An article published on July 8, 2021 in The Journal of the National Cancer Institute entitled “Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics” reported: “Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults.”
The authors of the article found that for the period from 2013 through 2017, death rates decreased for 11 of the 19 most common cancers among males, and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. The overall cancer incidence rates for all ages during that time period were 487.4 per 100,000 population among males (cancer incidence rates remained stable among males) and 422.4 per 100,000 population among females (cancer incidence rates slightly increased among females). The overall cancer death rates for 2014 through 2018 were 185.5 per 100,000 population among males and 133.5 per 100,000 population among females. During this period, the overall cancer death rates decreased in both males and females.
The article reported that for 2014 through 2018, the declines in cancer death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children 14 and younger and adolescents and young adults ages 15 to 39, the cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during the period from 2001 through 2009 but increased by 3.1% per year for those diagnosed during the period from 2009 through 2014, with comparable trends among males and females.
The average 2-year age-standardized relative survival for melanoma cases diagnosed from 2010 through 2014 was 99.4% for localized-stage, 84.9% for regional-stage, and 41.6% for distant-stage tumors.
Cancer Rates Among Children
Among children aged 0-14 years, the incidence rate for all cancers combined was 16.8 cases per 100,000 standard population, ranging from 12.6 among AI/AN children to 17.8 among White children. Overall cancer incidence rates increased during the period of 2013 through 2017. The increase occurred in all racial/ethnic groups except among AI/AN children, in whom rates were stable. The most common cancer types included leukemia (5.2 cases per 100,000 standard population), brain and ONS (3.8), and lymphoma (1.6), with increasing trends of 0.7%-0.8% per year on average for each of these cancers during the period from 2001 through 2017. Leukemia incidence rates increased during the period from 2013 through 2017 among White, Black, AI/AN, and Hispanic children but were stable among API children.
The cancer death rate among children was 2.1 deaths per 100,000 standard population, ranging from 1.8 among API children to 2.6 among AI/AN children. The overall cancer death rate among children decreased during the period of 2014 through 2018. The most common cancer deaths were from brain and ONS cancer (0.7 deaths per 100,000 standard population) and leukemia (0.5). During 2001-2017, death rates among children for brain and ONS cancer were stable while death rates from leukemia declined an average of 2.9% per year.
Cancer Rates Among Adolescents And Young Adults
Among adolescents and young adults (“AYA”) aged 15-39 years, the overall cancer incidence rate was 75.9 cases per 100,000 standard population, ranging from 55.6 among API AYA to 84.4 among White AYA. The most common cancer among AYA was female breast cancer. The next most commonly diagnosed cancers were thyroid (12.1 per 100,000 standard population) and testicular cancer (11.0), with substantial variations in incidence rates by racial/ethnic group, being lowest among Black AYA (5.6 for thyroid and 2.6 for testis cancer) and highest among White AYA (13.8 for thyroid and 13.4 for testis cancer).
The cancer death rate among AYA was 8.9 deaths per 100,000 standard population and was highest among Black AYA (11.4) and AI/AN AYA (10.7) and lowest among API AYA (6.8). The most common cancer deaths among AYA were from female breast (2.2 deaths per 100,000 standard population), brain and ONS (1.0), leukemia (0.9), and colorectal cancer (0.9). Death rates from female breast cancer among Black AYA (4.0) were twice as high as among White AYA (2.0). Overall death rates among AYA declined during 2001-2018, with a faster average decline earlier (3.0% per year during 2001-2005) than in more recent years (0.9% per year during 2005-2018).
Overall cancer incidence rates among AYA increased during 2001-2017, as did incidence rates of testicular cancer, whereas rates decreased for lymphoma and melanoma.
The authors concluded: “The decline in overall cancer death rates in the United States has accelerated in recent years, largely driven by accelerated declines in lung cancer death rates. Other favorable recent changes include a decline in melanoma death rates and stabilization (among males) and deceleration (among females) of earlier increasing trends in liver cancer death rates. In contrast, earlier declines in colorectal and female breast cancer death rates have slowed down and declining trends for prostate cancer have stabilized in recent years. The observed trends in cancer death rates reflect changes in cancer risk factors (notably, cigarette smoking), screening, and treatment. In contrast to death rates, overall cancer incidence rates continue to increase among females and AYA and have stabilized among males after earlier declines, largely reflecting changes in cancer risk factors, notably increases in excess body weight. Changes in diagnostic practices have also influenced incidence trends for certain cancers, such as thyroid and prostate.”
“Death rates for multiple cancer types and overall remain higher among Black persons than in other racial/ethnic groups. The continuing disparity largely reflects a combination of multiple intertwined factors of tumor biology, stage at diagnosis, receipt of timely and effective treatment, and systemic discrimination in cancer care delivery. Furthermore, largely owing to social determinants of health inequalities, Black persons and individuals of lower socioeconomic groups in general are more likely to have a higher exposure to some cancer risk factors and limited access to healthy food, safe places for physical activity, and evidence-based cancer preventive services. Broad and multifaceted interventions can help close the racial mortality gap and address system failures across the continuum of care.”
“Female breast cancer is the most commonly diagnosed cancer among women and among AYA, and the second leading cause of cancer death among women. The increase of breast cancer incidence is largely driven by hormone-receptor positive cancer, which may in part reflect continuing reduction of parity rates, advanced age at first birth, the obesity epidemic (postmenopausal breast cancer), high levels of physical inactivity, and increase of alcohol consumption.”
“Prostate cancer incidence rates stabilized from 2014 to 2017 after sharply declining during 2007-2014. These trends coincide with changes in use of prostate specific antigen (PSA) testing following the USPSTF recommendations against PSA-based screening for prostate cancer for men aged ≥75 years in 2008 and for all men in 2012 … A recent analysis of prostate cancer incidence by stage at diagnosis, however, showed that rates continued to decline for local-stage disease, whereas rates increased substantially for regional and distant stage diseases. The increases in regional- and distant-stage diseases may have contributed to the recent stabilization of death rates after years of declining trends.”
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