The New York Times (pg. A14)  [Printer-friendly version]
January 18, 2007


By Denise Grady

The number of cancer deaths in the United States has dropped for the
second year in a row, the American Cancer Society reported yesterday.
The finding suggests that the small drop reported last year -- the
first in more than 70 years -- was real, possibly the start of a
continuing decrease and not merely a statistical fluke, researchers

Much of the decrease is due to smoking cessation and improved
detection and treatment of colorectal, breast and prostate cancers.
But it has taken enormous efforts and ingenuity to produce relatively
small gains.

From 2003 to 2004, cancer deaths fell by 3,014, considerably more than
the previous year's decline, 369. (These are the latest years for
which figures are available.) Although the drop is notable, it still
pales in comparison with the number of cancer deaths, 553,888 in 2004.
Cancer is the second leading cause of death in the United States,
after heart disease.

By far the greatest decreases in mortality have been in colorectal
cancer -- 1,110 fewer deaths in men, 1,094 fewer in women.

Dr. Elizabeth Ward, a managing director in epidemiology and
surveillance at the cancer society, said the most important factor in
the decrease was screening for colorectal cancer, which can detect the
disease early when it is most treatable, or even prevent it entirely
by finding precancerous polyps, which can be removed before they turn
malignant. Progress has been significant even though only about half
the adults who should be screened have been. If more people were
screened, there would be even steeper declines in death and the
incidence of the disease.

The screening methods include stool tests; colonoscopy, which examines
the entire large intestine; and sigmoidoscopy, which examines the
lower part of it.

Dr. Alfred I. Neugut, the director of cancer prevention and control at
Columbia University Medical Center, said colorectal screening was
comparable to the Pap test, which led to an 85 percent decrease in the
incidence of cervical cancer in this country.

Improved treatment has also played a part in lowering the death rate
from colorectal cancer, Dr. Neugut said. "There was a revolution in
treatment between 1998 and 2000, and revolution is a mild word," he
said. "We went from having one drug to having six or seven good
drugs. The cure and survival rates have increased dramatically as a
result. The cost of care has also gone up, but you get what you pay

The death rate from cancer has been falling by slightly less than 1
percent a year since 1991, but until 2003 the actual number of deaths
kept rising because the population was growing and aging. Then, in
2003, the cumulative drop in death rates finally became large enough
to outpace aging and population growth.

"The decline in the cancer death rates, which has ultimately resulted
in a decline in the total number of deaths, really reflects the years
of effort and investment in tobacco control, programs for early
detection and screening, and programs in clinical and basic
research," Dr. Ward said. "We've made a great deal of progress, but
we still have a long way to go."

One great concern, Dr. Ward said, is that African-Americans have
markedly higher death rates than whites from nearly every type of
cancer. Researchers do not fully understand why. Having less income,
education and access to health care account for much of the
difference, but not all of it, researchers say.

"If we really want to continue to make progress by applying what we
know," Dr. Ward said, "we have to figure out a way to make sure to
reach all populations with the information they need to prevent
cancer, and make sure that all populations have access to early
detection and treatment -- quality treatment -- so that 10 to 20 years
from now we don't see the same big differences."

The report also notes differences with other racial groups. American
Indians and Alaska natives have the highest incidence and death rates
from kidney cancer, but the reason is not known. Compared with whites,
Pacific Islanders and Asian-Americans have a higher incidence and
death rate from stomach and liver cancers. The main reason is that
they are more likely to be exposed to the hepatitis B virus, which can
cause a chronic liver infection that leads to cancer, and to the
bacterium Helicobacter pylori, which can lead to ulcers and stomach

Hepatitis B can be prevented by a vaccine. There is no vaccine for
Helicobacter, but infections can be treated with antibiotics.

Originally, the new statistics were to be made public on Friday, but
the cancer society changed the release date to Wednesday at the
request of the director of the National Cancer Institute, who wanted
the announcement to coincide with President Bush's visit to the

Lung cancer is still the leading cause of cancer mortality in the
United States, with 160,390 deaths expected in 2007. In men, deaths
have been decreasing, but in women they are still increasing slightly,
because women quit smoking later.

Now, the lung cancer epidemic may be starting to plateau in women just
as it did in men about 15 years ago, Dr. Ward said.

Another cancer is likely to increase, not in rates, but in numbers as
the population ages. "I think prostate cancer is going to be the bane
of the next century," Dr. Neugut said.

The incidence of the disease probably will not change, he said, but
the number of cases will increase. About 219,000 new cases are
expected in 2007, and 27,000 deaths.

"As the baby boom generation reaches the age where everyone's getting
prostate cancer, it's going to absolutely go through the roof in the
next decade or two," Dr. Neugut said. "It's going to be a good time
to be a urologist. We'll hit 300,000 cases in the next 10 to 20 years.
From a public health perspective, it means we'll be doing more surgery
and spending more on prostate cancer."

Screening is controversial, because not all prostate cancers are
deadly, yet once they are found many men feel they must have surgery
to remove the entire prostate gland.

"We're overdiagnosing it," Dr. Neugut said, adding that although he
is a cancer specialist, he does not endorse screening for prostate
cancer, not even for himself. "My wife gets mad at me and screams,"
he said.

Breast cancer incidence, which had been climbing steadily for decades,
has leveled off. One reason may be that many women abandoned
menopausal hormone treatment after a major study in 2002 found that it
increased the risk of breast cancer. Another reason may be that rates
of mammography -- and therefore of new diagnoses -- have also leveled
off. Death rates have been decreasing, but in women ages 20 to 59,
breast cancer is still the leading cause of cancer death.

Death rates from a few other cancers have increased.

One is esophageal cancer in men, an increase Dr. Ward said was
probably linked to obesity. Being overweight increases the risk of
acid reflux, in which stomach acid backs up into the esophagus,
causing a chronic inflammation that can eventually lead to cancer.

Liver cancer has also increased in both men and women, almost
certainly because of hepatitis viruses; about 3 million people in the
United States have chronic hepatitis C infections, and 1.25 million
have chronic hepatitis B. Hepatitis B is especially common among Asian
immigrants, many of whom were infected at birth. But obesity may also
raise liver cancer rates, Dr. Ward said.