. Brawley, MD, chief medical officer of the American Cancer Society, said in a press release. “A decline in consumption of cigarettes is credited with being the most important factor in the drop in cancer death rates. Strikingly though, tobacco remains by far the leading cause of cancer deaths today, responsible for nearly three in 10 cancer deaths.” by Cassie Homer


Disclosures: The authors report no relevant financial disclosures.