Annual report to the nation on the status of cancer

"Cancer Death Rates Plunge." This encouraging news appeared as a front-page, four-column headline in a recent edition of the Syracuse, New York daily newspaper. This headline was repeated in newspapers around the country, in newswire services, in nationwide network television newscasts and on the Internet. Many media emphasized that it was screening tests, public health and preventive measures, not necessarily advances in curative treatments, that resulted in a decrease of both cancer incidence rates and cancer death rates.

This was an annual report to the nation, compiled by the Center for Disease Control and the American Cancer Society. It was not a study published in a journal, subject to peer-review in the usual sense. It is described as a "U.S. government work" put together by 15 authors, one of whom is listed as being "under contract with the Indian Health Service for a portion of her work on this manuscript."

Through cancer registry programs and associations, SEER (Surveillance, Epidemiology, End Results) compilations, NCI (National Cancer Institute) and ACS (American Cancer Society) programs it was estimated that cancer incidence data for this report was available for "up to 82% of the U.S. population."

The report specifies that overall cancer death rates declined 1% from 2002 through 2004, compared to 1993 through 2002 (i.e., 2.1% compared to 1.1%). Breast cancer incidence (therefore death rate) decreased 3.5% a year in 2002-2004, but this drop was indicated to be chiefly due to a discontinuance by women of hormonal replacement therapy (HRT)--which was found to actually cause breast camcer--not to any treatment advance, as discussed in a previous blog.

A decrease in colorectal cancer for both men and women was largely attributed to screening tests, such as colonoscopy and stool guaiac examinations. At colonoscopy benign polyps--which can later become cancer--are easily excised and thus cancer incidence from this disease is
decreased; frank cancer found at colonscopy is usually found at an earlier--and therefore more treatable--stage than would normally be the case, and thus this examination can also lead to a decrease in death rate. Stool guaiac tests are also simple tests to detect occult blood in the stool, which could be coming from a cancerous tumor in the colon; these tests, too, lead to earlier diagnosis which in turn promotes a decrease in the death rate.

Favorable trends in the incidence and mortality from lung cancer in men were largely attributed to "enhanced tobacco control" (i.e., men giving up smoking). In women the death rate from lung cancer has overtaken that of breast cancer in recent years. Incidence and death rates from this cancer in women, unlike men, did not decrease during the 2002-2004 period; the incidence remained flat and death rates actually increased but at a slower rate than in previous years.

This report constitutes truly encouraging news. It means that cancer incidence and death rates can be controlled--by preventive measures, such as women's discontinuance of HRT and avoidance of the use of tobacco products, both of which are causative or contributive agents for breast, lung and other cancers. Also, use of screening tests, such as those employed for colorectal cancer, can result in a marked decrease in cancer incidence/mortality in various organ systems.

The negative side of this report, however--what this report also states--is that very little, if any, of the improvements in cancer incidence/death rates during this period is due to the advancement of cancer therapy per se. Once established in the body, major organ cancers--colorectal, pancreatic, lung, brain, breast and others--are extremely difficult to cure. The report, by omission, calls attenion to this deficit in innovative therapies which may significantly and beneficially alter the course of established cancers. What in fact this report silently screams is the need for new ideas, the need to implement old ideas that have not been adequately explored and the need to move away from the centralization of power and money as the determinants of cancer thought and therapy.