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Evidence-Based Oncology February 2020
Lessons From the Front: Designing and Implementing Clinical Pathways by and for Clinicians
David M. Jackman, MD; Joanna Hamilton, MA, MS; Emily Foster, MPH; Craig A. Bunnell, MD, MPH, MBA; Louis Culot, MA; Carole Tremonti, RN, MBA; Joseph O. Jacobson, MD, MSc
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From the Editor-in-Chief: The End of the Beginning
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Overall US Cancer Mortality Rate Reaches 26-Year Decline, but Obesity-Related Cancer Deaths Rise
Matthew Gavidia

Overall US Cancer Mortality Rate Reaches 26-Year Decline, but Obesity-Related Cancer Deaths Rise

Matthew Gavidia
The decline can be attributed to long-term drops in death rates for the 4 major cancers—lung, colorectal, breast, and prostate.
The overall death rate from cancer declined by 29% from 1991 to 2017, with a 2.2% decline from 2016 to 2017 serving as the largest single-year drop in reported cancer mortality, according to research published January 8, 2020, in CA: A Cancer Journal for Clinicians; however, obesity-related cancer deaths are rising and prostate cancer deaths remain stagnant.1

Cancer is the second leading cause of death in the United States, with researchers from the American Cancer Society predicting the disease will aff ect more than 1.7 million people and cause 600,000 deaths in the nation this year. Overall cancer mortality has seen an average drop of 1.5% per year in the last decade (2008-2017), with the steady decline from 1991 translating to approximately 2.9 million fewer cancer deaths. The decline can be attributed to long-term drops in death rates for the 4 major cancers—lung, colorectal, breast, and prostate.

Lung cancer mortality rates, which constitute a quarter of all cancer deaths, represent a chief infl uence on the historic decline in cancer mortality, as the pace of mortality reductions has doubled in recent years from 2% to 4%, with further signifi cant declines made over the long term among the other 3 major cancers:

• The death rate for breast cancer dropped by 40% from 1989 to 2017.
• The death rate for prostate cancer dropped by 52% from 1993 to 2017.
• The death rate for colorectal cancer dropped by 53% from 1980 to 2017 among men and by 57% from 1969 to 2017 among women.

Progress in treatment for melanoma of the skin drove the most rapid death rate decline seen in the research, as the overall melanoma death rate dropped by 7% per year during 2013 to 2017 in people aged 20 to 64 years. Before the FDA approval of 2 melanoma treatments, ipilimumab and vemurafenib, these death rates decreased by 2% to 3% each year among people aged 20 to 49 years, with a minimal decline of 1% in those aged 50 to 64 years.

Since 2010, the 1-year survival rate for patients diagnosed with metastatic disease rose from 42% (2008-2010) to 55% during 2013 to 2015. Although these long-term declines show promise, reductions in death rates slowed for female breast and colorectal cancers and halted for prostate cancer, causing lead study author Rebecca Siegel, MPH, scientific director of Surveillance Research at the American Cancer Society, to describe the signifi cance of the study fi ndings as mixed. “The exciting gains in reducing mortality for melanoma and lung cancer are tempered by slowing progress for colorectal, breast, and prostate cancers, which are amenable to early detection,” she said.2

Furthermore, cancers that exhibited increases in death rates, such as thyroid, pancreas, and uterus, were all linked to obesity, stressing the ongoing public health crisis caused by this epidemic, a challenge explored at length in the October issue3 of EvidenceBased Oncology. ™ As African American (46.8%) and Hispanic (47%) adults were shown to be disproportionately affected by obesity, these minority groups represent defi nite at-risk groups.

“It’s a reminder that increasing our investment in the equitable application of existing cancer control interventions, as well as basic and clinical research to further advance treatment, would undoubtedly accelerate progress against cancer,” said Siegel. 
References

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020 [published online January 8, 2019]. CA Cancer J Clin. doi: 10.3322/caac.21590.
2. Cancer mortality continues steady decline, driven by progress against lung cancer [press release]. Atlanta, GA: ACS pressroom; January 8, 2020. pressroom.cancer.org/CancerStats2020. Accessed January 19, 2020.
. Alvarnas A, Alvarnas J. Obesity and cancer risk: a public health crisis. Am J Manag Care. 2019;25(SP11):SP332-333.
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