Why Cancer Diagnoses Rise as Deaths Fall: David A. Siegel, MD, MPH

Cancer death rates in the United States fell for both men and women from 2019 to 2023, driven largely by accelerated progress against lung cancer, according to the 2026 Annual Report to the Nation on the Status of Cancer.^1,2 At the same time, overall rates of new cancer cases rose slightly each year from 2018 to 2022, driven by increases in breast cancer among women and prostate cancer among men. Despite the increase in prostate cancer, the overall rate of new cancer cases among men remained stable.²

In an interview with The American Journal of Managed Care^® (AJMC®), David A. Siegel, MD, MPH, a medical epidemiologist in CDC's Division of Cancer Prevention and Control (DCPC) and a coauthor of the report, discussed how to interpret rising diagnoses alongside falling deaths, how long policy changes take to show up in mortality data, and how CDC is directing its cancer control resources.

This interview has been lightly edited for clarity.

AJMC: Cancer deaths fell from 2019 to 2023, while new case rates ticked up slightly from 2018 to 2022, driven by breast and prostate cancer. From an epidemiological standpoint, how should the public interpret "more diagnoses, fewer deaths" happening at the same time? Is that mostly a lung cancer success story masking rising incidence elsewhere, or a broader story about earlier detection?

Siegel: These are best viewed as 2 separate trends rather than one masking the other. Progress in prevention, early detection, and treatment—especially for lung cancer—has driven down cancer death rates. However, modest increases in new diagnoses, particularly among women, may be driven by increases in the detection of early-stage cancers, which could be due to screening, as well as increases in hormone receptor–positive tumors among younger women. All these factors emphasize the need for continued focus on prevention, early detection, and access to care.

AJMC: The lung cancer progress reflects decades of tobacco control policy finally showing up in mortality data. As a medical epidemiologist, what lag time would you expect between a policy intervention today, such as further reductions in smoking rates, and a measurable mortality effect? Does that shape how the CDC prioritizes near-term vs long-term cancer control investments?

Siegel: The lag time between any intervention and its measurable effect on mortality is difficult to determine since it can depend on the intervention, the population affected, and how quickly it changes underlying behavior. In this report, we see that the mortality improvements are the results of long-term reductions in cigarette smoking and secondhand smoke exposure, together with increases in early detection and advances in treatment.

Cigarette smoking among US adults dropped from 22% in 2001 to 10% in 2024, and it's taken this full 2-decade period for that decline to translate into the mortality reductions reflected in this report. We know that lung cancer screening works for populations at high risk by finding cancer earlier when treatment is more successful, yet only about 18% of adults recommended for screening have been screened.

Providers play a key role in reducing lung cancer deaths by identifying eligible patients for screening, asking about tobacco use, and promoting tobacco cessation. Both near-term and long-term efforts are necessary to sustain and build on the progress described in this report.

AJMC: With prostate and breast cancer incidence rising while overall case rates in men stayed flat, is there a risk that lung cancer's dramatic improvement pulls policy and funding attention away from those growing burdens? How do you see this report being used internally to guide where CDC puts resources next?

Siegel: CDC's DCPC works to reduce cancer risk factors and promote screening so that every person has an equal opportunity to achieve the best health possible. The progress in lung cancer and the rise in breast and prostate cancer incidence each reflect distinct factors and require their own tailored approaches.

DCPC addresses cancer prevention and control at the national, state, and local levels. DCPC funds the National Program of Cancer Registries and coordinates with other federal agencies to collect data on nearly all cancer cases in the United States. These data are used to help guide efforts to prevent cancer and catch it early for cancers with recommended screening. The CDC supports screening for breast, cervical, colorectal (colon), and lung cancers as recommended by the US Preventive Services Task Force. We also fund states to prevent and control cancer through our National Comprehensive Cancer Control Program.

Specifically, for breast cancer, the CDC promotes awareness of family health history and hereditary risk factors, including BRCA1/BRCA2 mutations, through campaigns like Bring Your Brave, and supports screening access for underserved women through the National Breast and Cervical Cancer Early Detection Program.

For prostate cancer, the CDC encourages men at higher risk due to age, family history, or race to talk with their doctor about the benefits and risks of screening. It offers dedicated prostate cancer resources to support those conversations.

References

1. Henley SJ, Siegel DA, Firth AU, et al. Annual report to the nation on the status of cancer, featuring 21st century progress against lung cancer. Cancer. Published online September 22, 2026. doi:10.1002/cncr.70577

2. Annual report to the nation: progress against lung cancer drives down cancer mortality. News release. CDC. September 22, 2026. Accessed September 25, 2026. https://www.cdc.gov/media/releases/2026/annual-report-to-the-nation-progress-against-lung-cancer-drives-down-cancer-mortality.html