Annual Report Shows Continuing Decline in U.S. Cancer Incidence and Death Rates; Special Section Focuses on Lung Cancer and Tobacco Smoking

The rate of new cancer cases and deaths for all cancers combined as well as for most of the top 10 cancer sites declined between 1990 and 1996 in the United States, according to a new report released today by the American Cancer Society (ACS), the National Cancer Institute (NCI), and the Centers for Disease Control and Prevention (CDC). However, a special section of the study focusing on lung cancer and smoking reports that, unless the increase in adolescent smoking can be reversed, declining lung cancer rates are likely to start increasing again.

The "Annual Report to the Nation on the Status of Cancer, 1973-1996, With a Special Section on Lung Cancer and Tobacco Smoking," is published in the April 21, 1999, issue of the Journal of the National Cancer Institute.

"These findings underscore the remarkable progress we've made against cancer, but it also reminds us that our battle is far from over," said Health and Human Services Secretary Donna E. Shalala. "We must keep fighting this disease with everything we've got, which is why we again are urging Congress to support our proposal that Medicare patients participate in cancer clinical trials. Along with additional research dollars for the National Institutes of Health, this proposal would help bring effective, new cancer treatments into the mainstream of American medicine."

"This report also highlights the need to address the problem of tobacco use by young people. Lung cancer causes more deaths than any other cancer. Unless we invest now in anti-tobacco efforts aimed at our youngest citizens, we will waste the progress we have achieved so far and lose yet another generation to lung cancer and other tobacco-related illnesses," said Secretary Shalala.

The report shows that the incidence rate -- the number of new cancer cases per 100,000 persons -- for all cancers combined declined on average 0.9 percent per year between 1990 and 1996. The greatest decrease occurred after 1992, the year in which incidence rates peaked. This trend reversed a pattern of increasing incidence rates from 1973 to 1990, and continued the downward trend first documented in last year's report. From 1990 to 1996, cancer death rates have been falling on average 0.6 percent per year.

By far, the greatest decline in cancer incidence rates has been among men, who overall have higher rates of cancer than women. From 1990 to 1996, the decline in the cancer incidence rate was greater for men than for women. The largest decrease in men occurred among those who were 25 to 44 years old and 75 years and older. The largest incidence trends for women were a decrease among those 35 to 44 years old and 85 and older. The report analyzed data for white, black, Asian/Pacific Islander, American Indian/Alaska Natives, and Hispanic populations and noted large differences in cancer incidence by race and ethnicity, with incidence rates highest for African Americans for all the major cancer sites except for breast cancer.

Decreases in the death rate occurred in men of all ages except those 85 years and older. In fact, the drop in the death rate for men influenced the overall decline. Decreases in female death rates occurred for those younger than age 65. Death rates were highest for the black population for cancer overall and for the major cancer sites.

From 1990 to 1996, four cancer sites -- lung, prostate, breast, and colon and rectum --accounted for more than half of all new cancer cases and were also the leading causes of cancer deaths. Tracking trends for those primary sites shows that rates are going down for prostate cancer incidence and mortality. Breast cancer incidence rates have shown little change in the 1990s, while breast cancer death rates have been declining about 2 percent per year since 1990. Colorectal cancer incidence and death rates continued to decline for both men and women.

For two of the top cancer sites, the pattern is different. Incidence and death rates for non-Hodgkin's lymphoma are continuing to increase, although more slowly in the 1990s than the past decade. Incidence rates of melanoma are on the rise, up about 3 percent annually, but death rates have remained constant.

The report includes a special section on lung cancer and tobacco, and presents state data for lung cancer deaths and prevalence of smoking in adults and youth. Lung cancer causes more deaths than any other cancer, accounting for 28 percent of all cancer deaths each year. Lung cancer also represents about 14 percent of new cancer cases and continues to be a key factor driving overall cancer trends.

During the 1990s, lung cancer incidence and death rates declined among males of all racial and ethnic groups except American Indians/Alaska Natives. During 1990 to 1996, male lung cancer incidence rates decreased on average 2.6 percent per year. Male lung cancer death rates decreased about 1.6 percent per year. These declines reflect the large decreases over the past several decades in active smoking and exposure to environmental tobacco smoke that together cause about 90 percent of lung cancer.

In contrast, lung cancer incidence and death rates increased among women, although the rate of increase has slowed in recent years. Among females during the 1990s, the average annual percent increase was 0.1 percent per year for incidence and 1.4 percent for mortality. Because the prevalence of smoking in women lagged behind men, the impact of decreased smoking on female lung cancer rates over all ages and racial groups combined has not yet been observed. However, the age-specific patterns of declines seen for males are beginning to occur in females. Lung cancer incidence and death rates declined among women ages 40 to 49 and 50 to 59, were approximately level among females 60 to 69, and were continuing to increase among older women.

The prevalence of cigarette smoking among adults has declined over the past 25 years, but this trend has stalled during the past four to five years. At the same time, the number of high school students smoking cigarettes has continued to increase during the 1990s, and unless this trend can be reversed, the lung cancer rates that are currently declining may rise again.

The report is based on incidence data from NCI's Surveillance, Epidemiology, and End Results (SEER) Program and mortality data from the National Center for Health Statistics (NCHS). While SEER data collection covers 14 percent of the population, SEER sampling is designed to represent diverse populations. Data on smoking behavior are collected by NCHS in nationwide household interviews and by CDC's National Center for Chronic Disease Prevention and Health Promotion from state departments of health and education in the Behavioral Risk Factor Surveillance system and Youth Risk Behavior Surveillance system. The ACS, NCI, and CDC expect to continue monitoring the occurrence of cancer in the United States and collaborating in presenting this data to the nation.

*The authors of this year's report are Phyllis A. Wingo, Ph.D., M.S. (ACS), Lynn A.G. Ries, M.S. (NCI), Gary A. Giovino, Ph.D. (CDC), Daniel S. Miller, M.D., M.P.H. (CDC), Harry M. Rosenberg, Ph.D. (NCHS), Donald R. Shopland (NCI), Michael J. Thun, M.D. (ACS), and Brenda K. Edwards, Ph.D. (NCI).

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