Every January the American Cancer Society publishes Cancer Statistics based on the most recent data available. The abstract from the report is immediately below. The entire report is available at the end of this article.

Abstract: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

Several comments about the data as presented are warranted. The ACS has in recent years stopped reporting age adjusted mortality rates which are the most useful way of analyzing cancer deaths. This year they report mortality as the number per 100,000 people. This reporting is not as informative as is age adjusted mortality because a cancer death at age 90 compared to one at age 50 has obviously indifferent implications. The society is also backsliding into considerable discussion of of survival times. As they discuss themselves later in the report, this type of data is replete with bias from differences in the time of diagnosis. If you have an incurable cancer which will kill you in 10 years and it’s diagnosed one year after onset, your survival time is 9 years. If diagnosed after 9 years survival time is 1 year even though you die at the same age. Hence survival intervals tend to increase as diagnostic techniques become more focused and precise even if there is no improvement in treatment. The ACS should back off from reporting survival times and return to giving age adjusted mortality rates. Three figures below show where we are with our current management of cancers of various types.

As you can see, the biggest decrease in cancer mortality is that of lung cancer. This fall is almost entirely due to the cessation of smoking by most of the population. An interesting phenomenon is the virtual disappearance of deaths from stomach cancer which back in 1930 was the leading cause of death from malignancy. The reason for this precipitous decline is not known. It’s not due to better treatment as there has been no improvement in the management of stomach cancer. It has become a rare disease.

There are two cancers which also are declining – breast and colon. The decrease in breast cancer deaths is most likely the result of better treatment. Though not discussed here, mammography appears to have played little or no role in the improved survival of patients with breast cancer. Early diagnosis, especially of premalignant colon polyps, does seem responsible for the better numbers of colon cancer deaths.

The final figure (from the American heart Association) below compares deaths from cardiovascular disease to those from cancer. As you can see we’ve done much better with heart disease than with cancer.

As indicated above, here is the complete ACS report: