The pandemic put a pause on cancer diagnostics and screenings. When that pause went beyond the initial two-month hold that was first expected to an uncertain number of months, doctors and health officials had to assess getting those diagnostic tests and screenings back on line.
“We really discovered the level of importance that has,” said Ouellette, who was part of discussions on the state level during the pandemic to get back to providing diagnostic testing when patients are presenting symptoms. “It really is not realistic to delay things on a what-if basis.”
Declines in death rates continued a nearly two-decade trend
Ouellette said it was still encouraging to see the downward trend continuing for cancer deaths in the latest national data published in late October. The Annual Report to the Nation on the Status of Cancer is a collaborative effort among the National Cancer Institute, which is part of the National Institutes of Health, as well as the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries.
The report showed that from 2015 to 2019, overall cancer death rates decreased by 2.1% per year in men and women combined, according to the Centers for Disease Control. Separately, death rates decreased by 2.3% per year for men and 1.9% per year for women. The annual declines in death rates accelerated from 2001 to 2019 in both men and women.
While 2% sounds small, on a national level, those numbers are significant, Ouellette said.
The report showed declines in death rates were steepest among lung cancer and melanoma diagnosis, by 4% to 5% per year, respectively, among both men and women. Death rates increased for cancers of the pancreas, brain, and bones and joints among men, as well as for cancers of the pancreas and uterus among women.
“The findings in this year’s Annual Report to the Nation show our ongoing progress against cancer, continuing a more than two-decade trend in declining mortality that reflects improvements in preventing, detecting, and treating cancer,” said Dr. Monica M. Bertagnolli, director of the National Cancer Institute. “The advances shown in the report underscore the importance of working together across society to develop effective, equitable approaches to tackle this complex disease. I look forward to working with all our partners in the cancer community to meet these challenges head-on, because people affected by cancer—and that includes all of us—are counting on it.”
Incidence rates see slight increases
Men experienced increases in incidence rates for three of the 18 most common cancers from 2014 to 2018, including cancers in the pancreas, kidney, and testis. The greatest incidence rate increase for men was pancreatic cancer, which increased by 1.1% per year, and the steepest incidence rate decrease was seen in lung cancer, which fell by 2.6% per year.
For women, incidence rates increased for seven of the 18 most common cancers, including liver, melanoma, kidney, myeloma, pancreas, breast, and oral cavity and pharynx. Melanoma had the steepest increase in incidence, rising by 1.8% per year, and thyroid cancer had the sharpest decrease, falling by 2.9% per year.
Among those getting diagnosed are younger patients, some who have not even reached the age at which recommended screenings are supposed to start. Ouellette speculated a number of factors could be at play, including the environment, climate, changes in technology, and diet.
“Diet is a big thing when we talk about cancer,” Ouellette said. “Unfortunately in the United States, we have this enormous availability of packaged and/or processed food.” Diet contributes to the ongoing obesity epidemic, he said, and obesity factors into multiple different cancers.
Rates of smoking have gone down, but Ouellette spoke cautiously of the still unknown long-term effects of vaping, or electronic cigarettes.
“It takes a decade or more to really see those affects,” Ouellette said. “We’ll be waiting to see what that might do to people.”
Personalized approaches improving treatments
While early detection is important with cancer diagnoses, doctors are still seeing diagnoses at a variety of stages in the cancer. Ouellette said what is helping with that downward trend of cancer deaths are personalized treatments, including surgery, chemotherapy, immunotherapy, and targeted therapies for each patient’s individual case. Certain medications can target certain processes of the disease, so doctors and researches are trying to learn as much about cancerous tumors as they can to continue targeted approaches.
“There’s so much ongoing research,” Ouellette said. “The more information we get about a tumor itself, the more we can tailor the approach.” One example he used was of immunotherapy for melanoma and lung cancer, treatments of which “melt those tumors away” in some cases.
“Through funding scientific breakthroughs and raising awareness about prevention and early detection, we are making progress against a subset of the more than 200 diseases we call cancer,” said Karen E. Knudsen, chief executive officer of the American Cancer Society. “However, for certain cancer types, concerning trends persist, and durable cures remain elusive for many people. We are committed to improving the lives of all cancer patients and their families, through accelerating research, increasing access to care through advocacy, and by providing direct patient support in communities across the nation, toward the shared goal of eliminating cancer as we know it.”
Survival rates improving with aggressive cancers
Patients are also living longer with ongoing cancer diagnoses. Some of the treatments have been successful at slowing down the growth of tumors, so even with an aggressive cancer, patients are living longer and living more functional lives while still undergoing regular treatments.
“The fact that we can institute different treatments over someone’s lifetime has a pretty significant impact in terms of keeping people alive, (keeping their lives very functional),” Ouellette said.
The report on the status of cancer noted trends in pancreatic cancer. Pancreatic cancer accounts for only 3% of new cancer diagnoses, but it accounts for 8% of cancer deaths. It is the fourth leading cause of cancer deaths in the United States for both men and women.
Survival rates improved with various subtypes of pancreatic cancer. One-year relative survival of people diagnosed with pancreatic neuroendocrine tumors increased from 65.9% to 84.2% between 2001 and 2017, and for people diagnosed with pancreatic adenocarcinomas it increased from 24.0% to 36.7%, according to the CDC. Five-year relative survival also increased between 2001 and 2013, from 43.4% to 65.2% for people with pancreatic neuroendocrine tumors, and from 4.4% to 6.6% for people with pancreatic adenocarcinoma.
Researchers noted improvements with survival rates could be linked with developments with treatment therapies.
“Pancreatic cancer incidence and survival reflect both the underlying risk of disease as well as the difficulty of diagnosing pancreatic cancer at a treatable stage,” said Betsy A. Kohler, executive director of North American Association of Central Cancer Registries. “As advancements in screening technology and effective treatments for early-stage disease become available, we are hopeful for greater improvements in pancreatic cancer survival, which historically has been a particularly lethal cancer type.”
To view more of the Annual Report to the Nation on the Status of Cancer, visit https://seer.cancer.gov/report_to_nation/.
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