Despite Decline in Death Rates, Cancer Burden Expected to Rise With an Aging Population

New data for 1999 show that death ratesfor all cancers continued to decline in the United States. However, the numberof cancer cases is expected to rise in coming years due to the growth and agingof the population, according to a recent report. The "Annual Report to theNation on the Status of Cancer, 1973-1999, Featuring Implications of Age andAging on the US Cancer Burden" was published in a recent issue of thejournal Cancer (94:2766-2792, 2002).

The report is produced jointly by the National Cancer Institute(NCI), the American Cancer Society, the North American Association of CentralCancer Registries, the National Institute on Aging, and the Centers for DiseaseControl and Prevention (CDC), including the National Center for HealthStatistics and the National Center for Chronic Disease Prevention and HealthPromotion.

The initial report, issued 4 years ago, documented the firstsustained decline in cancer death rates. This marked a notable reversal from theincreases that had been seen since the 1930s—the period when death rates forthe entire nation were first reported.

"The continuing decline in the rate of cancer deaths onceagain affirms the progress we’ve made against cancer, but the report alsohighlights the need for an acceleration of research as the population of theUnited States ages," said Andrew C. von Eschenbach, MD, director of theNCI.

Lung Cancer Retains Its Title

Lung cancer remains the leading cause of cancer death in theUnited States. During the most recent reporting period, it accounted for almostone-third of all cancer deaths in men and about one-fourth of all cancer deathsin women. Colorectal cancer is the second leading cause of cancer death,followed by breast and prostate cancer.

"The good news in this report is the continuing fall incancer death rates by slightly more than 1% per year between 1993 and1999," said John R. Seffrin, PhD, chief executive officer of the AmericanCancer Society. "Of special note is the continuing decline in death ratesfor the four most common cancers."

According to James S. Marks, MD, director of the CDC’sNational Center for Chronic Disease Prevention and Health Promotion,"Another important issue in the report is that the incidence rate, or rateof new cancers, for all cancers combined was stable during most of the 1990s,after increasing during the 1970s through 1980s. These data highlight the needfor the rapid, full application of all we know about prevention, screening, andtreatment of cancer."

Growing Risk Factor

The single most important risk factor for cancer is age. Becausethe population in the United States is both growing and aging, the authorsfocused on how the number of people diagnosed with cancer will increase.

The authors projected the cancer burden 50 years into the futureby applying US Census Bureau population projections to current cancer incidencerates. "If cancer rates follow current patterns, we anticipate a doublingfrom 1.3 million people in 2000 to 2.6 million people in 2050 diagnosedwith cancer," said Holly L. Howe, PhD, executive director of the NorthAmerican Association of Central Cancer Registries. "The number of cancerpatients age 85 and over is expected to increase fourfold in this same timeperiod," she said.

Richard J. Hodes, MD, director of the National Institute onAging notes that "the data presented in the report underscore a criticalneed for expanded and coordinated cancer control efforts to serve an agingpopulation and reduce the burden of cancer in the elderly."

In addition, the authors posit a number of strategies fordealing with the future cancer burden. Special considerations in treating cancerin older people will need to be undertaken due to comorbid conditions andphysical limitations that have not been studied fully in older age groups.Increasing enrollment of older patients into clinical trials could help answerquestions about how best to treat this population of cancer patients. Theauthors also note the growing need for trained cancer care professionals.

Reporting Changes

Certain changes and limitations in reporting data for this fifthreport preclude comparisons with previous reports. In this report, ageadjustment of statistics used the year 2000 standard population—in contrast tothe year 1970 standard population—which makes rates of certain cancers appear20% to 50% higher. This change conforms to the new federal policy for reportingdisease rates. Also, a change in how cause of death is coded, starting with 1999deaths, further complicates comparisons with previous years.

Annual population counts at the county level prior to 1990 areavailable for blacks and whites only. Therefore, assessment of long-term trendsin other population groups is not possible. The report examined recent patternsof cancer occurrence in specific racial and ethnic populations such as Asian andPacific Islanders, American Indians/Alaska Natives, and Hispanics. For thelatest time period, from 1995 through 1999, cancer rates among these groups wereconsiderably different.

The report is based on incidence data from the NCI’sSurveillance, Epidemiology and End Results (SEER) Program, the CDC’s NationalProgram of Cancer Registries, and the North American Association of CentralCancer Registries. Mortality data were taken from the CDC’s National Centerfor Health Statistics.