NEWS

Report to the Nation Shows Cancer Mortality, Incidence Declining

Mike Miller

The third annual Report to the Nation on cancer incidence, mortality, and survival gives good news about continuing downward trends in the rates of new cancer cases and deaths.

According to the report, the incidence and mortality rates for all cancers combined declined on average 0.8% between 1990 and 1997, and most of the top 10 cancers also showed declines.

National Cancer Institute Director Richard D. Klausner, M.D., said in testimony given to the U.S. Congress that "the magnitude of these drops are such that, for the first time, between 1996 and 1997, the total number of cancer deaths did not rise, despite a growing and aging population."

The report was published in the May 15, 2000, issue of Cancer and was authored by investigators at NCI, the American Cancer Society, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention, which includes the National Center for Health Statistics.

Unlike previous reports and earlier NCI Surveillance, Epidemiology, and End Results (SEER) analyses, a new statistical technique called joinpoint analysis was used in this report to describe changing trends over successive segments of time. Lynn Ries, Ph.D., health statistician for SEER and first author of the report, said that "joinpoint analysis allows us to describe the amount of increase or decrease in a cancer rate within distinct time periods unlike before, where we primarily relied on overall trends."

In response to recent mandates for increased coverage of U.S. populations, this year’s report for the first time includes data from selected state and regional cancer registries that participate in NAACCR. The data are incorporated into a special section on colorectal cancer.

"Assembling data from multiple registries allows us to cover 49% of the U.S. population, which leads to a better understanding of cancer incidence patterns," said Holly L. Howe, Ph.D., executive director of NAACCR. SEER data currently represent 14% of the population.

One area in which rates did not decline was in incidence and death rates among some racial and ethnic groups. The authors were not able to pinpoint any specific overall causes for these disparities but suggest that factors such as late stage of disease diagnosis, barriers to health care access, biologic and genetic differences in tumors, and various health behaviors may contribute to the differing rates.

A central element of the special section was an analysis of the prevalence of colorectal screening in the United States. Screening rates for colorectal cancer, using methods such as sigmoidoscopy or colonoscopy, were found to be low. For example, only 18.4% of men reported use of fecal occult blood tests in the 2 years prior to the Behavioral Risk Factor Survelliance System assessment.

"The findings underscore the need to improve rates of colorectal screening since it can clearly save lives," said James S. Marks, M.D., director, National Center for Chronic Disease Prevention and Health Promotion, CDC.

New efforts are being undertaken to increase awareness of the benefits of screening for colon cancer, including a campaign called Screen for Life, which is led by the CDC. According to the National Health Interview Survey, there were gradual and modest increases in screening between 1987 and 1998. In a detailed part of the survey, procto-sigmoidoscopy use for people age 50 and over increased from 24% to 38% during the reported 10-year period.



             
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