The cancer death rate in the U.S. dropped 2.2% from 2016 to 2017, the largest single-year drop ever recorded, according to the latest report from the American Cancer Society, continuing a longstanding decline that began a quarter-century ago.
The drop is largely driven by progress against lung cancer, though the most rapid declines in the report occurred in melanoma. Advances in treatment are helping improve survival rates in the two cancers, experts say.
Cancer deaths continue their decline, driven largely by a decrease in lung cancer mortality.
Source: CA: A Cancer Journal for Clinicians
Falling smoking rates have played a big role in the decline in lung-cancer deaths, cancer doctors say, as well as improvements in detection and treatment. For melanoma, the report singles out the emergence of drugs like Roche Holding AG ’s Zelboraf that target the molecular roots of tumors and therapies like Yervoy from Bristol-Myers Squibb Co. , which enlist a patient’s own immune system in the cancer fight.
Despite the progress, cancer remains the second-leading cause of death in the U.S., after heart disease. And declines in colorectal, breast and prostate cancer deaths have slowed. The report, published Wednesday in CA: A Cancer Journal for Clinicians, projects 1.8 million new cancer cases and 600,000 cancer deaths in the U.S. in 2020.
“It’s a really exciting time in cancer research, and I think we’re seeing the fruits of many years of investments,” said Patrick Hwu, the head of cancer medicine at the University of Texas MD Anderson Cancer Center. “That being said, we still have a long way to go.”
The total death-rate decrease, 29% since 1991, translates to an estimated 272,450 fewer deaths in 2017 and 2.9 million fewer deaths overall than there would have been if death rates remained at their peak, according to the American Cancer Society.
The data dates back a few years because of the time required to collect and analyze the information, which is gathered from a variety of government databases and cancer registries, said Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society and the lead author on the report.
The cancer mortality rate in the U.S. has largely been fueled by deaths from lung cancer. It started to fall in the early 1990s, however, as fewer people smoked and doctors made progress in breast, prostate and colorectal cancers.
Progress against lung cancer has since accelerated, and survival rates have improved at every stage of the disease. Death rates for the disease have dropped 51% among men and 26% among women since their respective peaks.
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Remove lung cancer from the equation, and the total mortality drop from 2016 to 2017 is only 1.4%, compared with 2.2% overall, Dr. Siegel said.
Cancer doctors and epidemiologists attributed much of the declining lung-cancer mortality to fewer people smoking, as well as advances in screening and early detection, surgical techniques and radiation therapy.
Cancer doctors also pointed to relatively new kinds of treatments such as targeted therapies, which aim to use drugs to fight specific genetic mutations or proteins, and immunotherapies, which harness a patient’s immune system.
“Immunotherapy is the first time in lung cancer where we’re able to potentially use the word ‘cure’ for our patients,” said Helena Yu, a medical oncologist at Memorial Sloan Kettering Cancer Center who specializes in lung cancer.
Lung cancer still caused more deaths in 2017 than breast, prostate, colorectal cancer and brain cancers combined, according to the report, and uneven screening practices mean that a lot of early-stage cancers are missed.
Targeted treatments and immunotherapies for advanced melanoma probably played an even bigger role in declining cancer rates, experts said. Both the immunotherapy Yervoy and targeted agent Zelboraf were first approved in the U.S. in 2011. Immediately after, the one-year survival rate for metastatic melanoma jumped from 42% for patients diagnosed in 2008-2010 to 55% in 2013-2015.
In the years since, newer immunotherapies including Bristol’s Opdivo and Merck & Co.’s Keytruda, as well as targeted therapies and combinations of various drugs, have entered the market and added to the options available to patients.
The overall melanoma mortality rate dropped by 7% annually from 2013 to 2017 in people aged 20 to 64 years old. The rate also dropped 5% to 6% a year for patients 65 and older, even though the rates had previously been increasing. “It’s really dramatic,” said Dr. Siegel. “These drugs have had an incredible effect on the trend.”