First issued in 1998, the "Annual Report to theNation" is a collaboration among the National Cancer Institute (NCI),which is part of the National Institutes of Health (NIH), the Centersfor Disease Control and Prevention (CDC), the American Cancer Society(ACS), and the North American Association of Central Cancer Registries(NAACCR). It provides updated information on cancer rates and trends inthe United States.
According to NCI Director Andrew C. vonEschenbach, M.D., "These numbers reflect a trend in reduction of cancermortality that has now persisted for nine years. This can only beconsidered good news for the millions of cancer survivors who havebenefited from recent research and treatment advances and emphasizesthe expectation that we will achieve a time when no one will suffer ordie from cancer."
Death rates from all cancers combined declined1.5 percent per year from 1993 to 2002 in men, compared to a 0.8percent decline in women from 1992 to 2002**. Lung cancer is theleading cause of cancer deaths in both men and women. Death ratesdecreased for 12 of the top 15 cancers in men, and nine of the top 15cancers in women.
"Declines in mortality rates from manytobacco-related cancers in men represent an important, but incomplete,triumph of public health in the 21st century," said John R. Seffrin,Ph.D., chief executive officer of the ACS. "These trends reinforce theimportance of tobacco control programs in the U.S., as well as measuresto combat the increase in tobacco use in other parts of the world,particularly in developing countries."
Overall cancer incidencerates (the rate at which new cancers are diagnosed) for both sexes havebeen stable since 1992. Incidence rates were stable in men from 1995 to2002 and increased 0.3 percent annually in women since 1987 to 2002.The persistent increase in overall cancer incidence rates for women canbe attributed to increases in rates for breast and six other cancers:non-Hodgkin lymphoma, melanoma, leukemia, and thyroid, bladder andkidney cancer. However, according to more recent data from 1998 to2002, female lung cancer incidence rates have begun to stabilize afterincreasing for many years, which is good news. Changes in overallincidence may result from changes in the prevalence of risk factors andfrom changes in detection practices due to introduction or increaseduse of screening and/or diagnostic techniques.
This year's reporthighlights patterns of care for cancer patients. The authors note thatone strategy for reducing death and improving cancer survival is toensure that evidence-based treatment services are available andaccessible. In performing this analysis, the authors looked at datafrom NCI's Patterns of Care studies (which supplement routine datacollection from NCI's Surveillance, Epidemiology and End Results, orSEER Program, with more detailed data on treatment patterns) andSEER-Medicare databases (which link data from SEER registries toMedicare claims data to assess treatment histories for those over age65), as well as other resources. Using these data, they examinedwhether evidence-based care was delivered uniformly to diversepopulations and how rapidly changes in evidence-based guidelinesresulted in changes in cancer care.
"Day by day we are winningthe war against cancer as more people than ever before are beingscreened and are receiving treatments necessary for them to leadhealthy and productive lives," said CDC Director Julie Gerberding, M.D."However, there are gaps and missed opportunities so we must continueto pull out all the stops to ensure proper screening and access totreatment regardless of one's age, race, or geographic location."
Forbreast cancer, data on trends in the treatment of early-stage diseaseshow that the proportion of women diagnosed with stage I or II (earlierstage) breast cancer who received breast-conserving surgery withradiation treatment increased substantially during the 1990s. Thischange followed evidence-based guidelines that breast-conservingsurgery followed by radiation therapy may be preferable to mastectomybecause it provides similar survival but preserves the breast.
Theauthors also report findings of a separate study on use of chemotherapyand radiation therapy for women with early-stage breast cancer. Forwomen with lymph node positive disease, multi-agent chemotherapy, alongwith tamoxifen (a hormonal therapy) for those with estrogen-receptorpositive tumors, has been recommended since 1985 by the NIH. This studyfound that, between 1987 and 2000, the proportion of women who receivedboth chemotherapy and tamoxifen increased substantially. However, useof concurrent therapy remained relatively low among women age 65 andolder, who were more likely to receive tamoxifen only.
Forcolorectal cancer, the authors found that use of adjuvant (additionaltreatment that follows initial surgery) chemotherapy for stage IIIcolon cancer patients increased rapidly between 1987 and 1995. However,delivery of this therapy was uneven across age groups, with much lowerrates of treatment among patients age 65 and older. Also noted was thefact that the number of patients who received treatment decreased withthe increasing number of pre-existing medical conditions, but thelikelihood of receiving adjuvant therapy decreased with age even aftertaking other medical conditions into account.
For patients withadvanced non-small cell lung cancer, evidence-based guidelinesrecommend that chemotherapy may be beneficial for patients who are wellenough to withstand the treatment. One analysis found that, amongpatients age 65 and older diagnosed with this type of lung cancerbetween 1991 and 1993, only 22 percent received chemotherapy. A studyof patients diagnosed in 1996 found similarly low levels of treatmentamong patients age 65 and older. However, more recent studies havefound increasing trends in the late 1990s in the use of chemotherapyamong late-stage non-small cell lung cancer patients.
Unlikebreast and lung cancers, treatment for prostate cancer is morecontroversial. The most notable trend in prostate cancer treatment from1986 to 1999 was the decreasing proportion of cases that receivedwatchful waiting, surgical or chemical castration, or hormonaldeprivation therapy as primary treatment. More aggressive treatments,including newer radiation techniques, were found to be on the rise.However, black men were found to receive substantially less aggressivetreatment than white men.
The report concludes that substantialgeographical variations in treatment patterns exist, but that much ofcontemporary cancer treatment is consistent with evidence-based NIHConsensus Development Statements (http://consensus.nih.gov/ ), whichare considered a "gold standard" for care recommendations.
"Thevalue of cancer registries in population research is immeasurable.Through linkage with other data systems, the information can give usinsight into getting effective treatments to the general populationthat will have an impact on survival and mortality," said NAACCRDirector Holly L. Howe, Ph.D.
The authors also examined racialand ethnic disparities in cancer. From 1992 to 2002, prostate, lung,colon/rectum cancer in men, and breast, colon/rectum, and lung cancerin women, continue to be the leading sites for incidence and mortalityfor each racial and ethnic population. Rates for lung and prostatecancer decreased among men in all populations, while colorectal cancerincidence rates decreased only for white men. Among women, breastcancer incidence rates increased in Asian/Pacific Islander women,decreased among American Indian/Alaska Native women, and were stablefor other women. Colorectal incidence rates decreased only for whitewomen. Differences in cancer incidence and mortality persist,especially among black men, who have 25 percent higher incidence ratesand 43 percent higher mortality rates than white men for all cancerscombined.
The authors emphasize that reaching all segments of thepopulation with high-quality prevention, early detection, and treatmentservices could reduce cancer incidence and mortality even further, andthat monitoring the dissemination of cancer treatment advances is animportant aspect of ensuring uniformly high standards of care.
* The report was published on October 5, 2005, in Journal of theNational Cancer Institute: "Annual Report to the Nation on the Statusof Cancer, 1975-2002, Featuring Population-Based Trends in CancerTreatment," (Vol. 97, Number 19, pgs. 1407-1427). The authors of thisyear's report are Brenda K. Edwards, Ph.D. (NCI), Martin Brown, Ph.D.(NCI), Phyllis A. Wingo, Ph.D. (CDC), Holly L. Howe, Ph.D. (NAACCR),Elizabeth Ward, Ph.D. (ACS), Lynn A.G. Ries, M.S. (NCI), DeborahSchrag, M.D., (Memorial Sloan-Kettering), Patricia M. Jamison (CDC),Ahmedin Jemal, Ph.D. (ACS), Xiaocheng Wu, M.D. (NAACCR), CarolFriedman, (CDC), Linda Harlan, Ph.D. (NCI), Joan Warren, Ph.D. (NCI),Robert N. Anderson, Ph.D. (CDC), and Linda Pickle, Ph.D. (NCI).
**Time periods for rates between men and women (and also for racial andethnic comparisons) are not the same due to statistical methodology.Please see question #16 in Q&A for a detailed explanation.
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