Cancer deaths continue to fall, but CT lung screening lags

Cancer deaths continue to fall, but CT lung screening lags

By Brian Casey, staff writer

January 4, 2018 — In its annual report on cancer, the American Cancer Society (ACS) reported that cancer mortality in the U.S. declined by 26% over the past 20 years. But gains in lung cancer survival are being slowed because so few individuals who are eligible for CT lung cancer screening actually undergo the scans.

The U.S. cancer death rate fell from a peak of 215.1 deaths per 100,000 population in 1991 to 158.6 deaths in 2015, and the death rate dropped 1.7% from 2014 to 2015. The authors project that in 2018 there will be 1.7 million new cancer cases and 610,000 cancer deaths in the U.S.

The drop in cancer mortality means that almost 2.4 million people are alive today who would have died if death rates had continued at levels seen at their peak in the early 1990s, according to the report, which was published January 4 in CA: A Cancer Journal for Clinicians.

As the ACS has noted in the past, much of the gains are being driven by “steady reductions in smoking and advances in early detection and treatment,” the society said in a press statement. Death rates have declined for the four major sites of lung cancer, which account for 45% of all cancer deaths.

Declines in cancer mortality among U.S. men and women
Cancer type Men Women
Lung -45% (1990-2015) -19% (2002-2015)
Colorectal -52% (1970-2015) -52% (1970-2015)
Female breast NA -39% (1989-2015)
Prostate -52% (1993-2015) NA

The declines in cancer mortality and incidence haven’t been consistent across the board, however. Men experienced a greater decline in lung cancer incidence than women. For example, from 2005 to 2014, the cancer incidence rate declined at a 2% annual rate among men, but it was mostly flat among women, although the cancer death rate declined at a 1.5% annual rate for both men and women.

Among other trends, prostate cancer incidence has fallen dramatically since its peak in 1991, when prostate-specific antigen (PSA) testing was more commonplace and led to concerns about overdiagnosis and overtreatment. Prostate cancer incidence fell 10% annually from 2010 to 2014, as the use of widespread PSA testing declines, according to the report.

Lung disease has been the most deadly cancer, and mortality rates began to decline around 1990 among men as smoking cessation efforts took hold. The decline has come later in women, however, starting in the early 2000s, and has been less pronounced.

Lung cancer has also bucked the trend toward higher survival seen in other cancers, with only a 5% survival rate. This could be countered by earlier detection, but only 4% of the 6.8 million individuals who were eligible for low-dose CT lung cancer screening under U.S. Preventive Services Task Force guidelines actually had the scans in 2015.