Survival rates among AYAs with certain cancers show little to no improvement
Although 5-year survival rates have increased for multiple cancer types among adolescents and young adults, little or no improvement has been observed for some common malignancies in this population, according to findings published in Cancer.
Investigators at NCI called for a focused response and more research to address the latter trend, most apparent with breast cancer, gynecologic cancers and sarcomas.
“As SEER cancer data collection expands over time, including more years of diagnosis, we are able to piece together a larger part of the cancer survival story for the adolescent and young adult [AYA] population in the United States,” Denise Riedel Lewis, PhD, MPH, chair of the SEER Rapid Response Surveillance Studies committee in the division of cancer control and population sciences at NCI, said in a press release. “These results will help refocus our research efforts on [AYA] cancer survivorship.”
Lewis and colleagues used data from the SEER database and National Center for Health Statistics to analyze incidence, mortality and survival rates from 1975 to 2016 for nine cancer types with the highest mortality rates among AYAs aged 15 to 39 years. Researchers modeled relative survival trends using JPSurv, a new Joinpoint regression program designed specifically for survival data.
Results showed significant improvement in 5-year relative survival for brain and other nervous system tumors, colon and rectal cancer, lung and bronchial cancer, acute myeloid leukemia and non-Hodgkin lymphoma. Investigators attributed progress in these cancers to new prevention options, advances in diagnosis and treatment, and containment of risk factors such as HIV/AIDS and HPV, among other factors.
However, Lewis and colleagues found limited or no improvement in survival for female breast cancer, cervical cancer, ovarian cancer, and bone and joint sarcomas.
Survival rates have plateaued among AYAs with female breast cancer, which had the highest incidence and mortality rates among this population. Results of the trend analysis showed 5-year relative survival increased from 1985 through 2007, by an annual rate of 0.66 percentage points, and stabilized after 2007. Although mortality declined from 1986 to 2012, it has increased since 2012.
Among AYAs with cervical cancer, the 5-year relative survival rate exceeded 80% in 1975 and held steady through 2011. Disease burden decreased after 2005 due to declining incidence and a flat mortality rate.
Five-year relative survival for ovarian cancer rose slightly — by 0.24 percentage points — during the period analyzed, with incidence remaining stable since 1996 following large declines in 1993 and 1996. Mortality declined, as well.
For bone, joint and soft tissue sarcomas, 5-year relative survival increased by 0.82 percentage points from 1975 to 1989 before leveling off. Increased incidence between 1975 and 2016 and a flat mortality rate indicated an increased disease burden, Lewis and colleagues wrote.
Additional research is needed in cancers that have shown little or no improvement, according to the investigators.
“Substantial concern remains regarding the high number of breast cancers coupled with declining survival rates, the increases in colorectal cancer incidence, and the slow progress for sarcomas and AML, which suggest investigations of biological differences among AYA patients and efforts to further improve treatment in this group,” they wrote.