Good News, Bad News On Cancer

Lung cancer is inching down among women after decades of smoking-fueled increases and overall survival rates are improving for most types of tumors among both men and women.

Not everyone is reaping the gains: Minorities are still more likely than whites to die from cancer, says the nation's annual report on cancer, to be published Thursday in the journal Cancer.

But largely, the news remains optimistic. Death rates from cancer in general have dropped 1.1 percent a year since 1993, and Thursday's report confirms that decline continued in 2001. Rates of new cases are declining about half a percent a year, too.

Most striking in this latest tally is what's happening with the No. 1 cancer killer: Rates of female lung cancer diagnoses have declined about 2 percent a year since 1998, years after men began a similar improvement. Also, female death rates from lung cancer have leveled off, remaining virtually unchanged since 1995, the report says.

"For the first time, we are turning the corner in the lung cancer epidemic in women," said Ahmedin Jemal of the American Cancer Society, who co-wrote the report with scientists from the National Cancer Institute, Centers for Disease Control and Prevention and North American Association of Central Cancer Registries.

"We have been anticipating ... this for a long, long time," Jemal added. "It has been overdue."

Smoking became rampant among men long before women, and the resulting lung cancer consequently struck men sooner.

Lung cancer remains the nation's top-killing malignancy for both sexes, and the second most common cancer. But it slowly declined among men starting in the early 1990s as older smokers died and fewer young men took up the habit, a pattern doctors expect to eventually see in women.

The report's other new finding: More people are living at least five years after a diagnosis of most types of cancer.

Five-year survival is a major milestone for cancer patients, and the scientists found significant gains over the past two decades in how often that milestone was met.

For men, survival rates improved the most: more than 10 percent for cancers of the prostate, colon and kidney, and for melanoma and leukemia.

For women, the biggest survival improvements came in colon, kidney and breast cancers.

What does that mean? Today, 99.3 percent of men diagnosed with prostate cancer will live five years, up from 70 percent in the 1970s. Five-year survival for breast cancer is 88 percent, up from 75 percent in 1970s.

But that survival is strongly connected to how early cancer is caught, stressed co-author Brenda Edwards of the NCI's cancer-control division.

For example, five-year survival for lung cancer is just 15 percent, largely unchanged from the 1970s, because more than half of patients are diagnosed after the disease has spread beyond their lungs. In the few cases where tumors are caught early, five-year survival jumps to 49 percent, but there is no proven early-screening method for lung cancer.

Even with colorectal cancer, where good tests have improved survival, only one of three cases still is caught at the earliest stage, Jemal lamented.

Then there's the racial gap.

When looking at all cancers combined, black men are 26 percent more likely to die of a malignancy than white men, and Hispanic men are 16 percent more likely than non-Hispanic whites, said the cancer society's Jemal. Black women are 52 percent more likely to die of cancer than white women, and Hispanic women 20 percent more likely, he said.

Much of the disparity reflects minorities' poorer access to cancer prevention and early detection services, Jemal said.

But notable differences remain even when scientists examine people diagnosed at the same stage of cancer, said NCI's Edwards. Black women were more likely to die of breast cancer, even though that disease is more common among whites.

Access to the best treatment options probably plays a role, as may additional illnesses patients have that complicate cancer treatment, Edwards said.

"It's not one simple story as to what is our national cancer burden," she cautioned.

Added Jemal: "We know much about cancer. We need to apply everything about cancer control equally to all populations."