Medical Technology

Substantial Declines in Mortality for most cancers

A new study shows that cancer mortality has declined significantly in the United States in the past five decades.

Researchers discovered that the incidence of all cancers decreased by 27% overall between 1971 and 2019 and declined significantly for 12 of the 15 cancer sites that were analyzed.

The data showed that certain cancers have seen higher mortality rates in particular years. For instance, mortality from lung cancer was 44% lower in 2019 compared to its peak rate in 1993, whereas it was only 13% lower when compared to the morality rate in 1971.

“The cancer mortality rate has decreased significantly since 1971, for the majority of cancer sites , and for the entire population,” Ahmedin Jemal (DVM PhD), American Cancer Society, Kennesaw Georgia and co-authors write.

Advances in surgery, radiotherapy, chemotherapy, precision medicine and combination treatments over the last five decades have led to the dramatic decline in mortality, Jemal and colleagues explained. They also credit the “expanded investment” in the National Cancer Institute’s annual budget, following the 1971 National Cancer Act, which increased the budget by 25 times from $227 million in 1971 to $6 billion by 2019.

The report, which was published online today in JAMA Oncology, looked at mortality rates for all cancers as well as the top 15 websites using the National Center for Health Statistics.

Researchers discovered that, overall there was a significant drop in deaths from all kinds of cancers during the time of the study. The most dramatic changes since 1971 were seen in cervical and stomach cancers, with 72 percent and 69%, respectively, lower mortality rates. Also, colorectal and pharynx cancer (56%), ovarian cancer (43 percent), and oral cavity and pharynx cancer (43 percent). The mortality rates of female breast cancer and prostate cancer have also decreased significantlyat 39% and 39% respectively..

“The decrease in mortality rates for female breast, cervical, colorectal, and prostate cancer in part is due to the increased detection (and removal) of premalignant lesions as well as cancers in the early stages,” Jemal and colleagues noted.

The data suggests that around half the declines in the mortality rate of colorectal cancer between 1975 and 2002 could be attributed to screening likely. A 2019 study found that 63 percent of the declines in mortality from breast cancer among women occurred between 2000 and 2012.

The authors also note that “the declines in lung, oral cavity and bladder cancers result from a reduction in smoking due to enhanced public awareness of the health risks and the implementation of a higher taxes on cigarettes, and the introduction of comprehensive smoke-free legislation.”

However mortality rates did rise in certain categories. For instance the pancreatic cancer mortality rate increased by 3 percent between 1971 and 2019, and by 8 percent for Esophageal and brain cancers. The mortality rates for cancer were also higher in 29% of United States counties that were included in the analysis, mostly those in the south.

The rising mortality rate due to pancreatic cancer is likely due to the increasing prevalence of obesity in the US as well as the lack of real advancements in pancreatic cancer prevention, early detection, or treatment, according to the authors. The slow progress in the south could also be due to a lack of access to treatment.

The authors conclude that increasing equity through investments in social determinants of equity and research on implementation is essential to advance the national cancer control agenda.

The authors did not disclose any financial relationships.

JAMA Oncology. Published online on November 11, 2021. Research letter

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