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Edited by: Fern Sidman
In a significant stride against cancer, the American Cancer Society’s annual report brings both positive and challenging news. As was recently reported by the NYT, while cancer deaths in the United States have seen a notable decline, reaching four million prevented deaths since 1991, the report highlights an increase in new cancer cases, surpassing two million in 2023. Understanding the dynamics of changing death rates and cancer diagnoses is crucial for advancing the fight against this formidable disease.
The American Cancer Society emphasized three key factors driving the reduction in cancer deaths: declines in smoking rates, advancements in early detection methods, and notably improved cancer treatments, according to the NYT report. The strides made in treating various forms of cancer, such as breast cancer, have played a pivotal role in this positive trend.
Breast cancer mortality has witnessed a significant impact due to advancements in treatment modalities. In the 1980s and 1990s, metastatic breast cancer was often considered a dire prognosis. However, a recent paper published in JAMA, authored by Donald Berry from the University of Texas MD Anderson Cancer Center and Sylvia K. Plevritis from Stanford University, sheds light on the remarkable progress in breast cancer outcomes, the report in the NYT said.
The study reveals that the death rate from breast cancer plummeted to 27 per 100,000 women in 2019 from 48 per 100,000 in 1975. This reduction includes metastatic cancer, accounting for nearly 30 percent of the overall decline in breast cancer death rates. Speaking to the NYT, Ruth Etzioni, a biostatistician at the Fred Hutchinson Cancer Center, underscored that breast cancer treatment has become a more significant life-saving factor than screening.
The study’s findings indicate that treatment improvements have become the unsung hero in the fight against breast cancer. According to the information in the NYT report, even among women in their 40s, who generally did not undergo regular mammograms, death rates have declined, showcasing the substantial impact of advanced treatments. Also speaking to the NYT was Dr. Mette Kalager from the University of Oslo and Oslo University Hospital. Dr. Kalager emphasized the transformative effect of treatment on breast cancer outcomes.
Dr. H. Gilbert Welch, a cancer epidemiologist at Brigham and Women’s Hospital, celebrated the significant progress in breast cancer treatment as “unambiguous good news,” according to the NYT report. The evolving landscape of cancer care reflects a broader trend towards improved survival rates and enhanced patient outcomes, bringing hope to those affected by this pervasive disease.
The American Cancer Society’s findings point to a notable uptick in the incidences of several cancers, encompassing breast cancer, prostate cancer, uterine cancer, oral cavity cancer, liver cancer (in women, not men), kidney cancer, and colorectal cancer, as was indicated in the NYT report. Melanoma incidence has also witnessed an increase. The reported numbers have been adjusted to account for changes in the population’s size.
Dr. William Dahut, the Chief Scientific Officer of the cancer society, expressed particular concern about colorectal cancer, where the overall rate has seen a decline, except in a specific demographic – people under the age of 55, as was noted in the NYT report. In this age group, the incidence rate stands at 18.5 per 100,000, with a consistent annual increase of 1 to 2 percent since the mid-1990s. An estimated 30,500 individuals are expected to be diagnosed with colorectal cancer in this age group this year, the NYT report added.
In the late 1990s, colorectal cancer ranked as the fourth leading cause of cancer-related death for individuals under 50. However, it has now become the leading cause in men under 50 and the second leading cause in women, marking a significant shift, the report in the NYT said. Despite this trend, medical professionals find themselves grappling with uncertainty as they attempt to pinpoint the underlying causes.
Dr. Dahut acknowledged the lack of a definitive explanation for the rise in colorectal cancer among younger individuals. The NYT report indicated that various factors are speculated, including diet, obesity, environmental influences, and even in utero exposure. The complexity of the situation prompts questions about the interplay of these elements and their contribution to the observed trend.
It’s essential to note that while colorectal cancer is on the rise among those under 55, it remains predominantly a cancer affecting older individuals. Among those aged 65 and above, the cancer’s incidence has been on a decline, dropping by 3 percent each year, according to information provided in the NYT report. The current incidence rate is 155.4 per 100,000, with an expected 87,500 diagnoses in this age group this year.
As cancer research advances and screening technologies become more sensitive, a conundrum emerges – the rise in cancer incidence. This phenomenon has led to increased detections, but the interpretation of these findings is a complex task. The NYT reported that researchers grapple with the intricacies of overdiagnosis, emphasizing the need to discern between harmless and life-threatening cancers.
Cancer researchers posit a compelling notion – the more diligently one searches for cancer, the more instances will be unearthed, the NYT report said. This concept becomes particularly relevant as screening methods evolve to detect even the minutest signs of cancer. While the intention is noble – early detection and intervention – it introduces a dilemma known as overdiagnosis.
Overdiagnosis occurs when cancers are detected that might never pose a threat to an individual’s life. Some cancers may remain dormant or even regress without treatment, while others might progress at a glacial pace, allowing individuals to succumb to other causes before the cancer becomes fatal, as was indicated in the NYT report. The challenge lies in distinguishing between benign and malignant cases, leading to the treatment of all detected cancers, regardless of their potential harm.
The sensitivity of screening tools, such as mammography, adds another layer of complexity to the situation. Speaking to the NYT, Dr. Donald Berry noted that estimates of overdiagnosis with mammography range widely from 0 to 50 percent. The evolving landscape of cancer detection introduces concerns, prompting researchers to delve deeper into the factors contributing to increased incidence rates.
While a surge in cancer incidence may raise immediate concerns, experts caution against hasty interpretations. Dr. Etzioni emphasized the importance of understanding the reasons behind these increases, considering that they may, in some cases, be artifacts of heightened screening sensitivity, the NYT report said. The challenge facing cancer researchers is to differentiate genuine rises in cancer cases from those influenced by overdiagnosis and screening intricacies.
The current landscape in cancer research is marked by the ongoing challenge of unraveling the complexities of overdiagnosis and screening sensitivity. As incidence rates continue to fluctuate, researchers strive to develop a nuanced understanding of the factors contributing to these variations. The NYT report said that the ultimate goal is to refine screening practices and diagnostic criteria, ensuring that individuals receive timely and necessary interventions without subjecting them to unnecessary treatments.
The evolving field of cancer research requires continuous exploration and refinement of screening practices to ensure that interventions are beneficial and aligned with the goal of improving patient outcomes.
