Cancer — Some Good News

CANCER DEATH RATES HAVE BEEN DROPPING for nearly 20 years. Today we explore how it is happening with a particular focus on the extraordinary progress made in the early detection and management of lung cancer. With the COVID-19 pandemic dominating each current news cycle, I want to share some good news.

Here is the title of a recent report from the American Cancer Society: “Risk of Dying from Cancer Continues to Drop at an Accelerated Pace. Behind the striking headline are these numbers:

The cancer death rate for women and men combined fell by one-third (32 percent) from its peak in 1991 to 2019, the most recent year for which data were available.

Cancer death rates drop

3.5 million. That’s the number of deaths averted from 1991 to 2019. A big driver? Improvements in lung cancer outcomes. Approximately one in four cancer deaths are attributable to lung cancer.

Mortality rates for lung cancer decreased by roughly five percent each year between 2015 and 2019. In comparison, overall cancer mortality declined by about two percent.

How are we achieving these improvements in lung cancer outcomes? Some of the reductions in deaths are secondary to an increase in the percentage of patients living longer after diagnosis. Another contributor to the positive news is that we are catching more people at an early stage of the disease.

Lung cancer improvements

Let’s talk a little about lung cancer screening. While only a tiny percentage of those at high risk for lung cancer have screening (two percent in 2010 and five percent in 2018, according to the American Cancer Society), the upsides have been substantial. Look at the numbers:

In 2004, detection of lung cancer at an early age occurred in 17 percent of those with the disease. Contrast that figure with 2004, when 28 percent of those with lung cancer had early-stage disease.

Why does catching lung cancer when it is early and localized? Here at the United States Surveillance, Epidemiology, and End Results odds of surviving lung cancer for at least five years (2011–2017):

• Localized 60 percent
• Regional (spread to nodes) 33 percent
• Distant (spread to distant organs) 6 percent

Appropriate screening is critical. Here’s what the US Preventative Services Task Force recommends:

Annual screening for lung cancer with low-dose computed tomography (CT scan) in adults aged 50 to 80 years who have a 20 pack-year (see below) smoking history and currently smoke or have quit within the past 15 years.

*For example, if you smoked one pack of cigarettes daily for 25 years, you have a 25 pack-year history.

We see screening drop off with each peak of Covid-19. Such delays will likely lead to numerous deaths that would have been prevented. Talk to your primary healthcare provider to see what cancer screening is appropriate for you.

Lung cancer — smoking drop key to stats

To be clear, it is not only early detection or treatment advances that are moving the marker regarding lung cancer mortality improvements; what has been critical is a drop in the number of folks smoking.

Now, this is disturbing news: While we are making impressive progress in reducing deaths from lung cancer, advanced stage presentations are increasing for breast and prostate cancers. These are the most common cancers among women and men, respectively. Please get screened appropriately.

So much of what we hear about cancer is negative. I am delighted that I can share with you the good news — We are seeing significant progress in cancer risk reduction and management.