New data for 1999 show that death rates for all cancers combined continued to decline in the United States. However, the number of cancer cases can be expected to increase because of the growth and aging of the population in coming decades, according to a report released today. The "Annual Report to the Nation on the Status of Cancer, 1973-1999, featuring implications of age and aging on the U.S. cancer burden" is published in the May 15, 2002 (Vol. 94, No. 10, pages 2766-2792), issue of Cancer.

The report is by the National Cancer Institute (NCI); the American Cancer Society (ACS); the North American Association of Central Cancer Registries (NAACCR); the National Institute on Aging (NIA); and the Centres for Disease Control and Prevention (CDC), including the National Centre for Health Statistics (NCHS) and the National Centre for Chronic Disease Prevention and Health Promotion.

The initial Report to the Nation, issued four years ago, documented the first sustained decline in cancer death rates. This trend was a notable reversal from increases that had been seen since the 1930s, which was the period when record keeping on deaths first included the entire nation.

"The continuing decline in the rate of cancer deaths once again affirms the progress we've made against cancer, but the report also highlights the need for an acceleration of research as the population of the United States ages," said NCI Director Andrew C. von Eschenbach, M.D.

Lung cancer is still the leading cause of cancer death in the United States. During the most recent reporting period, it accounted for almost one-third of cancer deaths in men and about one-fourth of cancer deaths in women. Colorectal cancer is the second leading cause of cancer death, followed by breast and prostate cancer.

"The good news in this report is the continuing fall in cancer death rates by slightly more than one percent per year between 1993 and 1999," said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. "Of special note is the continuing decline in death rates for the four most common cancers."

According to James S. Marks, M.D., director of CDC's National Centre for Chronic Disease Prevention and Health Promotion, "Another important issue in the report is that the incidence rate, or rate of new cancers, for all cancers combined was stable during most of the 1990s, after increasing during the 1970s through 1980s. These data highlight the need for the rapid, full application of all we know about prevention, screening, and treatment of cancer."

The single most important risk factor for cancer is age. Because the U.S. population is both growing and aging, the authors focused on how, even if rates of cancer remain constant, the number of people diagnosed with cancer will increase.

The authors projected the cancer burden in about 50 years from now by applying U.S. Census Bureau population projections to current cancer incidence rates. "If cancer rates follow current patterns, we anticipate a doubling from 1.3 million people in 2000 to 2.6 million people in 2050 diagnosed with cancer," said Holly L. Howe, Ph.D., executive director of NAACCR. "The number of cancer patients age 85 and over is expected to increase four-fold in this same time period," said Howe.

NIA Director Richard J. Hodes, M.D., notes that, "the data presented in the report underscore a critical need for expanded and coordinated cancer control efforts to serve an aging population and reduce the burden of cancer in the elderly."

Furthermore, the authors posit a number of strategies for dealing with the future cancer burden. Special considerations in treating cancer in older people will need to be undertaken due to co-morbid conditions and physical limitations that haven't been studied fully in older age groups. Increasing representation of older patients in clinical trials could help answer questions about how best to treat older people with cancer. The authors also note, in particular, the growing need for trained cancer care professionals.

Certain changes and limitations in reporting data for this fifth report preclude comparisons with previous reports. For this report, unlike previous reports, age adjustment of statistics used the year 2000 standard population in contrast to the year 1970 standard population, which makes rates of certain cancers appear 20 percent to 50 percent higher. This change conforms to new federal policy for reporting disease rates. Also, a change in how cause of death is coded, starting with 1999 deaths, further complicates comparisons with previous years. Annual population counts at the county level prior to 1990 are available for blacks and whites only. Therefore, assessment of long-term trends in other population groups is not possible. The report has examined recent patterns of cancer occurrence in specific racial and ethnic populations such as Asian and Pacific Islanders, American Indians/Alaska Natives, and Hispanics. For the latest time period from 1995 through 1999, cancer rates among these groups were considerably different.

The report is based on incidence data from NCI's Surveillance, Epidemiology and End Results (SEER) Program, the CDC's National Program of Cancer Registries (NPCR), and NAACCR. Mortality data comes from the CDC's NCHS.