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• Declining Death Rates Reflect Progress against Cancer 

Conclusions/Significance

Progress in reducing cancer death rates is evident whether measured against baseline rates in 1970 or in 1990. The downturn in cancer death rates since 1990 result mostly from reductions in tobacco use, increased screening allowing early detection of several cancers, and modest to large improvements in treatment for specific cancers. Continued and increased investment in cancer prevention and control, access to high quality health care, and research could accelerate this progress. . . .

Advances in prevention, early detection, and treatment all have contributed to this progress in reducing death rates from cancer [2], [17], [18], [19], [20]. The decreases in death rates from lung cancer and other smoking-related cancers resulted mostly from reductions in smoking prevalence since the 1950s [2], [21]. Most of the reduction in lung cancer death rates observed since in 1990 in men and since in 2002 in women represents smoking cessation that began among educated men and women in 1950s; the full benefits of reduced initiation among adolescents will emerge in the future as these generations age. Between 1965 and 2006, current smoking prevalence among all U.S. adults 18 year and above decreased by 54% (from 51% to 24%) in men and by 46% (from 34% to 18%) in women [22]. Despite these substantial reductions in smoking prevalence and mortality from smoking-related cancers, cigarette smoking still accounts for approximately 30% of all cancer deaths, with lung cancer contributing most (80%) of these deaths [23]. About 45 million adults continue to smoke cigarettes. Decreasing initiation and increasing cessation through proven tobacco control interventions continue to be important priorities for reducing cancer mortality in the short and long term. . . .

The greater decrease in the overall cancer death rates in men than women largely due to differences in mortality trends from lung cancer which accounts for about 80% of all smoking attributable cancer deaths and nearly 30% of the total cancer deaths in the U.S. [21], [58], [59]. Lung cancer death rates have continued to decrease since 1990 in men, while they continued to increase through the mid 2000 in women. Trends in lung cancer also explain, in part, why the decrease in overall cancer deaths rates began earlier and were larger in proportionate terms in the younger than in the older age groups. Smoking prevalence and lung cancer peaked in those men born around 1920s and in women born around the late 1930s, now in their 70–90s. Younger cancer patients are also more likely to receive aggressive treatment and to participate in clinical trials [17].

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