Cancer rates have fallen, but the news is not all good
The news out of the American Cancer Society recently was mostly encouraging. Cancer rates have been falling steadily for the past 25 years, according to the 2019 annual report of cancer statistics in the United States, which the organization released in January.
“It’s very reassuring that all of these trends just seem to be continuing and getting better,” said Daniel Canaday, MD, a radiation oncologist at Falmouth Hospital and Cape Cod Hospital.
The reasons are multi-factoral, depending upon the type of cancer that you’re talking about, he said, but are primarily due to healthier lifestyles, screening, and improvements in treatment.
“With lung cancer, most of it has to do with smoking cessation. Smoking rates really began to decline in this country in the 1980s and about 10 years later we began to see the mortality rate from lung cancer start to decline, and it has continued to do so.
Improvements in and the growing acceptance of screening have played a major role in better cancer survival. The improvements in breast cancer probably has more to do with screening, because we are catching these cancers at an earlier stage than ever before. Newer mammography equipment is much more sensitive than the scans we had in the 1980s and 1990s. Earler detection improves outcome for prostate cancer as well and colorectal cancer as well, and those are the three most common cancers besides lung cancer for men and women,” he said.
Treatments have also improved dramatically, Dr. Canaday said. For example, in 1995, the FDA approved just one new chemotherapy cancer drug. In 2015, it approved 15. Options for treatment have increased, helping to save more lives.
In the past, when oncology doctors attended their annual conference, there were not many game-changers announced, according to Dr. Canaday. But that is no longer true. For the past few years, almost every annual conference includes “pindrop moments” when better treatments are reported and every doctor in the room knows their practice is going to change for the better as soon as they get home, he said.
“Because of the decline in the risk of dying of cancer between 1995 and now, estimates are that there are two million people still alive that wouldn’t be, if we hadn’t made these gains,” Dr. Canaday said. “It’s had a huge impact.”
Screening is Key
The national guidelines for mammograms is to begin at the age of 50 and continue yearly after that, but screening at age 40 is recommended for those at high risk with a strong family history, like a first-degree relative who was diagnosed.
“Additionally, when you go for a mammogram and screening here on the Cape, part of what they do is evaluate women who might be a higher genetic risk and offer them genetic testing,” Dr. Canaday said. “We’ve been doing that for years in both hospitals.”
For colorectal cancer, the guidelines are to start testing for everyone at age 50 and get additional colonoscopies every 10 years, but people with a strong family history could benefit from testing at a younger age. Fecal Occult Blood Testing should also be done yearly to look for small amounts of blood in the stool.
“There’s no such thing as a good tumor, but if you do get one, you want to catch it early because the cure rates are much, much better for early stage cancer compared to more advanced,” Dr. Canaday said. “That’s why we’ve been trying to pioneer things like routine screening for lung cancer with CAT scans for people who are at high risk.”
In years past, testing for lung cancer involved chest X-rays, which were not very precise. Current testing is done with a low-dose CT scan that emits very little radiation. There have been some negative news stories about the risk of false positives, but Dr. Canaday said these screenings are incredibly worthwhile for those select patients who are at high risk for lung cancer due to a long history of smoking.
“The false positive rate is higher because it’s a more sensitive test, but that’s the trade-off for trying to catch these things early,” Dr. Canaday said. “It can potentially lead to more biopsies, but there is pretty clear evidence from a large study that was done about 10 years ago that routine lung cancer screening has a huge impact in terms of reducing cancer deaths in the high risk populations where it is used. So that is something that we are definitely trying to increase on the Cape.”
For women in the United States, routine pap smears have so dramatically reduced cervical cancer, that it has actually become quite rare, he said.
Screening for prostate cancer has been another controversial topic, and the ACS report addresses the fact that the prostate cancer death rate fell dramatically over the past two decades, but has remained stagnant for several years. Some physicians speculate that the numbers are because of the 2011 U.S. Preventive Services Task Force decision to stop recommending routine testing of men using a PSA blood test.
Patients should talk to their doctor about pros and cons of prostate and all other screening at their annual physical, Dr. Canaday said.
Not All Good News
The ACS report also had some discouraging news. Obesity-related cancers are rising along with the obesity rate in this country. Part of the problem is that obesity-related cancers like uterine cancer and pancreatic cancer are hard to screen for. Liver cancer among obese patients is also on the rise, but Dr. Canaday pointed out that while the risks of those cancers may have gone up, the overall incidence is still small compared to things like lung cancer or prostate cancer.
Incidence Goes Up With Age
Some parts of the report need to be put into perspective to understand the implications. Nationally, cancer is the number two cause of death behind heart disease, but in Massachusetts and 22 other states it is actually the number one cause of death. Dukes County has the highest incidence of cancer in the state and Barnstable claims the number two spot.
“Part of the reason for that is that our cardiac care has gotten so much better over the last 20 years,” Dr. Canaday said. “The other thing is that a lot of these cancers just become more prevalent as people get older. Life expectancy has gone up dramatically and we expect to see a lot more cancers because of this. In fact, we expect the number of new cases is going to increase 45 percent over the next 20 years. The biggest rise is actually in men and women over 80 at this point, because people are living longer and they’re healthier.”
Those who live to be 80 have a one in three chance of developing cancer. Cape Cod Heathcare and hospitals across the country know the that aging population will mean an increase in cancer rates, so they are working to prepare for the increased numbers and the stress that puts on healthcare systems in terms of resources.
Cape Cod Hospital recently became a member of the Dana-Farber Cancer Care Collaborative, which will elevate cancer care on Cape Cod. The partnership will make it easier for patients to receive the latest diagnosis and treatment for a wider spectrum of cancers close to their home, family and support system.
Collaborative members have met rigorous standards set by Dana-Farber, including safety protocols, nursing, pharmacy, chemotherapy administration and information systems.
“We’re trying to expand cancer services here on the Cape, and that’s true anywhere in the country because we know it’s coming,” Dr. Canaday said. “We’re fortunate that we have the support of the community and we have leadership in the hospital system that recognizes this and want us to be prepared for the next decade or two.
“Our mandate is to make sure people on the Cape have whatever services that they need right here. We encourage people to get second opinions and we interact a lot with the specialty hospitals in Boston, but the vast majority of people can get what they need right here close to home, and that convenience and decrease in stress is a huge part about being able to successfully get through treatment.”