Cancer death rates in the United States have been experiencing a steady decline, dropping 2.3% per year every year from 2016 through 2019, according to a new report from the American Association for Cancer Research (AACR).
The organization's yearly Cancer Progress report says more people than ever before are living longer and fuller lives after a cancer diagnosis and as of January 2022, there's more than 18 million people living in the United States who have a history of cancer.
“Age-adjusted overall cancer death rate in the US has been declining since the 1990s, with the reductions between 1991 and 2019 translating into nearly 3.5 million cancer deaths avoided,” Timothy Yap, MBBS, PhD, associate professor of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center and member of the AACR Cancer Progress Report Steering Committee, told Health.
This is exciting news, particularly at a time when President Biden has promised to further step up the country's investment and focus on cancer research.
Here's a closer look at the study, its' findings, and what it all means for the future of the disease and those impacted by it.
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Many Reasons Cancer Death Rates Are Declining in the U.S.
Cancer death rates are dropping largely due to a reduction in environmental factors that contribute to the development of cancer, Wally Curran, MD, FACR, FASCO, global chief medical officer at Genesis Care, with expertise in radiation oncology, told Health.
Most notably, Dr. Curran said there’s been a decline in cigarette smoking and tobacco use in the country, which is “probably the leading cause of preventable cancer.” The CDC reports current smoking has declined from 20.9% in 2005 to 12.5% in 2020.
"Tobacco use among Americans continues to decline and thankfully, the younger generations continue to reject it as a strong and positive social norm, which is very different from the 1950s and 60s," he said. "Besides lung cancer, there's a lot of other cancers where the risk is slightly worsened by tobacco use."
In addition, other health experts say advances in technology—involving surgery, radiation, imaging, screening, medications, and most recently, the increased use of immunotherapies—are contributing to the declining cancer death rates the U.S. is currently experiencing.
“Innovative technology is helping to ensure proper tests are ordered, timely work-up is complete, and personalized treatments are being performed for each patient, regardless of health disparities,” Brook Blackmore, MBA, MSN, Azra AI’s vice president of clinical operations and cancer expert, told Health.
Yap and Lisa Coussens, PhD, president of the American Association for Cancer Research, shared a few other factors that are contributing to the steady decline, including:
- Unprecedented progress against lung, colorectal, breast, and prostate cancer, which they say are the four most common cancer types in the U.S.
- Improvements in screening
- Significant breakthroughs in cancer treatment— including for previously intractable cancers such as melanoma and lung cancer
Immunotherapies: What Are They and How Do They Work?
It's not an overstatement to say immunotherapies have been "transformational in cancer care in the last decade," Dr. Curran said. They are a treatment option that's been playing an important role in helping to drive down cancer death rates.
Immunotherapies are a class of cancer treatments that boost the natural defenses of the immune system so that it works harder to find and destroy cancer cells, explained Yap. In other words, this type of therapy leverages the natural ability of a patient’s immune system to fight cancer.
To explain further: If there is a foreign object in your body, then your body develops an immune response and tries to attack it, Dr. Curran said. For example, when you have a thorn in your finger, your body develops an immune response to prevent infection. But what cancer does in some cases, is put the brakes on our immune system, which tricks our immune system into not fighting.
However, Dr. Curran explained, “the best types of immunotherapy in the last decade are those that take the brakes off the immune system caused by cancer and therefore allow our immune system to attack cancer and cancer cells.”
What’s more, immunotherapy can be given in different ways— including IV (intravenously) which goes directly into a vein, oral in the form of a pill, and topical treatment such as a cream. These approaches to treatment have already been approved for more than 20 different cancer types, Yap said.
Immunotherapy can also be used alone or in combination with a range of drugs, such as other immunotherapy drugs, chemotherapy and targeted cancer treatments.
“We have seen many successes with immunotherapy drugs, such as immune checkpoint inhibitors, for the treatment of a wide range of cancers, including melanoma and lung cancer,” Yap said. “We have also had success with cell therapies, including CAR T-cell therapy, in treating hematologic cancers, as well as molecularly targeted drugs for the treatment of different cancers.”
The Cancer Research Institute highlights that as of 2017, the U.S. Food and Drug Administration (FDA) has approved 32 different types of immunotherapies for patients with varying cancers—including melanoma, bladder cancer, kidney cancer, lung cancer, lymphoma, leukemia and prostate cancer.
The AACR also reports that in March 2011, the FDA approved the first immune checkpoint inhibitor (ICI) which is a drug called ipilimumab (Yervoy) for metastatic melanoma. Following this, as of July 31, 2022, the FDA approved eight other ICIs for 18 types of cancer.
"Cancer patients now have treatment options that are specific to the genetic changes driving their cancer," Yap said. "These therapies target cancer cells within a tumor more precisely, making the treatment more effective and less toxic – not only saving the lives of cancer patients but also improving their quality of life after treatment."
While immunotherapies have shown success compared to earlier treatments in some patients with certain types of cancers even after cancer has grown, Coussens said "not all types of tumors respond to this type of treatment."
Dr. Curran also noted that most uses of immunotherapies are not resulting in necessarily higher cure rates, but better response rates and longer survival.
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Which Cancers Have the Highest Survival Rates and Lowest Survival Rates?
While experts say this is a complex question to answer, generally, patients with breast and prostate cancer have higher survival rates. Coussens said this can be attributed to early detection methods, screening tests and effective therapies that are available.
Cancers that have no population-based early detection tests available for average-risk patients, or effective treatments, especially for late-stage diseases like pancreatic cancer, have low survival rates, added Coussens.
“For certain historically intractable cancers such as melanoma, survival rates have improved considerably in recent years thanks to the FDA approval of the wide range of molecularly targeted therapeutics and immunotherapeutics to treat advanced disease,” she said. “In the case of lung cancer, while there’s a screening test available for the high-risk population, the uptake among eligible individuals continues to be very low, and many patients are still diagnosed at a late stage.”
Adding to that, Dr. Curran said the three most common types of cancer that have declining mortality rates include lung cancer, breast cancer and colorectal cancer. For aggressive types of cancers, including brain tumors, pancreatic cancer, and cancers of the upper abdominal area, there hasn’t been “much progress that’s shown in the data.”
"About 80% of the cases of cancer in the United States are cancers of the lung, breast, colon, and rectum or prostate," he said. "So, if we make progress against the most common then it will reflect in these kinds of headlines every year."
What Is the Key to Cutting Cancer Death Rates Even More?
The key to continuing decreasing cancer death rates across the U.S. is boosting education on early screening and identification, Blackmore said.
"Making sure people understand the importance and impact on survival of early cancer detection will continue to decrease deaths caused by cancer," she said. "In addition, utilizing artificial intelligence technology to identify patients who are not aware they have cancer is also key to surface patients and get them to treatment faster, increasing survival rates."
Beyond declining smoking rates, improved screening strategies, and bridging equity gaps, Yap said on an individual level, people can exercise and consume a healthy diet "to improve the survivorship experience."
"Ultimately, survivorship relies on the use of patient navigators to coordinate cancer care, support for family caregivers, and equitable access to telehealth," he said.
Dr. Coussens said continued federal funding is also critical to drive the next wave of discoveries and accelerate progress in cancer treatment.
Even though improvements are being made, health experts say there's still a lot of work that needs to be done.
“There’s still about 1.9 million Americans diagnosed with cancer each year and about 600,000 who die. That’s about the population of the city of Boston dying every year now from cancer,” Dr. Curran said. “It’s really exciting to see the progress and it’s certainly real, but there’s a long way to go.”