1. Eastman, Peggy

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The latest Annual Report to the Nation on the Status of Cancer contains promising news: from 2014 to 2018 overall cancer death rates declined for women, men, children, and adolescents and young adults (AYAs). The new report covers the pre-pandemic period 2001 to 2018. During that time period, the decline in deaths from lung cancer accelerated and death rates for melanoma declined markedly in more recent years, reflecting a considerable increase in survival for patients with metastatic melanoma.

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The report, which appears in JNCI: The Journal of the National Cancer Institute, is a joint effort of the American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC); National Cancer Institute (NCI); and North American Association of Central Cancer Registries (NAACCR). Overall, the new report shows a decrease in death rates for 11 of the 19 most common cancers among men, and 14 of the 20 most common cancers among women from 2014 to 2018 (2021; doi: 10.1093/jnci/djab131).


"The continued decline in cancer death rates should be gratifying to the cancer research community, as evidence that scientific advances over several decades are making a real difference in outcomes at the population level," said NCI Director Norman E. "Ned" Sharpless, MD.


Chief Executive Officer of the ACS, Karen E. Knudsen, MBA, PhD, also hailed the promising data in the new report. "The declines in lung cancer and melanoma death rates are the result of progress across the entire cancer continuum-from reduced smoking rates to prevent cancer to discoveries such as targeted drug therapies and immune checkpoint therapies," she said.


But Knudsen warned that, even as this progress is celebrated, the commitment to cancer research, patient support, and advocacy must remain strong to maintain momentum. That is especially true as the nation emerges from the coronavirus pandemic, which has had a devastating effect on cancer screenings, treatment, and research. Cancer specialists are concerned that there could be a serious backsliding in progress against cancer because of COVID-19.


Cancer Progress After COVID-19

According to a new study also published in JNCI, the COVID-19 pandemic caused declines in cancer detection and surgical treatments (2021; doi: 10.1093/jnci/djab122). Specifically, that study found there were 29,905 fewer pathology reports in 2020 than in 2019. This represents a 10.2 percent decline in real-time electronic pathology reports from population-based cancer registries in 2020 compared to those in 2019. The nadir was early April 2020, with 42.8 percent fewer pathology reports than in April 2019. Declines were observed in all age groups.


The study observed substantial declines in reporting among cancers with effective screening tests, including breast cancer and colorectal cancer, as well as across cancer sites and age groups without effective screening tests. The authors state that their study findings suggest there were substantial delays in diagnostic and treatment services for cancer during the pandemic. The authors advise that "ongoing evaluation can inform public health efforts to minimize any lasting adverse effects of the pandemic on cancer diagnosis, stage, treatment, and survival."


As previously reported by Oncology Times, oncologists' caseloads dropped during the pandemic and are still well below those of pre-pandemic levels. Cancer screenings also dropped and are still below those of pre-pandemic levels. The use of oncology medicines also declined (except for checkpoint inhibitors). The NCI has estimated that nearly 10,000 excess U.S. deaths from breast and colorectal cancer alone over the next 10 years will occur because of pandemic-related delays in cancer screening and treatment.


Data in the new annual report to the nation show that before the pandemic hit, cancer death rate declines accelerated in both males and females from 2001 to 2018. In males, a decline of 1.8 percent per year in 2001-2015 accelerated to a decline of 2.3 percent per year during 2015-2018. In females, a decline of 1.4 percent per year from 2001 to 2015 accelerated to a decline of 2.1 percent per year during 2015-2018. From 2014 to 2018, overall cancer death rates decreased in every racial and ethnic group.


"It is encouraging to see a continued decline in death rates for many of the common cancers," said Karen Hacker, MD, MPH, Director of CDC's National Center for Chronic Disease Prevention and Health Promotion.


Hacker emphasized the need to dismantle existing health disparities, which the pandemic has laid bare and exacerbated. So did Betsy A. Kohler, MPH, CTR, Executive Director of the NAACCR.


"When evaluating health disparities, it is critical to acknowledge the social factors that influence the health of communities and access to health care," she noted. "Social and economic indicators, particularly based on small area assessments, are increasingly important to understanding the burden of cancer."


Not all the news from the new report is good. Previous declining trends for colorectal and female breast cancer death rates slowed during 2014-1018, and death rates from prostate cancer leveled off. Death rates increased for cancers of the brain and nervous system and pancreas in both sexes, along with the oral cavity and pharynx in males, and liver and uterus in females. Decelerations of previous declining trends in death rates for colorectal cancer and female breast cancers are most likely due to risk factors such as obesity.


"I believe we could achieve even further improvements if we address obesity, which has the potential to overtake tobacco use to become the leading modifiable factor associated with cancer," said the NCI's Sharpless.


While cancer death rates continued to decline among children (those under age 15) and AYAs (those aged 15-39), there were troubling increases in cancer incidence rates in these population groups from 2001 to 2017. Cancer incidence rates in children and AYAs increased in all racial and ethnic groups except American Indian/Alaska native children, where incidence rates remained stable. Among AYAs, the most common cancer was female breast cancer. The authors state that because data show cancer incidence rates continue to increase among females, children and AYAs, "these findings inform effort related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under-resourced populations."


Other findings from the new report to the nation include the following:


* Overall cancer incidence rates were higher among men than women in every racial and ethnic group with the exception of Asian/Pacific Islanders, where the rates were similar.


* Overall cancer incidence rates were slightly lower among Blacks than Whites.


* In contrast, overall cancer death rates were slightly higher among Blacks than Whites.


* Incidence rates of liver cancer were previously increasing, but data show incidence rates have stabilized among both men and women.


* Two-year relative survival for advanced-stage melanoma cases diagnosed during 2001-2009 was stable, but it increased 3.1 percent per year for those diagnosed during 2009-2014.


* Two-year relative survival increased only slightly for early-stage and intermediate-stage melanoma cases diagnosed during 2001-2014 (0.03% and 0.4% per year, respectively).



Peggy Eastman is a contributing writer.