There are two tropes about cancer that seem to be accepted as facts. First, cancer is a modern disease, unknown to previous generations. And second, the cancer mortality rate is increasing because of the usual suspects, from GMOs to whatever. This is a good thing about science, there’s actually evidence that gives us a different image.
If you use Google as your source for cancer facts, you’d think that we have a raging epidemic of the disease, killing more people today than just a few years ago. But the facts say something else – the cancer mortality rate declined from 1975 to 2012 in the USA in one study, and that it was the lowest since 1991 in another study. By any reasonable examination of data, we are actually winning the war on cancer in the USA.
The myth that the cancer mortality rate is increasing, along with the trope that Big Pharma and oncologists make more money by not providing real treatments for cancer are completely debunked by this data. The cancer-woo pushers probably are saddened by what we’re learning about cancer, but it certainly provides us with excellent data that science is beating cancer. Sure, we aren’t at the point of curing all 200 or so cancers that afflict humans, but we’re doing better than we were 10, 20, 30 or 40 years ago.
Except for liver cancer bucking the trend. We’ll look into that too.
I’m certain that the reason for the lower cancer incidence and mortality rates are complicated. It’s possible that people are starting to embrace the handful of science-based preventions to cancer – like reducing smoking. It’s also better medications from Big Pharma. And better science-based treatment options for cancer. Cancer treatment has evolved massively in just 3-4 decades. I’m sure if you spoke to an oncologist today, and queried him about techniques from the 1970s, he or she would just cringe.
Let’s look at these studies that gave us this data. And maybe we can put to rest some of the memes about cancer ravishing modern humans.
Report on the war on cancer
In the Annual Report to the Nation on the Status of Cancer, 1975-2012, published (pdf) in the journal Cancer, A. Blythe Ryerson et al. from the National Cancer Institute (NCI), the Center for Disease Control and Prevention’s (CDC) Division of Cancer Control and Prevention, and the American Cancer Society (ACS) determined that the overall cancer death rates for men and women of all major racial and ethnic populations decreased by 1.5% per year from 2003 to 2012.
Additionally, incidence rates, that is, new cancer cases diagnosed per 100,000 population, decreased among men, while remaining stable among women during that same period of time.
Here are some of the details of the report, for the time period of 2003-2012:
- Cancer mortality rates for men decreased by an average of 1.8% per year.
- For women, the mortality rates decreased by an average of 1.4% per year.
- For children and adolescents, the rates decreased by an average of 2.0% per year.
- Among all individuals, the cancer incidence rate decreased by an average of 0.7% per year.
- For men, the incidence rate decreased by about 1.4% per year, while for women, the rate remained flat (although it was an improvement from the increase in cancer rates from 1992-2003).
The cancer incidence data were obtained from the CDC, NCI, and North American Association of Central Cancer Registries (NAACCR). The data about cancer mortality rates were obtained from the CDC’s National Center for Health Statistics (NCHS). The study examined the rates of all cancers.
Despite all of the good news (and refutation of some of the cancer myths that float out there), liver cancer mortality went against the trend of decreasing rates. According to this study, liver cancer deaths increased 2.8% per year in men and 2.2% per year in women from 2003 to 2012.
Furthermore, from 2008 to 2012, the incidence of liver cancers was nearly three times higher in men than in women. For men, the incidence rate increased by 11.5%, and for women, it increased by 3.9%.
What’s going on with liver cancer?
Probably the major risk factor for liver cancer is a hepatitis C (HCV) viral infection. The incidence of new HCV infections increased from the 1960s through 1980s, before the virus itself was discovered and preventive measures could be recommended. Generally, HCV is transmitted through unprotected sex with an infected individual or through sharing of contaminated needles. However, there are other transmission methods such as blood contamination in health care settings, organ transplants, tattoo and acupuncture needles that aren’t properly sterilized, and other methods where blood borne infections can be easily transmitted from an infected person.
A less frequent cause of liver cancer is cirrhosis of the liver, which can be caused by hepatitis B (HBV) and C, and alcohol abuse. HBV is a common risk factor for liver cancer among Asian/Pacific Islander populations, especially among Asians not born in the United States.
Of course, HBV infection rates are declining worldwide, owing to increases in hepatitis B vaccination of children beginning at birth. Furthermore, HBV vaccinations can also be given to adults, helping to reduce your risk of cancer. HPV and HBV vaccinations are two the best methods to reduce cancer risks.
Unfortunately, there are no vaccinations for HCV. There are medications to treat the disease (and reduce the incidence of liver cancer), but they are fairly expensive, costing US$30-40 thousand per course of treatment. Most insurance covers the cost, but the deductible might be so high that it reduces uptake of the drugs to treat HCV.
Government agencies, that often negotiate prices directly with manufacturers, are beginning to force down the prices considerably for Medicare and Medicaid patients. Sadly, the price decreases are not transparent, so those on non-governmental drug payment and insurance plans often do not benefit from these price decreases for many years.
Once there is a substantial decrease in prices along with greater uptake of anti-HCV drugs, it is predicted that the incidence of HCV related liver cancer will drop significantly.
But HCV medications are not the only issue contributing to liver cancer. A second problem is fatty liver disease, related to other metabolic syndromes like type 2 diabetes and obesity. This is an issue that not only plagues the USA, but other countries too. And the researchers behind this report believe that fatty liver disease will soon become the most common cause of both cirrhosis and primary liver cancer.
Finally, liver cancer lacks good chemotherapy treatment options, unlike those available for other common cancers such as colon and breast cancer. At this time, the best management for liver cancer is surgery, but only if the disease is caught early. And because there aren’t a lot of early symptoms of liver cancer (and the liver can often compensate for the cancer), a large mass can form which may be difficult to treat surgically.
There is a perfect storm of issues that has led to the significant rise in liver cancer – HCV infection (along with the lack of a preventative vaccine and the cost to treat it), the huge increase in fatty liver disease, and the lack of viable chemotherapy strategies, are all contributing factors to the increase in incidence and mortality from liver cancer.
But aside from that one cancer, the news is mostly good.
All about that decreasing cancer mortality rate
In another article, RL Siegel et al., found that the cancer mortality rate has dropped to its lowest rate since 1991. In 1991, when mortality rates were at their peak, 215.1 out of every 100,000 people would die of cancer. In 2012, when the most recent statistics were made available, the cancer mortality rate dropped to 166.4 – that’s a 22.3% decrease. This means that more than 1.7 million deaths from cancer that were avoided, had the 1991 rate continued.
The numbers peaked in 1991 largely because of better diagnosis and screening, especially for prostate and colorectal cancers, according to the study. The authors also speculated as to why the mortality rates had dropped so significantly — improvements to screening, prevention, and treatment. For example, fewer people smoke now than in the past because the habit can greatly increase the risk for many types of cancer.
Unfortunately, this decrease wasn’t found across all types of cancers. While fewer patients are dying from colorectal and lung cancers, diagnoses for thyroid, liver, pancreatic, ovarian and breast cancer, some of the most fatal types of cancer, have increased. The researchers speculated that the increase in some of these cancers might be due to over diagnosis, along with environmental factors, especially obesity.
The researchers also found that the lifetime probability of being diagnosed with an invasive cancer is higher for men (42%) than for women (38%). Now that might sound a bit scary, but because of better diagnosis and treatment, the overall survival rate from cancer is about 69% versus 49% in the mid-1970s.
RL Siegel et al. also stated that cancer may soon overtake heart disease as the primary cause of death in some parts of the USA – this isn’t because cancer is becoming more prevalent, it’s because physicians manage heart disease better than they did in the 1990s.
Based on this data, the authors concluded that:
The continuous decline in cancer death rates over 2 decades has resulted in an overall drop of 23%, resulting in more than 1.7 million cancer deaths averted. Despite this progress, cancer is now the leading cause of death for much of the US population. Moreover, incidence and death rates are increasing for several cancer types, including liver and pancreas—2 of the most fatal cancers. Advancing the fight against cancer will require continued clinical and basic research, which is dependent on funding, as well as the application of existing cancer control knowledge across all segments of the population, with an emphasis on disadvantaged groups.
The cancer mortality rate – TL;DR version
- We’re winning the war on cancer – I didn’t say we won it, we’re just winning.
- Incidence of all cancers, except for liver cancer, has dropped significantly since 1975, especially over the past decade, partially as a result of reduction of cancer risk behaviors (like smoking and sitting under a tanning bed). Smoking itself is the largest risk factor for cancer.
- The cancer mortality rate for most cancers, except for liver cancer, has also dropped significantly over the past two to four decades. This is a result of earlier detection (which allows for easier treatment of the disease), better treatment options (from Big Pharma), lowered risk factors like smoking, and more awareness of symptoms.
- Deaths from some cancers, such as colorectal and prostate, have dropped substantially because of better diagnostic tools.
- Liver cancer is a critical issue as a result of hepatitis C virus (along with the lack of a preventative vaccine and the cost of treatment), cirrhosis of the liver, fatty liver disease, and the lack of chemotherapy options.
If you read some woo that cancer is more prevalent now than in the past. Well, that’s wrong. And if you read some other junk medicine that chemotherapy kills more than it saves – this study shows that’s completely and utterly false. Science based medicine is reducing the mortality rate of almost every cancer.
Of course, our science denier in chief, Donald Trump, has proposed to cut $1 billion from the National Cancer Institute, so there’s a huge step backwards.
We haven’t won the war on cancer, but we’re winning it. But the disease is being pushed back on all fronts. Thanks to science, researchers, and physicians. Not because of some blueberry kale shake pushed by a pseudoscience charlatan.
- Ryerson AB, Eheman CR, Altekruse SF, Ward JW, Jemal A, Sherman RL, Henley SJ, Holtzman D, Lake A, Noone AM, Anderson RN, Ma J, Ly KN, Cronin KA, Penberthy L, Kohler BA. Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer. 2016 May 1;122(9):1312-37. doi: 10.1002/cncr.29936. Epub 2016 Mar 9. PubMed PMID: 26959385; PubMed Central PMCID: PMC4840031.
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan-Feb;66(1):7-30. doi: 10.3322/caac.21332. Epub 2016 Jan 7. PubMed PMID: 26742998.