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Report: Cancer deaths are down but pancreatic cancer is growing, racial disparities persist

Targeted drugs and immunotherapies are among the advances that contribute to declines in incidence and deaths from non-small cell lung cancer, according to the Annual Report to the Nation on the Status of Cancer. But the trends are on the rise for some other cancers and racial disparities persist, highlighting the need to better understand these differences.

Cancer death rates are coming down for adults and children, and the declines are steepest in some of the most commonly diagnosed types of cancers. However, pancreatic cancer stands out as one of the few cancer types whose incidence and death rates are on the rise.

The findings come from the Annual Report to the Nation on the Status of Cancer, a document compiled by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries. Those entities have collaborated on the annual report since 1998. The most recent data for this year’s report are from 2019; the findings are based data from before the COVID-19 pandemic. The report was published in the journal Cancer.

Let’s start with the declines. From 2015 to 2019, cancer death rates in men decreased by 2.3% per year, according to the report. In women, death rates decreased by 1.9% per year. The recent reductions observed in cancer deaths was driven by declines in lung cancer mortality, the report said. Lung cancer and melanoma together saw the declines in both men and women.

Declines in lung cancer incidence and deaths were attributed to continuous declines in smoking as well as better treatments, specifically advances in targeted therapies and immunotherapies for non-small cell lung cancer (NSCLC). AstraZeneca’s Iressa became the first targeted therapy approved for NSCLC in 2003 leading the way for other targeted therapies to pass regulatory muster, followed by the class of cancer immunotherapies called checkpoint inhibitors.

Non-treatment variables that may contribute to the declines in lung cancer deaths include improved access to care following the expansion of Medicaid to a broader group of low-income adults starting in 2014, the report said. Another factor is the increase in screening, which in turn leads to earlier diagnosis. Despite this progress, the report notes that lung cancer remains the most common cause of cancer death across racial and ethnic groups and the more than 30 million adults who smoke cigarettes.

In adolescents and young adults, defined as ages 15 to 39, the report states cancer incidence rates increased by less than 1% per year from 2014 to 2018. The most common type of cancer in this age group was female breast cancer; next was thyroid cancer.

In some cancers, the death rates are climbing. In men, the report shows an increase in death rates for cancers of the pancreas, brain, and bones and joints. In women, death rates are increasing for cancers of the pancreas and uterus. Pancreatic cancer accounts for just 3% of new cancer diagnoses. Despite the rareness of this type of cancer, it leads to 8% of cancer deaths, making it the fourth-leading cause of cancer deaths for males and females, the report said.

From 2001 to 2018, the incidence of pancreatic cancer increased by 1% per year in men and women; death rates increased by 0.2% per year, according to the report. Two of the most common subtypes of pancreatic cancer are neuroendocrine tumors and adenocarcinomas. Both types increased in men and women from 2001 to 2018.

Despite those increases, the analysis also found survival improvements according to subtype. In pancreatic neuroendocrine tumors the report found that one-year survival increased from 65.9% in 2001 to 84.2% in 2017. For those diagnosed with pancreatic adenocarcinomas, one-year survival rose from 24% to 36.7% in the same time span. Survival also increased at the five-year mark. These survival improvements may be due to improvements in therapy. However, no improvement was seen for other types of pancreatic tumors, which were mostly diagnosed in older adults.

Racial disparities persist for some types of cancer. While the incidence rates for bladder cancer declined in Whites, Blacks, Asian/Pacific Islanders, and Hispanics, the report found rates increased in American Indian and Alaska Native people. The incidence of uterine cancer was similar in Black and White women, but the death rates from this type of cancer are nearly twice as high in Black women. For breast cancer, the death rate for Blacks is 40% higher than it is for Whites.

“The highest breast cancer death rates seen among Black females are partially caused by the significant barriers to providing access to timely, high-quality medical care, which require addressing multiple dimensions of disparity across the continuum of cancer care,” the report said.

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