Doctors Upbeat About Report

National Cancer Institute Shows Drop In Cancer Death Rate In U.S.

By Robert Miller

For years, the medical establishment has been preaching the virtues of screening tests for cancer, reasoning that the earlier the disease is detected, the easier it is to treat.

"We'd hoped we were right on this," said Dr. Orion Howard, director of medical oncology at the New Milford Hospital-Columbia Presbyterian Regional Cancer Center. "We just didn't always have the data."

Now doctors have those numbers. The National Cancer Institute, in conjunction with several university teaching centers and the Centers for Disease Control and Prevention, has issued its annual report on cancer deaths in the United States.

The report shows the number of cancer deaths declining 2.1 percent a year between 2002 and 2004. That's double the 1 percent drop in cancer deaths recorded from 1993 to 2002.

The difference means that thousands of people who might have been died from cancer are still alive.

"It highlights all the good things that are going on," said Dr. Edward Chu, deputy director of the Yale Cancer Center in New Haven.

"It has to do with early detection and screening. It has to do with lifestyle changes," Chu said. "And we've been seeing real progress in surgical techniques, in radiation therapy and chemotherapy."

"The report showed mortality declines in several cancers -- most notably breast cancer, colon cancer and prostate cancer," said Howard, of New Milford Hospital.

"These are three forms of the disease that doctors can screen for," he said. "Screening is one of the best tools we have for reducing cancer deaths."

The report said mortality from lung cancer -- overall, the most deadly form of the disease -- is declining in men. For women, the rate of lung cancer deaths is still going up, but at a slower pace.

Chu, of Yale, said this is because women, who were slower to start smoking cigarettes, have been slower to quit them.

Because 90 percent of all lung cancers are smoking-related, that means women are behind the curve of behavioral change that's already benefitting men. As more women stop smoking, he said, this will change.

"I think in five to 10 years, we're going to see valuable declines in women's lung cancer deaths as well," Chu said.

Dr. Vincent Rella, an oncologist at the Praxair Cancer Center at Danbury Hospital, said as people stop smoking, there will be lower mortality rates in several other forms of cancer -- oral cancers, bladder cancer and esophageal cancers, among them.

"Of the top 15 types of cancer for men, there are declines in mortality for 12 of them," Rella said. "For women, it declines in 10 of the 15. A lot of those cancers are smoking-related."

Colorectal cancer is one form of cancer with a declining mortality rate that's clearly linked to a screening test -- the colonoscopy -- which is now recommended for everyone 50 years old or older, or earlier if there are additional risk factors, like a family history of the disease.

But Dr. Joel Levine, who runs the colon cancer prevention program at the University of Connecticut Medical School in Farmington, said colonoscopies can only catch 50 to 60 percent of polyps and early colon cancers.

"That's good, but it's not great," he said. "You can't put all your faith in colonoscopies. It's what you do between colonoscopies, in terms of lifestyle changes -- diet, exercise, obesity -- that's also important."

Howard, of the New Milford Cancer Center, said oncologists are now buoyed by new drugs coming on the scene.

"For 30 years, we had one drug to treat colon cancer," he said. "Now we have six. Of those, five came on the scene in the past 10 years. I'm seeing patients with metastatic colon cancer staying alive that I know would not have made it a few years ago."

And, Howard said, there are many more targeted drug therapies coming on the market.

These won't necessarily cure cancer, Rella said. But they'll let patients live longer and with far fewer side effects than the old forms of chemotherapy.

Levine, of the UConn Medical Center, said genetic testing may let doctors better match the drugs available to specific cancers and specific patients, rather than using a one-size-fits-all approach.

And as new screening tests become available -- even for hard-to-diagnose cancers like ovarian cancer and lung cancer -- there will be new rounds of talks and classes to teach people about them. Howard said the recent declines in cancer mortality prove this can be done.

"Either we're doing a better job at educating the public than I thought, or people are reading about these screening tests, coming to our offices and demanding them,'' he said.

Quick Links

UConn Cancer Dialogue

A quarterly publication designed for medical professionals who are involved in cancer research or care of patients with cancer. Read the latest edition.