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Annual Report Shows Death Rates Declined, Focuses on Patients Aged 20-49

Danielle Ternyila
Published Online:8:22 PM, Fri May 31, 2019
According to the latest Annual Report to the Nation on the Status of Cancer, cancer death rates have declined in men, women, and children across all cancer types, and have continued to decline between 1999 and 2016. In a special section of this year’s report, however, data show that both cancer incidence and death rates were higher in women aged 20 to 49 compared to male counterparts.

“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study. The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women,” lead author Elizabeth Ward, PhD, who is a consultant at the North American Association of Central Cancer Registries (NAACCR), said in a statement.

The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and the NAACCR collaborated on this annual study in which incidence data were compiled from the CDC and NCI registry programs; death rates were included from the National Vital Statistics System as well in order to analyze trends in cancer incidence and death rates.

The average overall annual incidence rate between 2011 and 2015 was about 1.2 times higher across all cancer sites in men than in women. Between 2012 and 2016, the average annual death rate was 1.4 times higher in men as well. However, between 2011 and 2015, the average annual incidence rate (per 100,000 people) for the 20 to 49 age group was 115.3 among men versus 203.3 among women.

At the same time, the incidence rates of all invasive cancers decreased at an average of 0.7% per year (5-year AAPC, –0.7%; 95% CI, –1.0% to –0.4%) in men and 1.3% per year (1.3%; 95% CI, 0.7%-1.9%) in women. Within the 20 to 49 age group, the annual death rates declined 2.3% per year (95% CI, –2.4% to –2.2%) in men and 1.7% (95% CI, –1.8% to –1.6%) in women between 2012 and 2016 across all cancer types.

Among women aged 20 to 49, the most common cancer types (per 100,000 people) included breast cancer (73.2), thyroid cancer (28.4), and melanoma of the skin (14.1). Among men in the same age group, the most common cancers were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).

Incidence rates of in situ breast cancer and nonmalignant central nervous system tumors were substantial in both men and women aged 20 to 49. The most frequent malignant and nonmalignant tumors in this age group were associated with considerable long-term and late effects related to the disease or treatment, leading to the conclusion that access to timely and high-quality treatment and survivorship care plays an important role in the quality of life for younger patients with cancer.

Among all age groups, rates of new cases and deaths from lung cancer, bladder cancer, and larynx cancer continue to decrease as tobacco smoking declines. However, rates of new cases of cancer associated with excess weight gain and physical inactivity have increased in more recent decades; these cancer types include uterine, post-menopausal breast, and young adult colorectal cancer.

Another trend noted in this year’s report includes the stabilization between 2013 and 2015 in thyroid cancer incidence rates after years of increases in women. Authors noted that this could be due to recent changes in the American Thyroid Association’s guidelines on management for small thyroid nodules. In addition, the study authors also noted a decline in the death rates for melanoma of the skin, which was previously seen as stable in men and slightly decreasing in women; between 2014 and 2016, this rate declined 8.5% in men and declined 6.3% in women between 2013 and 2016.

“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” J. Leonard Lichtenfeld, MD, MACP, interim chief medical officer of ACS, said in a statement. “This rapid change shows us how important it is to continue working to find effective treatments for all kinds of cancer.”

According to data from 2012 to 2016, the overall cancer death rates decreased 1.8% per year in men (95% CI, –1.8% to –1.8%) and 1.4% in women (95% CI, –1.4% to –1.4%). Men experienced a decrease in death rates for 10 of the 19 most common cancers while women experienced a decrease in 13 of the 20 most common cancers; 3 of these 13 cancers included the most common cancers: lung and bronchus, breast, and colorectal. However, death rates from 6 cancers increased in men versus 5 for women. The steepest increases were in liver cancer, oral cavity and pharynx cancer, and non-melanoma of the skin for men and cancers of the uterus and liver for women.

Between 2011 and 2015, the incidence rates for all cancers combined were stabilized in women and decreased by 2.1% per year in men (95% CI, –2.6% to –1.6%). Rates of new cancers decreased in 8 of the 17 most common cancers in men while 6 of 18 decreased in women. Alternatively, 7 cancers increased versus 9 in men versus women, respectively, and 2 cancers were stable versus 3 in men versus women.

Across both women and men of all ages and all racial and ethnic groups, black men and black women had the highest cancer death rates. Black men and white women, however, had the highest overall incidence rates while Asian/Pacific Islander men and women had the lowest overall incidence rates. Non-Hispanic men and women had higher incidence rates compared to Hispanic men and women.

“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”
Ward E, Sherman RL, Henley SJ, et al. Annual Report to the Nation on the Status of Cancer, 1999–2015, Featuring Cancer in Men and Women ages 20–49 [published online May 30, 2019]. J Natl Cancer Inst. doi: 10.1093/jnci/djz106.

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