Clinical Context

The US Department of Health and Human Services has envisioned a society in which all people live long, healthy lives. To help fulfill this vision, the national initiative Healthy People has set 4 broad health goals: attain high‐quality, longer lives free of preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve health among all groups; create social and physical environments that foster good health for all; and enhance quality of life and healthy development.

To monitor progress in reaching these goals as they apply to cancer prevention and treatment, the CDC, ACS, NCI, and NAACCR jointly issued their annual update on cancer occurrence and trends in the United States. Part 1 describes national cancer statistics, and part 2 discusses progress in achieving select Healthy People 2020 cancer objectives.

Synopsis and Perspective

Cancer death rates continued to decline in the United States for cancer of all sites combined, and this trend was seen in all major racial and ethnic groups as well as in men and women and in all age groups, noted the authors of the Annual Report to the Nation on the Status of Cancer.

The 2020 targets were met for reductions in mortality from lung, prostate, breast, and colorectal cancer, according to the companion report, Progress Toward Healthy People 2020 Objectives for 4 Common Cancers.

Both reports were published online March 12 in Cancer.

Overall, cancer death rates decreased an average of 1.5%/y from 2001 through 2017, with more rapid declines seen among male individuals, at 1.8%/y, than among female individuals, at 1.4%/y, noted the authors, headed by Jane Henley, MSPH, CDC, in Atlanta, Georgia.

"The largest declines in death rates were observed for melanoma of the skin and lung cancer," they added.

In addition, cancer deaths decreased in every racial and ethnic group from 2013 through 2017.

"In the field of cancer, good news is always precious and should be cherished. This year's update of cancer death rates and progress in achieving health goals is one of those times," Robert Ferris, MD, PhD, University of Pittsburgh, in Pittsburgh, Pennsylvania, wrote in an accompanying editorial.

"These welcome trends reflect population science success in reducing cancer risk factors while increasing screening test use," he continued.

"Coupled with breakthrough treatment advances such as cancer immunotherapy and genome-targeted treatments, these 2 reports bode well for continued improvements," he added.

The Annual Report to the Nation on the Status of Cancer is a collaborative effort by the CDC, NCI, ACS, and NAACCR.

Cancer Incidence Findings

The annual report includes data on cancer incidence and cancer deaths.

During the most recent 5-year period, from 2012 to 2016, the incidence of cancer overall decreased by 0.6%/y, on average, but trends differed by sex. Incidence remained stable among male individuals and increased slightly among female individuals.

Among male persons, cancer incidence remained stable among whites but decreased among blacks, Asian Pacific Islanders, American Indian/Alaska Natives, and Hispanic male persons.

In contrast, the incidence of cancer overall increased among female individuals in every racial and ethnic group during the study interval, the researchers pointed out.

"The stable trend in overall cancer incidence among males was largely driven by stable trends for 7 of the 17 most common cancers," the authors explained.

The slight increase in overall incidence among female persons, in part, owed to an upsurge in incidence rates for 8 of the 18 most common cancers, including uterine, liver, brain, and pancreatic cancer.

Childhood/Adolescent Cancers

For the first time, the annual report provides incidence and mortality rates for the most common cancers among children and adolescents as well as adults up to age 39 years.

Small increases in incidence rates for cancer overall and for the most common types of cancer were observed in each of these age groups, but overall death rates among children ages 0 to 14 years decreased an average of 1.4%/y.

Among adolescents and adults ages 15 to 39 years, death rates from cancer decreased on average by 1%/y.

The most common cancers among younger children were leukemia, lymphoma, and brain and other nervous system cancers. The most common cancer among adolescents and young adults was female breast cancer; incidence rates were highest among young black women.

Healthy People 2020

In the companion article to the annual report, researchers examined progress in 4 of the most common cancers: lung, prostate, female breast, and colorectal cancer.

Target death rates for all cancers combined and target death rates for the 4 most common cancers were all met, Ms Henley and colleagues reported; however, several lifestyle targets were not met, including those regarding smoking, excessive alcohol use, and obesity.

The target of having smoking rates drop to 12% was not met, either overall or in most groups.

In addition, "most groups did not yet meet the target for reducing excessive alcohol use," the researchers added.

One target was to reduce the proportion of obese adults to 30.5%; "however, the prevalence of obesity increased among all groups between the periods 2005 to 2008 and 2013 to 2016," they stated.

From 2013 to 2016, 39% of all adults were obese, according to the report.

Many groups did achieve physical activity targets from 2008 to 2017. The exceptions were persons of Hispanic descent, persons living in rural areas, and persons with less education (high school or less).

The target of having more than 80% of women undergo breast cancer screening was not met in any group except women with advanced educational degrees.

Similarly, colorectal cancer screening rates improved somewhat, but rates did not reach the target of more than 70%, except among adults with advanced educational degrees.

Highlights

CDC- and NCI‐funded population‐based cancer registry programs compiled by NAACCR allowed gathering of data on new cancer diagnoses during 2001 through 2016.

The National Center for Health Statistics' National Vital Statistics System allowed gathering of data on cancer deaths during 2001 through 2017.

Using join point analysis, the investigators estimated trends in incidence and death rates for all cancers combined and for the leading cancer types by sex, racial/ethnic group, and age, as reflected by the average annual percentage change during the most recent 5 years (2012‐2016 for incidence and 2013‐2017 for mortality).

During 2012 through 2016, overall cancer incidence rates decreased 0.6%/y, on average, but trends varied by sex, racial/ethnic group, and cancer type.

For male persons and non‐Hispanic white male individuals, cancer incidence rates were stable overall but declined in other racial/ethnic groups.

Cancer incidence rates increased for 5 of the 17 most common cancers, were stable for 7 cancers (including prostate), and declined for 5 cancers (including lung and bronchus [lung] and colorectal).

From 2012 to 2016, cancer incidence rates in female persons increased by an average of 0.2% annually in all racial/ethnic groups, with increased rates for 8 of the 18 most prevalent cancers (including breast, uterine, liver, pancreas, and brain), stable rates for 6 cancers (including colorectal), and decreased rates for 4 cancers (including lung).

During 2013 to 2017, overall cancer death rates declined by 1.5%/y, on average, (1.8%/y in male persons and 1.4%/y in female persons) and decreased for all cancers combined among both male and female individuals in each racial/ethnic group.

During the same period, cancer death rates decreased for 11 of the 19 most common cancers among male persons (including lung and colorectal) and for 14 of the 20 most common cancers among female persons (including lung, colorectal, and breast).

The largest decreases in death rates were for melanoma of the skin (annual declines of 6.1% in male persons and 6.3% in female persons) and for lung cancer (annual declines of 4.8% in male persons and 3.7% in female persons).

In children younger than age 15 years, cancer incidence rates rose by an average of 0.8% annually during 2012 to 2016, and cancer death rates declined an average of 1.4%/y during 2013 to 2017.

In this age group, leukemia, lymphoma, and brain and other nervous system cancers were the most prevalent cancers.

Among persons ages 15 to 39 years, cancer incidence rates rose by an average of 0.9% annually during 2012 to 2016, and cancer death rates fell by an average of 1% annually during 2013 to 2017.

Female breast cancer was the most common cancer in this age group, and young black women had the highest incidence rates.

According to their findings, the investigators concluded that overall cancer death rates continue to fall but that incidence rates are stabilizing in male persons and rising slightly in female persons, reflecting population changes in cancer risk factors, screening utilization, diagnostic practices, and treatment advances.

Early detection helps prevent or effectively treat many cancers.

Population‐based cancer incidence and mortality data, such as these can inform strategies to reduce the US cancer burden and regularly monitor progress toward goals.

Part 2 of this report highlighted Healthy People 2020-selected objectives, including death rates, cancer screening, and major risk factors, for 4 common cancers (lung, colorectal, female breast, and prostate).

Using national surveillance systems data gathered from the Healthy People 2020 website, the investigators studied baseline values, recent values, and the percentage change from baseline to recent values overall and by select sociodemographic factors.

The overall population and most sociodemographic groups met targets for death rates.

Male persons, blacks, and people in rural areas did not meet targets but had larger declines in rates than other groups.

Cancer death rates declined by 15% overall during 2007 through 2017, ranging from −4% in rural areas to −22% in metropolitan areas.

Targets for breast and colorectal cancer screening (> 80% and > 70%, respectively) had not been met overall or in any sociodemographic groups except for persons with the highest educational level.

Lung cancer screening rates were generally low (< 10%).

Risk factor objectives were met overall for secondhand smoke exposure and physical activity but not for cigarette smoking rates (declining to 12%), recent smoking cessation, excessive alcohol use, or obesity, for which the target was to lower the percentage of obese adults to 30.5%.

Sociodemographic groups varied in whether or not they met targets and in degrees of improvement in reaching objectives.

For example, Hispanics, residents of rural areas, and persons with high school or less education failed to meet physical activity targets.

All groups had an increase in obesity prevalence during 2005 to 2008 and 2013 to 2016 (prevalence, 39% among adults).

According to their findings, the investigators concluded that monitoring trends in cancer risk factors, screening utilization, and mortality could help evaluate the progress made toward reducing the US cancer burden.

Many interventions to decrease cancer risk factors and facilitate healthy behaviors have been shown to be effective, but they may not be equitably applied or effective in every community.

Sustainable, focused, and culturally appropriate cancer prevention and control interventions may reduce disparities and improve success in communities with the greatest need, providing all Americans with a path to long, healthy, cancer‐free lives.

Clinical Implications

Overall cancer death rates continue to fall in the United States, but incidence rates are stabilizing in male persons and rising slightly in female persons, reflecting population changes in cancer risk factors, screening utilization, diagnostic practices, and treatment advances.

Monitoring trends in cancer risk factors, screening utilization, and mortality could help evaluate the progress made toward reducing the US cancer burden.

Implications for the Healthcare Team: Early detection helps prevent or effectively treat many cancers. Healthcare teams need to be aware of these recent trends in cancer rates and continue to improve the care that all patient populations receive related to cancer screening, early identification and treatment strategies to continue the current Healthy People 2020 trends.