BMJ  2006;332:444 (25 February), doi:10.1136/bmj.332.7539.444

News

US cancer mortality falls for the first time

New York

The total number of deaths from cancer fell in the United States for the first time since 1930, when nationwide statistics were first compiled, says a new report by the American Cancer Society. The decline occurred in 2003, when 556 902 people died from cancer; the number who died in 2002 was 557 271.

John Seffrin, chief executive officer of the American Cancer Society, said, "For years we've proudly pointed to dropping cancer death rates, even as a growing and aging population meant more actual deaths.

"Now, for the first time, the advances we've made in prevention, early detection, and treatment are outpacing even the population factors that in some ways obscured that success."

The fall in deaths from cancer was primarily due to a decline in the overall incidence of cancer related to smoking, said the society's programme director for cancer occurrence, Ahmedin Jemal.

"This is mainly because of a substantial reduction in smoking prevalence since the 1964 surgeon general's report on smoking and health," he said. "The percentage of adults who currently smoke cigarettes decreased from 42.4% in 1964 to 20.9% in 2004."

Some experts questioned the society's claim that screening and prevention programmes have contributed to the decline in cancer mortality, particularly in prostate and breast cancer.

"The prostate cancer death rate has been declining around the world, including places where prostate cancer screening is not widely used, like the United Kingdom," said Otis Brawley, professor of haematology, oncology, and medicine at the Emory University School of Medicine, Atlanta, and a former assistant director at the US National Cancer Institute.

The incidence of breast cancer continues to rise, but the report says that breast cancer mortality among women fell by 2.3% a year from 1990 to 2002.

Over this period the number of deaths from cancer among women rose, largely because of the increase in the number of women taking up smoking from the 1960s to the 1990s. Between the mid-1960s and 2002 lung cancer mortality among women increased by more than 400%.

Dr Brawley worries that news of the report is creating overly optimistic expectations regarding cancer treatment and prevention. "Two dots do not make a trend," he said. There were 778 fewer deaths among men, but 409 more deaths among women—and that's out of 556 902 deaths overall," he said. "I'd call that a levelling off and not a decline. There's so much emphasis on screening. But the real bang for the buck is in smoking cessation and prevention of uptake."

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