"This welcome news on declining rates underscores the incredible progress we've made against cancer, but it also reminds us that our fight is far from over," said Health and Human Services (HHS) Secretary Tommy G. Thompson. "It is clear that we must not only treat cancer, but beat this deadly disease. That is why we are aggressively promoting cancer-related research at the National Institutes of Health (NIH)."HHS has proposed an increase of $514 million for cancer-related research at NIH in 2002, a 12 percent increase over current year spending.

The "Annual Report to the Nation on the Status of Cancer, 1973-1998, Featuring Cancers with Recent Increasing Trends" is published in the June 6, 2001 (Vol. 93, Issue 11, pages 824-842), issue of the Journal of the National Cancer Institute.*

"These findings highlight the progress we've made against cancer but also underscore the critical need for research and for equitably applying what we already know to sustain this progress," said NCI Director Richard D. Klausner, M.D.

The report shows that the incidence rate for all cancers combined -- the number of new cancer cases per 100,000 persons per year -- declined on average 1.1 percent per year between 1992 and 1998. This overall trend reversed a pattern of increasing incidence rates from 1973 to 1992. Most of the decline can be attributed to a 2.9 percent yearly decline in white males and a 3.1 percent yearly decline in black males. "I am most excited to see that rates of new cases of cancer declined in the 1990s for both black and white men. It will take time to tell, but this could be a sign that the disparities among racial and ethnic groups are lessening," said James S. Marks, M.D., director of CDC's National Center for Chronic Disease Prevention and Health Promotion.

"More good news is the continuing fall in cancer death rates by 1.6 percent per year for men and 0.8 percent per year for women between 1992 to 1998," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. "Particularly welcome is that the largest decrease -- 2.5 percent per year -- occurred in black men, who bear the heaviest cancer burden." Overall cancer mortality declined 1.1 percent yearly for the period from 1992 to 1998.

Four cancer sites -- lung, prostate, breast, and colorectum -- accounted for about 56 percent of all new cancer cases and were also the leading causes of cancer deaths for every racial and ethnic group, which includes white, black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic populations. Because these sites comprise over half of all cancer cases, they have a strong influence on overall cancer trends.

Breast cancer makes up 16.3 percent of all cancer cases and accounts for 7.8 percent of all deaths due to cancer. Breast cancer death rates have continued to decline due to improvements in early detection and treatment. However, breast cancer incidence rates have increased by more than 40 percent from 1973 to 1998.

One explanation for the increase in breast cancer incidence rates comes from analyses which indicate that more early stage disease is being diagnosed, suggesting that use of aggressive screening and early detection, primarily mammography, may account for part of this increase. "The extent to which other factors, such as more obesity and post-menopausal hormone use, may contribute to the increase is unknown," said Brenda K. Edwards, Ph.D., of NCI, final author of the report. A rise in the rate of stage II node-positive disease diagnosed in white women 50 to 64 years of age is a more recent observation, Edwards added.

Prostate cancer, which accounts for 14.8 percent of all cases, saw a sharp increase in incidence rates starting in the late 1980s with the introduction of screening for Prostate Specific Antigen (PSA). Subsequently, however, rates have started to decline. Death rates have also declined in recent years. Much of the wide variation in prostate cancer incidence rates across the country can be attributed to differing rates of PSA screening, with geographic areas of high usage of PSA reporting high incidence rates, often the result of the discovery of clinically insignificant tumors.

Lung cancer accounts for 29 percent of cancer deaths in the United States and 13.2 percent of the cases. Overall, lung cancer incidence rates decreased 1.6 percent per year between 1992 and 1998, due mainly to a decline of 2.7 percent per year in men and a leveling off of rates in women, both manifestations of reductions in tobacco smoking since the 1960s. Lung cancer mortality began to decrease in 1990 in men but an increase in mortality continued until at least 1998 in women. Long-term trends show that women have lagged behind men in lung cancer incidence and death rates. "Significantly, lung cancer death rates in women increased 0.8 percent per year but this rate of increase is slower than earlier periods," said Edward J. Sondik, Ph.D., director of CDC's NCHS.

Colorectal cancer accounts for 11.6 percent of all cancer cases but incidence and death rates vary widely by race and ethnicity. Incidence rates for colorectal cancer ranged from 10.2 per 100,000 in the Hispanic population to 22.8 per 100,000 in the black population. Historically, incidence rates from colorectal cancer increased until 1985, then decreased 1.8 percent per year through 1995, and have stabilized through the latest reporting period in 1998. A long-term decrease in death rates in most populations began between 1992 and 1998 but remained stable in black females during this period. Detection of earlier stages of disease and more effective treatments have led to the decline in death rates seen in most populations.

"Ten other cancers, in addition to the recent rise in female breast cancer incidence rates and the long-term increase in female lung cancer death rates, have increased in either incidence or death rates from 1992 to 1998. These 10 cancer sites together account for about 13 percent of all cancer cases and deaths," said Holly L. Howe, Ph.D., executive director of NAACCR, and senior author of this report.

These diverse and relatively uncommon cancers include (in descending order of their contribution to total cancer deaths):

• Non-Hodgkin's Lymphoma (4.4 percent of deaths, 4.0 percent of cases in 1998)

• Liver and intrahepatic bile duct (2.3 percent of deaths, 1.2 percent of cases in 1998)

• Esophagus (2.2 percent of deaths, 0.9 percent of cases in 1998)

• Melanoma (1.4 percent of deaths, 3.5 percent of cases in 1998)

• Acute Myeloid Leukemia (1.3 percent of deaths, 0.8 percent of cases in 1998)

• Soft (connective) Tissue including Heart (0.7 percent of deaths, 0.6 percent of cases in 1998)

• Thyroid (0.4 percent of deaths, 1.5 percent of cases in 1998)

• Small intestine (0.2 percent of deaths, 0.3 percent of cases in 1998)

• Vulva (0.1 percent of deaths, 0.3 percent of cases in 1998)

• Peritoneum, Omentum, and Mesentery (0.1 percent of deaths, 0.1 percent of cases in 1998)

The report is based on incidence data from NCI's Surveillance, Epidemiology, and End Results (SEER) program, the CDC's National Program of Cancer Registries (NPCR), and NAACCR. Mortality data come from the CDC's NCHS.

Authors of this report identified several strategies for reducing future incidence and death from cancer, the most critical being the reduction of tobacco use in all segments of the population, since smoking causes an estimated 30 percent of all cancer deaths. Another strategy would be to improve the use of currently effective but underutilized cancer screening tools. Other strategies identified include developing and applying state-of-the-art diagnostic tests and treatments, as well as identifying and reducing health disparities across diverse populations.

*The authors of this year's report are Holly L. Howe, Ph.D. (NAACCR), Phyllis A. Wingo, Ph.D. (CDC), Michael J. Thun, M.D. (ACS), Lynn A.G. Ries, M.S. (NCI), Harry M. Rosenberg, Ph.D. (CDC), Ellen G. Feigal, M.D. (NCI), and Brenda K. Edwards, Ph.D. (NCI).

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For additional background on this report, a set of Questions and Answers can be found at: http://thyroid.about.com/library/news/blcancerq&a.htm

For more information, visit the following Web sites:

SEER Homepage: http://www.seer.cancer.gov
(This site contains all data points for graphs in the manuscript as well as supplementary data and charts. Click on the icon, "1973-1998 Report to the Nation")

National Cancer Institute: http://www.cancer.gov

American Cancer Society: http://www.cancer.org

CDC's Division of Cancer Prevention and Control: http://www.cdc.gov/cancer

CDC's National Center for Health Statistics mortality report: http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm

NAACCR: http://www.naaccr.org/